Question

Mr. Sakiewiec is a 32 -year-old man with severe mental retardation who has been institutionalized since childhood. He is noncommunicative and has never been able to verbalize his preferences on any decision. His parents are dead and the institution and a court-appointed guardian manages him. He has developed leukemia that is severe and incurable. Chemotherapy involves significant risk and discomfort and only a small chance of prolonging his survival. What should be done in terms of his medical treatment? a. Proceed with the chemotherapy. b. Confer an "expert panel" to determine therapy. c. Bone marrow transplantation. d. Ask the guardian what is in the best interests of the patient. 

    Mr. Sakiewiec is a 32 -year-old man with severe mental retardation who has been institutionalized since childhood. He is noncommunicative and has never been able to verbalize his preferences on any decision. His parents are dead and the institution and a court-appointed guardian manages him. He has developed leukemia that is severe and incurable. Chemotherapy involves significant risk and discomfort and only a small chance of prolonging his survival.
What should be done in terms of his medical treatment?
a. Proceed with the chemotherapy.
b. Confer an "expert panel" to determine therapy.
c. Bone marrow transplantation.
d. Ask the guardian what is in the best interests of the patient.
Show more…
Medical Ethics for the Boards
Medical Ethics for the Boards
Conrad Fischer 3rd Edition
Chapter 1, Problem 43 ↓

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Sakiewiec's current medical condition, including the severity of his leukemia and the potential benefits and risks associated with chemotherapy.  Show more…

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Mr. Sakiewiec is a 32 -year-old man with severe mental retardation who has been institutionalized since childhood. He is noncommunicative and has never been able to verbalize his preferences on any decision. His parents are dead and the institution and a court-appointed guardian manages him. He has developed leukemia that is severe and incurable. Chemotherapy involves significant risk and discomfort and only a small chance of prolonging his survival. What should be done in terms of his medical treatment? a. Proceed with the chemotherapy. b. Confer an "expert panel" to determine therapy. c. Bone marrow transplantation. d. Ask the guardian what is in the best interests of the patient.
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Key Concepts

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Incapacity
This concept refers to a patient's inability to make informed decisions regarding their own medical care due to mental or physical limitations. In situations like this, where the patient’s decision-making capacity is compromised, it is essential to recognize that the patient cannot provide informed consent and that alternative decision-making processes must be employed.
Substitute Decision Making
Substitute decision making is the process by which a surrogate, such as a legally appointed guardian, makes medical decisions on behalf of a patient who is incapable of expressing their own choices. The surrogate is tasked with considering the patient’s overall values, preferences, and best interests when making healthcare decisions.
Best Interests Standard
The best interests standard is an ethical guideline used in healthcare decision making for patients who cannot decide for themselves. It involves evaluating all available benefits and burdens of the treatment options to choose the action that promotes the patient’s well-being and minimizes harm, ensuring that any decision made reflects the patient’s welfare.
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