My mother, who has a well documented dementia, is no longer able to identify me. She also talks regularly about my father visiting her daily (he died in November of 2014) and calls her on her TV remote. She knows her own first name, but has trouble remembering her last name. When her brother visited in December, she didn't know who he was.
The problem with having a written declaration is that the demented person will have no memory of having signed it. They are not likely to be able to made an informed decision as they will (at a point in the progress of their dementia), no longer be able to reason. They may or may not even recognize their spouse or have any concept of what their "spousal duties" are.
Using the "she didn't say no" argument is kind of like saying it is OK to have sex with someone in a coma because "they didn't say no".
As I explained to my accountant/close friend, trying to reason with a person with dementia is like trying to reason with a 2 year old. However, my college room mate (who has watched his parents descend into dementia) puts it even better - "Aliens stole my mother's brain."
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