Years ago, when I was struggling with addiction, I would occasionally (once a month or less) engage in sex work to help make ends meet. This was voluntary — no one made me do anything I didn’t want to do — but it’s still uncomfortable for me to think about sometimes. I always used protection during these encounters and continue to get screened for S.T.D.s regularly. If anything, I think I’m slightly less likely than the general population is to pass anything on.
I’m in a new relationship that’s starting to get serious. He knows about my past issues with addiction. Do I have to disclose the fact that I used to be a sex worker? He’s been very accepting about everything up to this point, but as a woman I’m aware that there’s so much social stigma around sex work that I think there’s a chance he might end the relationship if he knew about this. Even if he didn’t end the relationship immediately, I imagine it would make him incredibly uncomfortable. I really don’t want to ruin a good relationship over something that ended five or six years before we met. But I feel as if I’m keeping something important from him.
Exactly how much about my sexual past does my current partner have a right to know? For that matter, what about anyone I might date in the future? Twenty years from now, is this still something I need to disclose? — Name Withheld
From the Ethicist:
The stigma around sex work you mention is real enough, and has multiple sources. Part of it is surely a spillover from times when people thought all extramarital sex was wrong. And then, for many, sexual intimacy has a special kind of significance, such that engaging in it for any reason other than as an expression of desire is upsetting. Some negative associations, too, arise from the fact that much sex work is not fully consensual, even though the wrong there is done to, and not by, the sex worker. Despite the medical facts you mention, concerns about disease can merge with inchoate notions of moral pollution: The sex worker is seen as tainted, contaminating the social body.
These perceptions are highly gendered. Women’s sexuality has traditionally been far more strictly regulated than men’s. That’s why there’s no male equivalent of the ‘‘fallen woman,’’ and nobody talks about ‘‘easy men.’’ Recent fictional, and autofictional, depictions suggest that these patterns persist. When the novelist Justin Torres writes about male sex work, there’s little sense of it as character-defining or tragic; it’s one of the curious odd jobs you might take to get by. By contrast, it weighs heavily on the human rights lawyer in Sally Rooney’s latest novel that his girlfriend has been ‘‘borderline what you might call a sex worker.’’ Social stigmas are readily internalized, so you’ll want to come to grips with your own discomfort. I hope it comes from your having put yourself in the situation where you did something you feel you can’t freely talk about — and not because you see yourself as a sexual sinner.
Thinking all this through will help you get a handle on what your own attitude is and should be; it doesn’t settle what you owe to your partner. Most people today don’t expect a partner to reveal details of their earlier sexual lives. This doesn’t mean there aren’t things about your sexual past that partners would feel they ought to have been told. If your partner would be upset by learning about your sex work, you can assume that this is one of the things he wouldn’t want withheld from him. Yet that’s not the same thing as his having the right to know. Most people have done things in their past that they’d rather keep to themselves. You don’t have a duty to announce them all when you enter a serious relationship. And if, with the passage of years, this episode in your life recedes in significance for you, so would the rationale for discussing it.
But, given your struggles with addiction, the work of recovery is part of who you are now. Although I don’t think you have a duty to reveal this part of your past, I still hope you resist being silenced by stigma, and for a few reasons. First, this was part of the story of your struggle with addiction, which you’ve otherwise been upfront about; concealing it could compromise your own sense of authenticity. Second, if he’s not willing to accept this unedited version of you — if he were to react with harsh judgment — you can wonder whether he’s the right person to share your life with. Third, the disclosure would also be an act of respect. Suppose he found out the truth one day and felt betrayed because of your failure to trust him. A leap of faith might be what your relationship needs to find solid footing.
Readers Respond
The previous question was from a reader with an ailing friend. She wrote: “My significant other has a friend who is a longtime alcoholic, while also being intelligent, entertaining and conniving. … He was off the radar for a bit, and then we learned he had a liver transplant. After that, he had an episode of hepatic encephalopathy, a brain disorder caused by liver dysfunction. It seems the doctors knew he was still drinking but gave him the new liver anyway and counseled abstinence. A few parties later, he was sneaking vodka, gin and whatever else was around. He lies to everyone and has made his guy friends vow not to tell his wife about his drinking. They’ve made a meager attempt to confront him, only to be assured that he just fell off the wagon and would be good. Just don’t tell the wife! I’m appalled that they’re going along with this. … Do the friends have an obligation to tell this man’s wife that he’s still drinking?”
In his response, the Ethicist noted: “This fellow’s friends weren’t looking after him when they agreed to uphold this boozy bro code and keep mum. He doesn’t want to die, but he’s drinking himself to death, which means that, at least in this key area, he lacks the capacity for rational decision-making. In a situation like that, it’s more important to attend to his interests than to respect his autonomy. If there’s a chance that his life can be extended by successful management of his alcoholism, and if discussing the problem with his wife will help, thoughtful friends would do just that. Her interests matter, too. She needs to know the score for her own sake as well as his. In fact, I wonder whether she’s entirely in the dark. So maybe the task isn’t so much to communicate the facts to her as it is to help her face up to them. These friends need to face the facts, too. They may think they’re being stand-up guys, but they’re making themselves complicit in this man’s downfall.” (Reread the full question and answer here.)
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This is a very balanced, well-written and well-informed piece about alcoholic liver disease, alcohol use disorder and liver transplants. — Ian
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I grew up around alcoholism — grandparents, parents, siblings. I was never chemically dependent and rarely drank alcohol, but I have understanding and compassion for those with the disease. However, when we let people with an active addiction receive a liver that a sober person could have, I am saddened. In 2021, I was diagnosed with intrahepatic cholangiocarcinoma, or liver bile duct cancer. I live by a healthy vegetarian diet and exercise seven days a week; my hepatologist could not find the cause. He also told me I would not be a candidate for a liver transplant at my medical center, even though my cancer was only in the bile duct and had not spread. It’s hard to understand why people who maintain a healthy lifestyle cannot receive the liver that an active alcoholic will receive. I had a liver resection and further treatment and am still here. But I know many others with cholangiocarcinoma who cannot receive a new liver. — Whitney
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It’s understandable that the letter writer is upset, especially because she had a friend who died waiting for a transplant. However, as someone who spent more than 14 years working with addicts and those in recovery, addiction is a disease, not a life choice. I knew folks who lost their freedoms, their children and even their lives. Often addicts have unresolved trauma and/or suffered abuse. Add to that, the emotional and physical toll of waiting for and then receiving a transplant. Afterward, the transplant recipient has to take medication for the rest of his or her life. Depression isn’t unheard-of following a transplant. The process is a difficult experience for everyone involved. The Ethicist is right. The person in question and his family need support from his friends, as well as wraparound services including mental health and recovery treatment. Reach out. See if there are support groups for the man and his family. — Diana
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My sister was a vibrant, active, community-minded organ donor who was killed by someone who may have been drinking and driving. I find this a sad and disturbing ethical question. I am certain that my sister’s 11 children are grateful that through her organ donation their mother was able to give new life to recipients who would embrace the gift they were given. I realize this is complicated for those with addictions. I could only hope they seek help. — Marilyn
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