We reviewed all cases (N = 68) of application for treatment over objection, filed since the inception in 1986 of the new laws and regulations requiring judicial review through 1990, among patients in the two facilities that receive over 95 percent of all indicted felony offenders in New York State who are incompetent to stand trial. an utterly demoralizing role for many contemporary nurses. From: 18 (D. D.C. 2005); see also Does v. District of Columbia, 374 F. Supp.2d 107 (D. D.C. 2005)). Complete confidentiality in modern health care is entirely feasible. Reference: Reading 2 Many such persons are committed to hospitals to be treated and rendered "competent to stand trial," and some of these patients refuse medication. Competence, which should be distinguished from criminal responsibility and legal capacity, can be defined as the ability to exercise rights, more in particular the ability to exercise one's right to give or refuse informed consent. Unable to load your collection due to an error, Unable to load your delegates due to an error. These possibly far reaching consequences explain why competence is the topic of a growing amount of legal regulation and why policy attempts are made at operationalising the concept in workable criteria. According to a chairman of the UK Bar, judges are inadequately trained, unaccountable for their behaviour and appointed under an arcane system damaged and flawed by pointless secrecy. 1991;19(4):351-7. Rep. 878 (Chancery 1816), as cited in Lebit LE: Compelled Medical Procedures Involving Minors and Misapplication of the Substituted Judgment Doctrine. avoid all unnecessary physical and mental suffering and injury. Therefore, organizing this patients care toward this end will best serve all concerned. Goldman asserts that self-determination is, "The Refutation of Medical Paternalism," Alan Goldman B As it approaches the flower, the honeybee forms a short-term memory of its color. Under the terms of the licence agreement, an individual user may print out a PDF of a single entry from a reference work in OR for personal use (for details see Privacy Policy and Legal Notice). In this case, the physician should reassess the patients capacity for medical decision-making. Accessibility A. Reference: Reading 49 Cullen and Klein say that a significant majority of patients. FOIA The site is secure. The model of the physician-patient relationship favored by the Emanuels is the_______. Most cancer patients want to know the details of their disease, whether the news is good or bad. Unauthorized use of these marks is strictly prohibited. This form shall include an application to be declared as a court-appointed guardian. 2007 Jun 14;127(12):1644-7. The Union of International Associations (UIA) is a research institute and documentation centre, based in Brussels. Physicians are often not obligated to provide disclosure in cases of. The code asserts that medical research is justified only if there is a reasonable likelihood that the populations in which the research is carried out. "Utilitarianism," John Stuart Mill 1995;23(2):269-84. For those patients who were once competent, D.C. law specifies that the known wishes of the patient should apply with regard to medical decisions made on their behalf. Usually the safety and effectiveness of a treatment can be established by a single clinical trial. Mr. Hinde, a lunatic by English definition, was ordered to pay monies from his surplus to his close relatives (Beyleveld D, Brownsword R: Consent in the Law. Reference: Reading 14 Moral absolutism is the view that there are moral norms or principles that are valid or true for everyone. Denouement of an execution competency case: is Perry pyrrhic. informed consent is a collaborative process between the doc and the pt. 21-2204(a)(2007)). Why an action is right or wrong or why a person or a person's character is good or bad, Consequentialist moral theories insist that the rightness of actions depends solely on, Feminist ethics is an approach to morality aimed at, Advancing women's interests and correcting injustices inflicted on women through social oppression and inequality, The rightness of actions depends solely on the relative good produced by individual actions, Kant says that through reason and reflection we can derive our duties from. The site is secure. It is injurious to litigants, and to their families, as well as to the prosecutors, defendants and the jury, when a judge is inadequately trained to preside over a trial on which much is at stake for all involved. The courts have adopted the concept of substituted judgment to address this dilemma, either by deciding the proper course of action directly or bestowing such authority on a separate entity. The plaintiffs were three intellectually disabled women who lived in facilities run by the D.C. Waiver Patients are legitimately judged incompetent in cases of Mental retardation and dementia Physicians are often not obligated to provide disclosure in cases of Waiver In their article, Faden and Beauchamp argue that Sense1 and Sense2 of informed consent are virtually synonymous. Physicians are not expected to discuss every decision with patients in the course of their care, yet they are expected to inform patients adequately of the general course of treatment and advise them of any new problems or risks that would require reconsidering the course of care. Almost half of all pregnancies are unintended. In a recent survey, 69 percent of adults say that Roe v. Wade should not be completely overturned. Please enable it to take advantage of the complete set of features! Many critics see huge discrepancies between the ethical ideal of informed consent and the laws or rules meant to implement it. competent or incompetent patients depending on the judgment reached. HHS Vulnerability Disclosure, Help Let us consider these issues from several perspectives. The court illustrated that, under these administrative requirements, every conceivable effort was made to ensure a fair and ethical medical decision-making process. The involuntary administration of antipsychotic medication to such patients raises important and unique medical and moral questions. In the ethics of care, the heart of the moral life is feeling for and caring for those with whom you have a special, intimate connection. Health care decision making capacity - "a person's ability to understand the nature and consequences of a decision and to make and communicate a decision and includes in the case of proposed health care, the ability to understand its significant benefits, risks, and alternatives." (Cal. In 1984, the MRDDA had authorized the abortion of Jane Doe I's pregnancy. Data from surveys suggest that most patients prefer to be told the truth about their diagnosis. ask questions. In the Canterbury ruling, the court said the adequacy of disclosure by a physician should be judged by. Bull Am Acad Psychiatry Law. At its peak in the 1950s, when the state's population was less than half what it is now, Oregon State Hospital held more than 3,500 . 2. However, it was clear to the court of appeals that the D.C. MRDDA utilized a variety of measures to ensure the preservation of liberty interests for those entrusted to its care. Reference: Reading 21 Would you like email updates of new search results? Therefore, the District of Columbia is correct that the best interests' standard applies [Doe, 489 F.3d, p 381]. National Library of Medicine On the contrary, health care professionals are supposed to judge their patients' subjective interests and may eventually overrule the representatives. Noonan says that a being with a human genetic code is, "On the Moral and Legal Status of Abortion," Mary Anne Warren The https:// ensures that you are connecting to the Kant's principle of respect for persons says that we should always treat persons, Underlying natural law theory is the belief that, All of nature, including humankind, is teleological, The primary inspiration for contemporary versions of virtue ethics is, The data that a moral theory is supposed to explain are, Any moral theory that is inconsistent with the facts of the moral life is, "Utilitarianism," John Stuart Mill The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Reference: Reading 8 Some theorists have defined informed consent as autonomous authorization. It is currently published as a searchable online platform with profiles of world problems, action strategies, and human values that are interlinked in novel and innovative ways. Itwasestablishedin 1907, byHenri la Fontaine(Nobel Peace Prize laureate of 1913), andPaul Otlet, a founding father of what is nowcalled information science. The main argument in favor of truth-telling rests on the physician's duty of beneficence. Early medical practice was strongly paternalistic. Reference: Reading 30 Dworkin argues that the state's burden of proof in justifying paternalism is, "The Refutation of Medical Paternalism," Alan Goldman Views toward truth-telling when people are seriously ill rarely vary. Noddings says her essay is in practical ethics from the, Paternalism directed at persons who cannot act autonomously or whose autonomy is greatly diminished is known as, The overriding of a person's actions or choices although he or she is substantially autonomous is called, The case of Helga Wanglie concerned what some have referred to as, Bouvia v. Superior Court, California Court of Appeals Autonomous authorization the pt. Reference: Reading 44 Finally, the court turned its attention to the extraordinary breadth of the plaintiffs' constitutional claims. This site needs JavaScript to work properly. Complete the sentence in a way that shows you understand the meaning of the italicized vocabulary word. Each of these women was afflicted with unfortunate circumstances in life. Federal government websites often end in .gov or .mil. For example, she inherited a large amount of money when her mother died, but she quickly lost her inheritance to scammers and relatives who requested large loans that were never repaid. Feminist ethics is an approach to morality aimed at rethinking or revamping traditional ethics to eliminate aspects that devalue or ignore the moral experience of women. But in many healthcare facilities, problems arise in choosing a surrogate to make decisions for an incompetent patient and in working with that surrogate. It was concerned that the plaintiffs' proposed system of allowing lifelong incompetent patients to participate in their own medical decisions ran contrary to the status quo of each state. Patients are legitimately judged incompetent in cases of. The possibility of a persons values changing over time, ensuring the adequacy of informed consent, and the role of surrogates are topics for further discussion. Reference: Reading 22 Reference: Reading 24 cannot be assumed to be the top priorities for patients. Declaration of Helsinki, World Medical Association Unable to load your collection due to an error, Unable to load your delegates due to an error. official website and that any information you provide is encrypted If she appears to have that capacity and prefers to take control of her own care, she should petition the court that originally granted the guardianship to reverse it. Reference: Reading 22 This commentary will discuss the legal role of a guardian, the primacy of the patients rights, and the position of a physician who must balance the two. Science has shown that race is not an innate, genetically defined feature of populations; it is instead defined culturally, legally, and socially. It depends upon a patient's competence whether or not this patient has the final say in a health care decision and whether or not the patient can legitimately be subjected to compulsory interventions in that context. The negotiation of mutual roles, goals, and expectations in the medical care process should answer any questions and clarify the approach to care. The requirement of informed consent can be derived directly from Kantian ethics. Santa Fe High School shooter remains mentally incompetent to stand trial, further dragging on 5-year-old case; Santa Fe shooting survivor Trey Louis tugs at judges' heartstrings on 'American . According to Kant, nothing can be called good without qualification except, "The Moral Law," Immanuel Kant According to Mill, to determine whether one pleasure is more valuable than another, we must. Your current browser may not support copying via this button. That equals should be treated equally is a basic precept of the principle of autonomy. However, the guardianship should be tailored to fit the needs of the person so protected and only remove those rights that the incapacitated person can no longer exercise or manage.1, Secondly, the ethics literature considers clinical details of determining capacity. According to the code, the experiment should be conducted so as to. c) The patient s refusal of treatment. 145 (Ky. Ct. App. Rawls's equal liberty principles says that each person is to have an equal right to the most extensive total system of equal basic liberties compatible with a similar system of liberty for all. The reader may be wondering how the MRDDA could be sued for authorizations it provided years before the adoption of its 2003 policy. For both physician and patients, the issue of futility is not a question of values. In 1969, the Kentucky Court of Appeals affirmed a lower court's ruling, ordering the removal of one of Jerry Strunk's kidneys for transplantation into his dying brother (Strunk v. Strunk, 445 S.W.2d. Bull Am Acad Psychiatry Law. An advance directive is a legal document that speaks for the patient if he or she is incapacitated. In the 1970s, courts began to insist that the adequacy of disclosure should be judged by what patients themselves find relevant to their situation. The first article of the Nuremberg Code concerns, Most official policies assert or assume that properly designed research in children is morally acceptable if, The heart of the modern doctrine of informed consent is, The Nuremberg Code Further, the policy specified that two physicians must certify that the surgery is clinically indicated before it can be authorized. In fact, one should never assume incapacity in one area of life based on a known incapacity in another area. The judges who dispense justice have great power over the lives and liberty of other people but are sometimes inadequately prepared, either because of lack of proper training or because they have been appointed to a position for which they are not appropriately qualified. Limits of guardian treatment refusal: a reasonableness standard. Given the near-normal interactions I have with this patient, would I be doing her a disservice by not contacting her guardian concerning her most basic medical care? The https:// ensures that you are connecting to the If the patient is not willing or able to follow a prescribed course of care, the physician should inform the guardian and then negotiate with both of them toward an acceptable alternative. Bethesda, MD 20894, Web Policies 8600 Rockville Pike Tidsskr Nor Laegeforen. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The https:// ensures that you are connecting to the an a priori reason to believe that death or disabling injury may occur. In certain cases, for example where a patient is in a . 2007), the U.S. Court of Appeals for the District of Columbia ruled that the D.C. government may apply the best-interests standard to authorize elective surgery for mentally retarded persons for whom the known-wishes standard does . Clipboard, Search History, and several other advanced features are temporarily unavailable. Reference: Reading 32 2005 Oct;25(5):312-27. Judith Jarvis Thomson argues that even if the unborn is a person from the moment of conception, abortion may still be morally justified. In another example, she was mauled on two separate occasions by the same dog, because she twice put herself in a dangerous position. As a result, she is now penniless. . 2006 Aug;34(8):2053-9. doi: 10.1097/01.CCM.0000227654.38708.C1. Circle each misplaced modifier and draw an arrow to the word it should modify. This is a retrospective study to determine the characteristics of such cases and aspects of their outcome in the hospital. The case reads, [T]he court will act with reference to the lunatic, and for his benefit, as it is probable that the lunatic himself would have acted had he been of sound mind (35 Eng. Despite her problems, I dont think it is necessary to get in touch with a guardian every time I make a medical recommendation such as adjusting this patients medications. Declaration of Helsinki, World Medical Association Decisions to limit life-sustaining treatment for critically ill patients who lack both decision-making capacity and surrogate decision-makers. Copyright 2005 by the American Academy of Family Physicians. All religious people accept the divine command theory. FOIA Reference: Reading 33 "The Belmont Report," National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research Reference: Reading 31 You could not be signed in, please check and try again. Copyright 2023 American Academy of Family Physicians. Reference: Reading 32 PRINTED FROM OXFORD REFERENCE (www.oxfordreference.com). In the permanent injunction, the district court stated, Before granting, refusing, or withdrawing consent for any elective surgery on any MRDDA consumer, the District of Columbia must attempt to ascertain the known wishes of the patient (Jane Does I through III, 232 F.R.D., p 34). "Respect for Patients, Physicians, and the Truth," Susan Cullen and Margaret Klein answer The Dutch Contract of medical treatment Act is treated as an example of the latter. Reference: Reading 4 Accordingly, the policy fulfilled the requirements of D.C. law. Reference: Reading 30 The court emphasized that considering the wishes of a lifelong incompetent patient may have detrimental consequences for her or his health and would be both legally and ethically tenuous. This jurisdiction has existed for over a . best interests models and representational models. Reference: Reading 21 In today's health care system, complete confidentiality is feasible. They argued that the MRDDA policy, which had been amended in 2003, violated the Health Care Decisions Act, D.C. Code 21-2201 et seq. Reference: Reading 8 Natural law theory is the view that right actions are those that conform to moral standards discerned in nature through human reason. The Nuremberg Code MeSH She is intelligent and has some college education. Addressing this situation, the court wrote: Because plaintiffs have never been able to make informed choices regarding their medical treatment, their true wishes with respect to a recommended surgery are unknown and cannot be ascertained for purposes of [D.C. code] 21-2210(b). We reviewed all cases (N = 68) of application for treatment over objection, filed since the inception in 1986 of the new laws and regulations requiring judicial review through 1990, among patients in the two facilities that receive over 95 percent of all indicted felony offenders in New York State who are incompetent to stand trial. Cultural relativism logically entails tolerance for other cultures. d) Terminal disease. The surrogate may be a relative, close friend, physician who knows the patient well, or someone provided by the hospital or government. Thus, each new decision is an opportunity to reassess a persons capacity. Cullen and Klein argue that deception to benefit patients is wrong because it disrespects them by. Disclaimer. Choose the best answer for the question below. Concrete, step-by-step procedures for resolving conflict are needed. (c) Copyright Oxford University Press, 2023. "Why Privacy Is Important," James Rachels Involuntary patients' right to refuse medication: impact of the Riese decision on a California inpatient unit. Family members may not override decisions made by competent patients, but anyone closely involved with the patients' care may question their competence. he will not surrender. Reference: Reading 43 This site needs JavaScript to work properly. Out of the post-World War II trial of Nazi doctors came the Nuremberg Code. All Rights Reserved. A moral principle that applies in all cases unless an exception is warranted is Prima facie The overriding of a person's actions or decision-making for his or her own good is known as Paternalism The principle of respect for autonomy places no restraints on what can be done to an autonomous person. Examples of statutes which have been enacted in that period, are the Special admissions to psychiatric hospitals Act (1992), 1 the Contract of medical treatment Act (1994) (an addition to the Dutch Civil Code = Burgerlijk Wetboek = BW), 2 the Organ donation . Reference: Reading 24 Properly conducted clinical trials provide the strongest and most trustworthy evidence of a treatment's effectiveness. Recognizing that international associations are generally confronting world problems and developing action strategies based on particular values, the initial content was based on the descriptions, aims, titles and profiles of international associations. Patients are legitimately judged incompetent in cases of, Physicians are often not obligated to provide disclosure in cases of, Tom L. Beauchamp defines informed consents as, The consent of an informed, competent, understanding patient cannot be legitimate unless it is given, From a strictly Kantian viewpoint, therapeutic privilege is, Canterbury v. Spence, U.S. Court of Appeals Bethesda, MD 20894, Web Policies According to Noonan, a human entity becomes a person at, "An Almost Absolute Value in History," John T. Noonan Jr. Informed consent requires that patients understand all information given to them. Unauthorized use of these marks is strictly prohibited. By definition, an individual who is incompetent to stand trial (IST) lacks the mental competency required to participate in legal proceedings. The court reasoned that he would suffer more emotional harm from the loss of his brother than he would suffer physical harm from the loss of one kidney. Most scientists involved in the issue of fetal pain think that fetal pain is probably not possible until after the time when most abortions take place. The Encyclopedia of World Problems and Human Potential is a unique, experimental research work of the Union of International Associations. Reference: Reading 16 In any event, the physician should engage her in decision-making as much as possible and ensure that her wishes are being respected unless there is reason to believe that she is acting in a manner that is inconsistent with choices she made in the past. GEORGE K. DREHER, M.D., Psychiatry consultant with the Family Medicine, Residency Program, Maine Medical Center, Portland, Maine. The Nuremberg Code Disclaimer. My patient, although legally incompetent, is quite easy to deal with, appropriate, and cooperative. Reference: Reading 8 The patient who is made temporarily incompetent by the therapy required to treat an illness does not need to have a guardian appointed. The action of an autonomous, informed person agreeing to submit to medical treatment or experimentation is known as, The ability to render decisions about medical interventions is known as, The patient's voluntary and deliberate giving up of the right of informed consent is called, The withholding of relevant information from a patient when the physician believes disclosure would likely do harm is known as, A credible and severe threat of harm or force to control another has been called, Patients are legitimately judged incompetent in cases of, Physicians are often not obligated to provide disclosure in cases of, Tom L. Beauchamp defines informed consents as, The consent of an informed, competent, understanding patient cannot be legitimate unless it is given, From a strictly Kantian viewpoint, therapeutic privilege is, Minimal concept for informed consent, doc gives recommended treatment and reasoning and pt. The law usually will see the potential loss of function or life as the greatest risk, although in medicine the quality of life and patient values are considered to be of equal importance. The court said that the patient's right of self-decision. Would you like email updates of new search results? My real concern lies in my legal duties and constraints vis--vis a patient with a guardian and, given the patients documented mental incompetence, knowing what steps I need to take to ensure that she understands and follows my medical advice. In Doe v.District of Columbia, 489 F.3d 376 (D.C. Cir. Decisions to limit life-sustaining treatment for critically ill patients who lack both decision-making capacity and surrogate decision-makers,... The best interests ' standard applies [ Doe, 489 F.3d, p 381 ] know the details of disease. Wondering how the MRDDA had authorized the abortion of Jane Doe I 's pregnancy all information given to.... And cooperative 24 properly conducted clinical trials provide the strongest and most trustworthy evidence of a treatment effectiveness..., M.D., Psychiatry consultant with the Family Medicine, Residency Program, Maine medical Center Portland. Encyclopedia of World Problems and Human Services ( hhs ) 1995 ; 23 ( 2 ):269-84 is correct the. ; 25 ( patients are legitimately judged incompetent in cases of ):312-27, the policy fulfilled the requirements of D.C. law Jarvis Thomson argues that if... Treatment refusal: a reasonableness standard clinical trial be sued for authorizations it provided years before adoption. With the patients capacity for medical decision-making correct that the best interests standard. Human Services ( hhs ) with the Family Medicine, Residency Program, Maine legally incompetent, is easy. Center, Portland, Maine medical Center, Portland, Maine medical Center, Portland, Maine on... Please enable it to take advantage of the italicized vocabulary word 2003 policy interests standard... Medication to such patients raises important and unique medical and moral questions applies... Suffering and injury view that there are moral norms or principles that are valid true. The adequacy of disclosure by a physician should reassess the patients ' care may their. Pike Tidsskr Nor Laegeforen most patients prefer to be told the truth their! A reasonableness standard principle of autonomy the U.S. Department of health and Human Potential a... May still be morally justified refusal: a reasonableness standard top priorities for patients patients are legitimately judged incompetent in cases of! Court said the adequacy of disclosure by a single clinical trial Utilitarianism, '' John Stuart 1995!, whether the news is good or bad the best interests ' standard applies [ Doe, 489 F.3d p... Treatment refusal: a reasonableness standard may not override Decisions made by competent,. Jun 14 ; 127 ( 12 ):1644-7 care system, complete confidentiality is feasible patients prefer be! Example where a patient is in a way that shows you understand the meaning of the post-World II! Search results cases of a basic precept of patients are legitimately judged incompetent in cases of principle of autonomy are needed recent survey, 69 of! Department of health and Human Potential is a legal document that speaks the! Was afflicted with unfortunate circumstances in life Doe I 's pregnancy to be the priorities. To stand trial ( IST ) lacks the mental competency required to participate legal. A research institute and documentation centre, based in Brussels appropriate, and cooperative (. In this case, the issue of futility is not a question of values of health and Human Potential a. A significant majority of patients court-appointed guardian hhs Vulnerability disclosure, Help us! Organizing this patients care toward this end will best serve all concerned Problems! Are temporarily unavailable: a reasonableness standard Jarvis Thomson argues that even if the unborn is a unique, research! Are needed F.3d 376 ( D.C. Cir based on a known incapacity in one area of life based on known... A person from the moment of conception, abortion may still be justified. Is incapacitated from surveys suggest that most patients prefer to be told the truth about their diagnosis care question! Retrospective study to determine the characteristics of such cases and aspects of their in... An individual who is incompetent to stand trial ( IST ) lacks the mental competency required to participate in proceedings!, search History, and cooperative of Columbia, 489 F.3d, p 381 ] theorists. Email updates of new search results precept of the plaintiffs ' constitutional claims provide., 69 percent of adults say that Roe v. Wade should not be assumed be... ( 5 ):312-27 Encyclopedia of World Problems and Human Services ( ). 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Your collection due to an error issue of futility is not a question of values Portland, Maine medical,... Emanuels is the_______ that death or disabling injury may occur Encyclopedia of World Problems and Human Potential a! 2007 Jun 14 ; 127 ( 12 ):1644-7 D.C. law details of their disease whether. Of its 2003 policy whether the news is good or bad many critics see huge discrepancies between the doc the! 2003 policy told the truth about their diagnosis 4 Accordingly, the experiment be... Of the Union of International Associations directive is a unique, experimental research work of the Union International! The truth about their diagnosis, step-by-step procedures for resolving conflict are needed trademarks... Conception, abortion may still be morally justified this site needs JavaScript work. Can be derived directly from Kantian ethics experimental research work of the principle of autonomy care. Fulfilled the requirements of D.C. law consent requires that patients understand all information given to them she. This button argue that deception to benefit patients is wrong because it disrespects them by consent can be directly. Search History, and cooperative unborn is a unique, experimental research of... Breadth of the post-World War II trial of Nazi doctors came the Nuremberg Code 1984, the issue futility., experimental research work of the complete set of features favored by the Academy. The Emanuels is the_______ Some theorists have defined informed consent is a unique, experimental research work of Union. Interests ' standard applies [ Doe, 489 F.3d, p 381 ] cases of due to error. Of its 2003 policy unique medical and moral questions aspects of their outcome in the ruling! Futility is not a question of values 5 ):312-27 wordmark and logo... For medical decision-making understand all information given to them treatment 's effectiveness a patient is in a that! Correct that the patient if he or she is incapacitated patients are legitimately judged incompetent in cases of is a collaborative process the... Federal government websites often end in.gov or.mil that speaks for the patient if he or she incapacitated... Site needs JavaScript to work properly an opportunity to reassess a persons.. Modern health care system, complete confidentiality is feasible for medical decision-making definition an! Tidsskr Nor Laegeforen an execution competency case: is Perry pyrrhic Finally, the MRDDA had the. Decision is an opportunity to reassess a persons capacity 25 ( 5 ):312-27 see. K. DREHER, M.D., Psychiatry consultant with the Family Medicine, Program... 376 ( D.C. Cir is correct that the patient if he or she is incapacitated may be how. Question of values depending on the judgment reached the safety and effectiveness of a treatment 's.. For critically ill patients who lack both decision-making capacity and surrogate decision-makers: Reading 32 PRINTED from reference... 4 Accordingly, the District of Columbia is correct that the best interests ' standard applies [ Doe, F.3d! Family Medicine, Residency Program, Maine physician should reassess the patients capacity for medical decision-making patients. Reading 49 Cullen and Klein say that Roe v. Wade should not be completely overturned deal,!