Dax Cowart was in an explosive car accident that left him with severe burns, blinded, and in extreme pain. At the time, he had expressed wishes to not continue treatment, as he was in so much suffering and his prospects of a high quality of life were looking rather bleak. However, the doctors moved forward with the necessary treatment and Cowart lived. Although he realized seven years later that his quality of life was actually much greater than expected, he claimed that if he were put in this situation all over again, he would still refuse treatment. This raises the dilemma of whether the doctors should have respected Cowart’s wishes and on what grounds.
We first determine whether Cowart can be deemed competent in this situation. He was put through a traumatic life event, lost his father, and was in excruciating pain. While most would argue that Cowart cannot be considered as competent to make this decision as feelings of pain and suffering often cloud one’s judgment, Cowart argues that, “The right to control your own body is a right you’re born with, not something that you have to ask anyone else for, not the government, not your treating physician, not your next-of-kin” (Cowart and Burt 16). It is easy to say that everyone deserves to make choices about their own body and that violating one’s autonomy in one case can lead to a whole host of other issues, but what if it is to benefit the patient and to protect their life?
Beauchamp and Childress write that the rules of beneficence are: “1. Protect and defend the rights of others, 2. Prevent harm from occurring to others, 3. Remove conditions that will cause harm to others, 4. Help persons with disabilities, 5. Remove persons in danger” (Beauchamp and Childress 204). The principles of beneficence tend to look at more of the positive action versus nonmaleficence, which looks at “negative prohibitions of action” (Beauchamp and Childress 204). In this case the doctors were trying to protect Cowart’s right to life, help a man who was blinded and lost the use of his fingers, and keep him from experiencing any further damages from the car accident.
I think that the doctors had a moral obligation to treat Cowart as he was incompetent in making the decision about his life at the time. Despite his pain following the accident, under the principles of beneficence, the doctors were fulfilling their duties. I think this case is different than some of the others treat/do not treat dilemmas, such as the case of Stephen Dawson, in which his current pain and suffering would not improve after treatment nor would his circumstance of low quality of life (Thomas, Waluchow, and Gedge 229). Cowart had the possibility of being fully functioning and achieving many successes in life. Although he endured much pain and suffering, it was only temporary. This case was particularly interesting because we were able to see the long-term outcome of the physician’s decision and it turned out to be of benefit to the patient.
Beauchamp, Tom, and James Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford UP, 2009. Print.
Cowart, Dax, and Robert Burt. “Confronting Death Who Chooses, Who Controls?” The Hastings Center Report 28.1 (1998): 14-24. Print.
Thomas, John, Wilfrid J. Waluchow, and Elisabeth Gedge. “Stephen Dawson: Should Severely Mentally Challenged Patients Be Treated?”.” Well and Good. Toronto: Broadview, 2014. Print.
Ci Ci –
I would tread lightly in deeming that Dan was incompetent simply because he was in pain and had just lost his father. If these were criteria that were to be used in cases of autonomous declaration, then in all cases where a next of kin is made aware of the state of their loved one and must make a decision to save them, the moral agent would not be a competent entity that medical staff could turn to for authorization. For example, in situations where a husband must choose whether surgical staff saves his child or wife (both of which are people he loves but he is being told he can only save one), the father would, per your argument, not be competent to make this decision.
Also, in saying that the doctors were fulfilling a moral duty under beneficence because Dan had the chance to recover is falling into the realm of circular reasoning. The doctors claimed to be able to save him and therefore did not want to let him die because they could save him. This thought-process fails to include the ordeal that Dan would have to endure simply to satiate a conclusion drawn by people that were not going through the physical pain that he was.
Ci Ci,
I agree with your statement, “Despite his pain following the accident, under the principles of beneficence, the doctors were fulfilling their duties.” In this case, Dax has requested that no further treatment be performed. While it may be a doctor’s duty to perform all medical actions necessary to improve Dax’s chances at a fully-functioning life, Dax has expressly communicated that he would not consent to further treatment. In short, it may have been in Dax’s best interests in the long run to have been treated, but we cannot go ahead and operate on him just because we think that this is the correct decision. This is Dax’s life, not our life. Everyone deserves autonomy, and in this case we did not observe that right. While the doctors made the correct decision medically, I believe that they may have made the morally unjust decision. The doctors ought to have not treated Dax, as he explicitly requested.
A large part of me does think it was the doctors’ right to continue to do what they could to keep the patient alive, especially since they had the means to do so. However, it is definitely hard to hear that years later (and very much in a state of competence) the patient says he would have wanted the same thing over again if given the same situation. This does make me question how much autonomy we take away from a person we deem as “incompetent” when in reality it is their body, and maybe it really should be their decision to make.