What is the appropriate action when an intellectually disabled pregnant woman with an Intelligence Quotient (IQ) of 80 wants to continue her pregnancy, but her mother wants her to have an abortion?

Respecting Autonomy in Reproductive Decision-Making for Intellectually Disabled Patients

The appropriate action is to refuse to perform the abortion (option A) as the patient has expressed her desire to continue the pregnancy and has the capacity to make this decision despite her intellectual disability.

Understanding Decision-Making Capacity

An IQ of 80 falls within the borderline intellectual functioning range, which generally does not impair an individual's ability to make informed healthcare decisions about pregnancy. According to the Society for Maternal-Fetal Medicine (SMFM), individuals with borderline intellectual functioning typically maintain the ability to:

• Understand basic information about pregnancy and childbirth
• Communicate their choices
• Appreciate their situation and its consequences
• Reason about treatment options 1

Ethical Framework for Decision-Making

The SMFM emphasizes several key ethical principles that apply to this case:

• Respect for autonomy: Pregnant individuals with intellectual disabilities should have their autonomy respected to make decisions that align with their core values after appropriate counseling 1
• Third-party preferences: The mother's preference for abortion should not override the patient's autonomy when the patient has demonstrated capacity 1
• Justice: Equitable care must be provided to all pregnant individuals without discrimination based on intellectual disability 1

Why Option A (Refusing to Perform the Abortion) Is Correct

• The patient has clearly expressed her desire to continue the pregnancy
• With an IQ of 80, she likely has sufficient capacity to make this reproductive decision
• Performing an abortion against her wishes would violate her autonomy and bodily integrity
• The SMFM guidelines specifically state that "the patient's expressed wishes to continue the pregnancy must be respected as long as they have decision-making capacity" 1

Why Other Options Are Inappropriate

• Option B (Perform the abortion): Incorrectly assumes the patient is not competent based solely on her IQ, which is discriminatory and violates ethical principles 1
• Option C (Call child protective services): Premature and inappropriate at this stage as pregnancy itself is not a reason to involve CPS
• Option D (Obtain a court order): "Seeking a court order to override the patient's wishes would be inappropriate when the patient has demonstrated capacity to make their own reproductive decisions" 1

Supporting the Patient's Decision

While respecting the patient's autonomy, healthcare providers should:

1. Provide appropriate counseling about pregnancy, childbirth, and parenting
2. Assess what formal and informal supports might be needed during pregnancy and after birth 2
3. Consider involving specialized support services like doulas who have experience working with intellectually disabled parents 3
4. Develop a comprehensive care plan that addresses any specific health risks associated with her intellectual disability 4

Potential Pitfalls to Avoid

• Assuming incapacity: Don't assume incapacity based solely on an intellectual disability diagnosis or IQ score
• Allowing family coercion: Be vigilant about potential reproductive coercion from family members
• Neglecting support needs: While respecting autonomy, ensure appropriate resources are available to support the patient throughout pregnancy and beyond 1

The American Society of Human Genetics affirms that pregnant women have the right to make their own reproductive choices 5, and this right extends to women with intellectual disabilities who demonstrate decision-making capacity.