Dax Cowart: A Case Study in Patient Rights and Autonomy

Dax Cowart's Story

• The Incident: Dax Cowart and his father were caught in a propane explosion, resulting in severe burns and his father's death.
• Dax's Wishes: Dax repeatedly asked to be allowed to die, refusing treatment for his extensive injuries.
• Medical Paternalism: Doctors ignored his wishes, leading to his survival but with severe disfigurement and disabilities.
• Advocacy: Dax became a lawyer and patient's rights advocate, emphasizing patient autonomy in treatment decisions
• Ethical Debate: His case sparked ethical debates in bioethics conferences, graduate schools, and hospitals.
• Media Coverage: Documentaries (Please Let Me Die, Dax's Case), news segments (ABC's 2020), and articles covered his story.
• Death: Dax Cowart died at 71 from leukemia and liver cancer complications.

The Right to Die Movement

• Early Advocate: Cowart was an early figure in the right-to-die movement.
• Broader Focus: He advocated for individual's right to choose, not just the right to die.

Medical Perspectives and Competency

• Questioning Competency: Some doctors questioned Cowart's mental state due to pain and medication.
• Charles Baxter's View: Dr. Baxter likened Cowart to a child resisting a shot but ultimately complying.
• Family Influence: Cowart's mother and lawyer insisted on treatment despite a psychiatrist declaring him competent.

The Trauma and Treatment

• Painful Procedures: Cowart described the extreme pain of bleach tank treatments despite morphine.
• Physical Consequences: He lost his eyes, nose, lips, eyelids, ears, and most of his fingers.
• Reconstruction: He underwent numerous surgeries, skin grafts, and facial reconstruction with plastic eyes.

Life After the Incident

• Challenges: Cowart faced depression, sleep problems, and dependence on others.
• Suicide Attempts: He attempted suicide twice.
• Finding Purpose: He found a mission in advocating for patient autonomy.

Impact and Influence

• Positive Influence: Cowart's warmth and articulation positively influenced young doctors.
• Increased Autonomy: Americans, including doctors, increasingly support patient autonomy, especially in end-of-life decisions.
• Death with Dignity: Several states have "death with dignity" statutes.

Background

• Early Life: Born in Henderson, Texas on 12/16/1947, his father was a cattle rancher and real estate agent and his mother was a teacher.
• Education and Military Service: He earned a finance degree from the University of Texas at Austin and served in the Air Force.
• Name Change: He changed his name to Dax after the explosion.
• Legal Career: He studied law despite blindness and lack of fingers, earning a degree from Texas Tech in 1986.
• Accomplishments: He won a significant verdict in 1998 and married Samantha Berryessa in 2003.
• Final Thoughts: Despite an accomplished life, he maintained that forcing treatment upon him was wrong and wished to have a choice regarding medical interventions.

Ethical Considerations and Discussion Points

• Personal Choice: The critical question is whether to end one's life or continue living in severe pain and disability.
• Varying Tolerances: People have different pain tolerances and values.
• Beyond Human Level: Some pain may exceed human capacity to bear it.
• From Able-bodied to disabled: Transitioning from able-bodied to disabled can be particularly challenging.
• Importance of Counseling: Psychological help may have altered Cowart's perspective.
• Pain Minimization: Minimizing pain can significantly influence a patient's willingness to undergo treatment.
• Contractual Model of Human Interaction:
  • Onora O'Neill critiqued the contractual model in medicine.
  • In the contractual model, doctors act solely on patient requests.
  • This model assumes patients possess sufficient medical expertise.
  • Implementation risks include patients seeking harmful treatments.
• Doctor's Role: Doctors are viewed as experts; patients rely on their knowledge.
• The Question of Limits: Where is the line when patients dictate medical procedures, potentially leading to detrimental actions?
  • Nothing is forbidden if it's consented to
  • Robert Burt and Dax Cowart disagree with the contractual model
    • The doctors should check on what the patient genuinely wants
• When is it the End of the Day?: Deciding when to respect a patient's decision to end treatment is a complex issue.
  • Dialogue before conceding to a patient's wish to die
• Check on what the patient genuinely wants: Checking on what the patient wants can be patronizing
• The Importance of Thinking about the Pain: Is Dax's reaction an emotional one?

Key Questions

• Under extreme duress will a person think about the consequences?
• At what point do you listen to the patient?
• How long do you wait before assessing the quality of life?
• Is Death with Dignity appropriate? Can it be written into a law?