Beauchamp and Childress describe the principle of beneficence as a “statement of moral obligation to act for the benefit of other” one that “connotes acts of mercy, kindness [and] friendship” (B&C p. 203). In this case Dax Cowart was severely injured during a gasoline explosion, leaving the majority of his body very deeply burned. Not only was Dax severely physically injured (burned, blind, lost use of hands, and fingers amputated), but also he was emotionally distraught (lost father in accident).
In this case, the main dilemma that arises is did the physicians have the right to go against Dax’s wishes, even though he was competent? Dax endured the excruciating pain he was put through and has achieved many accomplishments since the accident, but does this make the actions of the physicians justified? Dax states, “I tried to take my life twice–three times if you count the time I crawled over the hospital bed rails trying to get to the window to jump out an eight-story window” (RD p.21). The desperation Dax felt was evident and the suffering was immense. I do not believe the doctors were sympathizing with Dax nor were they displaying mercy and kindness towards Dax, especially since Dax implied pain management treatment was withheld.
One could argue that Dax is not being realistic about his possible life quality after enduring the surgeries. Dax makes statements alluding to little success in his life post operation stating “you know, all I’m going to be able do is to sit on a street corner and sell pencils” (RD p.15). This is Dax’s opinion of what will happen, and an opinion the doctors seemed to disagree with and thus a reason why the doctors are continuing with the surgeries and procedures despite Dax’s unwavering objections. Now since Dax has surpassed both his own and the doctors expectations it is clear that he did not have a realistic image of his future. Does this make Dax incapable of being competent at the time? In the article, it states Dax was deemed competent at least twice. I do not believe just because Dax did not imagine a future with the quality of life he wanted to live, he should be deemed incompetent. Although his quality of life was much greater than he ever imagined, this may not have been the case and thus Dax is entitled to the uncertainty of the future and the right to make his decision based on his current state and not on a possible future state.
I will now consider the principles autonomy and non-maleficence. Since Dax was deemed competent multiple times he should hold autonomy and the “freedom…to make the wrong choices” (RD p.17) as he wishes. Furthermore, he is suffering immensely to such an extent that I believe the principle of non-maleficence is being violated. Two of the five rules specifying non-maleficence are “do not kill” and “do not cause pain or suffering” (B&C p. 154). In Dax’s case these two rules are in conflict. One could argue the principle of non-maleficence is supported as we are not killing Dax nor are we depriving him of the goods for life by conducting the surgeries. In fact, one may argue by doing the surgeries we even may be providing Dax the opportunity to enjoy the goods of life. However, the pain and suffering we are causing him through extensive replacement of skin grafts needs to be evaluated. Dax states, “the pain was so excruciating, it was so far beyond any pain that I ever knew was possible, that I simply could not endure it “ (RD p.17). Although one could argue by not performing these surgeries on Dax we are killing him, the intention is to relieve Dax of his suffering and respect his wishes. I support Dax’s current stance that his wishes to die should have been respected at the time.
Work Cited
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. Seventh ed. New York, NY: Oxford UP, 2001. Print.
Cowart, Dax, and Robert Burt. “Confronting Death Who Chooses, Who Controls?” JSTOR. The Hastings Center, n.d. Web. 18 Mar. 2015. <http://www.jstor.org/stable/3527969>
“Tag Archives: Doctor/patient Relationship.” Tag: Doctor/patient Relationship. N.p., n.d. Web. 18 Mar. 2015. <http://www.thehealthculture.com/tag/doctorpatient-relationship/>.
Alexandra,
I agree with you that since Dax was deemed competent multiple times during his recovery his requests to die should have been respected. I think the doctors just saw a patient who had gone through a severely traumatic event and they wanted to believe he wasn’t sound of mind and simply ignored the facts. I also agree with on your point that Dax not being able to envision a realistic outcome for his recovery was not grounds for the physicians to continue treating him against his will.
If Dax was declared incompetent during his recovery, then of course the doctors would have been within reason to continue treating him against his wishes. It is very uncomfortable to be how one factor like competency vs incompetency could be the deciding factor over how someone or whether or not someone gets treated and/or if their autonomy is respected.
To play devils advocate a little, do you think that because DAX was in pain that he could recover from he should still take his own life? I feel that it is the right of the individual to chose the path they take with their life but when its outside the realm of degenerative disease or terminal illnesses, essentially we know they can recover, is that still the same kind of thing. Are physicians exercising non-malefacene when they allow someone who can recover to take their own life because they do not want to deal with what it takes to get better? I think on that notion one could easily fall into a slippery slope of things like misguided mercy killings.
I do think the physicians are exercising non-maleficence when allowing someone who is in excruciating pain to take their life. In Dax’s case, when considering the principle of non-maleficence one could argue two of the rules specifying the principle are in conflict. One could argue we are going against the rule of “do not kill” by allowing Dax the opportunity to die. However, I believe by not going against the rule of “do not kill” we are strongly violating the rule of “do not cause pain and suffering”. When rules like this are in conflict, the physician must evaluate which rule he will act under and in doing so he should act in the best interest of the patient. The patient is competent, and in excruciating pain, and thus deserves the opportunity to die if he so wishes. I do not believe this could fall into a slippery slope argument. I do not see the rational argument demonstrating the mechanism by which inevitable events would result by allowing Dax to die to alleviate his extreme suffering.