[nabs-l] condoms and Sexual Health

Arielle Silverman arielle71 at gmail.com
Sat Sep 8 21:47:02 UTC 2012


Beth,
Regarding privacy and decisionmaking: I am pasting some information to
the bottom of this email regarding the conditions under which your
parents are legally allowed to take charge of your medical and other
life decisions. I do not know your mental health history well enough
to judge whether or not your parents' involvement is still justified,
but if you feel they are overstepping their bounds, you may want to
consult with the psychologist who wrote this blurb (who happens to be
based in Florida). His contact info is at the bottom of this message.
Best,
Arielle

A: Competency, in civil legal terminology, refers to the capacity to
make independent decisions and conduct legal and financial
transactions on one's own behalf. Adults are generally presumed
competent to handle their own affairs, but this presumption may be set
aside by law if there is compelling evidence to the contrary. Both the
state and private parties, usually family members, may raise the
issue.

If the court declares a person to be incompetent, that person is
usually appointed a guardian, who is legally empowered to make
decisions regarding another individual's person and property. Again,
this is often a family member, but in some cases the court itself
becomes the guardian, and then the person is declared a ward of the
court.

The role of the psychological expert in a determination of
incompetency is to conduct an evaluation of the individual's mental
function via a thorough clinical examination, review of records,
interview of family members or other collaterals, and the
administration of a number of psychological and neuropsychological
tests.

Mental function skills relevant to competency include attention,
concentration, reality orientation, memory, reasoning, judgment,
emotional state, and especially knowledge and appreciation of the
nature and purposes of the decisions that are the subject of the
competency action (e.g. manage finances) and the ability to carry them
out (mathematical ability or knowledge of banking rules, investing,
etc.).

The law's presumptions of competency of its adult citizens means that
the burden of proof is generally on the party challenging the
subject's competency, and what defines "competency" often differs from
case to case. For example, the type or degree of mental impairment
that would render an individual incompetent to make a will or manage
finances, might not be sufficient to deprive them of their right to
marry or consent to medical treatment.

Another complication is the nature of the clinical syndrome that
produces the incompetency, which falls into three major classes. First
are relatively stable conditions such as severe mental retardation or
autism which present lifelong disability, and for which the need for
permanent guardianship is evident. Second are slowly progressive
syndromes, such as schizophrenia or Alzheimer's disease, where the
point at which impairment worsens to a level warranting incompetency
may hardly be clear-cut.

Third are abrupt-onset impairments in mental functioning in a
previously healthy individual, such as from a stroke, traumatic brain
injury, or bipolar manic episode. In addition to the issue of
impairment level, these are syndromes that may actually show
improvement over time, so a person incompetent at one point may well
meet formal criteria for competency a year later.

The problem is that, in most jurisdictions, guardianships are plenary,
that is, they don't distinguish between different types of
competencies (medical, marital, financial), and they don't include
time limits. A person that has recovered from a brain injury, for
example, may now have the burden of proof of demonstrating restoration
of competency and setting aside the guardianship. Guardians may not
always be willing to relinquish their control.

For their part, guardians should consider that they are obliged to be
responsible and legally liable for the actions of their ward. To
reduce such risks, some guardians may restrict and control their wards
even more than necessary. When difficulties in this area arise,
parties should seek both legal and psychological counseling.

Laurence Miller, PhD is a clinical, forensic, and consulting
psychologist in Boca Raton, Florida. This information is for
educational purposes only, and is not intended to make a clinical
diagnosis or render a legal opinion. Dr. Miller can be reached at
561-392-8881, or at docmilphd at aol.com.


On 9/8/12, Beth <thebluesisloose at gmail.com> wrote:
> Unfortunately for me, my privacy as an adult patient i violated
> on a daily bais if I'm in Florida with my parents.  They want
> protection, protection, protection, but there' nothing wrong with
> telling them to go away at thi point.  I am not going to tell you
> guy whether or not I wa exually active, but I have a quetsion.
> Mot of u are on Medicaid, right?  I wonder if any of you can tell
> me whether a government ervice uch a Medicaid will cover birth
> control pills.  I've been told to try birth control, but I
> already take mental health meds, o I wonder if I should put even
> more bad chemical in my body, and the other thing i that
> government insurance may not cover birth control because it' the
> government.  I don't know because of thoe comment made by the
> demagogue Limbaugh (ome p0o9litical people might know whuat I"m
> talking about.)  And if we elect the wrong peron, I might not be
> able to get free birth control.  Thank.
> Beth
>
>  ----- Original Message -----
> From: Arielle Silverman <arielle71 at gmail.com
> To: nabs-l at nfbnet.org
> Date sent: Sat, 8 Sep 2012 11:00:57 -0600
> Subject: [nabs-l] condoms and Sexual Health
>
> Hi all,
> I know the recent discussions about sex and dating are kind of in
> a
> gray area as to whether or not they're on-topic for this list,
> since
> most of the issues Koby brought up are not really unique to
> blindness.
> So if the moderators or Dave feel this is getting too far afield,
> I
> will happily respect your judgment. However, I also think that
> Brandon's question about where to get condoms is a legitimate one
> and
> that there might be other blind people out here, including
> teenagers,
> who have similar concerns about how to get condoms, birth control
> or
> sexual health information without a lot of awkwardness or
> embarrassment. It can be particularly difficult if you have to
> depend
> on someone else (especially parents) for transportation which can
> make
> going to a clinic or drugstore difficult.
> There are a few places to buy condoms online, including
> www.condomania.com
> www.undercovercondoms.com
> and
> www.condomdepot.com
> Believe it or not, they also have some condom choices at
> www.amazon.com
> If you go to your health center on campus for any reason, it
> shouldn't
> be a problem  to ask a doctor or nurse there about condoms.
> I cannot answer the questions about when to begin having sex with
> a
> partner because that is a highly individual decision. However, I
> feel
> it important that anyone who is considering having sex for the
> first
> time ensure you understand what all of your options are for
> preventing
> pregnancy and sexually transmitted diseases, the advantages and
> disadvantages of each option, and the proper way to use condoms
> and
> birth control. There are  a couple different websites with this
> kind
> of information:
> www.plannedparenthood.org
> (includes live chat with a sexual health educator) or
> www.scarleteen.com
> This issue is particularly close to my heart at the moment
> because my
> boyfriend's sister just had an unintended pregnancy at a very
> inopportune time (while still in college, with a guy she had only
> known for a few months) and was apparently taking birth control
> pills,
> but had not been taking them consistently. While I don't believe
> that
> sex  should be feared, it is something that takes some
> responsibility,
> planning and foresight to ensure it is enjoyable while minimizing
> the
> risks. Also, while I won't go into details here, there are other
> ways
> to be physically intimate with someone that are less risky, which
> these online forums will talk about.
> I also want to bring up  an issue that is somewhat relevant to
> sexual
> health, which I experienced and I think that some of you might
> also be
> struggling with. This is the issue of having your parents drive
> you to
> doctors' appointments and then having them want to sit in or even
> participate in your appointments. Since I attended college in my
> home
> city, my mother always wanted to drive me to my doctors'
> appointments
> and would then want to come in and chat with the doctor while
> he/she
> was examining me. This was partly because my parents and I saw
> many of
> the same doctors and she often thought it was a good opportunity
> to
> ask the doctor a quick question about her own health while she
> was
> there, or because she was curious to see what the doctor
> recommended
> to me about a particular issue. I eventually realized that while
> it
> wasn't ill-intentioned, it was a violation of my privacy as an
> adult
> patient and I asked her to wait in the waiting room while I was
> seeing
> the doctor. I didn't actually take this stand until I was 21 and
> in
> hindsight I wish I had done  it much earlier. By the time you are
> 18,
> unless you have a serious cognitive disability, you have a right
> to
> privacy of your medical information and it is important to
> establish a
> good doctor-patient relationship without a third person
> interfering.
> This is especially true when it comes to sexual health and by the
> time
> you are 18 or even 16, you will want to start discussing your
> sexual
> activities or questions with your doctors without your parents
> being
> around. You might also want to consider getting a driver or even
> taking the bus to medical appointments to avoid this problem.
> On a related note, by the time you are in high school, you should
> know
> the names of all medications you take on  a regular basis and any
> chronic medical conditions you may have. If you ever have to go
> to the
> emergency room, this kind  of information may be requested of
> you.
> Best,
> Arielle
>
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