A recent newspaper story describes a 15-year-old Sydney boy, terminally ill with cancer, who told the nurse caring for him that he wanted to experience sexual intercourse before he died. The nurse asked a psychologist to see the boy and a psychiatrist was consulted. The health care team involved in looking after him thought about 'passing around the hat' to raise money to pay for the services of a prostitute. The boy's parents learnt after he died that he had had sex with a prostitute. Media reported that approximately 50 per cent of people polled strongly endorsed what had occurred and 50 per cent were appalled. What are the ethics of this situation?
Answering that requires us to identify the issues.
Is the problem that a fifteen-year-old boy is having sex? What if he had a girlfriend the same age who wanted to have sex with him before he died? If we find the latter acceptable, is the problem, therefore, that a prostitute is involved? Do we find the latter more acceptable if we refer to a sex industry worker? (I am assuming that the encounter with the prostitute did not raise any legal issues.) Does it matter ethically that this sexual encounter was not based on a personal caring relationship? Could facilitating it be considered, in any way, part of "whole person" palliative care?
Does it make an ethical difference that the young man is dying and that this was an unsolicited major wish on his part? Without being disrespectful or meaning to trivialize the issues involved, could our anthropomorphic reaction to the situation of Bongo the famous movie star lion, whose story has recently been front page news in North America, offer any insights? Bongo lived his life without sex in order to prevent him from becoming aggressive. When he was diagnosed with terminal lung cancer a female lioness was flown to California from a Quebec safari park to be his sexual partner. Were the frequently repeated statements that Bongo should have the chance to experience sex before he died really a projection of what we believe we would want if we were in the same circumstances? Should it make a difference whether we are an adult or only fifteen?
Or is the problem that the healthcare professionals facilitated the young man's sexual encounter? Or that they acted without the parents' knowledge or agreement? Or that they facilitated an encounter with a prostitute? Third party involvement in a situation changes the ethics and sometimes the law. For example, suicide is not a crime but assisting in suicide is. And health care professionals are important people in forming and carrying societal values in secular societies like Australia and Canada. Are we mainly concerned about the impact of their action on our important shared values?
Or is the problem that we desexualize people who are ill or physically or mentally disabled or even just "too old" - as compared with "too young", as here - especially if they are institutionalized or hospitalized? We have started to examine the ethics of both sexual activity and its prevention among institutionalized adults in need of long-term, special care. Some of our attitudes and values in these respects have been adopted primarily for our moral comfort and organizational convenience, not the benefit of the people receiving care. And in some cases they result in cruel, unethical outcomes, for instance, physically separating an aged couple who have slept in the same bed most of their lives.
Or is the problem at the level of the meaning of sexual intercourse? Such meaning is relevant and created at personal and societal levels, and can range from simply the physical to the moral, existential and religious.
When a totally private sexual act, that is not legally prohibited, is involved, we respect personal privacy and rightly do not enquire into its meaning. But the involvement of health care professionals in this case gave the boy's act a public aspect and, consequently, it challenges us to consider the meaning and values that sexual intercourse does and should carry at the societal level in a post-modern society. Not an easy question to answer when we recognize that, whatever other needs it may fulfil, sexual intercourse has a primary purpose of transmitting human life to future generations and is still - cloning and other new reproductive technologies aside - the way in which we do that. What kind of respect and values regarding sexual intercourse does that demand of us as a society? And how can we accommodate changed sexual attitudes? Despite these, most of us still, at least deep down, believe that engaging in sexual intercourse should "matter".
In a different ethical domain, what journalistic and media ethics should have governed this case? Should this story ever have been published?
Finally, could this have been a life-affirming act on the part of this young man in the face of death? The hallmark of people who want euthanasia is hopelessness. Might this young man, in his own way, have found hope in his experience?