Perlin discusses the problem of institutions that neglect to grant sexual freedoms to their patients because of their presumptions of coercion. Sexual coercion is a valid issue within institutions, but the way we understand and take precautions for potential coercion is crucial. Perlin says that it is not enough for hospitals to deny a patient of their freedom of expression based on presumptions of coercion. However, Perlin advises that they must instead make policies that protect unwanted sexual activity, while still allowing patients to maintain their right to autonomy. The legal reality is that institutionalized patients are guaranteed at least some rights to sexual expression and autonomy. By rejecting this legality,
“…public opinion creates a social disconnect and allows for an irrational universe in which the extent to which a patients rights may be vindicated may well rest on triviality…”(496 Perlin).
The triviality which Perlin is talking about has to do with the geographic location the patient is housed in. This is the same for the reproductive and sexual rights of incarcerated pregnant women, where only three states in the U.S. have policies which prohibit the use of restraints during delivery. It is in the nature of institutions like these, to thoroughly limit and control every aspect of inmate life.