Mental
Health
Painful
Treatment for a Severely Retarded Man
**
Medical decision making in adults who have never had decisional capacity
** State interests in
treatment decision-making
** Treatments with a limited
chance of success: balancing benefits and burdens and establishing goals
of care
Bill is profoundly retarded man who has lived in a state hospital for
many years. He as no contact with family members, and he has become a
ward of the state. At the age of 58, Bill developed acute myelogenous
leukemia (AML). Chemotherapy has been recommended, but its
appropriateness was questioned on the basis that Bill would not
understand the uncomfortable and prolonged treatment of a disease with
such an uncertain prognosis. His physicians wonder if they should forgo
attempts at treatment and instead adopt a palliative care plan.
Who may make
treatment decisions for a patient who never possessed decisional
capacity?
- What interests of the
state might be invoked that could influence or restrict decisions to
withdraw or withhold care?
- What is the
significance of the limited probability of the proposed treatment’s
success?
From: Ahronheim
JC, Moreno JD, Zuckerman C. Ethics in Clinical Practice, 2nd
Edition. Aspen Publication, Maryland, 2000.
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