Ethical nursing strategies for ART in intellectual disability: tools and systemic pathways

BackgroundThe use of assisted reproductive technology (ART) in individuals with intellectual disabilities raises significant ethical tensions between reproductive autonomy and the welfare of future offspring. Global guidelines addressing this dilemma remain absent. In China, nurses frequently encounter these dual responsibilities without clear operational frameworks.AimTo explore how nursing interventions can support ethical decision-making and reproductive safety for an intellectually disabled patient undergoing ART.DesignA qualitative, exploratory single-case study.MethodsThe study followed a 27-year-old woman with mild intellectual disability through an in vitro fertilization (IVF) pathway. A nurse-led dual-intervention strategy was implemented: (1) cognitively adaptive decision-making tools (pictogram-based IVF guides, emoji risk charts, visual medication calendars); and (2) government-integrated perinatal care services, including prenatal registration, structured follow-up, and postpartum home visits.Ethical ConsiderationsEthical approval was obtained, and the study adhered to strict ethical standards, including a tailored informed consent process and robust guarantees of confidentiality.FindingsThe intervention ensured informed consent completion, medication adherence without errors, and comprehensive prenatal tracking via the national maternal health system. The patient delivered a healthy infant (Apgar score = 10). These outcomes demonstrate that nurse-designed cognitive adaptations, combined with systemic safeguards, enhance patient autonomy and reproductive safety.ConclusionThis study illustrates an ethical and practical paradigm for reconciling reproductive justice and cognitive equity in ART. Nurse-led innovations, supported by institutional governance, may inform global frameworks for ethically complex fertility care.