The power of discretion and the discretion of power: personal assistants and sexual facilitation in disability services

Aim: The purpose of this article is to explore how personal assistants, working in state-funded services for mobility-disabled people in Sweden, perceive and experience their work, with special focus on sexual facilitation (assistance with sexual activities). Background: Personal assistance services are a legal right, aiming to give certain disabled people the possibility to live on equal terms in society with non-disabled citizens. The services are to be grounded on the principles of self-determination, autonomy, integrity, and user influence according to independent-living ideology. However, the legislation does not mention sexuality, and in addition, there are often no local policies; hence, it is unclear what service users can demand in terms of sexual facilitation, and on the assistants’ part, what is and what is not acceptable to assist with. Methods: The methods used to gather data were interviews with 15 personal assistants as well as observations in an online discussion forum for personal assistants. Findings: The analysis suggests that personal assistants may experience that there is a taboo against discussing sexual facilitation in the workplace. There are no predetermined policies, regulations, or ethical codes of conduct regarding sexual facilitation, and the personal assistants’ discretion is therefore strong. Different strategies for managing this discretion were identified, greatly influenced by personal values, as well as societal norms. Conclusion: The normative context of discretion is highly visible, suggesting the importance of uncovering the interplay between the power dimensions of sexuality, disability, gender, and professionalism