Justice Liacos's comments on the Saikewicz decision should end much of the debate that has swirled around the scope of this landmark case, and I commend MEDICOLEGAL NEWS or publishing his remarks. However, two aspects of the article deserve further comment.

First, it seems unfair to criticize lawyers for not immediately reading the case the way Justice Liacos now says it should have been read. While the opinion in Saikewicz is reasonably clear about the substantive rights of incompetent patients, it is imprecise about the procedures to be followed in implementing those rights. For example, in discussing the role of the probate court in such cases, the broad language used in the decision could be read as requiring a judge to review all treatment decisions involving incompetent patients.

At one point in Edgar Allan Poe's Narrative of Arthur Gordon Pym of Nantucket, Pym, who has stowed away in the hold of a whaling vessel, believes he has been abandoned and that the hold will be his tomb. He expresses sensations of “extreme horror and dismay,” and “the most gloomy imaginings, in which the dreadful deaths of thirst, famine, suffocation, and premature interment, crowded in as the prominent disasters to be encountered.”

It is probably uncommon for hospitalized patients to feel as gloomy as Pym. Nevertheless, installed in a strange institution, separated from friends and family, forced to wear a degrading costume, confined to bed, and attended to by a variety of strangers who may or may not keep the patient informed of what they are doing, the average patient is intimidated and disoriented. Such an atmosphere encourages dependence and discourages the assertion of individual rights.

After eight years of review, analysis, several rejections, at least one near passage, and little or no floor debate in 1979, the Massachusetts Legislature enacted a patients' rights statute. Its passage was generally greeted with rising apathy except for one section which requires physicians treating female patients to make available “in the case of a patient suffering from any form of breast cancer, complete information on all alternative treatments which are medically viable.” The enactment of the patients' rights statute has imposed no major burdens on hospitals since the majority of the provisions of the act were already general practice among most institutions.

The Davis decision, which allowed a federally-assisted college to exclude a severely hearing impaired woman from its registered nurse training program, provoked great concern among handicapped people and their advocates. Institutions of higher education also have reason for dissatisfaction with the decision since it fails to provide sufficient guidance for those federal recipients to measure their compliance with section 504. In a letter to college presidents dated October 5, 1979, Secretary of Health, Education and Welfare Patricia Roberts Harris sent forth the department's official statement concerning the decision.

The letter indicates a middle-of-the-road approach to Davis and HEW's future enforcement of section 504: it views the Supreme Court's decision as consistent with regulations adopted by the Department to implement section 504. While recognizing that colleges can establish legitimate academic requirements, it states that they must demonstrate the necessity and legitimacy of policies which result in the exclusion of handicapped people.