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The Saikewicz Decision: A Medical Viewpoint

Published online by Cambridge University Press:  29 April 2021

Arnold S. Relman*
Affiliation:
The New England Journal of Medicine; Harvard Medical School

Abstract

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.

Type
Article
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 1978

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References

1 Superintendent of Belchertown State School v. Saikewicz, 1977 Mass. Adv. Sh. 2461, 370 N.E.2d 417 (1977).

2 In re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976).

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12 Supra note 10.

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