A thorough examination is crucial to document sexual abuse and to prevent the spread of disease. The physician should be aware that the mentally retarded in community group homes can become easy targets for abuse by caretakers or other members of the community, since the majority of abusers are known to the individual.
Thus, physicians must be courageous to inquire about sexual activity and to report any irregularities. A clinically documented case of sexual abuse involving a mentally retarded individual has the potential for strong legal action in the future. Second, medical professionals shoulder an awesome responsibility in determining IQ and mental age assessments. Such scores will categorize an individual and must be done accurately to assist in proper social and educational development.
IQs can be detrimentally used in court if not accompanied by sufficient documentation of strengths and weaknesses excluded by the standardized test. Third, the primary care physician is legally able and medically ideal to assess opinions of medical competency for a court's final review. Physicians in general have a designated responsibility to determine opinions of mental competency and expert testimony for sexual abuse cases. They must be clear and thorough in their diagnosis and mindful that their decision will impact court rulings and future legal precedents. Fourth, the primary care physician should have contact information available for mentally retarded patients needing further education and counseling on sexual issues.
Such education to resist potential abusers empowers the mentally retarded individual and will greatly facilitate communication about sexual abuse cases in both the medical and legal settings. Physicians have the great responsibility of serving alongside the legal court as 1 of the 2 essential pillars of sexual abuse defense among the mentally retarded. The primary care physician in particular serves an important role in cases of sexual abuse by providing the court with physical evidence of abuse and by documenting opinions of mental competency.
Medical and legal analysis of terminology pertinent to sexual abuse reveals that both professions recognize a contextual element of consent and emphasize the importance of the ability of the mentally retarded individual to understand the nature and consequences of any sexual activity.
It is imperative for physicians to understand the biological aspects of mental retardation in order to make informed decisions concerning the rights of the mentally retarded in the community. It is crucial for physicians to recognize that mentally retarded citizens, from childhood to adulthood, have a unique biological profile that makes them particularly vulnerable to sexual abuse. Knowledgeable primary care physicians in the front lines in our community are in a unique position to detect and prevent such sexual abuse, ideally before the case even reaches the courts.
With the rapidly changing demographics of the mentally retarded population across the country, it is crucial to raise awareness among primary care physicians in order to identify and stop cases of sexual abuse. The author acknowledges Pamela D. Morano is a candidate for a degree in Medicine at the University of Tennessee, Memphis.
The research conducted for this publication was initially undertaken at the direction of the Tennessee Bureau of Investigation's Medicaid Fraud Control Unit MFCU by a team of medical, legal, and pharmacy students involved in an internship program during the summer of The Tennessee Bureau of Investigation has not exercised editorial control over the contents of this publication; thus, the opinions, conclusions, and recommendations expressed within are solely those of the author and do not necessarily reflect the opinions, position, or policies of the MFCU or the Tennessee Bureau of Investigation.
National Center for Biotechnology Information , U.
acts with a mentally retarded woman in a New Jersey basement four lured by the promise of a date with one of the defendants' brothers. So when the year-old mentally retarded woman was driven home one day by a co-worker, she was not sure what was happening when he.
Author information Article notes Copyright and License information Disclaimer. Received Sep 21; Accepted Nov This article has been cited by other articles in PMC. Abstract The primary care physician has a vital role in documenting and preventing sexual abuse among the mentally retarded populations in our community. Profile of Individuals With Mental Retardation Individuals with mental retardation fall within a spectrum of abilities, characteristics, and personal attributes, as is seen in any general population. Medical Classification of Mental Retardation: Open in a separate window.
Four Categories of Mental Retardation Based on the aforementioned standards set forth by the APA, mental retardation is classified into 4 categories: Clinical Features of Mental Retardation a. Sexual Maturation and Fertility of the Mentally Retarded The onset of puberty varies widely among mentally retarded individuals, and sexual development of the retarded may be reached at a later chronological age.
Mental Retardation Versus Mental Illness Mental illness is separate from but can coincide with mental retardation.
Abuser Profile Mentally retarded individuals are especially vulnerable to abuse and exploitation. LEGAL ANALYSIS Laws protecting the mentally retarded individual across the nation are consistently characterized by both medical and legal scholars alike as vague, inconsistent, and inadequate in their protection of vulnerable individuals from sexual abuse. Defining Legal Consent Legal consent, like medical informed consent, is greatly influenced by the context of the incident in question. Defining Competency Versus Capacity As discussed earlier, competency is a legal concept, but primary care physicians are both able and uniquely positioned to submit opinions for the court's final determination.
The Role of Medicine in the Courtroom The scientific medical community traditionally has had several significant roles in courtroom proceedings of cases of sexual abuse among the mentally retarded. Acknowledgments The author acknowledges Pamela D. Consent to sexual activity. A Guide to Consent.
American Association of Mental Retardation. Sexuality, rape, and mental retardation. University of Illinois Law Review.
Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision. Introductory Textbook of Psychiatry. Inclusionary standard for determining sexual consent for individuals with developmental disabilities. Disorders usually first diagnosed in infancy, childhood, or adolescence.
Vineland Adaptive Behavior Scales.
Sexual expression of mentally retarded people: Am J Ment Retard. The nature and types of mental illness in the mentally retarded. Reducing barriers to sex education for adults with mental retardation. Sexuality in the mentally retarded patient.
tiolatrirera.cf The mental health professional, the mentally retarded, and sex. Sexual behaviors in retarded children and adolescents. Staff members' attitudes towards the sexual behavior of mentally retarded residents. Am J Ment Def. Sexuality and the mentally retarded adolescent. Sexual abuse of adults with mental retardation: Toward a model of the legal doctrine of informed consent.
The End of Silent Acceptance? Evaluation of mental competency. Patterns of sexual abuse and assault: Sexual abuse prevention for persons with mental retardation. If it works for the two of them, there's nothing wrong with it.
And ultimately this is their decision. That "we're working on her" expression in your question brought me to a halt as I read. It's nice that you care about this woman and are trying to help her, but maybe your attitude towards her could do with some adjusting. I have a friend who has an at least average IQ, probably higher, and who married a guy who probably has an IQ on the borderline of being handicapped.
They've been married for something like 12 years now, and were together maybe three years before that. She is a very controlling and self-absorbed person, and I think all she really wanted in a man was that he let her run their lives and be her audience. He's willing to do that, and moreover he's a sweet-natured, hard-working, conscientious and good-looking guy. Her former relationships were blitzkriegs; in his he got used for sex and then dumped a lot. It seems to be working. They seem happy, and they've got a nice home and good life together. Not my cup of tea at all, but it's also not my life so my preferences in tea aren't even really relevant.
There can be very different dynamics in relationships. Try to keep an open mind and you might learn something here.
This sounds sketchy to me, just because of the power differential. At first I thought, "what's the harm? Maybe get another opinion from someone who knows more about it, knows the people involved. I don't think you're overreacting. Seems to me like it is normal to be worried in a situation like this. Remember that what you are also saying is that the mildly "retarded" man can never have a relationship with anyone who isn't "retarded.
As the brother of someone with serious developmental delays - which is to say the brother of someone who had two kids and then dumped the kids with her husband, and ran off to learn to be a rodeo barrel racer out in the country - I fully understand your concern. And yet, I'm here to tell you that no matter what you do, it wont be the right thing. If you agonize over this, making impassioned pleas to your sister-in-law and laying out all the reasons why this is a bad idea, it will only do a handful of things - and none of them good.
It will drive a wedge between you. It will inspire her to chase after this man harder. It will take up your precious time, wasting it with trivialities. And ultimately it will prevent you from being what your sister-in-law needs: If you say nothing, she may still pursue him. She may still marry him. And she may still have children with him. And he may still live up to whatever doomsday scenario you are playing out in your head. But the good news is that the odds are lower that she will do that simply in an effort to assert her independence from you and from her family.
The doomsday scenarios can be terrifying.
A Guide to Consent. And what do you mean by 'it'? As Coulehan and Block 27 emphasize repeatedly, informed consent is a process of informational internalization and not just a scribbled patient signature on a piece of paper. Keep track of everything you watch; tell your friends. This sounds a bit Benny and Joon 'ish to me.
What if they have children and pass on the disability? What if he becomes violent when he can't argue on her intellectual level in a heated discussion? What if they are incapable of supporting each other and become a burden to the family? What if, what if, what if But the truth is that those scenarios could and do!