The autonomy of adult women should be paramount, not the exam

The respect shown by clinic personnel for the adult status of their patients, and the right of people with mental retardation to good routine gynecologic care are not at issue. What is at issue is the right of a mentally retarded woman to refuse the intrusion of a pelvic examination. To accept an accommodated decisional capacity to say yes or indicate assent but to deny the reverse might be in the patients' medical best interest, but it is neither consistent nor respectful of their autonomy.