A Med School Memoir

In our ethics class recently, we discussed the case of Dax Cowart.  His case is well known in the medical community, but I had never heard of him before–for those who aren’t familiar, here’s a quick rundown of his story.  In 1973, Dax and his father were surveying some land in rural Texas that Dax was thinking about buying.  When they went to start the car to leave, they were caught in a freak gas line explosion.  Dax’s father did not survive the accident, and Dax was covered in severe burns on the majority of his body.  At the time of the incident, Dax asked the farmer who came to his rescue for a gun so that he might put himself out of his misery, but the farmer declined.

From that point on, Dax was subjected to over a year of medical treatment against his will.  As he was completely incapacitated, he didn’t have the strength to refuse treatment by walking away–instead, his body was actually physically carried, against his will, back and forth to various modalities of painful treatment such as dips in a solution of bleach, and wound debridement procedures that were, according to Dax, agonizing.  He continuously asked to be left alone to die because he was in such excruciating pain, but his physicians continued on with the treatment despite the fact that Dax continuously refused treatment.  As a result of the accident, Dax was left blind in both eyes and without the use of either of his hands, not to mention disfigured.

One of the reasons the doctors continued to provide him with treatment, despite his refusal, was that they assumed he lacked the adequate capacity to make such decisions, on account of his condition.  During the course of his treatment, two psychiatrists were brought in, and both confirmed that, in fact, he had the full mental capacity to be making these decisions on his own; his decisions to end treatment did not stem from the fact that he was insane–he simply didn’t want to bear the pain anymore.  Regardless, the power to determine his own fate was stripped from him and given to various proxies–namely his mother and his lawyer.

Dax’s case brought the issues of a patient’s right of autonomy, and the patient’s right to refuse treatment into focus.  To this day, Dax maintains that he should have been allowed to die in 1973, even though he is now alive and leading a productive life.

I’ve been thinking a lot about this case.  I agree that a patient should have the right to refuse treatment that is being proposed–especially if that treatment is tantamount to torture, as some of Dax’s treatments were.  But at the same time, this case seems so much more complicated than that, because the physicians knew that if they stopped treating Dax, he would die.  And no physician wants to let a patient die if he or she can help it.  Putting myself in the shoes of Dax’s physicians, it’s hard to imagine myself being okay with letting him die, even though he was practically begging for death.  It’s a really tough case–one that I hope I never have to face!

As I mentioned before, Dax is currently alive and well, and he has become an advocate for patient’s rights.  I found a lecture that he gave at the University of Virginia not too long ago.  I highly recommend it, for those who aren’t familiar with his story.  It’s not for the faint of heart, but it really does highlight the essence of his struggle.

Link: Dax’s Story: A Severely Burned Man’s Thirty-Year Odyssey

Tags:   Dax Cowart · ethics4 Comments