A pregnant patient with intellectual disability requests no abortion, while her mother and husband urge abortion. What is the physician's ethical course of action?

A pregnant patient with intellectual disability requests no abortion, while her mother and husband urge abortion. What is the physician's ethical course of action?

• A. Proceed with abortion due to family wishes.
• B. Respect the patient's autonomous decision and perform a formal capacity assessment if needed.
• C. Refer to a legal guardian to decide.
• D. Let the mother's decision be final because of the patient's disability.

Answer: (B)

Respecting patient autonomy and accurately assessing decision-making capacity are at the heart of this scenario. A patient with intellectual disability can still have the ability to decide about abortion if she understands the information, appreciates the consequences, can reason about options, and can communicate a clear choice. The physician’s duty is to honor her decision if she demonstrates capacity, even when family members disagree. If there’s any doubt about her capacity, the physician should conduct a formal capacity assessment. This involves checking four elements: understanding the medical situation and options, appreciating how the information applies to her own life, reasoning about the pros and cons, and consistently communicating a choice. The goal is to determine whether she can make an informed, voluntary decision without coercion. Presenting information in accessible language, using decision aids, and involving support persons as needed can help clarify capacity. If she is found to have capacity, her autonomous decision to continue the pregnancy should be respected, and the family’s wishes should not override hers. If she is determined not to have capacity, then a lawful surrogate decision-maker or guardian would step in to decide, ideally reflecting the patient’s best interests and previously expressed wishes, while continuing to involve her to the extent possible.

Respecting patient autonomy and accurately assessing decision-making capacity are at the heart of this scenario. A patient with intellectual disability can still have the ability to decide about abortion if she understands the information, appreciates the consequences, can reason about options, and can communicate a clear choice. The physician’s duty is to honor her decision if she demonstrates capacity, even when family members disagree.

If there’s any doubt about her capacity, the physician should conduct a formal capacity assessment. This involves checking four elements: understanding the medical situation and options, appreciating how the information applies to her own life, reasoning about the pros and cons, and consistently communicating a choice. The goal is to determine whether she can make an informed, voluntary decision without coercion. Presenting information in accessible language, using decision aids, and involving support persons as needed can help clarify capacity.

If she is found to have capacity, her autonomous decision to continue the pregnancy should be respected, and the family’s wishes should not override hers. If she is determined not to have capacity, then a lawful surrogate decision-maker or guardian would step in to decide, ideally reflecting the patient’s best interests and previously expressed wishes, while continuing to involve her to the extent possible.