The authors discuss haunting aspects resulting from a request for ethics consultation to support surrogate decision-maker authorization of long-acting reversible contraception in an individual with disabilities. The authors highlight the ethical tension between procreative freedom and equitable access to contraception, particularly noting ableism underlying each side of the argument. Bringing in prior case law, the authors favor a least-restrictive approach to contraception to best preserve the individual’s reproductive rights.

The narrative of the chapter explores haunting aspects of a patient’s inability to participate in capacity assessment due to communication challenges and generalized weakness. Through relying on prior wishes and historical context provided by the surrogate decision-maker, the ethical analysis presented by the authors demonstrates expressed concern with the surrogate decision-maker’s request for long-acting reversible contraception. As the consultation progresses to the patient’s assent to an informal arrangement of supported decision-making, each author shares their professional reflections on issues including equity, diversity and inclusion with a keen focus on ableism in the care of individuals with disabilities. While it may be legally permissible as well as ethically supportable to permit for surrogate decision-maker authorization of long-acting reversible contraception through supported decision-making, the authors grapple with whether the decision honored the patient’s values.