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Synopsis of The story of Dax Cowart : In 1973 Donald ‘Dax’ Cowart, a 25-year-old, and his father were victims of a pipeline explosion in east Texas. From the earliest moments following the explosion, Cowart insisted on being permitted to die ._Dax was rushed to the Burn Treatment Unit of Parkland Hospital in Dallas. As the result of a freak accident tax Cowart was left severely burned (over 65% of his body), and damage to both eyes, ears, and hands was beyond repair. During much of his 232-day hospitalization at Parkland, his few weeks at the Texas Institute of Rehabilitation and Research in Houston, and his subsequent six-month stay at the University of Texas Medical Branch at Galveston, he repeatedly pleaded for treatment to be discontinued and that he be allowed to die. Despite this demand, wound care was continued, skin grafts performed, and nutritional and fluid support provided. 1
The words Murder and Euthanasia resonate in two very different ways, both so final, however, one is associated with a daunting horrible act, and the other is associated with the act of mercy. Physician-assisted suicide (PAS)is a passionately debated topic today, ripe with both moral conflict and ethical decision-making. Physicians have always been seen as resuscitators, healers, and those that have taken an oath, to do no harm now physicians are asked being asked to transition from the role of resuscitator to the role of a facilitator of death. In addition to causing controversy among practicing physicians today, there are divided opinions amongst the public resulting in opposing sides, one that believes physician-assisted suicide should be legal and another that disagrees with the practice altogether The case of Dax Cowart demonstrates the complexity of bioethical principals such as autonomy, beneficence, nonmaleficence, and justice1. This paper seeks to prove that PAS does not violate the integrity of medical practice, by examining arguments both for and against PAS and how it relates to bioethical principles such as autonomy, beneficence, nonmaleficence, and justice.
The case of Dax Cowart is a case in which the patient’s autonomy was neglected. Dax attempted to exercise his moral and legal right to autonomy, requesting life-sustaining interventions be stopped, his request was ignored by medical professionals choosing to act in a manner they determined would result in the highest patient beneficence1. It can be assumed that the goal of medicine and healthcare patient beneficence, implied by the Hippocratic oath, is first, do no harm . Thus, Intrinsic goals of healthcare include alleviating pain, curing ailments, prolonging life, alleviating pain, and providing treatment options that result in maximal patient beneficence, a balance requiring that good outweighs the harm. Often overlooked is the fact that patient beneficence has an intrinsic margin of uncertainty, primarily depending on means that have risks; such as convenience and cost. Thus the patient’s values must be weighed when determining beneficence. In the case of Dax Cowart, medical professionals assumed prolonging Daxs life would result in something commonly perceived as the highest beneficence, but for Dax, it would come at a price he was simply not willing to pay. Dax went on to pursue a law degree, becoming a lawyer and a prominent advocate of patient rights of autonomy1.
In order to accurately address the argument for physician-assisted suicide, the distinction must be drawn between euthanasia and assisted suicide. In physician-assisted suicide, the physician provides the patient with the means to end his or her own life. In euthanasia, the physician deliberately and directly intervenes to end the patients life; this is sometimes called active euthanasia to distinguish it from withholding or withdrawing treatment needed to sustain life (Frileux 330). The Oregon Death with Dignity Act, enacted on October 27th, 1997, made PAS legal. The Death with Dignity Act gave physicians the right to prescribe a lethal dose of medication to terminally ill patients, experiencing persistent, intolerable pain, under certain constraints. These constraints included the patient’s prognosis being confirmed by a second physician, and the patient making a series of requests, both oral and written over a period of 15 days. Furthermore, that the patient must be competent, and lucid enough to understand the full extent of the consequences of their request and have had all other treatment options explained to them. The physician is not allowed to administer the lethal dose, it is prescribed for self-administration only, after a period of time has passed to make sure the patient is sure of their decision (although the patient can withdraw their decision at any time) (Ganzini, 2000).
Proponents of the legalization of physician-assisted suicide make their cases using several different arguments. Most compelling is the argument for patient autonomy and self-determination in end-of-life care. &. there ought to be a right to physician-assisted suicide under United States law in order to enable qualified patients to avoid unnecessary suffering, to enable qualified patients to die with dignity and to respect those patients right to autonomy or self-determination (Wellman 19). Proponents argue that quality and value of life is not in the eye of doctors, nurses, or any other healthcare professionals. It is uniquely subjective, held in the eye of the beholder, making them the most qualified to make the decision that their quality of life is no longer at their standard of living. Allowing the patient to end their suffering results in patient beneficence. In addition, advocates of PAS see it as a means of preventing possible abuses of doctors that seek to illicitly assist patients’ sources. Without the proper sequencing and events in order, a physician that engages in clandestine activity could find themselves accused of murder.
Opponents of legalizing physician-assisted suicide make their argument based on the premise of its current existence as a criminal act. There are religious undertones to the argument, suggesting suicide be viewed as a sin and furthermore, that the fate of each individual resides in a higher power. Other opponents of physician-assisted suicide resist the act on the basis of conservatism and the mere sanctity of life stating, To legalize euthanasia would damage important, foundational societal values and symbols that uphold respect for human life (Somerville 33).
There is an additional argument against physician-assisted suicide that states, that the role of the physician in PAS will cast physicians in a conflicting light. Do opponents contend that the act of PAS violates the integrity of medicine as a whole by discouraging the pursuit of health and healing and furthermore jeopardizes strains? physician-patient relations. As it stands, physicians are held in high regard by society. The Hippocratic oath that doctors take has led the public to associate the role of the physician with acts of altruism and healing. Opponents of PAS argue that allowing the physician to participate in ending a person’s life, even if not actively, by providing the means to end ones life, would have an adverse effect on the public perception of the physician, and consequently, the level of trust the public bestows in healthcare professionals as a whole. Source
After examining the arguments both for and against the legalization of physician-assisted suicide, I am in favor of the legalization of physician-assisted suicide. I feel that the religious argument made by opponents of PAS is a difficult one to defend. As it stands, the law is not, and has never been, dictated by faith. Faith is a subjective entity and laws must apply to a variety of faiths and atheists equally. The Hippocratic oath argument can be addressed using similar reasoning, non-maleficence is an additional subjective entity. While some will view the role of the physician in PAS as an act of maleficence, those who have their pain and suffering alleviated by the physician’s role in PAS might see it as an act of benevolence, by allowing them to die on their own terms, under the circumstances of their choosing, with their dignity intact. Furthermore, I don’t foresee the role of the physician in PAS leading to a stigma in the profession or leading to a mistrust of healthcare professionals by patients. Physicians have been implicated in procedures opposing advocates of the pro-life movement procedures (i.e. prescribing birth control, administering abortions), and their role and reputation in society are still very much intact. Life is a truly precious gift and should be treated as such. However, the obligation to alleviate pain and end suffering is an obligation that should not be overlooked. In the unfortunate circumstance where a patients diagnosis is terminal and the patient’s prognosis holds unimaginable suffering, there is a need for PAS and thus it should not be a crime for a physician to do the humane, altruistic thing and assist the patient in passing peacefully.
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