{"id":3685,"date":"2020-01-30T20:42:27","date_gmt":"2020-01-30T19:42:27","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=3685"},"modified":"2020-01-30T20:50:59","modified_gmt":"2020-01-30T19:50:59","slug":"disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/01\/30\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\/","title":{"rendered":"Disability, sexual rights and sexual duties: still puzzling after all this time?"},"content":{"rendered":"<p>By Ezio Di Nucci<\/p>\n<p><a href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/01\/29\/baselining-sexual-rights-as-health-care-rights\/\">Steven J. Firth and Ivars Neiders<\/a> (thanks! our little debate is \u2018fun\u2019 and, as you say, extremely important) have responded to <a href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/01\/17\/sexual-rights-as-healthcare-rights\/\">my defense<\/a> of the <a href=\"https:\/\/jme.bmj.com\/content\/37\/3\/158\">sexual rights<\/a> <a href=\"https:\/\/jme.bmj.com\/content\/early\/2019\/07\/04\/medethics-2019-105642\">puzzle<\/a> according to which\u00a0<a href=\"https:\/\/jme.bmj.com\/content\/early\/2019\/07\/04\/medethics-2019-105642\">\u2018universal positive sexual rights are incompatible with universal negative sexual rights\u2019<\/a> by arguing that:<\/p>\n<ul>\n<li>There is a difference between \u2018positive rights to the <em>funding<\/em> of sexual services\u2019 and \u2018positive rights to the <em>provision<\/em> of sexual services\u2019 (emphasis in the original); and that<\/li>\n<li>Positive sexual rights do not result in any positive sexual duties for specific individuals or healthcare professionals.<\/li>\n<\/ul>\n<p>The first claim is, I reckon, meant to defuse the sexual rights puzzle accordingly: the puzzle might arise with positive rights to the provision of sexual services but it does not arise with positive rights to the funding of sexual services.<\/p>\n<p>The second claim is, on the other hand, meant to reassure that nobody will be coerced to provide sexual services even within a system that recognizes positive sexual rights.<\/p>\n<p>Before I engage with the above claims, let me again state that I am very sympathetic to the whole enterprise and look forward to read the authors\u2019 upcoming work on this.<\/p>\n<p>Now the two claims: first of all, there is tension between (1) and (2), at least in so far as they are supposed to deal with my sexual rights puzzle. This is because if (2) is true and positive sexual rights do not result in the monstrosity of positive sexual duties, then (1) is superfluous.<\/p>\n<p>Still, it could be that (2) is in fact implicitly referring to positive rights to the <em>funding<\/em> of sexual services rather than to positive rights to the <em>provision<\/em> of sexual services; and that additionally the authors concede that positive rights to the provision of sexual services would indeed result in positive sexual duties and that only by defining positive sexual rights in terms of funding rather than provision does (2) turn out to be true (even though we will see below that this doesn\u2019t seem to be the way Firth and Neiders are going).<\/p>\n<p>This coherence worry put aside, let us look at the merit of (1) and (2) taken separately. What is the difference between a positive right to the \u2018funding of x\u2019 and a positive right to the \u2018provision of x\u2019? Supposedly at least the following: a right to the funding of x does not imply a right to the provision of x. And here the authors are then relying on a further empirical premise according to which there happens to be enough availability of provision so that we can be satisfied with the funding alone, because no one\u2019s needs would be left unsatisfied \u2013 given this empirical premise \u2013 if funding is guaranteed.<\/p>\n<p>By distinguishing between funding and provision, though, the authors do not only allow for the possibility of funding without provision, they also allow for its legitimacy (at least from the point of view of positive rights). But if the sexual needs of disabled persons and persons with neurodegenerative diseases are as important as we all agree (at least within this debate) that they are, I am not sure I would be satisfied with the money alone. In fact, if money is all we are going to get, then I am not sure there is any improvement on <a href=\"https:\/\/jme.bmj.com\/content\/37\/3\/158\">my original proposal from a decade ago now<\/a>. Worse, it could be plausibly argued that the commercialization of such a morally important need is actually worse than my old no-profit proposal.<\/p>\n<p>So far I have argued against the distinction between funding and provision in general, but I want to also briefly comment on whether the distinction defuses the puzzle: the puzzle is defused as long as the content of the relevant right does not result in a positive sexual duty; and I guess the distinction between funding and provision is supposed to result in the healthcare system having a duty to provide <em>funding<\/em> for sexual services without thereby having a duty to actually <em>provide<\/em> sexual services. So really the only way in which the puzzle is defused is by no longer guaranteeing that the relevant sexual needs are satisfied. But that, the other side will agree, is too high a price to pay.<\/p>\n<p>Finally, what about the second claim? If \u2018positive sexual rights\u2019 in the second claim refers to funding alone without provision, then see above \u2013 we would have made no progress in guaranteeing the satisfaction of the relevant needs. If \u2018positive sexual rights\u2019 in the second claim does on the other hand refer to provision, then the idea could be that the puzzle is resisted in virtue of the fact that the healthcare system\u2019s positive duty to provide sexual services does not result in any positive sexual duties for specific healthcare professionals.<\/p>\n<p>Here again I see no progress: either the reason why the duty to provision does not result in any specific sexual duties is because any particular healthcare professional can appeal to conscientious objection considerations, but then the relevant sexual duty would fall on some other healthcare professional; or the reason why the duty to provision does not result in any specific sexual duties is that those duties were already implied by the relevant professional code \u2013 as Firth and Neiders suggest in their latest contribution; but then they would have conceded that their position does imply the monstrosity of positive sexual duties.<\/p>\n<p>In conclusion, let\u2019s agree at least on the following: the sexual needs of disabled persons ought to be a moral priority; efforts to satisfy those needs should be integrated as much as possible within any civilized healthcare system; and this ought to be implemented while at the same time paying particular attention to the vulnerability of disabled persons and also without compromising the sexual autonomy of service providers. Whether the implementation of such a system requires positive sexual rights \u2013 and whether positive sexual rights are themselves morally dubious \u2013 we still disagree upon.<\/p>\n<p><strong>Author<\/strong>: <a href=\"https:\/\/publichealth.ku.dk\/staff\/?pure=en\/persons\/507287\">Ezio Di Nucci<\/a><\/p>\n<p><strong>Affiliation<\/strong>: Professor of Bioethics and Director of the <em>Centre for Medical Science and Technology Studies<\/em> at the University of Copenhagen.<\/p>\n<p><strong>Competing interests<\/strong>: None declared.<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Ezio Di Nucci Steven J. Firth and Ivars Neiders (thanks! our little debate is \u2018fun\u2019 and, as you say, extremely important) have responded to my defense of the sexual rights puzzle according to which\u00a0\u2018universal positive sexual rights are incompatible with universal negative sexual rights\u2019 by arguing that: There is a difference between \u2018positive rights [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/01\/30\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":353,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8064,8062,8063],"tags":[],"class_list":["post-3685","post","type-post","status-publish","format-standard","hentry","category-justice","category-rights","category-sex"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Disability, sexual rights and sexual duties: still puzzling after all this time? - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/01\/30\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Disability, sexual rights and sexual duties: still puzzling after all this time? - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Ezio Di Nucci Steven J. Firth and Ivars Neiders (thanks! our little debate is \u2018fun\u2019 and, as you say, extremely important) have responded to my defense of the sexual rights puzzle according to which\u00a0\u2018universal positive sexual rights are incompatible with universal negative sexual rights\u2019 by arguing that: There is a difference between \u2018positive rights [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/01\/30\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2020-01-30T19:42:27+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2020-01-30T19:50:59+00:00\" \/>\n<meta name=\"author\" content=\"Mike King\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Mike King\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2020\\\/01\\\/30\\\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2020\\\/01\\\/30\\\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\\\/\"},\"author\":{\"name\":\"Mike King\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/b107957622bc42b2097d15e5e02a112c\"},\"headline\":\"Disability, sexual rights and sexual duties: still puzzling after all this time?\",\"datePublished\":\"2020-01-30T19:42:27+00:00\",\"dateModified\":\"2020-01-30T19:50:59+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2020\\\/01\\\/30\\\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\\\/\"},\"wordCount\":1023,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"articleSection\":[\"Justice\",\"rights\",\"sex\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2020\\\/01\\\/30\\\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2020\\\/01\\\/30\\\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2020\\\/01\\\/30\\\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\\\/\",\"name\":\"Disability, sexual rights and sexual duties: still puzzling after all this time? 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Firth and Ivars Neiders (thanks! our little debate is \u2018fun\u2019 and, as you say, extremely important) have responded to my defense of the sexual rights puzzle according to which\u00a0\u2018universal positive sexual rights are incompatible with universal negative sexual rights\u2019 by arguing that: There is a difference between \u2018positive rights [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/01\/30\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\/","og_site_name":"Journal of Medical Ethics blog","article_published_time":"2020-01-30T19:42:27+00:00","article_modified_time":"2020-01-30T19:50:59+00:00","author":"Mike King","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Mike King","Est. reading time":"5 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/01\/30\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/01\/30\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\/"},"author":{"name":"Mike King","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/person\/b107957622bc42b2097d15e5e02a112c"},"headline":"Disability, sexual rights and sexual duties: still puzzling after all this time?","datePublished":"2020-01-30T19:42:27+00:00","dateModified":"2020-01-30T19:50:59+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/01\/30\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\/"},"wordCount":1023,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#organization"},"articleSection":["Justice","rights","sex"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/medical-ethics\/2020\/01\/30\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/01\/30\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\/","url":"https:\/\/blogs.bmj.com\/medical-ethics\/2020\/01\/30\/disability-sexual-rights-and-sexual-duties-still-puzzling-after-all-this-time\/","name":"Disability, sexual rights and sexual duties: still puzzling after all this time? 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