Mental retardation and decision making: balancing autonomy and protection

Balancing autonomy with protection in caring for patients with mental retardation remains a formidable task for many clinicians. Though historical debate has resulted in an attitude supporting increased autonomy for all patients generally, and in legislation for enhanced decision making for the developmentally disabled specifically, the operationalization of such attitudes and policies lacks sufficient attention in the literature. The authors discuss three important areas of decision making as these relate to the care of patients with mental retardation: competence, respect, and multiple stakeholders; and, offer recommendations in each area to provide clinicians with some guidance in balancing the goals of autonomy and protection in clinical care when treating people with mental retardation.