In this Article, Dr. Arnold S. Relman, the Editor of The New England Journal of Medicine, takes issue with the 1977 Saikewicz decision of the Massachusetts Supreme Judicial Court, which addressed the question of whether chemotherapy should be provided to a severely retarded 67-year-old man who had developed acute leukemia. Dr. Relman interprets Saikewicz as requiring that medical treatment decisions involving the life or death of incompetent patients must receive judicial resolution instead of resolution by the patient's family and physicians. This rule, he asserts, violates medical tradition, and its application will result in serious problems, such as the unnecessary prolongation of the suffering of many seriously ill persons. Dr. Relman proposes, as an alternative to the Saikewicz approach, that in such cases judicial resolution should occur only when there is disagreement, concerning treatment, among next of kin, or between next of kin and attending physicians, or when there is a complaint of injury or of wrongdoing. In all other situations, resolution solely by next of kin and attending physicians should be sufficient. Adequate protection of the interests of the incompetent patient could be achieved by a requirement that the physician in charge document in the medical record that the treatment decision received the concurrence of the family and advance approval of a group of the physician's professional colleagues who have no vested interest in the outcome of the decision.

中文翻译：

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Saikewicz 决定：医学观点

在这篇文章中，Arnold S. Relman 博士，新英格兰医学杂志，对 1977 年提出异议赛克维茨马萨诸塞州最高司法法院的决定，该决定解决了是否应该为一名患有急性白血病的严重智障 67 岁男子提供化疗的问题。雷尔曼博士解释赛克维茨要求涉及失能患者生死的医疗决定必须经过司法决议，而不是由患者家属和医师决议。他断言，这条规则违反了医学传统，它的应用将导致严重的问题，例如不必要地延长许多重病患者的痛苦。Relman 博士建议，作为赛克维茨方法，在这种情况下，只有在近亲之间或近亲与主治医生之间存在分歧时，才应进行司法解决，或者当有伤害或不当行为的投诉时。在所有其他情况下，仅由近亲和主治医师解决就足够了。要求主治医师在病历中记录治疗决定得到家属的同意，并事先获得一组没有既得利益的医师专业同事的同意，从而充分保护无能力患者的利益。对决定结果的兴趣。