A Sexual Rights Puzzle, Un-puzzled

Theoretical Medicine and Bioethics, 2023

In his recent article, Ezio Di Nucci questions whether or not we have done enough to support our argument for welfare funded sex-doulas, maintaining that we have still not resolved his sexual rights puzzle. We are not claiming here, as we think Di Nucci does, that “sex rights” are some sort of metaphysical fact—rather, we are saying that there exist certain basic human needs (in this case, sexual citizenship needs) that, for many disabled people, are not being met. Thusly, we hold that sexual rights are analogous to healthcare rights and that the state has a duty to help people meet those needs. Our motivation is to advocate for the development of a welfare funded sex doula programme focussed on the provision of assisted mechanisms of meeting and maintaining disabled people’s sexual needs. In this article, we consider and refute some of Di Nucci’s criticism of our sex doula programme, and repudiate his belief that we have not resolved his sexual rights puzzle. In addition, we believe that a meta-ethical discussion of the nature of sexual rights diverts attention away from those people who are most in need of sexual support — and they do not have time for us to make a full reckoning of the place of sex has in society.

Journal of Medical Ethics, 2019

The sexual citizenship of disabled persons is an ethically contentious issue with important and broad-reaching ramifications. Awareness of the issue has risen considerably due to the increasingly public responses from charitable organisations which have recently sought to respond to the needs of disabled persons—yet this important debate still struggles for traction in academia. In response, this paper continues the debate raised in this journal between Appel and Di Nucci, concurring with Appel’s proposals that sexual pleasure is a fundamental human right and that access to sexual citizenship for the severely disabled should be publicly funded. To that endeavour, this paper refutes Di Nucci’s criticism of Appel’s sex rights for the disabled and shows how Di Nucci’s alternative solution is iniquitous. To advance the debate, I argue that a welfare-funded ‘sex doula' programme would be uniquely positioned to respond to the sexual citizenship issues of disabled persons.

Journal of Medical Ethics, 2019

The sexual citizenship of disabled persons is an ethically contentious issue with important and broad-reaching ramifications. Awareness of the issue has risen considerably due to the increasingly public responses from charitable organisations which have recently sought to respond to the needs of disabled persons — yet this important debate still struggles for traction in academia. In response, this paper continues the debate raised in this journal between Appel and Di Nucci, concurring with Appel’s proposals that sexual pleasure is a fundamental human right and that access to sexual citizenship for the severely disabled should be publicly funded. To that endeavour, this paper refutes Di Nucci’s criticism of Appel’s sex rights for the Disabled and shows how Di Nucci’s alternative solution is iniquitous. To advance the debate, I argue that a welfare funded ‘sex doula program’ would be uniquely positioned to respond to the sexual citizenship issues of disabled persons.

Theoretical Medicine and bioethics, 2023

The Human Condition is neither a well-defined nor well-described concept-nevertheless, it is generally agreed that human sexuality is a fundamental and constituent part of it. For most able-bodied persons, accessing and expressing one's sexuality is a (relatively) trouble-free process. However, many disabled persons experience difficulty in accessing their sexuality, while others experience such significant barriers that they are often precluded from sexual citizenship altogether. Recognising the barriers to the sexual citizenship of disabled persons, the concept of a Welfare-Funded Sex Doula Program has been advanced-a program specifically aimed at meeting the various (and often complex) sexual needs of disabled people. Below we show how that program can be justified within at least two different moral frameworks, the capabilities approach and liberal utilitarianism, and consider and repudiate arguments against it.

Sexuality and Disability, 2000

The Palgrave Encyclopedia of Disability, 2024

The Welfare-Funded Sex Doula Programme is a proposed sexual needs service that advances the sexual citizenship of disabled people by providing specially trained ‘sex doulas’ to meet the various, often complex, sexual needs of disabled people. Conceived as providing disabled individuals with practical sexual support services, the role of the sex doula includes advocacy, counselling, therapy, and practical relief from sexual tension. The programme constitutes a robust, comprehensive, and theoretically cohesive welfare service that seeks to provision access to sexual citizenship for disabled people. Grounded in Aristotelian concepts of flourishing, the programme identifies sexual citizenship as a fundamental basic need and seeks to ensure that disabled people have the opportunity to achieve the same level of sexu- ality as able-bodied people. Work advancing the programme includes both philosophical and theoretical arguments showing how the programme is justified under several moral frameworks, and claims made therein have resulted in velitation in the literature regarding the potential of such a programme to violate individuals’ negative rights.

Sexuality Research and Social Policy, 2007

Sexuality Research and Social Policy , 2024

Introduction This article explores how sexuality is conceptualised and managed in a Spanish residential care unit for recently injured people. The institution operates under the banner of independent living, a key belief of the international disabled people's movement, which champions self-determination, autonomy, and control over their support. Methods A focused ethnography was conducted between September 2021 and February 2022, with semi-structured interviews and participant observations with the residential care unit's service users (n = 13), staff (n = 12), and managers (n = 7). Results Managers and staff organise the support in ways that prevent service users' autonomy, privacy, and intimacy, contrary to the independent living philosophy. Service users' behaviour, relationships, and whereabouts are constantly monitored and controlled in a gendered, desexualising manner. When sexuality is discussed, it often concerns sexual assistance-a service offered by some organisations in Spain-effectively redirecting attention to a therapeutic approach and shifting focus away from institutional responsibilities towards an individual (male) issue. Conclusions Critical disability studies and organisational theory inform an analysis that finds the institutional policy for managing sexuality is 'strategic ignorance': sexuality is simultaneously silenced and controlled in the name of professionalism. This post-institutional way of organising disability services is highly gendered and desexualising, resulting in 'anti-independence'. Policy Implications Residential care managers and staff should be trained to work ethically and professionally with sexual rights. Training should be based on the independent living philosophy, which empowers disabled people to take control over their lives.

Sexuality Research and Social Policy, 2007

Consideration of sexual pleasure in the lives of people with disabilities plays little part in lay consciousness, and practically none in social policy. This article investigates such repression by engaging with a cultural imaginary that fears nonnormative sexuality as being a potential point of societal breakdown. Recent work in disability studies gives a very different understanding of the sexuate body that opens up the parameters of sexuality for everyone. This work challenges current social policy's supposedly rational utilitarian basis and the principle of equality that together ground a sociopolitical economy of disability predicated on rehabilitation or compensation. Nonetheless, the call for sexual citizenship for people with disabilities is fraught with difficulties, not least regarding the potential extension of governmentality. An effective approach not only will take into account the sociopolitical aspects of this issue but also will respond to both the full embodiment of disability and its significance in mainstream culture.

Bulletin of Science, Technology & Society, 2006

The disability rights movement grounds material critiques of the treatment of people with disabilities in a social constructionist perspective, locating disability in the social rather than physical realm, and demedicalizing the concept of disability. However, this conceptualization is threatened by the medicalization of nonnormative erections as the biomedical pathology erectile dysfunction (ED). Although use of medical treatments for ED can have positive outcomes for individuals, the medical community's tendency to include sexual difference in the rubric of disability threatens to remedicalize that category. Furthermore, medicalized conceptions of ED often serve to refocus sexuality around phallocentric, normative sex acts and gender roles, undoing the deconstructive work of disability sex studies. Finally, although aging Western populations targeted for ED treatment represent potentially expanded bases for disability movement activism, the pathologizing of nonnormative sexuality may have the power to instead focus this group on individualistic use of medical interventions geared toward "normalcy. "