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EDITOR---We have followed the interesting discussion of the case
history of Miss Webb, aged 24 years with Down syndrome, where a
hysterectomy was performed due to menorrhagia, but complicated with
postoperative hypoxia and pericardial effusion due to undiagnosed
hypothyroidism (1,2).
First of all we believe that there is a lot to learn from people with
intellectual disability, both as persons we need to integrate as much as
possible into our societies, but also as part of the training of medical
students about the basics of medicine and human dignity, where the topic
has been invisible.
The American Association on Mental Retardation (AAMR) Policy
Statement on health care (3) has the following considerations about
informed consent for persons with intellectual disability. Informed
consent require that the person or the guardian:
1. have the legal capacity to give content
2. be given enough information to understand the benefits and risks
of the proposed treatment or procedure
3. be offered the opportunity to ask questions and receive answers
understandable to that person
4. not be forced to accept a particular treatment through deceit or
treat
If the person is unable to make his or her own decisions a guardian
must be appointed to and such a surrogate decision-maker must always work
for the best interest of the individual in question (3).
It was therefore very positive to read that all these considerations
also were taken into account in the case of Miss Webb (1). We hope that
such deliberations will be taken into account with all people with
intellectual disability coming in contact with the health care system.
AFFILIATION
Efrat Merrick, is a medical student at the Sackler School of
Medicine, Tel Aviv University and a research assistant at the National
Institute of Child Health and Human Development, Faculty of Health
Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel. E-mail: efratmerrick@gmail.com
Joav Merrick, MD, DMSc is professor of child health and human
development, director of the National Institute of Child Health and Human
Development and the medical director of the Division for Mental
Retardation, Ministry of Social Affairs, Jerusalem, Israel.
E-mail: jmerrick@internet-zahav.net. Website: www.nichd-israel.com
REFERENCES
1. Siotia AK, Chaudhuri A, Muzulu SI, Harling D, Muthusamy R.
Postoperative hypoxia in a women with Down’s syndrome: Case outcome. BMJ
2005;330:1068.
2. Siotia AK, Muthusamy R. Commentary: Easy yet so easily missed. BMJ
2005;330:1070-1.
paediatricians regularly check children with downs syndrome for
hypothyroidism...from general experience hypothyroidism can present with a
funny anaemia and gynae probs...this raises the question as to whether
surgery could have been avoided had the hypothyroidism been
recognised...hence is or should thyroid screening be part of investigation
of menstrual probs, but its not for a paediatrician to advise
gynaecologists...
Ethics and Down syndrome
EDITOR---We have followed the interesting discussion of the case
history of Miss Webb, aged 24 years with Down syndrome, where a
hysterectomy was performed due to menorrhagia, but complicated with
postoperative hypoxia and pericardial effusion due to undiagnosed
hypothyroidism (1,2).
First of all we believe that there is a lot to learn from people with
intellectual disability, both as persons we need to integrate as much as
possible into our societies, but also as part of the training of medical
students about the basics of medicine and human dignity, where the topic
has been invisible.
The American Association on Mental Retardation (AAMR) Policy
Statement on health care (3) has the following considerations about
informed consent for persons with intellectual disability. Informed
consent require that the person or the guardian:
1. have the legal capacity to give content
2. be given enough information to understand the benefits and risks
of the proposed treatment or procedure
3. be offered the opportunity to ask questions and receive answers
understandable to that person
4. not be forced to accept a particular treatment through deceit or
treat
If the person is unable to make his or her own decisions a guardian
must be appointed to and such a surrogate decision-maker must always work
for the best interest of the individual in question (3).
It was therefore very positive to read that all these considerations
also were taken into account in the case of Miss Webb (1). We hope that
such deliberations will be taken into account with all people with
intellectual disability coming in contact with the health care system.
AFFILIATION
Efrat Merrick, is a medical student at the Sackler School of
Medicine, Tel Aviv University and a research assistant at the National
Institute of Child Health and Human Development, Faculty of Health
Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel. E-mail:
efratmerrick@gmail.com
Joav Merrick, MD, DMSc is professor of child health and human
development, director of the National Institute of Child Health and Human
Development and the medical director of the Division for Mental
Retardation, Ministry of Social Affairs, Jerusalem, Israel.
E-mail: jmerrick@internet-zahav.net. Website: www.nichd-israel.com
REFERENCES
1. Siotia AK, Chaudhuri A, Muzulu SI, Harling D, Muthusamy R.
Postoperative hypoxia in a women with Down’s syndrome: Case outcome. BMJ
2005;330:1068.
2. Siotia AK, Muthusamy R. Commentary: Easy yet so easily missed. BMJ
2005;330:1070-1.
3. http://www.aamr.org/Policies/pos_healthcare.shtml
Competing interests:
None declared
Competing interests: No competing interests