Patient’s Medical Indication

Beneficence

According to the principle of beneficence, the guardian ad litem appointed to decide the fate of Joseph Saikewicz should prioritize ‘doing good’ above everything else. The Guardian ad litem is mandated to act ethically to solve the medical dilemma for the patient, given his inability to make sound and informed judgment regarding his health situation. The fact that Joseph has no close relatives and cannot communicate audibly makes it harder for the decision makers to find the way forward. As stated, chemotherapy for patients over 60years can be fatal. Its choice as a method of treatment for Joseph (70 years old) will be a violation of the principle of Beneficence. Though there are no promises that a stem cell transplant would be the best option, the fact that the alternative option can be fatal for patients with advanced conditions makes a stem cell transplant the appropriate choice. 

Least Harm

Joseph Saikewicz has multiples of health woes. First he has a low IQ, advanced age, and unsound mind which justify his institutionalization. His inability to communicate properly makes it harder for any physician to understand his need for medical attention. Besides, the latest diagnosis (myeloblastic monocytic leukemia) dooms his chances of survival. Considering all these, it is safe to conclude that neither of the  choices tabled for treatment would be beneficial. In light of this, the guardian ad litem is morally obliged to exercise his duty as per the ‘least harm' ethical principle. The chosen mode of treatment should focus on minimizing the patient's suffering. 

Conclusion

There is a sharp contrast in the beneficence principle and the ethical principle of ‘least harm’. While both can be applied in the case of Joseph, it is undeniable that there will be repercussions on any decision made. However, the aim is to provide an appropriate treatment to the patient. Thus, any decision made should focus on the patient’s mental status. If need be, bone marrow transplant should be considered.