Free Britney! Capacity, Competence, and Consent for Those with Diminished Decision-Making Abilities

It is commonplace for people with intellectual and developmental disabilities to have a guardian who is legally authorized to make decisions on their behalf. Such guardianships are often comprehensive, providing the guardian with legal authorization to make all decisions on behalf of a person with intellectual and developmental disabilities. This comprehensive legal authority clashes with the understanding of patient autonomy dominant in clinical ethics whereby nearly every patient has the right to make some of their own decisions. Drawing lessons from Britney Spears’s conservatorship as a case study of tension between moral obligations and legal authority, this manuscript explores an identical tension ubiquitous in the lives of those with intellectual and developmental disabilities.