Free Essay Example: Analysis of Dax's Case

Dax's case is often mentioned in the debate on the doctrine of informed consent. Donald 'Dax' Cowart was an Air Force pilot and amateur pilot who became a stalwart of personal autonomy after unsuccessfully declining treatment for burns in the early 1970s. He was just 25 years old when, together with his father, he was caught up in a pipeline explosion in Texas back in 1973. Cowart survived, although his father succumbed to injuries within hours. He was facially disfigured, blinded, lost the ability to use both hands, and suffered over 65% body burns (Parsi & Winslade, 2019). Right after the incident, Cowart insisted on being allowed to die, although doctors declined to grant his wishes. This essay presents a detailed analysis of Dax's case.

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When the incident happened, the policy of informed consent was already quite well-developed. However, the doctrine of informed refusal was another different matter. Cowart was competent and in the capacity to make informed decisions, despite what his doctors may have thought. Today, this is perceived as a standard in bioethics- a patient in a position to make lucid decisions has an ethical and legal right to decline any treatment, even if it can save his or her life. Yet, in the early 1970s, it seemed like a radical thing to do.

Even if a hospice has an ethics committee, it is advisable to regularly review policies touching on ethical decision-making, and implement necessary improvements. A notable way of doing this involves training staff to apply the four-box method of figuring out ethical decisions. Also known as Jonsen's model, it can be applied to any situation where healthcare staff is faced with ethical issues (Pugh, 2017). The method is practical as it enables staff to rank the salient issue and prioritize what is most important. It is a tool that ensures a healthcare professional has all the information needed to make an ethical decision.

The first step in using the four-box method involves gathering information and then dividing it according to four boxes. The first box is meant for medical indications and is all about the patient's prognosis, the disease to process, and any medical issues that the patient may be experiencing. The second box contains the patient's preferences and highlights his or her wants, desires and goals. It also indicates if the patient can speak for themselves, or whether his or her interests have to be represented by a family member.

The third box is all about the quality of life. It contains information on the patient's ability to enjoy themselves. It also shows the quality of life currently being experienced by the patient and how he or she would like to live. The fourth box holds contextual characteristics and can be thought of as the storage bag that contains the patient's entire information. This includes religious and cultural aspects, family features, living arrangements, and so on. By organizing the patient's information into the four boxes, the ethics committee gets a more accurate picture of what is going on. The next step is all about applying ethical principles to come to an ethical decision and conclusion.

In Dax's case, the principles associated with the second box were violated. According to Jonsen's model, it should be about the patient's preferences, whether or not he or she is mentally capable of making sound decisions, and whether or not he or she understands the benefits and risks of what they were asking for. Despite being in excruciating pain, Dax was in a good mental condition and fully lucid. His injuries were so severe that he unsuccessfully declined treatment at the burn unit of a medical facility in Dallas, where he received painful therapy. He was then transferred to a rehabilitation center where he reiterated his desire to be left to die. His physician at the rehab had actually agreed to his requests. However, Dax's mother and his lawyer took him to another burn unit against his will, where he once again had to undergo painful procedures.

For the first box, Dax suffered severe burn injuries to more than 65 percent of his body. His eyes were severely damaged while his hands and face had third-degree burns. The prescribed treatment was full-burn therapy. There was an initial period during which doctors doubted Dax's chances of survival. All in all, he was stabilized, his right eye removed, and several fingers amputated. During most of his hospitalization which lasted 232 days, Dax repeatedly requested discontinuation of the treatment and that he should be allowed to die. His requests were ignored, with the physicians continuing with wound care, performing skin grafts, as well as provision of fluid and nutritional support. When Dax was eventually discharged, he was completely blind, badly scarred, having minimal use of his hands, and dependent on others to help with various bodily functions.

For the third box, it is worth noting Dax's quality of life before the fire incident. He was a young and athletic former pilot who was running a real estate business. After the accident, he endured a lengthy hospitalization characterized by excruciating pain and intense depression. He also endured severe physical limitations such as blindness, disability and disfigurement. Dax initially had the mental capacity to determine the quality of life he wanted for himself. However, the depression he suffered during hospitalization clouded his judgment at a time when he was expected to make critical decisions. Consequently, his mother and physicians had to make certain quality-of-life decisions on his behalf.

For the fourth box, several contextual features were significant in Dax's case. His mother was opposed to the request to cease treatment for religious reasons. At the time, the legal consequences of honoring his wishes were not that clear. According to Gerrek (2018), the effects of undergoing almost two years of intensive burn therapy were quite adverse. In addition, the way Dax refused to cooperate with treatment is likely to have influenced the attitudes of the doctors and nurses caring for him.

No physician at the time would have agreed to grant Dax death. While members of his treatment team undoubtedly sympathized with his situation, any kind of assisted suicide did not exist then. Performing it was equivalent to murder, and the doctors together with his mother risked legal action if they agreed. As much as his injuries were horrific and painful, they were not terminal. The doctors dismissed any chances of ending his life as they presumably thought they had treatment options. Pugh (2017) argues that Dax's situation revealed that a system was in place that was seemingly bigger than these humanity elements. At the time, the system was made up of a list of codes of physicians and the law in general. It deterred someone who wished for nothing else but to die from doing just that. Whatever Dax wanted, death was simply out of consideration.

If a similar case occurred today, healthcare providers and hospital leaders should consider hospice or palliative car. Often, patients who request to be allowed to die are those who fear pain, do not wish to live a poor quality of life, or feel that their care is burdening their loved ones. A patient suffering from unbearable or intractable pain can choose hospice or palliative care to improve his or her life in the course of their illness. Hospice care is usually adopted when the patient decides to decline treatment, or when all medical treatments or available cures of the condition have failed. On the other hand, palliative care can start at any point during treatment, and usually works hand in hand with the treatment to offer other forms of care.

Both palliative and hospice care can manage the patient's pain as well as other unpleasant symptoms, offer in-home support such as a nurse, and ensure the patient stays in an environment that supports his or her quality of life. They help the suffering patient minimize pain while also offering physical, emotional and spiritual care. Whatever the form of care is applied, death is not hastened on purpose in any way. Patients are likely to have a pleasant time as their stressors are minimized by care offered by an interdisciplinary team of physicians, nurses, dietitians, and health aides, while their symptoms are sufficiently controlled.

The case of Donald 'Dax' Cowart can be credited with bringing into the limelight the issue of informed consent. After suffering horrific injuries in a burning incident, Dax unsuccessfully tried to convince his medical team to let him die. He subsequently advocated for the rights of patients, in particular the right to die. Dax cannot be considered as simply an individual who advocated for his own interests, but those of patients in general who he would have never known or met. He capitalized on a life he had no desire of living in order to fight for those who experiences medical situations similar to his own.

Reference

Gerrek, M. L. (2018). Getting Past Dax. AMA journal of ethics, 20(6), 581-588.Parsi, K., & Winslade, W. J. (2019). Why Dax's Case Still Matters. American Journal of Bioethics, 19, 9, 8-10.

Pugh, G. L. (2017). A model of comparative ethics education for social workers. Journal of Social Work Education, 53(2), 312-326.