intellectual disability

• when making health care decisions, determine if patient with intellectual disability has guardianship
• parents are assumed guardianship before 18 years old
• after 18, if parents do not pursue guardianship, then the patient makes own decision
• assess decision making capacity with patient first, if not able to have capacity, pursue guardianship first

Women with intellectual disabilities must freely consent to their own sterilization. In extremely rare circumstances, some states allow sterilization through a court-mediated process, but fear of pregnancy on the part of the caregiver is not an acceptable reason. This patient does not clearly and freely consent to sterilization, and the procedure should not be performed (Choice B).