Background:

In Why Doctors Should Intervene by Terrance Ackerman, the author brings up the idea that autonomy is compromised when one is sick. To him there is a premium being put on patient autonomy by the community which while good intentioned is ultimately flawed. This is because the current model of autonomy “fails to take account of the transforming effect of illness.”(14) This is not an attack upon the idea of autonomy rather an argument that the current model of autonomy that is legally taken is inadequate and potentially harmful by limiting to patient practitioner dynamic to merely a business transaction with the only responsibility is for the doctor towards autonomy is being honest.

Dilemma:

The dilemma presented in this paper is  straight forward on the surface but when taking a deeper look it becomes rather complicated. On the surface the only question we must answer is if sickness does compromise autonomy. If one were to disagree with Ackerman’s point of view, then the current model outlined by Beauchamp and Childress use for autonomy becomes valid and the argument theoretically ends there. We can take that barring mental, physically, or educational disability so long as the patient has intentionality, understanding, and non-control then they are autonomous and as a practitioner we should respect their autonomy. Of course this unto itself leads into the questions of where do we draw the line of understanding and competency. How do we define or test for understanding in patient and what if the patients beliefs are false? Does this remove their intentionality? Also we must ask when does a practitioner trying to help a patient become coercive and violate the non-control aspect.

A second set of dilemmas comes up if we do agree with Ackerman’s ideas on autonomy. If we are too assume that sickness does compromise autonomy we must ask ourselves how much does it violate autonomy and more importantly in what way is autonomy being compromised? Obviously there is pain and discomfort which may cloud judgement yet we take most people who have a cold to be  competent in terms of decision making and only if they are undergoing extreme pain does the question of autonomy even come up. Second it brings up the question of how to limit the power the practitioner has over the patient. If Ackerman’s ideas were to become the standard for the industry this could lead to massive abuse as the patient’s will become overridden by the practitioner’s decision. As much as we want to assume that no physician or doctor would abuse this relationship there is always the chance of this occurring and thus how to prevent such abuse is a problem that must be addressed.

Discussion:

I wish to discuss the second set of dilemmas as the first set of dilemmas has been discussed before and highlighted in more detail in previous case studies.

I personally actually do agree with many of Ackerman’s points. From personal experience sickness does affect one’s mood heavily. Even small sicknesses like the common cold tend to turn people irritable and unhappy do to the pain and discomfort caused by the cold. For more advanced diseases this effect is even worse. An irritable person is not a level headed person and thus is liable to make rash or unwise decisions. This to me means that we should take into account this factor.

The current model as Ackerman has pointed out states that regardless of mood or sickness the default is that we assume the individual to be autonomous and up to the task of doing the best for themselves until proven otherwise. This to me is dangerous as most things in society tend to require the opposite. A person must prove themselves that they are autonomous and competent individuals able to fulfill certain duties for a given task. Take for example the process to get into college or apply for a job. One does not simply tell a college or company by asking them to take them and pay them a small fee. They must prove themselves to the college or company that they can fulfill the duties required to them based on what they have done in the past. Being sick I feel should be dealt with the same way. Physicians have gotten to their position because they have proven they are competent and know what they are doing in regards towards sickness. A normal person does not have that level of training or education. Thus when making decisions towards curing sickness while focusing on patient autonomy while we are sick does not make sense as there is the double threat of lack of understanding and irritability. Thus we should place less importance and weight on patient autonomy and let the practitioner do the job he was hired to do.

This of course does not mean completely remove patient autonomy, but rather put it at less of a premium. As for where to draw the line on understanding education plays a key role. This education on what it means to be sick can be taught as the practitioners are taught thus if the patient is willing to learn more about their disease and treatment then by all means should they be helped by the practitioner in learning more. On how to judge understanding and how much autonomy has been compromised, this should be part of the curriculum in becoming a practitioner. As Ackerman puts it there is a “physician’s art” and to me that means as an art it can only be learned through experience. Thus physicians should be trained in a way that teaches this art. This may not seem scientific but for example professional cooks learn from experience on how to gauge when a meat is fully cooked or when a pastry is right. This is not measured or explained to in lecture only learned through experience and hard work. Society today place a premium on a methodical and scientific approach and there is a stigma on what cannot be explained yet there are many things that we do as humans that cannot be easily put into words and the physician’s art is one of them. This idea of education also applies to how we can limit the possibility of abuse as training for a physician should include teachings about limiting the abuse of the physician-patient relationship.

Citations:

Ackerman, Terrance. “Why Doctors Should Intervene.” The Hastings Center report 12(1982):14-17.

Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York, NY: Oxford UP, 2009. Print.

Ackerman argues that respecting a patient’s autonomy does not mean a doctor should not interfere on a patient’s decision. He argues that it is a doctor’s duty to interfere and give the patient control over his/her body again. I agree with Ackerman that respecting autonomy does not require noninterference, but I do not agree with his construction of illness or the aspect of control.  He argues that illness interposes the body between us and reality (15). This means that a sick body is lies somewhere between the human experience and reality.  I do not agree with this statement for several reasons. First, it makes humans and reality mutually exclusive. This is a problem because both humans and reality a very much intertwined. Human’s perception of the world around them creates reality. Therefore, one cannot exist without the other.

Second, this view asserts that the ill body creates the separation between humans and reality. In order for this to be true, the body has to be separate from the human. A human body is what makes a person a person because the body is the foundation of all human experiences. Through our bodies, we interact with and get to know the world around us. We create reality through our bodies, thus you cannot separate humans from their bodies. Issues arise when you separate a human from his body because he is no longer considered human. For example, a fetus is not considered a person until it has human bodily features and functions.

Third, this view states that illness is not a part of reality. Every human at some point in time will experience some form of illness. This may be the flu, a cold, cancer, or a broken limb. The human body is susceptible to illness and that is a huge part of our reality. Illness is common in the sense that everyone at some point will get sick, but it is uncommon because people should not get sick often. When a person is frequently ill and that illness hinders him from having other experiences that is when illness becomes a problem. But in most cases of illness people are still very much connected to reality. Illness changes reality, but it does not void it. We have to realize that illness is very much a part of realty and the human experience. I find it very interesting that Western society has made the process of aging an illness. As we get older, our bodies naturally begin to degrade and become more susceptible to disease. That is supposed to happen, yet our society has made aging a disease. There a treatments for wrinkles, sagging body parts, and dysfunctional body parts.

Maybe, illness is not the issue. Maybe the issue is how we conceptualize illness. I believe Ackerman wrongly assumes that we have control over our bodies. He believes that it is the doctor’s job to give us control over our bodies again, but I believe that illness reminds us that we never had control. I do not agree with Ackerman’s justifications for a doctor interfering, but I do agree with his conclusion. Doctors should interfere and help patients, but I do believe that the principle of autonomy is strong enough to support this conclusion, or at least not in the way that Ackerman specifies it.

References

Ackerman, Terrance “Why Doctors Should Intervene” The Hastings Center Report 12 (4): 14-17 (1982).

Case

Beauchamp and Childress describe a hypothetical case about woman with Alzheimer’s. She is described as being an extremely happy person. In the beginning stages of her disease, Margo had made a living will. In this living will she stated that she did not want life-sustaining treatment if she were to develop another life-threatening illness. Now, Margo has developed pneumonia. The health care team is now deciding whether or not to administer the antibiotics (Beauchamp and Childress 229).

Ethical Dilemma

The health care team and surrogate decision maker are faced with a dilemma between respecting ones autonomy or acting beneficently. Should they not administer an antibiotic, which respects her advance directive, and will likely result in her death, or should they ignore it and give her the antibiotic, which will probably save her life.

Discussion

In this case, I believe the health care team and surrogate decision maker ought to administer the antibiotics. The health care team would be acting under the principle of beneficence and would be able to save this woman’s life. They would be acting under the best interest standard. According to Beauchamp and Childress “the best interest standard can in some circumstances validly override advanced directives executed by formerly autonomous patients” (Beauchamp and Childress 228). In this case Margo made her advanced directive just as she had been informed of a devastating illness. At this point she may have assumed the worst possible outcomes of the course of her illness. With that assumption in mind, she may have not wanted to be kept alive in order to just suffer more from the notoriously devastating Alzheimer’s. According to the doctor, Margo was one of the happiest people she has ever known. This shows that Margo may have overestimated the severity of her Alzheimer’s. It is unclear that if Margo knew she would have a more mild case would she still have decided to forgo life-sustaining treatment in the case of acquiring an additional illness. It may be unfair to keep a now incompetent person bound to a prior decision, which could have been not adequately informed. This raises issues of advanced directives. One problem with an advanced directive is that it may not be sufficiently explicit (Beauchamp and Childress 189). In this case Margo is not clear about which types of measures she does not want to have taken. She may not want to spend her time in a hospital being kept alive by a ventilator or feeding tubes, but she may not oppose minor interventions. In this specific circumstance she has contracted pneumonia. This illness is life-threatening but it also can be cured with a relatively noninvasive treatment: antibiotics. Margo has also not shown any deep personal views against antibiotics. Giving her antibiotics is acting out of beneficence because it will ultimately save her life. This decision could be considered as an act of hard paternalism because it is acting against Margo’s autonomous preferences but it can be considered justified hard paternalism. It is justified because her pneumonia has put her at risk of significant, preventable harm (being death) and giving her antibiotics would most likely prevent death. This brings one to have to consider the treatment with antibiotics. It is not a futile treatment because it will produce a physiological effect, they are likely to be effective, and are more beneficial than burdensome (Beauchamp and Childress 169). “Actions that prevent major harms… while only trivially disrespecting autonomy have a plausible paternalistic rationale” (Beauchamp and Childress 221). The prevention of harm, giving Margo antibiotics, clearly outweighs the risk of death because they are relatively noninvasive and have a high probability of being effective. In this case the medical team ought to act beneficently because this act only slightly infringes on Margo’s autonomy and will provide a great benefit.

References 

Background

A couple months ago, NPR featured a news story titled “If You Have Dementia, Can you Hasten Death As You Wished?”   The news story discusses the case of Margaret Bentley, a former registered nurse, who decided, and even expressed in a written will, years ago that she wanted to stop eating if she ever became completely disabled. However, now, she has sunk so far into dementia that she needs the help of other people to carry out the wishes that she had expressed while she was competent.  Margaret Bentley’s case has resulted in a conflict between the administrators of her nursing home who do not want to carry the wishes she expressed when she was autonomous while her family wants her to be allowed to die.

For a while, the family hoped she would die peacefully in her sleep. However, as the years dragged on, Bentley became progressively more demented, and her family continued to fight to put her living will into action.  By 2011, 8 years after being institutionalized, Bentley was living at her second nursing home. At this point, the aides were doing everything for her “including diapering, moving, lifting and feeding her”.   The aides as well as the Fraser Health Authority collectively decided that it was time to stop giving her food and water. However, one person at the nursing home, did not want to stop feeding Bentley because she would open her mouth when they brought a spoon to her lips which he or she believed signified that she actually did actually want to eat.  However, the daughter insists that it is simply a reflex and that her mother opens her mouth even when the spoon is empty.

Dilemma

Should the caregivers work with the family to carry out the wishes that Margaret expressed while she was fully competent? Or should they grant Margaret’s immediate wishes who wants to eat when she is hungry?

Reflection

In this particular case, I would have to agree with the Margaret’s family rather than the aides.  The most ethical course of action would be to respect and carry out the wishes that Margaret expressed while she was a competent individual. It is unethical to go against Margaret’s wishes because she gave clear directions of what she wanted to happen if she were to be disabled while she was autonomous, and it is unethical to go against a patient’s autonomy.

The specification used for autonomy is that the patient must be competent in order to make autonomous decisions.  Thus, a possible argument that one of the aides would make would be that because Margaret is currently incompetent, then she cannot express any of her immediate wishes or any changes in her decision.  Because she is currently incompetent, then she does not meet the requirements to carry out the autonomous decisions she made when she was competent. Therefore, it is important to continue feeding her because as an incompetent patient, she may not be able to express what she does or does not want in the present moment as opposed to what she may have wanted in the past.  However, I find this counterargument morally questionable and problematic. Because Margaret is clearly an incompetent patient suffering from Alzheimer’s, then why is it automatically assumed that she wants to eat and continue to live because she opens her mouth when a spoon is placed in front of her? If she cognitively unable to refuse food because of her condition, then shouldn’t her immediate actions be interpreted with more skepticism? Moreover, it is clear that Margaret lacks to the ability to reason when she opens her mouth even when the spoon is empty.  Alzheimer’s has prevented Margaret from expressing that her end-of-life plan be executed in the immediate moment.  Margaret expressed clear preferences not to be fed food and water when reaching a particular condition, and those advance directives should be respected.

In the “Beneficence” chapter of PBE, Beauchamp and Childress outline three different standards that have been proposed for surrogate decision makers for incompetent patients. The three standards are the substituted judgment, pure autonomy, and the patient’s best interests (Beauchamp & Childress 226). The substituted judgment standard requires the surrogate decision maker to “make the decision the incompetent person would have made if competent” (Beauchamp & Childress 227). The pure autonomy standard is  “asserts that whether or not a formal advance directives exists, caretakers should act on the patient’s prior autonomous judgments” (Beauchamp & Childress 228). Lastly, the best interest standards protects seeks “to protect and incompetent person’s welfare interests by requiring surrogates to assess the risks and probable benefits of various treatments and alternatives to treatment” (Beauchamp & Childress 228). When applying the substituted judgment standard and the pure autonomy standard, Margaret’s advance directives should not be overridden, and the aides should stop feeding her food and water.  Margaret clearly outlined that she wanted to stop eating if she became disabled which automatically answers any questions about what she would of wanted or what her decision would have been if she was autonomous.  According to Beauchamp & Childress, the best interests standard is the standard often used to override a patient’s advance directive.  However, even if the best interest standard is applied to Margaret’s case, it is still not morally ethical to continue feeding her. Over time, Margaret has become increasingly disabled and needs help to do anything including moving, eating, and diapering. There are no benefits to continue feeding her to keep her alive because her cognitive and motor abilities will not improve.   Because there are no real benefits, the best interest standard cannot be used as justification to override Margaret’s advance directives. Moreover, the NPR article writes that death “brought by cessation of eating and drinking might sound scary in prospect, but it’s said to be relatively painless if done correctly” (Hening). Thus, if not feeding Margaret does not causes her immediate pain or harm and is is respecting her autonomy, then her advance directives should not be overridden.

It’s also important to highlight that Margaret worked a registered nurse, and was probably very familiar with conditions such as Alzheimer’s and how previously competent people lived when they became disabled.  Margaret’s decision to stop being fed was likely to be a well-reasoned decision that should continue to be respected though she is not able to express them in the present moment. Also, why are the aides, rather than the immediate family, making the surrogate decision for Margaret? The aides of the nursing home are assuming that they know what is better for Margaret than her immediate family. The immediate family probably understands Margaret’s values and wishes far more than the aides who are not familiar with how Margaret was before she was diagnosed with Alzheimer’s. Margaret’s family should be allowed to assume the role of being the primary surrogate decision-makers in order to allow Margaret to end her life the way she clearly wanted as expressed in her will.

Work Cited

Hening, Robin. “If You Have Dementia, Can you Hasten Death As You Wished?”. National Public Radio (NPR). 27 Mar. 2015. Web. 10 Feb. 2015.< http://www.npr.org/blogs/health/2015/02/10/382725729/if-you-have-dementia-can-you-hasten-death-as-you-wished>

Beauchamp, Tom L., and James F. Childress. “Beneficence” Principles of Biomedical Ethics. Seventh ed. New York: Oxford UP, 2013. 222-241. Print.

In this week’s readings, we shift from focusing on the distinction between non-maleficence and autonomy and which takes precedence to the same dilemma that presents itself when beneficence is put into the equation. Beneficence, or the principle to only practice good and prevent harm, is in my opinion more at odds with autonomous decisions than non-maleficence. This is because non-maleficence implicates not causing harm, while beneficence affirms to practice good regardless of the medical staff’s own moral and ethical opinion of the autonomous decision made by a patient.

This apparent conflict between autonomy and beneficence is highlighted in the case of Dan Cowart. Dan was seriously injured in a propane explosion that caused burns all over his body and even the death of his father. Throughout the entirety of his treatment, Dan openly and lucidly expressed his desire to not persist with treatment and no longer endure the management of condition. However, physicians continued to treatment given their expert opinion that his prognosis for a good recovery was high- and he was eventually brought to healthy standards. That said, even after recovering from his injuries, Mr. Cowart maintains that his doctors should not have continued treatment and that if put in the same position, he would still desire to be allowed to succumb to his injuries.

In this particular case, we see the moral dilemma faced by the medical staff tending to Dan’s injuries and watching over his care. On one hand, we have a competent patient who is enduring excruciating amounts of pain in order to potentially get better and voicing that this is a recovery struggle that he does not wish to push through. On the other hand, we have a team of doctors that believe his prognosis is not nearly as grim as he is making it seem and, based on their expert conclusions, choose to override Mr Cowart’s decision and continue with treatment until he recovers. In my opinion, the doctors were wrong in pursuing treatment and submitting Dan to this course of action. Although the doctors were following the principle of beneficence and choosing to prevent further harm (in this case in the form of preventing Dan’s death), it is not within the scope of their responsibility to assume that in order to maintain this principle’s integrity, they must force Mr. Cowart to endure the incredibly painful ordeal that burn recovery is known to  be. The doctors are in no position to say that the pain he would go through with medical intervention was outweighed by the supposed benefits of surviving his injuries. This was ultimately Dan’s call but because letting him die when there was the potential to live weighed heavily on the shoulders and morals of the doctors, they chose to forgo adherence to Dan’s autonomous decision and follow the guidelines of beneficence instead.

Works Cited

1. Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford University Press, 2013. Print.
2. Cowart, Dax, and Robert Burt. “Confronting Death Who Chooses, Who Controls?” The Hastings Center Report 28.1 (1998): 14-24. Web. 20 Mar. 2015.

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.

This week, I read a case entitled “Confronting Death: Who Chooses, Who Controls?,” which contained dialogue between Dax Cowart and Dr. Robert Burt. Dax was injured in a terrible gas tank explosion that left him blind and without the use of his hands. His father was also killed during the accident. Throughout the seven years that he was treated in an acute burn ward, he continually requested that treatment be stopped because of the extreme pain that he was going through, and he attempted suicide three times. Despite being declared competent by his psychiatrist, the doctors ignored his requests and continued treatments until the skin grafts were done, and he was able to walk again. Once again, this case brings up the recurring issue of autonomy versus benevolence. The dilemma is whether or not the patient’s power of autonomy should outweigh what the doctor believes is best for the patient. Should the patient be able to refuse life-saving treatment against doctor recommendation if he is deemed competent? Another question is whether or not the most benevolent act was actually to continue to treat the patient or let him die.

I believe that the doctor’s made the morally correct decision in treating Dax despite his competence and request to have treatment discontinued. Even though psychiatrists declared Dax competent, it doesn’t mean that emotionally he was in the right state to make life or death decisions. He lost his dad in the same accident and was in an incredible amount of pain while he was refusing treatments. It is possible that despite his competence, his judgment was still clouded enough for him not to see that treatment was the best thing for him. Along with the doctors, his family also wanted treatments continued despite his requests.

Usually when we see these cases of autonomy versus benevolence, the patient is refusing treatment and willing to die because he or she is terminal and simply speeding up the process of a quickly approaching, inevitable death. In this case, I don’t necessarily believe the most benevolent act would be to keep the patient alive. If they are in an incredible amount of pain and the treatments are futile, then I think refusing these treatments could be what is best for them. However, in Dax’s case, he is initially refusing treatments because of the pain and possible quality of life (which he later admits was not a factor in his current happiness), but the treatments were going to save his life. And isn’t that the doctor’s duty? To save lives? Of course we want to know that our doctor’s care about our opinions and aren’t being paternalistic, but I would much rather know that my doctor is doing everything in his or her power to save my life than being passive and just waiting for me to tell them what to do. Along with doing what is best for the patient, I would go as far to say that it is a doctor’s moral obligation to save lives when they can be saved. And while it is true that doctors can’t know exactly how much pain their patient is going through, I think it is safe to say that they understand pain more than a normal person. They’ve seen enough pain in their patients to know roughly what can be handled and what cannot. It’s not like they’re completely lacking in understanding of what it means to be in pain. Therefore, I don’t believe Dax’s doctors were acting purely paternalistically when they ignored Dax’s requests and continued to treat him. I believe they were doing what was best for their patient and fulfilling their moral duty by saving his life.

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.

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>.

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>.

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.