EthicsAdvancedMMI station
A patient with Down syndrome is pregnant and wants to keep the baby. Her mother and husband want her to have an abortion. What do you do?
Ethical dilemma: Competing duties with no perfect answer: consent, confidentiality, fairness.
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Sample answer outline
- Start from a presumption of capacity: Down syndrome alone does not mean she can't make this decision.
- Assess capacity for this specific choice, with supports: plain language, time, visual aids, a trusted advocate.
- Meet with her alone to hear her wishes free of pressure, and screen for coercion.
- Acknowledge the family's worries and bring them into planning support for her, not into overriding her.
- If capacity is truly lacking, follow legal surrogate processes and involve ethics, still centered on her values.
What makes it work
- It avoids the common trap of assuming disability means incapacity.
- It treats the family as partners without handing them the decision.
Avoid
- Siding with the family because they seem more "reasonable".
How to approach ethical dilemma questions
- Clarify the facts and what you would want to know before acting.
- Name who is affected and the principles in tension: autonomy, doing good, avoiding harm, fairness, confidentiality.
- Walk through realistic options, starting with the least drastic.
- Choose a course of action, explain why, and say who you would involve.
What it tests
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