When confronting major decisions in life, many of us find a sense of comfort when we know that those decisions are in our hands. But what can be said about the case of confronting death? Confronting death is the most important decision someone can make in his life, simply because, should an individual choose death, there will be no more decisions made from that point on. Death is such a big decision that many would argue it is not appropriate to only allow the patient to make the decision. Some would say that any patient in the state of mind where death is the best option should have the decision made by his attending physician. So then the question becomes this: who chooses whether or not a patient can be allowed to die in the face of extreme situations?
I mention the point about extreme situations to set a context from which this discussion comes from. I am not referring to a young girl feeling like her life is over because she is in a fight with her best friend. I am referring to the extreme cases of when someone is near enough to death that fighting to stay alive might actually not be worth the struggle. This was the case for Dax Cowart. Dax was part of an explosion that killed his father and left him with severe burns on 2/3 of his body. The treatment he underwent was excruciatingly painful and he did not want to face it anymore. He also knew that even if he survived the treatment, there would be several very real struggles to face regarding physical limitations. Because of all of this, Dax asked his doctors to just let him die (Cowart and Burt 14). His physicians, however, refused his request. They even brought in two psychiatrists to try and have him deemed incompetent so they could proceed. Even though the psychiatrists both determined him to be competent, however, they still proceeded with treating him (Cowart 14).
After surviving the treatment, Dax is now a practicing lawyer who speaks out on the situation he was in (Cowart 14). He shares his experiences so that others don’t have to go through the paternalism that he feels like he faced. This is something he would be unable to do if he had gotten what he wanted. The dilemma here is: does it matter that Dax’s future after the explosion reason enough to have disregarded his wishes and violated his autonomy? Ironically, he is a practicing lawyer who has found purpose in life in sharing about how his doctors should have let him die.
In times of distress, oftentimes we as humans can be shortsighted and don’t see the future that is beyond a major obstacle. In this case, though, the obstacle was excruciating pain so great that Dax would never wish it on even his worst enemy. To him, it didn’t matter that he could have a future where he could find purpose in life again. All he knew was that he had no desire to continue on in that kind of pain. Dax makes an interesting point in saying that people have a right to control their bodies, which also means they have a right to say whether they should go on living or not (Cowart 16). This runs into a lot of issues, however, because this implies someone in the midst of deep emotion can take his life and there is moral evidence that supports that action. I would have to agree with Dax, though. Ultimately, under the principles of autonomy, a person’s life is his to control and therefore, even death is his decision to make.
This is not to say that someone should be allowed to make a flippant decision to take his own life. Instead, much discussion needs to take place that would lead to a calm and purposeful decision to allow someone to end his own life. As a result, I also agree with Dr. Burt when he argued that he just needs time to be able to do his job as a caretaker (Cowart 19).
Ultimately, there needs to be an open dialogue between patient and physician where open communication allows them both to make the best decision possible for the sake of the patient (Cowart 19). This may mean letting the patient make the decision to die or it may mean letting the physician have a shot at providing treatment for the patient. Either way, it does mean that the patient needs to forgo some level of autonomy in order to have this open dialogue (Cowart 24). In this case, neither party is undermined because the patient will be able to make the final decision and the physician will be able to do his job and act as a care-provider.
Works Cited
Cowart, Dax, and Robert Burt. “Confronting Death: Who Chooses, Who Controls.” The Hastings Center Report 28.1 (1998): 14-24. JSTOR. Web. 18 Mar. 2015.
This scenario is challenging because the decision comes down to respecting autonomy or upholding benevolence. On one hand, someone can make the argument that we should respect Dax’s wishes to stop treatment, because he is in so much pain and is making the decision for himself. On the other hand, the argument can be made that he can survive this treatment with no long-term consequences, so the doctors should heal the patients, as they know best. In this scenario, I think it’s important to take the Dax’s competence into account when he is making these claims. It appears he solely wanted to die because of the pain he was in, but since the doctors knew that was short lived, I can respect their decision to uphold benevolence and continue treatment. It is easy for us to look back now and respect the doctor’s decision because Dax is fine and living a great life, but this makes me think about the question: What if Dax never recovered? Would we be on Dax’s side? Does the outcome greatly impact our feelings on this case? In this specific case, I believe it does.
I also agree with you Ann that a conversation should take place between the physician and patient to communicate the circumstances of the situation. However, where do you draw the line as to how much input the patient should have? Even if the patient is in so much pain that they choose to die, should they be the one to make the final call? Or should it be in the physician’s control to decide whether to go through with the procedure knowing that the patient’s pain may be short lived? I believe that if a physician believes the patient has a chance to live a normal life, they should make the final decision that is best for the future of the patient.
Ann brings up a good point that we are oftentimes shortsighted and cannot see the future beyond a major obstacle. I also agree that confronting death is the most important decision someone can make in his life (especially since there will be no more decisions from that point on). However, such as in Dax’s situation, there comes a point in life where it is merely impossible to overlook the current situation in order to foresee a future. In this case, the main argument lies within the decision to either respect autonomy or uphold benevolence. Setting aside Dax’s current mental condition (which has been deemed competent by two physicians but may very well still be clouded by his excruciating pain), I think it’s important to uphold benevolence in continuing Dax’s treatment. The physicians are entirely competent and have an entirely unbiased view toward Dax and his life – so if they believe that continuing treatment is the best decision for Dax, I believe it is as well.