Case 4

The case is presented in short segments with questions. Read the case material as it is presented, think through a response to the questions, and link to answers and related resources.

Ms. Grace Tester is a 63 year old woman with Down Syndrome who lives in a large institutional setting in Ohio.  She has an intellectual disability, arthritis, and asthma and wears a hearing aid for a moderate hearing loss. She has developed signs of dementia over the past year. Her only living relative is an 80 year old sister who lives on the east coast and rarely sees her. Ms. Tester turned 18 while living in the institution and her parents never saw the need to pursue guardianship rights, so she does not have a guardian. 

On a routine annual examination, her physician discovers a small lump in Ms. Tester’s left breast.  She has a family history of breast cancer; both her mother and a sister died of the disease.    A mammogram confirms a characteristic mass indicative of cancer.  The physician would like to perform a needle biopsy, followed by surgery and further treatment if cancer is confirmed.  He is not sure how to proceed since Ms. Tester does not have a guardian. 

Before answering the questions that will be posed in this case, it will be helpful to learn more about the lives and health of people with Down Syndrome.

Two books written by people with Down Syndrome provide personal insights:

Question 4.1
How can the physician obtain consent for a biopsy, and, if needed, treatment?

View answer and related resources