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In this article, we explore the role of substitute decision-makers (SDMs) in matters of sexual expression for continuing care residents with diminished cognitive capacity. We examine how Alberta’s current use of SDMs can enable an “all-or-none” approach to competence, wherein a person either has capacity to make all decisions or is incapable of making any. Three factors facilitate an environment in which this approach can influence residents’ sexual expression. These include the wording of current legislation, lack of resources for SDMs, and relational dynamics between SDMs and care staff. We provide a critical review of existing legislation and empirical evidence of its challenges in practice. Though we focus on the Alberta context, there is reason to believe that similar issues persist in other Western jurisdictions. We offer several recommendations for how we can better support residents’ sexual autonomy in continuing care and avoid pitfalls of the “all-or-none” approach to competence.

Medical assistance in dying (MAiD) was legalized in Canada in 2016. Canadians’ opinions on the service are nuanced, particularly as the legislation changes over time. In this paper, we outline findings from our review of representations of MAiD in Canadian news media texts since its legalization. These stories reflect the concerns, priorities, and experiences of key stakeholders and function pedagogically, shaping public opinion about MAiD. We discuss this review of Canadian news media on MAiD, provide examples of four key themes we identified (vulnerability, autonomy, dignity, and human rights), and discuss their implications for health policy and equity. Though key stakeholders share the values of autonomy, dignity, and human rights, they appeal to them in diverse ways, sometimes with conflicting policy demands. These representations offer a useful gauge of how views about MAiD continue to shift alongside changes in federal legislation. These stories can influence related policies, respond to the powerful voices that shape MAiD legislation, and have the potential to change national conversations. Our analysis adds to the existing body of scholarship on MAiD by examining post-Bill C-7 news media, identifying related health equity issues and tensions, and discussing potential impacts of MAiD’s representations in news media.

Introduction In continuing care homes, resident sexual expression is complicated by interpersonal, physical, and social features that are part of congregate living. Little is known about how managers navigate the complexities of these features. Methods We undertook a descriptive, exploratory study to pursue this line of inquiry. We conducted in-depth interviews with 28 participants from a network of managers, clinical ethicists, geriatric specialists, and social workers in Alberta, Canada.Results We present our findings as three dynamic tensions: 1) the tension between how sexual expression should be supported and how it is addressed in care homes; 2) the tension between private and public space in the care home; and 3) the tension between a medical model of care and a conceptualization of sexual expression as an activity of daily living. Conclusions These tensions are connected with sexual rightsspecifically, with the rights to equality and non-discrimination, privacy, and autonomy and bodily integrity. Sexual expression can also have physical, social, and emotional benefits for continuing care residents. Thus, the tensions surrounding resident sexual expression ought to be navigated with an approach that acknowledges sexual rights and best upholds them. Policy Implications We suggest that in order to realize the benefits and prevent the harms associated with resident sexual expression, there is both need and opportunity for a coordinated, multi-level approach.

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