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  • Title: Making up her mind: consent, pregnancy and mental handicap.
    Author: Higgs R.
    Journal: J Med Ethics; 1983 Dec; 9(4):219-26. PubMed ID: 6668587.
    Abstract:
    The perplexing issues of informed consent and decision making in the care of mentally handicapped patients are explored in a British case study involving a retarded, pregnant seventeen-year-old. Physicians and other health workers at the local clinic believe an abortion would be in her best interest, but the girl is unable or unwilling to make a decision or give consent, and the older couple with whom she lives is actively opposed to this solution. Three commentaries discuss qualifications for parenthood, the meaning and value of autonomy, and the obligation of health professionals to intervene in situations where competence is at issue. A case conference is recounted of a 17-year old mentally handicapped and pregnant young woman who came to see Dr. Davidson, a trainee general practitioner working in inner London. Davidson saw from her records that she had been registered with the practice since birth and had not been seen for several years. He asked her to come back in a few days for a full antenatal check-up and meanwhile he discussed the consultation and his concerns about Mary with his trainer, Dr. Daniel, and with Susan, a health visitor in the practice. Susan went to see Mary and learned that Mary's mother, Rose, was "mentally subnormal," etiology unknown. The mother was living in a hostel in the East End of London and had had little contact with Mary over the previous year. Mary had attended a school for the educationally subnormal where her intelligence quotient (IQ) had been assessed as around 45. Since leaving the special school at age 16, she had gone to stay on a boat on the Thames with a man named Peter. He had taken her to the local hospital when he realized she was pregnant, and Mary had been seen by an obstetrician and social worker. As far as Susan knew, an abortion had not been discussed. Shortly afterwards, Mary left Peter and had come back to the practice area to stay with Ron and Ann, a couple in their 60s, also registered with and well known to the practice. They were all living in a squalid and filthy prefab, which should have been torn down. The question arose at the practice meeting of what help could be offered if Mary decided to continue with the pregnancy. The feeling expressed at the meeting was that the trauma of having an abortion was likely to be less painful and damaging to Mary than the seemingly inevitable separation from her child after it had been born. It was decided that Susan should ask Mary to come to the surgery to talk to 1 of the doctors about having an abortion, which should be arranged if possible. Yet, could the doctors take this matter into their own hands and make a decision which would profoundly affect Mary's life. But could Mary make an informed decision herself? A scan showed Mary to be 15 weeks pregnant. Interviews with Mary, the practical realities of proceeding with the abortion, her changing and unstable living situation, and this doctor's involvement are recounted in detail. The question for this trainee became how much responsibility should be taken for making crucial decisions that affect other people. And there is anger about the lack of provision of reasonable resources within this welfare state. Mary continued with her pregnancy, went off with Peter, and what happened to her is unknown.
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