Sexualité en institution psychiatrique : commencer une réflexion éthique

Changes in behaviors and patients' rights in psychiatric hospitals have brought about some paradoxical situations: co-existence of the paternalistic concept of care alongside the contractual requirement for care; the need to protect vulnerable people, but at the same time enable them to exercise autonomy. Each situation raises questions that deserve in-depth ethical reflection about representations and values torn between the concept of care and the needs of the patients. We know that social norms change from one era to another. The authors have studied the regulations under which the hospital operates since it opened. For a large part of the 20th century, any mention of sexuality was totally absent from such regulations. In the 1980s, at the same time as the abolition of segregated-gender wards by law and the rise of sexual freedom, some bold innovations appeared with the aim of fostering sexual expression within the psychiatric hospital. Currently, the internal regulations of the hospital state that “sexual relations are prohibited within hospital premises”. Are we still applying the historical rules and regulations of the past to our hospital? Amid all the rhetoric to define the human being, their rights, their ideals of health and happiness, what ethical principles should we use to analyze this human question? The way in which we behave and interact with others is revealing of the way we consider human beings. Psychiatry is at the very heart of these questions pertaining to the human being, whether they are affected by a pathology or not, in their relationship with the world around him, and this concerns every one of us; patients and medical staff alike, in our way of being in touch with our humanity, our own and that of other people.