The dialogue between Dax Cowart and Robert Burt is almost disturbingly paradoxical. On one hand, we have Dax who suffered injuries from a gas explosion, ten months of involuntary treatment and rehabilitation, and after being released, he faced seven years of severe depression riddled with unsuccessful attempts to take his own life. After all of the medical operations he endured, Dax was left without either of his hands, eyes, ears, and lost between 65 and 70 percent of the skin on his body. Throughout his hospitalization, he requested to cease further treatment so that he could die, and despite his remarkable recovery and successes he’s achieved following the procedures, Dax remains adamant that he was treated unjustly. On the other side of the argument is Dr. Robert Burt, who is an expert in the relationship between biomedical ethics and constitutional law. Within the debate against Dax, Burt takes a paternalist stance regarding the ethicality of how Dax’s case was handled. More specifically, he is arguing that patients who are suffering may not be able to refuse treatment in order to end their lives.

This discussion is peculiar for many reasons. Ironically, Burt is arguing with Dax about the sanctity of his (Dax’s) life with the underlying notion that he knows more about what is best for Dax than Dax himself. Burt’s opinion hinges on a paternalist interpretation of life, which seems to hinge on the idea that all lives are equally worth living. Another oddity with this is the concept of someone else deciding what your life is worth. Obviously no one can know what another person is experiencing—their thoughts, feelings, and perceptions—so without insight to these personal experiences, there is no way to truly evaluate another’s life. Furthermore, Burt in his argument seems to discount the pain and suffering Dax went through for several years, yet he maintains his view that Dax should not have been able to let die. To me this is disrespectful. And while this disrespect is not rooted in malice, it is the same disregard he received throughout his torturous process.

The core issues of this dialogue pertain to the autonomy of patients and how healthcare professionals should handle this autonomy. In short, Dax feels that with his autonomy being compromised and the forceful administration of various unpleasant treatments and procedures, the physician’s actions were immoral. Nonetheless, Burt is arguing that the doctors’ intervention and refusal to grant Dax’s requests was nothing short of acceptable. They each provided evidence and examples to support their positions. Much of the conservation revolved around what the ideal course of action would have been in retrospect and what it would be in hypothetically equivalent scenarios. Where Dax and Burt are somewhat able to superficially agree is on the topic of physician-patient discussion of the patient’s wishes. Both men concede that an interaction should necessarily take place; however, Burt posits that this conversation should be prolonged as long as possible, or until—as he seems to reluctantly admit, the physicians have exhausted all treatment options. From Dax’s perspective, it is easy to see the frustration with this proposal. Not only can Burt not comprehend the amount of agony that Dax endured, but also he is not acknowledging how slowly time passes when we are experiencing such suffering. As Dax states to the audience, one hour to him seemed like an eternity. This is reasonable given the documented proof of chlorinated baths and the excruciation of simply replacing bandages.

So Dax understandably disagrees with Burt here, but the pursuing objection Burt makes concerning how long the decision should be postponed after a patient requests to die. He addresses Dax in his opening statement, questioning the amount of time that would be appropriate for a physician to comply with the patient’s demand to let die. This is a fair issue to discuss considering how influential the emotional state that the patient would be in after a traumatic even may be on their decision to withhold further life-saving treatment. The trouble with raising this particular issue is that it results in a circular reasoning that could not render a realistic solution. When has enough time elapsed for the healthcare professionals to definitively say that there is nothing more that can be done to help the patient? This evokes the same issue. The issue is that there is no appropriate time to make such a decision. To contend that the patient should be willing to allow the physician an indefinite amount of time to look for other treatment options while they are experiencing so much pain is not only merciless but also unjustified.

A lack of empathy and justice are among the key concerns Dax has with the medical treatment he received, and within this argument, I believe, is a basic flaw of the healthcare system. In his statement, Dax mentions the distance that separates the doctor and patient and how this distance likely serves as the source of this merciless, unjustified, yet paternalistic approach.

Dax admits that he does not view the physician’s actions as a derivative from poor intentions. Indeed, he acknowledges his belief that they truly were acting in his best interest. However, a boundary was crossed was constantly denying his autonomy. The root of the problem, Dax offers, is the paternalistic outlook that a majority of doctors seem to adopt. As he discusses, this paternalism may perpetuate negligence for patients’ opinions and requests.

Today, it could be argued that the hierarchy of moral upstanding, God and doctors are a close one-two. Oftentimes medical professionals are held to a standard that provides them with permission to justify the means (whatever they may be) with the end (whatever it may be). Further, the product that results is conceptions that doctors always know what’s best for the patient or that they can’t do wrong, which may lead to an entitlement on behalf of the physician by which they can override any request made by a patient. This was certainly similar to the case in which Dax found himself. The main problem here is, as Dax explains, that our constitutional rights are not suspended when we enter a hospital. Perhaps the most basic of human rights is the right over one’s own body. This appears to be the foundation for Dax’s overall argument.

In general, it seems that the stance upheld by Dr. Burt is simply unrealistic. Paternalistic values may be beneficial to a certain degree, but at some point, when an individual loses the opportunity to make decisions for himself, this approach unjustly interferes with autonomy. Burt’s propensity to draw on all of Dax’s achievements as support for his argument in many ways highlights how unrealistic a paternalist approach to medicine actually is. Not many people would be able to recover and prosper to the extent that Dax was able to; so to argue that his case is evidence for paternalism is quixotic. If Dax had successfully killed himself after the years of rehabilitation, dying without a law degree or any remotely as impressive success story, would Burt persist in praising the doctors who prolonged Dax’s suffering against his will?

Sources:

Cowart, Dax, and Robert Burt. “Confronting Death Who Chooses, Who Controls?” The Hastings Center Report 28.1 (1998): 14-24. Web. 20 Mar. 2015.