15 October 2011

Interests, Rights, Identities

'Sexual Rights and Disability' by Ezio Di Nucci in 37 Journal of Medical Ethics (2011) 158-161 argues against Appel's proposal -
that there is a fundamental human right to sexual pleasure, and that therefore the sexual pleasure of severely disabled people should be publicly funded — by thereby partially legalising prostitution. An alternative is proposed that does not need to pose a new positive human right; does not need public funding; does not need the legalisation of prostitution; and that would offer a better experience to the severely disabled: charitable non-profit organisations whose members would voluntarily and freely provide sexual pleasure to the severely disabled.
Di Nucci states that -
Appel [in 'Sex rights for the disabled?' 36 Journal of Medical Ethics (2010) 152-154] has recently argued in favour of sexual rights for the severely disabled:
For too long, our society has viewed these unfortunate individuals as non-sexual beings, adopting rules in matters such as consent and reimbursement that may serve the interests of able-bodied society, but do a profound disservice when applied to those with disabilities. If we are to overcome these obstacles, and to live in a more just civilization, we must begin to see sexual pleasure as a fundamental right that should be available to all.
Appel proposes that, in order for such right to be upheld, sexual services for the disabled be publicly funded:
we should seriously consider including sexual surrogacy for the disabled in the basket of services that we provide. Already, we have made the choice to pay for other purely social and cosmetic services to help unfortunate individuals lead more pleasurable and productive lives - such as breast reconstruction for mastectomy patients and plastic surgery for children born with cleft lips... Sexual pleasure ought not be viewed any differently. Most western healthcare systems acknowledge this, to some degree, paying for medications to treat erectile dysfunction in men and subsidising birth control pills for women... Any notion of healthcare broad enough to encompass cosmetic surgery ought to be generous enough to include funding for the sexual pleasure of the disabled... [which] should be covered by all public health systems and private insurance plans.
Here I present a better argument than Appel's to address his concerns about the sexual satisfaction of the severely disabled. I also believe that the sexual interests and needs of the severely disabled ought to be met. But I have three worries with Appel's strategy:
1) Should we meet the sexual interests of the disabled by introducing a right to sexual pleasure? A right that Appel describes as 'fundamental', perhaps hinting to the stronger view that it should be an inalienable human right?

2) Should we meet the sexual interests of the disabled by appeal to the public purse? Sexual satisfaction for the severely disabled, according to Appel, "should be covered by all public health systems and private insurance plans".

3) Should we meet the sexual interests of the disabled by a restricted legalization of prostitution, as Appel argues for? If sexual pleasure is a fundamental right, as this author believes, then jurisdictions that prohibit prostitution should carve out narrow exceptions for individuals whose physical or mental disabilities make sexual relationships with non-compensated adults either impossible or highly unlikely.
Di Nucci goes on to comment that -
I agree with Appel that there is a problem, and that this is an important moral problem: there are individuals with legitimate interests which find it very difficult if not impossible to satisfy those legitimate interests without external assistance. That is precisely the framework within which society's intervention is called for. It is exactly within this framework that people routinely call for ambulances or the police: their own or someone else's legitimate interests in not being mugged, stalked, raped, or killed – in the case of the police; their own or someone's else legitimate interests in not bleeding to death, or lose a limb, or die of an heart attack – in the case of ambulances. A citizen has a legitimate interest that she wants upheld, so she calls in the state for help. So far, so good. So should there be a public service that severely disabled people (or more likely someone on their behalf) can call upon for the satisfaction of their legitimate sexual interests?

The 'legitimate interests satisfaction' framework that I have developed above does not just apply to calls to the police or the ambulance service. It also applies to pizza deliveries. A citizen has a legitimate interest that she wants upheld – she wants a pizza without having to leave the house – so she calls pizza delivery. Now it might be argued that if pizza deliveries had not proved to be a legal and commercially successful enterprise (maybe because of ancient prejudices like those against prostitution), then the state should come in and guarantee pizza delivery by public funding. But, more likely, the pizza delivery example shows that it is not enough that citizens – any citizen, more or less vulnerable – have legitimate interests for those interests to need, thereby, to be met with legislation and public funds.

This is indeed why Appel must talk not just of legitimate interests, but of rights. But the problem, with 'rights' talk in this context, is, firstly, in having to establish whether sexual services are more like the ambulance service and the police rather than pizza delivery. Secondly, we must either grant everybody the right to sexual satisfaction, or we must argue that severely disabled people have, in virtue of their increased difficulty to satisfy their sexual interests, a right to sexual services that non-severely disabled people do not have. Let me emphasize that these two options are genuinely alternative: namely, the latter is incompatible with the former. If sexual satisfaction (where physically possible, that is) is a human right, then severely disabled people do not have more of a right to it than everybody else.