In this week’s reading “Confronting Death: Who Chooses, Who Controls?”, a man named Dax Cowart, was severely burned in a propane gas explosion, which killed his father and severely burned two-thirds of Dax’s body leaving him blind and without the use of his hands. During his recovery, Cowart continuously demanded that the doctors stop treating him due to the extreme painfulness of skin graft treatments for his burns. Despite being deemed competent by a psychiatrist, Cowart’s requests were denied, his autonomy was not considered, and treatment was forced upon him. Despite surviving the incident and now living in what he believes to be the happiest time of his life, when asked today if the doctors should have treated him all those years ago, he still strongly believes that the doctors should have respected his wishes to have “please let [him] die.”
The dilemma in this case is one of the patient’s autonomy versus the healthcare professionals’ paternalistic beliefs that they know what is best for the patient. According to Beauchamp and Childress, paternalism in healthcare is the belief that the superior training and knowledge of a healthcare professional gives said healthcare professional the authority to determine a patient’s best interests (Beauchamp and Childress, 215). Mr. Cowart’s health care providers were not wrong in doing their job to be beneficient and non-maleficent towards Mr. Cowart. However, the amount of pain that Mr. Cowart went through makes this situation an even bigger predicament. If this was a situation where the patient was not as in such excruciating pain, and the patient was competent, then the amount of time the doctor’s took to try to battle the patient’s request to die probably would not be as big of an issue.
I think that if I were the health care professional, I would have attempted to treat Mr. Cowart for a period of time, but I would like to believe that I would step back at some point and respect Mr. Cowart’s wishes to die. What’s difficult to determine is when exactly that point would be? According to Robert Burt, that point in time would be after a physician has had the time to “get the resources [he/she knows] to exist [that could address the [issue] in some way” (Cowart, 20). Although Cowart was declared competent by the psychiatrist and was making demands to forego treatment and thus end his life, his doctor’s acted on the grounds that the excruciating pain he was going through was not allowing him to think clearly. For instance, Cowart believed that his condition was so bad that his only way to make a living after the accident would be to sell pencils on the streets. I agree with Alexandra’s post in that, although Cowart could not envision the life he currently has, a life in which he practices law and is more physically active than he could have ever imagined, these were still not grounds for the doctors to declare him unreasonable.
In a traumatic situation like this one, Mr. Cowart admitted that his pain was so bad that he could not even fathom his life after the pain, even though he knew the pain was temporary. Healthcare professionals should not allow a patient to endure such pain and suffering in order to one day be healed. The ends never justify the means. Cowart states in the interview that “[He doesn’t] believe our health care providers would be honest about letting go of a patient earlier than whatever we set up as the maximum time” (Cowart, 19). He ultimately believes that paternalism has clouded most doctor’s judgments and that legal action needs to be taken against abuse of the paternalistic mentality so that situations like his do not happen again. I agree. Paternalism and the belief that “doctor knows best” needs to be done away with so that horrible instances like this case do not happen to others.
Works Cited
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford University Press, 2013. Print.
Cowart, Dax, and Robert Burt. “Confronting Death Who Chooses, Who Controls?” The Hastings Center Report 28.1 (1998): 14-24. Web. 20 Mar. 2015. <http://www.jstor.org/stable/3527969>.
I agree with you that we should honor the patient’s wishes at some point in the recovery process. Dax had been psychologically tested numerous times, and was deemed competent with every test. Since competence was proven, I believe that Dax’s wish for no more treatment should have been heeded. The physician was making the best decision in his mind. This is because a doctor’s duty is to help their patients in the most beneficial way possible for their overall health. This is a case in which the doctor overstepped moral boundaries in order to perform their job. While I can understand why the physician continued treatment, I believe that the treatment was morally unjust. Dax’s requests to halt treatment should have been respected by all.
I definitely see your point; paternalism in the medical field leads to a whole host of violations of autonomy. However, I think this situation is not black and white and that if the doctors respected Dax’s wishes, they would also be violating other moral principles. They as physicians are required to do everything in their power to save a life. I think that if I were a physician and I knew that I could save someone’s life but I didn’t, I would feel as if I had had not fulfilled my duties as a doctor. Additionally, I think that if we said that the doctors should not proceed with treatment in this case, would that mean that doctors should not treat Amelda? Or that doctors should not force a glue sniffing mother into rehabilitation to save the life of her baby?
Hi Ci Ci,
I think that the pain that Dax experienced is the key factor that makes the act of the doctors respecting his wishes to stop treatment a lot different than Amelda’s and the glue sniffing mother case. With Amelda, the case never went into detail about Amelda’s competency, but more than likely, her anorexia compromised her ability to think rationally. In the case of the glue sniffing mother, the mother went into the hospital deliberately seeking help, while Dax never wanted to be treated. Furthermore, Ms. G did not go through pain that was anywhere close to the level of pain I am sure Dax went through. If Amelda and Ms. G were in the same amount of pain as Dax and if they were declared competent, then certainly, I believe that treatment should also stopped upon their request. But as the old saying goes, the ends never justify the means and putting Dax through that much pain was not justified in my opinion.
Doctors are morally obliged to act in favor of the patient’s well-being (beneficence) and cause no harm to patients (non-maleficence). Furthermore, doctors are also expected to respect the patients’ autonomy, acknowledge their right to make choices and act in accordance to their requests. But what if the patient’s autonomous decision is not in favor of the patient’s well-being? Should the doctors do what the patient wants or should they do what they have to do to save the patient’s life? What we learnt in Beauchamp and Childress on page 215 is that, according to paternalism concept, the healthcare professionals have the knowledge, experience and authority to act in the patient’s best interest and determine the treatment that will save the patient’s life. However, the patient has to be incompetent for applying this concept. When an incompetent patient’s autonomy opposes beneficence in a paternalistic act, then beneficence wins over autonomy (Matusek). The question that should be answered here is, “Was Dax Cowart incompetent”, though he was declared as being competent by the psychiatrists? I think, with an intense physical pain, enormous emotional suffering and agony for Dax’s father death and his new disabilities that will change the quality of his future life all had affected his mental judgements and rational decisions. Dax was in a fragile condition smashed both physically and emotionally, and tried to commit suicide; hence, there is a big argument that his decision to die is irrational due to his wretched condition. Nonetheless, at the end, the doctors should do all they can to save the patient’s life. They should provide the treatment that will save the patient’s life even if it is painful and risky. What motivates the doctors to continue the treatment is that they knew that there was a big chance of a good recovery. When there is a big chance of recovery, the disease is not terminal and the treatment is not futile, then doctors should not be in a position to let the patients tell them what to do but rather do what they have to do to save the patient’s life. Doctors did what they have to do and Dax was ultimately saved.
Doctors have been educated to rescue patients and act in their favor. They made a commitment to save lives and not to end lives. There are long terms painful – life saving treatments that will help the patient to recover. Doctors should not stop any treatment that will directly cause patient’s death. Forgoing treatment is morally acceptable when it doesn’t directly cause the death of the patient but “let him die sooner” especially in terminal diseases where treatment is futile and will only elongate the patient suffering. In Dax’s situation the painful long term treatment saved Dax’s life and if doctors stopped treating him then they would have directly caused his death. Doctors did what they have to do.
If Dax’s accident was after 1991 or after the legal reinforcement of the Patient Self Determination Act1 of 1991, then doctors might have felt obliged to respect the patient’s autonomy and his choice to end the treatment; the consequence would have been the death of Dax (Braddock and Clark). We can say that legally and in reference to the Self Determination Act of 1991, the doctors had violated Dax’s autonomy and his choice to stop treatment especially since he is declared competent by many psychiatrists; however, morally doctors have done what they should do to save the patient’s life and acted in accordance to the principle of beneficence.
Works Cited
Braddock, Clarence H., and Jonna Derbenwick Clark. “Do Not Resuscitate (DNAR) Orders.” Ethics in Medicine. University of Washington School of Medicine, n.d. Web. .
Matusek, Jill Ann. “Ethical Dilemmas in Treating Clients with Eating Disorders: A Review and Application of an Integrative Ethical Decision-making Mode.” Invited Review (n.d.): n. pag. Marshall. Web. .
Hey, Gabrielle. Thank you for your post, for I enjoyed making connections between multiple texts. For example, you articulate that psychiatrists deemed Dex as competent. However, he suffered from a great deal of pain as well. In “Why Doctors Should Intervene”, Ackerman argues that illness compromises autonomy. For instance, he explains that fear can limit a patient’s ability to make a decision. Thus, since Dex fears pain, he does not have the competency to make decisions about treatment. Therefore, the physicians ought to continue treating him based on the principle of beneficence. Furthermore, following the logic of the Ackerman argument, paternalism does not exist in this case, for the physicians are not overriding competent autonomy.
I believe that the one big responsibility of physicians is to save the lives of the patients if they see potential of patients having and leading happy lives after recovering from diseases or after any treatments. There is no doubt that the patient’s autonomy was violated when the skin graft treatment was carried out. However, it can be justified because it was the act of beneficence that outweighed the patient’s autonomy in the eyes of the doctors. I said in the eyes of the doctors, indeed. Many times, doctors know what and how to give the best treatment to the patients because they have been through so many cases. I am generalizing here, but they still saw the potential in Mr. Cowart’s life afterward. You mentioned that the ends never justify the means; however, values can change in the process. For instance, in class, Professor Risjord brought up Greek mythology Sirens and Odyssey to illustrate the point. When Odyssey heard the sirens, he was tied up and yelled to the sailors to let him go, but once they passed by, his values changed back to normal and was glad that he wasn’t let go. Mr. Cowart explicitly stated that the doctors still should have let him die after he fully recovered, but I want to ask him if he is willing to give up his life right now and rather be dead. To me, he is stating that if he were to go back, he wouldn’t go through it again, but right now, he is content about the life he is living. His values have changed. Therefore, I believe that the physicians did their best to recover not only Mr. Cowart’s physical conditions but also his values in life.