This section contains the nature of the case and procedural background.

Candura was born in Italy, emigrated to the United States in 1918, was married, and had a daughter and three sons. She lost her husband in 1976 and has been depressed and unhappy since. Her relationship with her children is marked by conflict. She lived in her own home until her hospitalization in November 1977. In 1974 she had an infection in a toe on her right foot which became gangrenous. She was discovered to be diabetic. The toe was amputated. In 1977 she bruised her right leg while getting into a bus. The bruise developed into gangrene which resulted in an operation in November 1977, in which a portion of her right foot was amputated. An arterial bypass was done to decrease the likelihood that gangrene would recur. She returned to the hospital and was found to have gangrene in the remainder of the foot. She originally agreed to amputation of the leg, but she withdrew her consent on the morning scheduled for the operation. She was discharged on April 21 and went to her daughter's home but returned and consented to the operation, but soon thereafter she reiterated her refusal. She has discussed with some persons the reasons for her decision: that she has been unhappy since the death of her husband; that she does not wish to be a burden to her children; that she does not believe that the operation will cure her; that she does not wish to live as an invalid or in a nursing home; and that she does not fear death but welcomes it. She expressed a desire to get well but indicated that she was resigned to death and was adamantly against the operation. She is lucid on some matters and confused on others. Her train of thought sometimes wanders. Her conception of time is distorted. She is hostile to certain doctors. She is on occasion combative in her responses to questioning. But she has exhibited a high degree of awareness and acuity when responding to questions concerning the proposed operation. She has made it clear that she does not wish to have the operation even though that decision will in all likelihood lead shortly to her death. P filed a petition in the Probate Court seeking the appointment of herself as temporary guardian with the authority to consent to the operation on behalf of her mother. Two psychiatrists were engaged to determine her competency. One determined she was not competent because she refused to talk to him and she talked with the second one stating she wanted to get well but was not certain if the operation could do that. Also, she did not want to become a burden on her family or live in a nursing home. The trial judge held as follows: 'It is fair to conclude -- without necessarily finding that the ward is mentally ill for all purposes -- that she is incapable of making a rational and competent choice to undergo or reject the proposed surgery to her right leg. To this extent, at least, her behavior is irrational. She has closed her mind to the entire issue to the extent that the Court cannot conclude that her decision to reject further treatment is rational and informed . . . . In the absence of substantial evidence that the ward has come to her current position as a result of a rational process after careful consideration of the medical alternatives, the Court finds that her confused mental condition resulting from her underlying senility and depression warrants the exercise of the jurisdiction of this Court and the application of a substitute choice for the ward as enunciated in the [Saikewicz] case . . . .' An order and a judgment were entered to that effect, from which D appointed to represent Candura has appealed.

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