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Towards a sexual ethics of rights and responsibilities
Ruth Dixon-Mueller,a Adrienne Germain,b Beth Fredrick,c Kate Bourned
a
b
c
d
Consultant, Grecia, Costa Rica. E-mail: [email protected]
President, International Women’s Health Coalition, New York NY, USA
Executive Vice President, International Women’s Health Coalition, New York NY, USA
Vice President, International Policy and Regional Programs, International Women’s Health Coalition, New York
NY, USA
Abstract: Sexual rights as human rights encompass individual freedoms and social entitlements.
Both depend for their realisation on equally important social responsibilities on the part of
individuals, couples, families, other social institutions, and the State. The principle that all persons
must understand their own sexual rights and responsibilities and respect the equal rights of others −
particularly those of their sexual partners − informs our interpretation of the ethical basis of sexual
behaviours. We propose a conceptual framework for defining a sexual ethics of equal rights and
responsibilities pertaining to five dimensions of sexual behaviour: 1) sexual relationships and the
right to choose one’s partner; 2) sexual expression and the right to seek pleasure; 3) sexual
consequences and the right to cooperation from one’s partner; 4) sexual harm and the right to
protection; and 5) sexual health and the right to information, education and health services. We
suggest that the ethical principles presented here pertaining to sexual partnerships should be
incorporated into sexuality education, sexual and reproductive health services, and social policies
aimed at promoting the health and rights of all persons regardless of gender, marital status, sexual
orientation, religion, ethnicity and other personal or group identities. ©2009 Reproductive Health
Matters. All rights reserved.
Keywords: sexual rights, sexual responsibilities, sexual ethics, sexual health, sexual pleasure
HE term “sexual rights” is generally understood to encompass both formal and nonformal applications of codified human rights
in the realm of sexuality and sexual relationships. These applications, which derive from
basic principles of the 1948 Universal Declaration
of Human Rights and subsequent international
agreements, include the right to self-determination,
freedom of association and expression, liberty
and security of the person, non-discrimination
and equal treatment under the law, the enjoyment of the highest attainable standard of physical and mental health, and protection from cruel,
inhuman or degrading treatment. 1–3 Sexual
rights also derive from principles of gender
equality as affirmed in the 1979 Convention on
the Elimination of All Forms of Discrimination
Against Women and other documents, and from
T
principles of non-discrimination based on sexual
orientation and gender identity as proposed in
the 2007 Yogyakarta Principles, among other
sources.4–6 The fulfillment of sexual rights as
human rights is a fundamental element of social
justice and of the exercise of full citizenship for
all persons.7–9
Declarations of sexual rights by United Nations
(UN) agencies10,11 and international assemblies,
non-governmental organizations,12–15 and activists and researchers16–25 offer a rich array of
perspectives on the nature of the individual freedoms and social entitlements that are “claimed”.
Although the obligations of the State and civil
society to create the enabling social, economic
and legal conditions necessary for the fulfillment
of individual rights are emphasized in many
declarations, such as the International Planned
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R Dixon-Mueller et al / Reproductive Health Matters 2009;17(33):111–119
Parenthood Federation’s 2008 Declaration on
Sexual Rights15 and the Yogyakarta Principles,4
most make only passing reference to the role of
individuals’ responsibilities. Yet, the realization
of sexual rights is possible only if all persons
respect the autonomy, dignity and equal rights
of others − especially of their sexual partners −
as well as their own integrity and self-worth.
Sexual responsibilities as sexual ethics:
five applications
In its groundbreaking affirmation of women’s
sexual rights by UN member states in Beijing
in 1995, the Platform for Action of the Fourth
World Conference on Women makes two references to individual responsibilities:
“The human rights of women include their right
to have control over and decide freely and responsibly on matters relating to their sexuality,
including sexual and reproductive health, free
of coercion, discrimination and violence. Equal
relationships between women and men in matters
of sexual relations and reproduction, including
full respect for the integrity of the person, require
mutual respect, consent and shared responsibility for sexual behavior and its consequences.”
(Paragraph 96)
Similarly, an interpretation of sexual rights
framed by an international group of women’s
health advocates who were deeply engaged in
the UN conferences held in the 1990s on the
environment, human rights, population and
women, declares that:
“Sexual rights refer to the human rights of all
persons with respect to the free and responsible
expression of their sexuality and their control
over their bodies. They encompass the right to
experience a pleasurable sexuality, which is
essential in and of itself and, at the same time,
is a fundamental vehicle of communication and
love between people. Sexual rights include the
right to liberty and autonomy in the responsible
exercise of sexuality.”16
Despite these and other references to “free and
responsible” sexual expression, the international community of sexual rights advocates
has been somewhat reluctant to spell out what
“responsible” sexual expression might mean.
There are several reasons for this − and, indeed,
112
for our own cautiousness in proposing such a
clarification. The first derives from a conservative
political climate in which sexual freedom is
equated with sexual irresponsibility and carries
strong moral and legal condemnation. Rather
than avoiding the issue, however, we believe
that sexual rights advocates must claim the concept of responsibilities and define it in the language of respect for the rights of others. A
second concern is that the idea that sexual partners have (or should have) equal rights and
responsibilities vis-a-vis one another appears
to overlook the realities of power hierarchies
that prevent many persons − especially women
and sexual minorities − from enjoying their
sexuality and protecting themselves from harm.
Yet, all declarations of human rights are statements of what ought to be and not necessarily
of what is: they are ideals. Because sexual rights
are human rights, we contend that an ethic of
equal rights, mutual respect, consent, and
shared responsibilities applies to all sexual partners regardless of their sex, sexual orientation,
gender identity, marital status, and other personal or social characteristics.
The ethical guidelines proposed here are not
meant to be legally enforceable in their entirety,
but neither are they simply wishful interpretations. Rather, they are proposed as logical extensions or applications of broader human rights
principles to individuals and couples with respect
to five dimensions of sexuality and sexual behaviour, namely: 1) sexual relationships and the
right to choose one’s partner; 2) sexual expression and the right to seek pleasure; 3) sexual consequences and the right to cooperation from
one’s partner; 4) sexual harm and the right to
protection; and 5) sexual health and the right to
information, education and services. The mutual
rights and responsibilities of sexual partners are
outlined in the context of the State’s obligations
to protect and fulfill a corresponding range of
individual freedoms and social entitlements pertaining to each of these five dimensions.
• Sexual relationships and the right to choose
one’s partner
Formal UN agreements such as the 1966 International Covenant on Civil and Political Rights
and the 1979 Convention on the Elimination of
All Forms of Discrimination Against Women,
which are binding on States Parties, declare that
R Dixon-Mueller et al / Reproductive Health Matters 2009;17(33):111–119
everyone of full age has the right (freedom) to
marry and found a family. In addition, men
and women have equal rights to freely choose
a spouse and to enter into marriage only with
their free and full consent. Non-formal declarations of sexual rights from non-governmental
organizations and other sources typically extend
the same rights to freedom of choice and consent
to non-marital relationships as well, and the same
marital and non-marital rights equally to all persons regardless of their sex, sexual orientation or
gender identity.
The implications of these principles for the
exercise of personal responsibilities are clear.
Because everyone has the right to refuse any
or all marital or non-marital sexual relationships with any other person, no one is entitled
to enter into a sexual relationship with another
person against that person’s will, or to coerce or
attempt to coerce another person into staying in
such a relationship if the other no longer consents to it. Everyone thus has the responsibility
to respect the equal rights to freedom of choice
and consent of his or her partner(s) and of other
persons in their families and communities.
Everyone also has an ethical obligation not to
participate in or condone practices that either
compel two people to form or remain in a marital or non-marital sexual relationships if at least
one of them does not wish to, or that prevent
any two persons above the age of consent who
wish to establish a marital or non-marital relationship from doing so.
• Sexual expression and the right to
seek pleasure
According to a working group convened by the
World Health Organization (WHO), all persons
have a right “to pursue a satisfying, safe and
pleasurable sexual life” free of coercion, discrimination and violence (emphasis added).11* Erotic
pleasure is celebrated as a “natural right” in many
non-formal declarations that grant to everyone −
including children, adolescents, adults and the
elderly − a right to know and value their own
body and to seek pleasure from it free of misinformation, shame, guilt or mockery.
Principles of sexual freedom and of the right
to seek sexual pleasure grant to no one the right
to receive or demand sexual satisfaction from
*This is not an official position of WHO.
others against their will, wishes, or inclination,
however. 26 The freedom to choose whether,
when, with whom, and how to have sexual relations or exchanges, and to initiate and respond to
expressions of sexual desire, carries a corresponding responsibility to respect the other person’s
integrity, privacy and freedom to choose −
including their right to say no − regardless of the
nature of the relationship. Sexual ethics places
limits on the pursuit of pleasure as well as on
its realization: a pleasurable sexual life cannot
be guaranteed.
The exercise of sexual rights requires freely
given consent in the context of mutual choice
in every sexual encounter. This means that
everyone is (i.e. should be) free to refuse, or to
demand the termination of, any sexual initiative, act, or practice at any time in any relationship, including marriage, cohabiting unions,
love affairs, dating relationships, casual encounters, and commercial sex transactions. Moreover,
consent to the formation of a sexual relationship
or to a sexual exchange in general, no matter
how brief, does not imply consent to all sexual
acts within that relationship. The growing body
of laws in many countries that recognize marital
rape, date rape and the rape of sex workers as
criminal offenses regardless of the perpetrator’s
claims of entitlement or implied consent attests
to the legitimacy of an individual’s right to refuse
any sexual act even within a relationship in which
sexual exchanges are (or may be) expected.
• Sexual consequences and the right to
cooperation from one’s partner
The Platform for Action of the 1995 Fourth
World Conference on Women declares that
sexual relations and reproduction should be
based on “mutual respect, consent and shared
responsibility for sexual behavior and its consequences”. Both positive and negative consequences are relevant here. Sexual expression
may contribute to the strengthening of emotional bonds between partners or to pain and
humiliation; to the conception and birth of a
much-wanted child or to an unwanted or lifethreatening pregnancy; to the physical health
and well-being of both partners or to the transmission from one to the other of a sexually
transmitted infection, including HIV.
With respect to protection from unwanted pregnancies, UN agreements since the Proclamation
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of Teheran of the 1968 International Conference
on Human Rights have affirmed that individuals
and couples have the right to decide freely and
responsibly on the number and spacing of their
children and to the information, education, and
means to do so. The entitlement of all persons to
the fullest possible range of safe, affordable and
acceptable contraceptive methods and to appropriate information and services has been emphasized in numerous international declarations,
such as the Programme of Action of the 1994
International Conference on Population and Development, and constitutes a fundamental obligation of the State to provide.
If individuals are to be guaranteed the right to
decide “freely and responsibly” on whether and
when to have children and how many, then it
follows that no person has the right to prevent
another − including his or her sexual partner −
from using contraception, or the right to force
another to use a method against his or her
will. If both partners agree that conception
should be avoided, then each is ethically responsible for using a contraceptive method or cooperating with its use by the other. If conception
does occur, the woman has the final right to
decide on the outcome of the pregnancy because
her bodily integrity is at stake, and no woman
should be forced to terminate a pregnancy or to
carry a pregnancy to term against her will.
If individuals and couples are entitled to information, education and the means of fertility regulation, then it also follows that no individual
has the right to prevent any other person −
whether a sexual partner or anyone else in the
family or community − from exercising this
entitlement. Rather, everyone has an ethical
responsibility to be informed, where possible,
and to ensure that his or her sexual partner is
informed. Family planning providers can promote an ethic of sexual cooperation by offering
routine joint counselling for couples on pregnancy prevention and pregnancy care.
The HIV/AIDS pandemic has thrown into high
relief conflicts over sexual rights and responsibilities relating to the prevention of HIV and
other sexually transmitted infections. HIV
poses particular ethical challenges to individuals, couples and governments given the difficulty people face in ascertaining their own and
their partner’s status, and the harsh personal,
social, economic and health consequences of
114
doing so in many countries. Nevertheless, if
everyone has the right to decide on matters
relating to his or her own sexual and reproductive health, as the Beijing declaration declares,
then everyone has a “need to know” the health
status of his or her partner and the right to insist
on safer sex (or no sex). Everyone also has an
ethical obligation to know and to inform his or
her sexual partner(s) of his or her own health
status in recognition of the partner’s need to
know and equal right to decide. 27,28 In this
sense, an individual’s ethical responsibility to
inform and to avoid transmitting HIV to a sexual
partner may compete with his or her right to
privacy. We argue for the individual to give the
greatest possible weight to responsibility and to
seek help with the disclosure process where necessary, recognizing that there may be disclosurerelated risks.
All persons involved in sexual relationships,
whether casual encounters or long-term commitments, are entitled to cooperation from their
partners in the use of male or female condoms or
other methods to prevent the transmission of
STIs/HIV. This means that everyone has a corresponding obligation to use a preventive method
or to cooperate in its use by their partner if the
possibility of infection is present. The same principles of cooperation apply to the obligation to
fully support a partner’s decision to seek STI/
HIV testing and treatment and to disclose their
status. As is the case for pregnancy prevention,
however, ultimately, each person must be responsible for his or her own protection if a mutually
satisfactory agreement cannot be negotiated.
Health service providers can encourage an ethic
of mutual rights and responsibilities by offering
routine couple counselling, testing, opportunities
for safe mutual disclosure, and treatment for
sexual partners regardless of their sex, gender
identity and sexual orientation.
In order for individuals and couples to exercise
their rights and responsibilities in ascertaining
their STI/HIV status and in protecting themselves
and their partners, governments must meet their
obligations to ensure that everyone has access to
confidential, voluntary testing and counselling
that offers comprehensive information on HIV
and other sexually transmitted infections, as
well as access to information and the means of
prevention and treatment. Governments and
civil society have a duty to work toward the
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elimination of stigma, discrimination and violence against those living with HIV and AIDS,
as do individuals with respect to their sexual
partners and others in their families and communities. Much needs to be done to elaborate further the responsibilities of State and non-State
actors in less than ideal conditions and to engage
multiple stakeholders, including women's health
and human rights activists as well as the international AIDS community.
• Sexual harm and the right to protection
The 1948 Universal Declaration of Human Rights
affirms that everyone has a right to liberty and
security of the person, to freedom from cruel,
inhuman or degrading treatment, and to freedom
from torture. These rights have been extended in
UN agreements such as the Vienna Declaration of
the 1993 World Conference on Human Rights
and the 1993 Declaration on the Elimination of
Violence Against Women as well as in nonformal declarations to encompass freedom from
rape, sexual violence, sexual slavery, forced
pregnancy, female genital mutilation, and other
forms of degradation and abuse.
The State can be held accountable for violations of sexual rights resulting from direct and
indirect actions or inactions, the latter involving
a failure to provide, enforce or protect. Direct
state actions include practices such as the use
of rape as an instrument of war; state-sanctioned
sexual torture of male or female prisoners; and
policies such as the criminalization of certain
types of consensual sexual relations (e.g. homosexuality or adultery). Indirect actions involve
the State’s failure to prevent or to fully prosecute rights violations such as violence against
women; the sexual abuse of male or female children; sexual trafficking; child marriage; rape
(including marital or date rape); “honour crimes”;
and related practices. Violations such as these
are addressed by the various monitoring committees of the human rights treaties of the UN,
while others still need to be clarified, legislated
and enforced.
The right to liberty and security of the person
encompasses both the freedom to make responsible sexual choices and the right to protection
from bodily harm. We suggest that all persons
above the age of consent have the right (freedom)
to engage in sexual relations with a willing
partner − including in exchange for cash payments,
gifts or other considerations − free from the threat
of discrimination, coercion, violence, arrest or
detention. However, no third person (e.g. pimp,
sexual trafficker) should have the right to
demand payment for the display or use of the
body of any other person. Similarly, despite
claims to the contrary regarding tradition in
some cultures,29 we contend that no individual,
family, kinship group, clan or community “owns”
the body of another person or is entitled to use
or abuse it, sell it, or dispose of it in any other
manner. Rather, everyone has an ethical responsibility to not engage in or tolerate practices that
cause harm to their sexual partners or others in
their families and communities, or that violate
their rights to safety and security with respect
to their sexuality.
• Sexual health and the right to information,
education and services
The UN Committee on Human Rights as well as
other UN agencies and committees have
affirmed that sexual and reproductive health
are integral elements of the right of everyone
to the enjoyment of the highest attainable standard of physical and mental health.30As part of
their overall mandate to respect, protect and fulfill people’s right to health, governments are
responsible for ensuring that high-quality sexual
and reproductive health information, services
and supplies are available and accessible to all,
without discrimination. The rights of adolescents
have been further elaborated in a number of
documents. The Programme of Action of the
1994 International Conference on Population
and Development, for example, declares that
“Full attention should be given to the promotion
of mutually respectful and equitable gender relations, and particularly to meeting the educational and service needs of adolescents to enable
them to deal in a positive and responsible way
with their sexuality.”31 Subsequent recommendations urge that legal, regulatory and social
barriers to information and care for adolescents
be removed; that health services be appropriate
to both male and female adolescents’ needs;
that adolescents’ rights to privacy, confidentiality and informed consent be respected; and that
young people’s responsibility for their own sexual
behaviours be promoted along with gender equality and the prevention of unwanted and early
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pregnancies, sexually transmitted infections,
and sexual violence and abuse.
Because everyone has the right (entitlement)
to acquire the information, education and means
to decide on matters relating to their sexuality,
including their sexual and reproductive health,
it follows that no one has the right to censor or
block another person’s access to such information or services. Rather, everyone has a positive
duty to acquire the information, education and
means to advance and protect his or her own
sexual health and rights, where feasible, and to
advance and protect the health and rights of
their sexual partners and any other persons −
such as children and young adolescents − for
whom they bear responsibility.
Conclusions
The global discourse on sexual rights reflects the
contributions of organizations and individuals
representing a variety of constituencies. Among
the contributors to the debate are representatives
of the reproductive health community, including
women’s health activists and family planning
organizations; sexology researchers and sex educators; feminist groups; human rights organizations; young people’s networks; associations of
people living with HIV; organizations of sex
workers; and coalitions of persons of diverse sexualities.32–34 Each of these constituencies brings
a somewhat different set of issues to the policy
table, and each reflects individual views as well
as the political, economic and socio-cultural conditions of particular world regions, countries and
social communities.
The potential for constructive collaboration
to advance the global sexual rights agenda is
significant. But so, too, is the potential for disagreement on content. Commentators differ on
the concept of sexual responsibilities, for example. Some argue that powerless persons may not
be able to exercise their rights or meet their
responsibilities without jeopardizing their personal safety, and that their inability to do so can
result in “blaming the victim”.35–37 Others fear
that the ethical obligation to behave responsibly
can too easily be translated into laws that violate human rights. Still others are concerned
that non-normative behaviours will be arbitrarily condemned as “irresponsible”, especially
because sexual rights advocacy has faced, in
116
various forms and degrees, opposition at international, national and local levels from powerful conservative forces for whom the idea of
sexual rights is deeply threatening, and for
whom the concept of responsibility means that
individuals must strictly conform to conservative and often punitive moral codes.38–40
With the goal of promoting sexual equality
and social justice for all, this paper aims to build
a common foundation for sexual rights discourse
based on an understanding of a sexual ethics that
encompasses individual responsibilities as well as
rights. Two major challenges must be addressed.
One, widely recognized, is to identify a core set
of legally binding and potentially enforceable
sexual freedoms and entitlements as basic human
rights for the purposes of negotiating the language of international agreements and national
and local laws and policies. These rights encompass both the freedom from harm, such as entitlements to protection from discrimination, rape
and other forms of sexual violence, sexual harassment or abuse, sexual trafficking, and forced marriage; and the freedom to make voluntary and
informed sexual choices. Whereas the former
category requires the imposition of laws and
policies to prevent and punish violations that
now often go unsanctioned, the latter requires
the removal of laws and practices that infringe
on the capacity of individuals to decide freely
and responsibly on matters relating to their
sexuality and sexual health. Both relate to the
obligations of governments to create, insofar as
is possible, a safe and secure environment for
their citizens based on effective protection of
human rights. The State is obliged to create a
policy framework for protecting all persons
from sexual harm and for guaranteeing their
sexual freedoms regardless of gender, marital
status, sexual orientation, age, race, nationality
and other social identities and characteristics.
Further, the State is obliged to recognize that
everyone has the right to know and exercise
their sexual rights, to receive information and
services relating to their sexual health and
rights, and to enjoy equal benefits and protection of the law.
The second challenge, which lies outside the
legally enforceable aspects of sexual rights,
involves the transformation of an array of attitudes, beliefs, prejudices and behaviours relating
to sexuality, sexual relations and gender that
R Dixon-Mueller et al / Reproductive Health Matters 2009;17(33):111–119
can best be approached from a rights-based
ethical perspective. Policy discussions and programmatic investments urgently need to stress
the ethical principles of equal rights, mutual
respect, consent and shared responsibility as
integral components of the rights of all persons
to decide freely and responsibly on matters relating to their sexuality, including their sexual and
reproductive health, free from coercion, discrimination and violence. Boys and men need particularly to understand their responsibilities to
respect the rights to freedom of choice, pleasure
and protection of their sexual partners; girls and
women need particularly to understand and
exercise their own rights.41 Rights and responsi-
bilities need to be balanced. We suggest that
these ethical guidelines be promoted as normative expectations relating to all forms of sexual
partnerships in programmes such as sexuality
education for young people, HIV counselling
and testing, contraceptive advice and services,
and public education messages that promote a
rights-based vision of sexuality, sexual relationships and gender equality.
Acknowledgement
The authors are grateful to Susanna J Smith of
IWHC for her assistance in the preparation of
this paper.
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Résumé
Les droits sexuels en tant que droits de l’homme
englobent les libertés individuelles et les
prestations sociales. La réalisation de ces deux
types de droits dépend de responsabilités sociales
aussi importantes de la part des individus, des
couples, des familles, d’autres institutions
sociales et de l’État. Notre interprétation du
fondement éthique des comportements sexuels
est basée sur le principe selon lequel tous les
individus doivent comprendre leurs responsabilités
et leurs droits sexuels, et respecter l’égalité des
droits de l’autre, en particulier leurs partenaires
sexuels. Nous proposons un cadre conceptuel
pour définir une éthique sexuelle d’égalité des
droits et des responsabilités touchant cinq
dimensions du comportement sexuel : 1) les
relations sexuelles et le droit de choisir son
partenaire ; 2) l’expression sexuelle et le droit de
rechercher le plaisir ; 3) les conséquences sexuelles
et le droit à la coopération du partenaire ; 4) les
atteintes sexuelles et le droit à la protection ; et
5) la santé sexuelle et le droit à des services
d’information, d’éducation et de santé. Nous
recommandons que les principes éthiques
présentés ici sur les partenariats sexuels soient
intégrés dans l’éducation sexuelle, les services
de santé génésique et les politiques sociales de
promotion de la santé et des droits de toutes les
personnes, quels que soient leur sexe, leur état
civil, leur orientation sexuelle, leur religion, leur
origine ethnique et autres identités personnelles
ou collectives.
Negotiating Reproductive Rights:
Women’s Perspectives Across
Countries and Cultures. London/
New York: Zed Books, 1998.
Resumen
Los derechos sexuales como derechos humanos
abarcan libertades individuales y derechos
sociales. La realización de ambos depende de
responsabilidades sociales de igual importancia
por parte de particulares, parejas, familias, otras
instituciones sociales y el Estado. El principio de
que todas las personas deben comprender sus
propios derechos y responsabilidades sexuales y
respetar la igualdad de derechos de los demás,
particularmente de las parejas sexuales, influye
en nuestra interpretación de la base ética de los
comportamientos sexuales. Proponemos un marco
conceptual para definir la ética sexual de la igualdad
de derechos y responsabilidades concernientes a
cinco dimensiones del comportamiento sexual:
1) relaciones sexuales y el derecho de escoger su
pareja; 2) expresión sexual y el derecho de buscar
placer; 3) consecuencias sexuales y el derecho a
la cooperación de la pareja; 4) daño sexual y el
derecho a la protección; y 5) salud sexual y el
derecho a la información, educación y servicios
de salud. Sugerimos que los principios éticos
aquí presentados concernientes a las parejas
sexuales se incorporen en la educación sexual,
los servicios de salud sexual y reproductiva y las
políticas sociales destinadas a promover la salud y
los derechos de cada persona independientemente
de su sexo, estado civil, orientación sexual,
religión, etnia y otras identidades personales o
de grupo.
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