By JIM NICHOLS
New Mexico recently became the tenth state (plus D.C.) to legalize a “right to die” process. Although using different descriptors, these “medically assisted suicide” laws (New Mexico calls theirs the “Life Options Act”) detail safeguards and procedures for legal steps for an individual to end his or her life voluntarily with the aid of the medical community. Although on the fringe of what most of us think about, this is an idea that has percolated throughout the medical ethics world for decades if not longer.
There have been several pivotal sample cases that have identified just how complicated it is; it is worthwhile for Christians to have at least some exposure to its complexity. One example case is that of Donald (Dax) Cowart. Although pain management techniques are much more sophisticated now than nearly fifty years ago when this occurred, the case remains significant.
In 1973 Dax Cowart was 25 years old, a fan of rodeo and a recently returned pilot from service in Vietnam. He and his father had driven to assess some land for sale in East Texas. Returning to their car, it would not start. They were unaware that they had parked in a dry creek bed over a propane gas line that was leaking. As the father lifted the car hood and they continued to try to start it, the car exploded.
Dax ran through walls of flame for a half-mile and collapsed. He asked the farmer who found him to shoot him because, he said, “Can’t you see I’m a dead man; put me out of my misery.” The farmer refused.
His father died on the way to Parkland Hospital in Dallas where Dax was initially taken. Eventually Dax was also treated in Galveston. His injuries were severe and disabling. He was blind and his ears and nose basically burned off with third degree burns over 65 percent of his body. His legs and arms were badly burned. He was unable to pick up anything with his hands because his fingers had suffered so much damage. Although not as complete as it would be today, the video and written documentation of his injuries and subsequent treatment show their magnitude. In the Biomedical Ethics course I taught for many years, we read the material and watched the interviews and treatment videos and several students turned away.
Treatment and rehabilitation began and continued for months and years. Beginning with the initial farmer and the ambulance, Dax continued to express his desire to die. He did not want treatment. The narcotics given him did not remove the “pain and agony” (his words) and the videos of his treatment illustrate that. Because he was so disabled, he was unable to resist care. He claimed that his autonomy had been taken because he was not being allowed to die, which he certainly would have had his burns not been kept from becoming infected. He had numerous reconstructive surgeries.
The Cowart family lawyer and Dax’s mother oversaw his care and they agreed to full treatment. Several physicians told him they could help him become capable of some degree of normal function. They suggested that the depression and pain of his injuries made it impossible for him to make a reasonable decision to end his life. On the other hand, an extended psychiatric evaluation concluded that Dax was well capable of making his own decisions.
After fourteen months of hospitalization, Dax was released to his mother’s care. In the ensuing years he graduated from law school, joined a firm, married three times, and tried to commit suicide twice. He lectured widely as a patients’-rights advocate. He claimed that he was not advocating that people choose to die, but that individuals had the right to decide for themselves. Even though he said that he was glad to be alive, he still thought his autonomy had been stripped away and that he should not have been treated.
Dax’s story is but a glimpse of some of the complexities in this discussion. There have been other high-profile end-of-life cases with different details. Those include Karen Quinlan and Terri Schiavo.
Especially for those of us trying to follow God, the tension between personal autonomy and community responsibility is troubling.
Dax Cowart died two years ago of cancer at age 71.
Jim Nichols is a retired Abilene Christian University biology professor and current medical chaplain