Joseph Saikewicz was a 67 year-old profoundly retarded man (IQ of 10) who had been institutionalized for 53 years. In 1976, he was diagnosed as having leukemia. Chemotherapy had a 30-50% probability of producing remission of 2-13 months. A guardian was appointed by the court to determine whether Saikewicz should receive the treatment. He recommended against the therapy because treatment is less successful in older patients, would be painful and debilitating, and Saikewicz could not understand or cooperate with treatment. A probate judge agreed. An appellate court reviewed the lower court’s decision and concluded it was correct. The court pointed out that incompetent patients should not be denied a right to refuse treatment. The court clarified the standard of substituted judgment--that is, that which the incompetent patient would have decided for himself or herself "taking into account the present and future incompetence of the individual." If, as in this case, nothing is known about what the patient would have wanted, then the proxy or patient advocate is to cast himself imaginatively into the patient’s perspective, trying to imagine what he or she would have wanted--following the best interests standard. [Source: Superintendent of Belcherton State School v. Saikewicz, 370 N.E. 2d. 417 (1977).]
Principles & Concepts: informed consent, proportionate/ disproportionate means, beneficence, surrogate decision-making.
