Patient Dax Cowert was critically injured in a propane gas explosion that very deeply burned two-thirds of his body causing him to be physically blind and unable to use his hands. For more than a year in treatment, Cowert demanded that he not undergo the painful treatment for his burns and that he would rather die. The major dilemma underlying this case is paternalism versus patient autonomy. Should the doctors respect the autonomy of the patient or should they exercise paternalism that is the policy or practice on the part of people in positions of authority of restricting the freedom and responsibilities of those subordinate to them in the subordinates’ supposed best interest.
The best decision in this case would be to listen to the patient, but not just leaving it at that. It would be wise for the physician to seek out the underlying reasons as to why the patient wouldn’t want to go through with a procedure that would potentially be of great benefit to them. The act of discourse and reasoning with the patient could be very useful in helping the patient come to terms with their prognosis and allowing them to see alternatives to their situation. As discussed in this case, at first Cowert did not want to undergo the treatment. Given much analysis as to why this was so, it was determined that Cowert believed that he wouldn’t be able to lead a meaningful life anymore in comparison to when he was able-bodied. Cowen would be able to think about his condition differently if he was familiar with disabled-bodied people who were blind or had missing limbs. It is still possible to live a meaningful life with a disability. Unfortunately, many able bodied people don’t believe they would be able to live a life of purpose. Cowert was able to overcome his fear and even went on to pursue a law degree.
The other side of this dilemma looks at patient autonomy. What would have happened if the doctors listened to Cowert and granted him his wish to die? Cowerts’ life would have ended prematurely. He would not have went to law school and become something great. Cowert clearly wanted to stop his treatment because he did not see the use in continuing treatment if he would just be prolonging a life where he was miserable and saw no hope for himself. This is where the physician must intervene and help the patient realize that they could still lead a great life. It is thus very important for the physician to develop a trusting relationship with their patient in order to get through to the patient successfully.
Works Cited
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 your point that while the patient’s autonomous decision must be respected, ending his life prematurely could also be the wrong option. It is also important to mention that the psychiatrist’s decision to label him as competent could have been misleading since he did attempt to commit suicide three times. While the doctors are causing Dax harm and suffering by forcing him to endure this painful burn treatment, they are also facilitating a potentially successful future for him, and he ends up leading a meaningful life. This situation reminds me of one of the first cases we addressed in the class with the girl who was a Jehovah’s Witness. Her religious beliefs suggested that she could not have a blood transfusion, but she also asked for the medical staff to not let her die before she lost consciousness. I argued that while the doctors were clearly violating her religious beliefs, it was important to save her from death with the blood transfusion first and then resolve all other issues after she recovered. Likewise, in my opinion, it is important to save Dax’s life first and then address any concerns after he continues to lead a meaningful life following his, hopefully, successful recovery.
I think one can look at this case in terms of ends and means. Does the fact that he ended up living and happy justify the excruciating pain that he had to endure? I personally believe no. Dax is very fortunate that he ended up in the state that he is now but putting someone through excruciating pain with no clear end in sight is unfair. This is an extreme case. I am not saying that short term pain should warrant anyone to end their life but in this case I think the pain was at a point in which his wishes should have been taken into consideration. He was not only in pain but he was also a prisoner inside his own body and the hospital. I think not only was his trust in medical professionals compromised but also for others that hear of this case. He was in such a vulnerable physical condition that they forgot to acknowledge him as a fully competent individual.
@Rebecca, I understand your point in regards to ends and means. However, I wonder if anyone has inquired about Dax’s viewpoint after he has been completely treated? Is Dax satisfied with the physician decision to not assist in helping him commit suicide? Also, we cannot blame the doctors for doing their duty. The doctor is not obligated to assist Dax with anything that is harming to the patient. The physician’s main focus is to preserve the life of the patient. The doctors would be held accountable for Dax’s death and would of perhaps faced backlash from the patient’s family members, the media, and the rest of society. It is great that Dax has turned out to live a very promising life and it would have been very sad to realize that in the event Dax died, that he would not be able to have led this life which could potentially impact and inspire the lives of others.
I understand your point that the doctors should help Cowert see the benefits and quality of life he could have if he continued treatment. I think that this, however, could seem too much like coercion and the doctors pressuring their own decisions on Cowert. It also can be difficult for doctors to realistically explain and demonstrate all of this to Cowert or other patients in this situation. With life-saving treatment like this, decisions needs to be made quickly and therefore information needs to be presented quickly. It could be too difficult for doctors to fully explain the benefits of continuing treatment and showing Cowert examples of other patients within the time frame that can be allowed for Cowert to receive treatment and within the time that doctors have to devout to Cowert and not other patients.