title: Approach to caring for developmentally disabled adults in the community: medical, ethical, and legal considerations.
abstract: OBJECTIVE
  To review the medical, ethical, and legal obligations in caring for adults with developmental disabilities (DDs) living in the community.
  
  
  METHODS
  Google and MEDLINE searches were conducted using the terms disabled, disability, vulnerable, and community. The pertinent legislation was reviewed.
  
  
  RESULTS
  The treatment of a patient with DDs varies with factors such as the pathogenesis of the patient's current problem, comorbid conditions, the severity of his or her disabilities, and his or her current social supports. While the shift from institutional to community care for patients with DDs is widely accepted as being beneficial, providing high-quality community care has proven to be challenging. However, there is little research on how to effectively provide community support to adults with DDs. As primary care providers, family physicians are often the first point of contact for patients, and are responsible for both the coordination and the continuity of care. With the movement toward preventive care and early disease detection, the patient's active participation is also vital. The patient's values and goals are an essential consideration, even when they are contrary to the patient's good health or the clinician's own values. The legislation for vulnerable persons varies among the provinces. Thus, the obligation to report suspected abuse might depend on whether the vulnerable person is living in a care facility or the community; whether the person with the suspicion is a service provider or health care professional; and whether the specific circumstances fall within the legislative definition of abuse or neglect.
  
  
  CONCLUSIONS
  Primary care providers must give adults with DDs compassionate care that respects the patients' wishes.
authors.affiliation: Associate Professor at the University of Western Ontario and a family physician practising in Mount Brydges, Ont, and Strathroy, Ont. wosmun@uwo.ca.
authors.forename: W E
authors.initials: WE
authors.lastname: Osmun
authors.affiliation: Assistant Professor at the University of Western Ontario and a family physician practising in London, Ont, and Exeter, Ont.
authors.forename: Nelson
authors.initials: N
authors.lastname: Chan
authors.affiliation: Distinguished Professor in the Faculty of Law at the University of Western Ontario in London.
authors.forename: Robert
authors.initials: R
authors.lastname: Solomon
mesh_terms: D000328:Adult; D002170:Canada; D003153:Community Health Services / Q000941:ethics* / Q000331:legislation & jurisprudence*; D002658:Developmental Disabilities; D006233:Persons with Disabilities / Q000331:legislation & jurisprudence*; D066086:Health Services for Persons with Disabilities / Q000941:ethics* / Q000331:legislation & jurisprudence*; D006801:Humans; D012944:Social Support