A patient with Down syndrome is pregnant and does not want an abortion. Her mother and her husband want her to have one. What should a physician do in this situation?

Where answers to this question lose points

Our scorer marks every answer on three parts. For each of the 216 applicants who finished this question on Confetto, we took their first scored answer and counted the part that scored lowest.

• Structure: a clear order and a clear point77 of 216
• Content: covering what the question needs68 of 216
• Communication: tone, clarity and professionalism21 of 216

Confetto data as of November 8, 2026. A part is shown only when 20 or more applicants share it. Answers where two parts tied are not counted toward either. We never show anyone's answers or details.

What this question tests

• Ethics
• Patient care

How to structure your answer

1. What it's about (15 seconds). The question asks how a physician should protect a pregnant patient's reproductive autonomy while assessing her decision-making capacity when her mother and husband oppose her choice. The answer centers the woman with Down syndrome as the patient to whom the physician owes primary responsibility.
2. Both sides (40 seconds). The answer emphasizes the patient's right to continue her pregnancy and rejects assuming incapacity because she has Down syndrome. It also acknowledges family concerns about medical risks and parenting responsibilities, treating these as reasons for discussion and support rather than authority to override her.
3. Your position (20 seconds). The answer supports continuing the pregnancy if the patient has decision-making capacity, because the physician's primary obligation is to respect her informed choice. It proposes a private, pregnancy-specific capacity assessment and advocacy with her family rather than allowing relatives to dictate treatment.
4. Its downside (15 seconds). Respecting her choice may leave family concerns unresolved and require substantial support during pregnancy and parenthood. The answer would soften these difficulties through a family meeting, prenatal specialists, genetic counseling, social work, and screening for coercion or abuse.
5. What would change it (10 seconds). The answer makes its position conditional on the patient's capacity to make this particular decision, rather than on her diagnosis. Evidence that she cannot understand the relevant implications would require reconsidering the decision-making process, although the answer does not specify that next step.
6. Common pitfalls. A flat yes or no about abortion before considering capacity would weaken the answer, especially if it assumes Down syndrome means incapacity. Other mistakes include treating family preferences as decisive or discussing autonomy without explaining the practical support and protection from coercion the patient needs.

Example answer from Confetto

Example answer from Confetto. Not a real applicant's answer.

I believe this situation requires careful consideration of patient autonomy while ensuring the patient has the capacity to make an informed decision about her pregnancy. As a physician, my primary responsibility would be to my patient, the woman with Down Syndrome, not to her mother or husband.

My first step would be to assess my patient's decision-making capacity specifically regarding this pregnancy. I would have a private conversation with her to understand her comprehension of pregnancy, childbirth, and parenthood. Many individuals with Down Syndrome can make informed decisions about their healthcare, and it would be discriminatory to assume otherwise without proper assessment. I would ensure she understands the medical implications, potential risks, and responsibilities involved.

If I determine she has decision-making capacity, I would respect and support her choice to continue the pregnancy. I would advocate for her autonomy and help explain her rights to her family members. While I understand their concerns, they cannot legally force her to have an abortion against her will. I would offer to facilitate a family meeting to discuss their concerns and help them understand my ethical and legal obligations to respect my patient's choice.

However, I would also ensure comprehensive support systems are in place. This would include connecting her with genetic counseling, prenatal care specialists, and social workers who can help prepare her and her family for the challenges ahead. I would also want to screen for any coercion or abuse, as individuals with intellectual disabilities can be vulnerable to exploitation.

Ultimately, if my patient has decision-making capacity and wants to continue her pregnancy, my role would be to provide the best possible medical care while protecting her right to make this deeply personal choice. The key is to balance respect for her reproductive autonomy with ensuring she has the support and resources needed for a healthy pregnancy and beyond.

Use it for its structure. Interviewers can tell a memorized script, so tell your own story.

Keep going

• A patient refuses a life-saving vaccination for their child based on personal beliefs. How do you balance the parents' autonomy with the child's well-being and public health concerns?
• You are the physician caring for Mrs. Miller, who has been declared brain dead and would be an excellent organ donor. When you ask her husband and son for consent, they strongly object. What would you do?
• A 14 year old patient requests birth control pills from you and asks that you not tell her parents. What would you do?
• Medical school interview questions by type
• The full interview question bank