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That outmoded idea should be discarded. Rayhons was always pleased to see her husband. Acknowledging sexual rights means giving patients the privacy to have sexual relationships. That pleasure was undoubtedly less visible in the final stages of her dementia, but even then there were minimal signs that she enjoyed this contact, and none that she did not. We certainly do not want social workers or psychologists monitoring the sexual activity of residents! Indeed, by all accounts, theirs was a loving and affectionate relationship, and Mrs. This is likely to be a greater concern with new relationships that spring up in the nursing home. Criminal charges against a loving spouse merely for continuing a sexual relationship they both enjoyed, and which seems beneficial, not harmful, to the patient, is quite another.{/INSERTKEYS}{/PARAGRAPH} Under common law, laws against rape were not considered applicable in marriage. Apparently, Mrs. Evidence of abuse or mistreatment is one thing. In other contexts, the absence of affirmative consent to sexual relations may be the right criterion for rape or other sexual abuse. This is not easy to determine, since sexual relations are by their nature private and intimate. Rayhons resisted sexual contact with her husband, nor were there any signs of abuse. However, this case is clearly not a case of spousal rape. That is, both partners must give affirmative consent, whether verbal or otherwise, for sex to be consensual. {PARAGRAPH}{INSERTKEYS}Rayhons died in August. The case raises questions about the capacity to consent in cases of severe dementia, an issue that is not limited to sexual relations. Without any signs of abuse, what was the basis for the arrest? He said she was not. Why would we want to diminish that? No one suggests that Mrs. For example, it is increasingly recognized that engaging in kissing or petting is not consent to sexual intercourse. By , it was a crime in all 50 states. Of course, this needs to be balanced against protecting patients, especially patients with severe dementia, from coercion and exploitation. Using affirmative consent as the standard would deprive patients with severe dementia of sexual relationships, because few retain the capacity to articulate a desire for sex. However, they can observe whether the resident is happy to see and be with the spouse, and whether she seems upset after visits. It comes up also in cases where patients initially resist food and water, but can be coaxed to eat.