Superintendent of Belchertown State School v. Saikewicz

Brief Fact Summary. Saikewicz (Defendant) was incompetent from birth, and the issue arose as to whether he was required to receive lifesaving medical treatment.

Synopsis of Rule of Law. A person who is incompetent from birth is not required to receive lifesaving medical treatment.

Facts. Saikewicz (Defendant) suffered from severe congenital mental retardation and was legally incompetent.  An issue arose as to whether he was required to receive lifesaving medical treatment.  [The casebook opinion did not state the nature of his medical condition, who the actual litigants in the dispute were, or the result in the lower court.]

Issue. Is a person who is incompetent from birth required to receive lifesaving medical treatment?

Held. (Liacos, J.)  No.  A person who is incompetent from birth is not required to receive lifesaving medical treatment.  Principles of equity and respect for all individuals mandate that lifelong incompetent people have the opportunity that other citizens have to refuse medical treatment.  Since an incompetent person cannot choose for himself, the state as parens patriae must try to assess, it its substituted judgment, that which is in the best interests of the incompetent person.  When there is evidence that those interests are not served by providing lifesaving medical care, this care should not be mandated.  This standard should be as subjective as possible, taking into account all relevant factors regarding the incompetent person.  Here, the facts on the record support the proposition that Saikewicz (Defendant), if competent, would have refused treatment.

Discussion. The court states that the decision regarding the incompetent person should be as subjective as possible.  This proposition is a difficult conception, as decisions of this nature are for the most part beyond the comprehension of an incompetent person.  The concept of “substituted judgment” is the best answer the court has to approach this difficult problem.