I am surprised that the subject of sex and disability has not arisen in the controversy surrounding Robin Hanson’s and Ross Douthat’s remarks on sex redistribution. The subject is one of active debate in the literature on medical ethics. Bioethicist Jacob Appel writing in the Journal of Medical Ethics in 2010 argued:

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 high unlikely. …A second area in which reform is desperately needed is the ‘no sex’ policies that exist in American nursing facilities, mental hospitals and group homes. Many such facilities require the doors of patients’ rooms to be open at all times, making intimacy all but impossible. The assumption underlying these restrictions is that anything short of clearly expressed wishes by a fully competent and rational individual does not fulfil a minimum standard to consent to sexual relations. The principle advanced by this approach is that institutionalised individuals require a higher degree of protection than those living outside of institutions. In many matters, this is certainly the case. However, in regard to sexual relations, this ‘higher’ standard often serves as an obstacle to meeting both the wishes and interests of individuals who cannot conform to ‘real world’ standards of consent.

More challenging than a ‘negative rights’ conception of sexual liberty is one that also embraces a ‘positive right’ to sexual pleasure for the disabled–either for those individuals who are too impaired to find mates and/or those who are so physically incapacitated that they are incapable of pleasuring themselves. Several European nations, including Germany, The Netherlands, Denmark and Switzerland, allow limited ‘touching’ services for the severely disabled through non-profit organisations.

In the UK charities exist to help match sex workers with the disabled. Similar services are available in Denmark and in the Netherlands and in those countries (limited) taxpayer funds can be used to pay for sexual disability services. The Green party has proposed such services elsewhere:

A German politician has sparked controversy by suggesting people with severe disabilities could receive “sexual assistance” paid for by the state. The Green party’s spokeswoman for age and care policy, Elisabeth Scharfenberg, said the government could “provide grants” for sexual services to disabled people who cannot achieve satisfaction by any other means. Such a system is currently operating in Denmark and the Netherlands, where certified “sexual assistants” with special training conduct visits to disabled people who cannot afford to pay themselves.

Regardless of the answers one gives, I think these are legitimate questions of profound and deep importance to the people involved. It’s unfortunate and wrong that someone who brings these issues to the public forum is denounced and called creepy. We can and should do better.