Questioning Sexual Rights As Conditional: Disability Professionals' Reactions to Capacity to Sexual Consent Practices

Background and Purpose: Women labeled with intellectual disability (ID) are routinely barred from sexual intimacy with others. While scholarship often attributes these rights violations to disability professionals’ attitudes, mounting reports from professionals themselves locate impediments in policies and standards of practice. As one such policy, ‘capacity to sexual consent’ (CTSC) abridges ID-labeled people’s right to sexual intimacy when they fail to meet various testing requirements. This study examines how disability professionals respond to the requirements, assessment considerations, and assessment model of CTSC.

Methods: This study uses a cross-sectional survey design and surveyed 108 disability professionals (M_age=44 years) from 24 states across the U.S. A majority identified as women (69%), white (67%), and heterosexual (66%). Professionals were employed by: 1) day or residential services serving ID-labeled people (77%); 2) the ID-labeled people they support (5%); or 3) organizations conducting policy development or advocacy in disability services (19%). Participants were recruited via email through state Home and Community-Based Services (HCBS) listservs and relevant professional listservs.

As part of a larger exploratory survey about how disability services address ID-labeled women’s sexuality, providers responded to researcher-developed measures about CTSC’s: 1) requirements; 2) assessment considerations; and 3) assessment model. To test for differences between requirements and between considerations, Friedman’s ANOVA with Bonferroni-corrected pairwise comparisons were conducted. To test for differences within response options for each item, one-sample chi-square tests were performed. Prior to implementation, the survey received feedback from four faculty with expertise on survey design and/or the content area.

Results: No differences were detected between endorsement of CTSC requirements, but there were differences in how professionals responded to each requirement. Across requirements, small minorities (under 12%) endorsed a CTSC approach. While majorities favored allowing relationships under certain conditions, substantial proportions (over 20%) adhered to an unconditional rights view. Differences between endorsement of CTSC assessment considerations related to perceptions of ability and vulnerability. For example, participants responded differently to women labeled with ‘mild’ or ‘moderate’ ID versus ‘severe’ or ‘profound’ ID. Differences in how professionals responded to each assessment consideration were detected for 12 of 13 considerations. For a majority (75%) of these, the largest proportion indicated the consideration should be used along with other factors. At least one-quarter of professionals favored an unconditional rights view across a majority (77%) of assessment considerations. While a slight majority agreed with CTSC’s current assessment model, nearly one-half endorsed an unconditional rights approach that assesses for the purpose of learning how to support women who want to have sexual relationships, rather than for restricting them.

Conclusions and Implications: Far from being the barrier to ID-labeled women’s sexual rights, many disability professionals oppose the ways that CTSC is designed to function. Moreover, a substantial proportion endorse an unconditional rights-based approach to practice. I use Nussbaum’s (2011) Capability Approach to consider the types of policy changes and professional supports (e.g., training) necessary for this vision. I also discuss how social work researchers are well-positioned to collaborate with professionals and ID-labeled people to develop a new, rights-based model for practice.