The right to intimacy at the end of life

I am 94 years old and, 2 years after the end of a 70-year-long relationship, I live alone. Although I am alone, I am not lonely. I have many friends, appreciated former colleagues, and kind acquaintances. I am in touch by phone or email with both close and distant family members. I even have the privilege of closely witnessing the miraculous growth of a new little human almost from the day of his birth, the child and grandchild of wonderful parents and grandparents. I consider myself most fortunate with these riches of social contacts and relationships. Yet I am aware of my periodically surfacing strong emotions, perhaps best described as yearnings, for what social scientists would define as intimacy. 

Intimacy refers to a variety of emotions or yearnings for actions, including physical touch and caress. It may mean different needs or experiences for each of us, at different depths, and at different times in our life. This came to mind as I was reading about aging and sexuality from Action Canada for Sexual Health and Rights. The focus of the article is on the right for individuals to be intimate at the terminal stages of illness and at the end of life. The need for relationship and touch does not vanish. As the article puts it, “people may in fact suffer from the absence of loving and intimate touch in the final months, weeks or days of life.” The article points out changes in appearance, physical pain, emotional discomfort or distress, and changing roles in relationships as partners may become caregivers. This all happens just as an individual may yearn for intimacy; not only to receive, but perhaps to offer physical caress. Health care providers have an opportunity to facilitate expressions of intimacy among patients and their partners.

The article provides realistic suggestions to address the physical intimacy needs of patients in terminal care facilities. Perhaps the most important recommendation to care staff is to provide patient privacy. Initiating conversations with patients and partners and normalizing or validating intimacy needs is valuable. Giving explicit permission to patients and partners to be physical even at advanced stages of their illness is valuable. Permitting partners to lie in bed next to each other even in advanced palliative care may be helpful. Care staff should be careful to avoid showing discomfort when discussing sex-practice-related concerns and refrain from presumptions of heterosexuality, monogamy, or assuming marital connection. 

Patients in facilities for terminal care need to feel they still have a right to intimate closeness of their choice or ability at this time of their life. 
—George Szasz CM, MD

Suggested reading
Action Canada for Sexual Health and Rights. Aging and sexuality. Accessed 17 August 2023.

Waldinger R, Schulz M. The good life. Lessons from the world’s longest scientific study of happiness. Simon and Schuster. 2023.

This post has not been peer reviewed by the BCMJ Editorial Board.

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