Mentally Impaired Patient Case Study

1. Summary of the Problem: Should a mentally impaired patient’s autonomy be given to the court or the family/guardians of the patient?
2. The Facts:
a. Clinical: A 67-year-old white male was reported to have an IQ of 10 and the mental age of approximately 2 years and 8 months, but was otherwise in good health, strong, and well built. He does not communicate verbally, but instead he uses grunts and gestures. The patient was diagnosed with acute myeloblastic monocytic leukemia, and his physician proposed chemotherapy. With chemotherapy, the patient had a remission chance of 30-50 percent. During chemotherapy, medical personnel envisioned that they would have to use orderlies to hold him down on his bed while the chemotherapy was administered.
Situational: Joseph Saikewicz, a 67-year-old white male, was reported to have an IQ of 10 and the mental age of approximately 2 years and 8 months, but was otherwise in good health, strong, and well built. He does not communicate verbally, but instead he uses grunts and gestures. He has been institutionalized in a state school since 1923 and at the Belchertown State School in Massachusetts since 1928. His only known family was two sisters who lived in California. On April 19, 1976, Mr. Joseph Saikewicz was diagnosed and suffering from myeloblastic monocytic leukemia. With chemotherapy, he had a chance of remission; with remission the side effects include nausea, bladder irritation, numbness and tingling of the extremities, loss of hair, and bone marrow depression. He would die in a matter of weeks or even months without the chemotherapy. The school administrator of the school he was attending was not certain whether the option of omitting chemotherapy was fair; they asked for a judicial opinion on what to do. The Massachusetts Supreme Judicial Court rendered an opinion that called into the question the role of doctors, family, and hospital committees in making the
Physicians must have respect for patient autonomy, must be honest with their patients, and empower them to make informed decisions about their treatment. Patients’ decisions about their care must be paramount, as long as those decisions are in keeping with ethical practice and do not lead to demands for inappropriate care. Since Mr. Joseph Saikewicz could not make informed decisions on his own, the physician thought it would be in the patient’s best interest to omit chemotherapy. Joseph Saikewicz would only have a matter of weeks or months if treatment was omitted and the school he was attending was not fair, for he had no right into say if he wanted the treatment or to slowly die from no treatment.
b. Beneficence:
i. Doctors ought to do promote the well-being of their patients, which means in the patients best interest. The physician that saw and omitted chemotherapy to Mr. Joseph Saikewicz thought that omitted chemotherapy would be the best option, but would omitting treatment be the best option for a mentally impaired patient that has a chance of remission?
4. The options for Mr. Joseph Saikewicz