Application of Autonomy in Mr. Saikewicz Case

Applicationof Autonomy in Mr. Saikewicz Case

Applicationof Autonomy in Mr. Saikewicz Case

Thecase presented Mr. Saikewicz, a 67 year old man, who resided in oneof the institutions that host developmentally disabled persons inMassachusetts. Saikewicz had severe mental retardation and hismental capacity was equivalent to that of 2 an 8 months old child(Beauchamp &amp Childress, 2001). He also suffered from leukemia.Several questions were raised on whether to administer Mr. Saikewiczshould undergo through chemotherapy in order to prolong his life.According to Beauchamp et al (2001), the Massachusetts court ruledthat a state of institution was less placed and equipped to resolveSaikewicz medical fate as compared to a court of law. The courtfurther argued that substituted judgment would be the best applicabledecision-making standard in this case. The standard involvedinvestigation of what Mr. Saikewicz world have wished to be done werehe in good medical condition. Since both competent and incompetentpersons share the same honor and dignity, the court declared thatboth parties should always be accorded the same panoply of choicesand rights (Beauchamp, 2001). In the end the court came to aconclusion that the patient would incur significant suffering ifexposed to chemotherapy without necessary improving his condition. Asa result, the patient never underwent through a chemotherapy processand eventually he died in the year 1976 with an infectiouscomplication.

Applicationof autonomy

Autonomyhelp individuals be free from being controlled by others as well asfrom personal limitations that prevent them from meaningful choice.Autonomous persons act in an intention manner with understanding andwithout controlling influences. Respect for autonomy is one of theprofessional ethics that nurses and other physicians are required toadhere to. It is the responsibility of medics to create conditionsthat necessary for others to make autonomous choices. This respectfurther includes respect to a patient need to self determination,confidentiality, maintaining privacy, and disclosing informationabout their medical conditions to patients. Therefore, physiciansshould educate their patients in their pursuit to make informed andappropriate choices.

Beauchampet al (2001) argue that it is inaccurate to accord the same rights,which are given to competent persons, of choosing the end-of lifetreatment to mentally disabled ones. This is highly attributed to thefact that self determination is the sole determiner of a personoption or choice to refuse medical treatments (Beauchamp et al.,2001). In any case, autonomous choices are never made by profoundlydisabled person. Again, such surrogate groups have a high likelihoodof acting in the interest of surrounding persons or the societyrather than the disabled individuals. Further, Beauchamp (2001)findings indicate that such groups highly base their substitutedjudgment of stereotypical and prejudice views. Since liberty based onautonomous choice is not the only significant liberty to profoundlydisabled persons, it is inaccurate to imply that such individualshave no liberty-based constitutional rights when it is argued thatthey cannot enjoy the same rights as decisionally-capacitated one.

Therefore,the court made a mistake when it invocated for a substituted judgmentsince the victim had never made a considered judgment. It also made amistake when it accorded the victim the same right as a competentperson in choosing medical treatment this is because the victim wasnot in a postion to exercise self determination. Nevertheless, thecourt was right when it permitted the surrogate to choose whether toinitiate treatment that would sustain the life of the victim. Thisaction was an integral part of according the profoundly disabledvictim self worthy and dignity. The surrogate would play a key rolein helping the victim receive due consideration in his constitutionalinterest in avoidance of suffering and bodily integrity. Anincompetent person readily receives significant constitutionalbenefits that are available to any other persons when surrogatechoices that take care of potentially beneficial medical options arepermitted. Substituted judgment in most cases is transformed into thebest interests approach in an inevitable manner. Substituted judgmentinvolves three scenarios. The first scenario includes a patient whohas not given his or her wishes in regard to his or her life supporthowever, a close friend or relative may testify to his or her behalf.The second scenario involve a patient who when competent may haveindicated the decision he or she would make in case of incompetence.The third scenario involves a decision that is made by a courtappointed guarding or patient’s family if there is no basis ofdetermine the patient wishes and preferences.


Undeniably,in some cases the well being of an individual may be enhanced bybeing allowed to die. For instance, the deny of treatment to anindividual may be considered as the best option if the preferredtreatment only serve to prolong his or her dying process that issolely dominated by extreme deterioration and suffering. If exclusionof surrogate is applied in such a scenario then the wellbeing of thepatient is prejudiced (Beauchamp et al., 2001).


Beauchamp,T.L &amp Childress, J.F. 2001. Principlesof Biomedical Ethics.Oxford: Oxford University Press.