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This Valentine’s Day, folks across the country will be either ignoring the romantic vibes altogether, deriding the holiday, praising the single life, celebrating an ongoing romance, or trying to start a new one. For folks seeking out companionship, relationships can be a minefield, as can sexual behavior. What does this have to do with bioethics, you ask?

Sexual behavior is one of the many ways that things can go wrong—or right!—in human relationships. Even sex-positive approaches to human relationships necessarily involve considerations ranging from physical health (safe sex and prevention of sexually transmitted infections) to mental health (how relationships end, mutually shared expectations, the PTSD and depression commonly experienced after sexual assault).

To prevent the worst health effects of sexual behavior, participants must have a fundamental respect for each other’s autonomy and for each other as persons. The Missouri case of a man who exposed over 300 people to HIV through unprotected sex without taking preventive measures or informing his partners, is an example of lack of respect for others’ autonomy and for them as persons.  It is not really autonomous consent if you don’t know what you are getting into, even if you say yes.

It is sometimes tempting as a bioethicist to view calls to privilege autonomy with some skepticism, especially as autonomy can conflict with beneficence, non-maleficence, confidentiality, fidelity, justice, and other major principles of medicine and nursing.  Classically in American bioethics, autonomy was given significant ordinal priority over other principles in order to counter the abuses of unnecessary paternalism.  But a nuanced and careful view of ethics may sometimes place autonomy second to other principles.

When it comes to sexual conduct, however, the autonomy of each participant must be unquestioned and unquestionable.  Autonomy doesn’t so much trump all other principles as it enrolls them in bolstering it, in part because the harms of overriding it are so severe. These harms include PTSD, substance abuse, self-harm/self-injury, sleep disorders, eating disorders, suicide, and depression.  It may be one (problematic) thing for a physician to say “This patient doesn’t know what he wants because no matter how hard I try to explain the risks and benefits, he still doesn’t understand.” It is something else altogether for someone to say of an intended sexual partner who refuses advances, “She doesn’t know what she wants.”

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Image Credit: CNN.com

Image Credit: CNN.com

Talking about sexual assault and safe sex on Valentine’s Day may seem singularly unromantic.  But lack of genuine consent, whether due to misinformation by a partner or refusing to take no for an answer or not waiting for yes, well, that is truly unromantic.  I won’t go so far as to echo the new saying that “consent is sexy”, as that is a loaded claim.

But true romance can’t happen without it.