BY – UROOJ KHAN April 19, 2018
Imagine spending countless years studying medical textbooks from cover to cover and working diligently in exhausting hospital rotations. Fully equipped with the necessary medical expertise, you finally enter the healthcare profession with the intention of being compassionate and above all, healing others. Then, you come across a patient who exerts no desire to live and requests that you to cut off their treatment. What would be the appropriate response to this scenario?
Dax Cowart was a successful Air Force pilot before a freak accident tragically altered his life. Planning to visit tracts of land that he wished to purchase with his father, Cowart remained unaware of a gas leak within the area; this was until the pair started their car which ignited propane gas and thus triggered an explosion. Unfortunately, Cowart’s father died at the scene and Cowart himself suffered from extensive burns in over two-thirds of his body in addition to losing his eyes, ears, and hands. From the very beginning, Cowart affirmed his desire to commit suicide or allow doctors to end his misery.
When presented with this situation, many doctors find themselves stuck in a true conundrum. Do they play an active role in a patient’s suicide or is it their responsibility to utilize their training in order to save the patient’s life (even if he does not wish to live)?
Biomedical ethics involves a set of guidelines or moral principles applied in the medical field to better care for the patient and address their concerns. Nonetheless, the failings of this system were made evident in Dax Cowart’s struggle to halt his burn treatment and willingly die. His case triggered a firestorm of controversy surrounding the role of the physician in regards to life and death as well as the autonomy of the patient.
Throughout his ordeal, Cowart described the power struggle that he endured with physicians who overtly embraced the idea of medical paternalism. Ideals of superiority made the doctors believe that they were ultimately doing what was in Cowart’s best interest despite his pleas implying otherwise. In fact, within the documentary, Dax’s Case, Cowart describes how this practice contributed to a God complex in which the physicians manipulated him in ways to fulfill their own duty — a twisted sense of responsibility “to benefit the patient even if the patient resists” (Beauchamp, McCullough 7). Evidently, this reflected a time where doctors were “intensely disrespectful of patients’ autonomy” (Confronting Death, 14). Limiting the patient’s right to self-govern matters of his own body, doctors executed decisions that they suspected would aid Cowart’s quality of life – failing to consider whether or not he even wished to continue living. Thus, while Cowart simply hoped for physicians who would provide comfort and recognize the reasoning behind his pleas, he instead encountered individuals too blinded by their own agenda to truly comprehend and fulfill his requests. This conflict highlights the need for more compassionate physicians who can balance the role of offering medically-backed information, and assistance while still maintaining respect for the decisions of patients.
Ultimately, the fact that Cowart was able to recover and achieve some functionality does not justify the means taken in order to reach his current state of health. The major conflict in Cowart’s case stems from the vast disconnect in perspective between himself and the physicians treating him. Although there was a chance that Cowart would get better and regain some sense of normalcy in his life, he reported that the pain during treatment made him want to die. This truly baffled physicians who were used to providing the best possible care to willing patients with the goal of prolonging life. However, Cowart’s situation became precedent when he raised the poignant question: “What gives a physician the right to keep alive a patient who wants to die?” (White, Engelhardt 10).
In the end, it is the patient who must decide if the pain and suffering endured throughout treatment can be overcome. If they cannot imagine a future following their diagnosis or treatment, they should have the right to discuss concerns and potential plans with their physician. The lack of biomedical ethics principles to govern this case prevented a competent adult from executing an understandable (but tragic) decision given his dire circumstances. Although this case certainly lies in the gray area of ethics, it serves as a reminder to physicians and patients alike to rethink and modify the way they interact in such difficult scenarios.
It also makes us ponder the question: Should medical paternalism or patient autonomy play a larger role in deciding a patient’s fate?
Reference(s) Confronting Death: Who Chooses, Who Controls? A Dialogue between Dax Cowart and Robert Burt by Robert Burt Medical Ethics by Tom L. Beauchamp and Laurence B. McCullough Dax’s Case (1984)