Question

Identify and explain the ethical principles that are in conflict with each other in the Dax case. Include the various ethical conflicts from not only Dax’s perspective, but from his mother’s perspective as well as from the providers’ perspectives. Be very detailed in your explainations.

Answer 1

Ethical conflict Dax case:

I. Ada Cowart

Dax Cowart’s mother, Ada Cowart was a religious person. She always had her believe in God and God’s will. The mental strain she had gone through during the whole process is unimaginable. The woman had lost her husband and her child is struggling between death and life, in such a situation even the strongest person would fall apart but she hold herself with determination. It's probably the faith in God and God's rule that made her even stronger. Though she was completely aware of the excruciation that her son was going through but as a mother she had a couple of things to consider. At first, she was afraid if they stop his treatment and medication to let him die, then what would happen if Dax Cowart changes his mind and want to leave. It might be too late to start treating him again. Moreover from a religious point of view Ada sees it against the God’s will to commit mercy killing. During an interview Ada told the interviewer that she had a desire that her son will take church teaching to know more about God and God’s way of living. She was certain in her believe that her son had not made his peace with God yet and wanted him to “realize his responsibility to God and to realize what he should be doing”. Though Ada confessed that seeing her son in agony, sometimes she had the feelings that it would be the best if her son had died with her husband. But as a mother she could never give up the try to save her son’s life no matter how much agony his son had to go through and how many times he begged for death. As a mother her foremost tendency was to keep his son alive.

From my analysis I found that Ada Cowart’s believes and thoughts were based on “Divine Command Theory”. It justifies her action to remain strong with her decision to keep treating her son despite excruciating pain. The theory views rightness as the way God has commanded and the only way to lead a moral life through following God’s rule. So, since God has prohibited mercy killing or suicide she had never positive about stopping the treatment. Moreover, her religious believes that her son have not made peace with God yet also constrain her decision.

II.   Dax's lawyer   -    Rex Houston

Dax’s lawer, Rex Houston played a crucial role in Dax’s case. He was a long time family friend and was also representing Dax’s mother. Along with Dax mother Ada, Houston had played paternalistic role in deciding whether to continue with Dax treatment or not. He really had a great impact on Dax throughout the whole process. His role in Dax life was not only limited to in making decision about the treatment but also shaping his future life. As, an attorney his primary responsibility was to get his client justice. For him, it was important that Dax continues the case as a living person for collecting substantial reparation from the gas company. Since Dax had never married, had no children and no dependent, a dead person of his status would not have any substantial impact on the case. For favorable lawsuit result, Rex needs to demonstrate the excruciating pain Dax had suffered and the challenges with his future rehabilitation. He believes that the best interest lies in getting ample settlement for a better future of Dax and his family. So, he never supported Dax claim to stop his treatment and let him die. Moreover he also helped Dax to plan his rather vague future through counseling, encouraging and helping him and then helping him in getting admission at law school.

So, I think Rex motivation towards his role in Dax case was ethical egoism. Ethical egoism based on the premises of personal benefit. The theory resemblance the importance of self-interest atop of any other factors like human wellbeing or any other moral guidelines. So, keeping Dax alive was his best interest to maximize the benefit from the lawsuit. Olson quoted Rex statement on keeping Dax alive as “had tremendous value….Here you have a person who had lost both hands and both eyes…..It [the law suit] has almost any value you can imagine….To me taking care of the family and taking care of him, I had to have a living plaintiff at the time this went to trial (Olson, 2015, p 240). Unlike Dax mother Rex major concern was monetary benefit through keeping his client alive. However, Rex Houston role were far from his legal responsibility as a lawyer. As a lawyer, his action could have been different, supporting his client’s wish and fighting legally to stop his treatment and let him out of the hospital. But he stood there as a family friend and did what he believes best for his friend and family. Here, Rex’s action could be best described by Situation Ethics theory which based on the premises that human action determined by the particular circumstance. So, there is no absolute right and wrong the best morally justifying action would be the one that brings the most ‘loving’ outcome on that particular situation. Yet it has been argued that Rex was keener to have a favorable result from the lawsuit through getting significant reparation as a lawyer than a real family friend.

III.   Dax's Doctors: Dr. Charles Baxter-Parkland

All doctors' decision was based on similar sort off moral reasoning. The sole intention was to perform their duties as a doctor and treat his patient until he gets well. For that reason, focusing on one doctor's ethical base behind decision making will represent all doctors’ situation. Dr. Charles Baxter, like all other doctors believed that his foremost duty as a doctor and the purpose of medication is to save human lives in the best possible way. Here doctors are rather focused on the end result i.e., saving human lives than the action they are undergoing to achieve desired outcome. So, any possible way sometimes seems to be the best possible way to keep his patient alive. In Dax case, the doctor’s are well aware of the fact that Dax was going through excruciating pain. His plea to stop treating and let him die, so that he can get relief from his agony is a clear expression of his suffering by the treatment. But the doctor ignored his request and keeps treating him because Dax still had the chance to survive.

In my opinion, the doctor’s action was based on situational ethical theory. The theory justifies any action morally right if the action brings the most loving outcome for that specific situation. In situational ethics there is no hard and fast rule in a particular situation. I think act-deontological theory which is also a form of situational ethical theory best describes the moral judgment that the doctors applies during Dax Cowart treatment. According to Frankena “Act-deontological theories maintain that the basic judgments of obligation are all purely particular ones like "In this situation I should do so and so," and that general ones like "We ought always to keep our promises" are unavailable, useless, or at best derivative from particular judgments” (Frankena, 1973, 15). So, it is quite similar with the moral obligations doctor’s have to their patience. Doctors will keep treating their patient till the very end at any possible cost. This dutifulness of doctors is not predetermined or prefabricated and they have to take action on situation basis. Though Dax had requested for a cell phone several occasions but the doctor never had listened to him because there were petty clear that Dax Cowart is going to use the cell phone to contact a lawyer who can file Dax’s petition to stop his treatment. In this specific situation the doctor’s thought that the best things to do and they might take an opposite kind of decision in some other case. One of the Dax physicians reflected on the situation as “I have a very difficult problem in terms of deciding not to treat a patient, because in my opinion when you do not treat a patient, you are in a sense killing that individual. I have the knowledge and the means of caring for this patient so that he does survive, and you are asking me not to do this….Why am I in medicine?” (Olson, 2015, p 240). So, his reflection reveals a golden rule for medical professional put patient life over quality of life patient is living. It was not significant for the doctor whether Dax was blind or deaf the most essential things was he lived.     

Dax Cowart’s decision to die using the Warner Ethical Conduct Paradigm:

Ethical Conduct Paradigm is a matrix of five mind filters that influence us in shaping our decision in critical ethical dilemma. These five factors may have different proportion of influence in different situation. Warner discussed these five factors as: (1) values & beliefs (2) wants and needs (3) relationship (4) intelligence and (5) discipline. These five factors have played a very crucial role in shaping Dax Cowart decision to die rather than live.

Before going in to further details it would be important for the discussion to have some insight on the situation. More than 30 years ago, “Dax” Cowart had an accident that took his father’s life and almost killed him. 65% of his bodies were burnt and he was in excruciating pain. His face, both eyes and his ears were extremely damaged through severe burning. He was entirely disfigured and his sufferings were beyond any human imagination. In addition to his extreme physical pain he was also enduring severs mental trauma because of his father’s death. It is important to find some answers to determine the basis of his decision to die rather than treat. First of all, he was feeling helpless, he was incapable of moving his body part can not see and can not hear almost. In such a situation the treatment he was undergoing was unbearable. So, he has to make a decision and have to make it quick what he should do. He decided not to live and requested to stop treating him because he could not bear the pain any more. The pain was excruciating for both his severe damage due to the accident and his treatment procedure is also very painful. He was in so much of agony that he tried to kill himself in several occasion but failed every times. The following section will try to discover different factors that had influenced Dax decision to stop his treatment and let him die.

Values & beliefs: Values and beliefs are “a group of principals, standards, tenets, or dogma considered inherently worthwhile, acceptable or desirable” (Warner, 2002, p 5). So, values and beliefs are deep rooted in our past. Our past experience and out currents context plays a crucial role in forming our values and beliefs. In Dax case it was probably the current context that shaped his values and beliefs. The doctors were not even certain that Dax will survive or not. So, it entrenched a believe in Dax mind that all his anguish has no ultimate values and he will die after all these sufferings. So, it would be better to die now at least it will release him all the current sufferings. Besides he was so severely disfigured that he was very uncertain about his life after, if he survives.    

Wants and needs: I believe this factor played a very crucial role behind Dax decision. His immediate need was to end his suffering. It was so intolerable that he preferred to die than undergoing the treatment. If we compare Dax situation with Maslow's hierarchy of needs we will a better understand about his mental reasoning. According to Maslow most fundamental need for a human being is his physiological need, the need for physical well being. With his condition, Dax was totally deprived from this basic fundamental needs. The next is safety need, since he can not move his body parts, neither can or hear his feelings of insecurity was much higher. The third one is Love and belonging, he was unmarried, no kid, lost his father in the accident and only have mother to care about. So, he was lacking a sense of belonging. His body was entirely disfigured and it could kill anyone’s self-esteem. It was very evident that even if he survives with his disfigured shape he would not be able to accomplish any of his passion. So, all the needs Maslow indicated were essential for human survival were missing in case of Dax Cowart. The only need at that moment was releasing him from this agony. So, he decided to die.

Relationship: As discussed earlier, apart from his mother, Dax left with no one. So, there was no considerable relationship that could affect his decision. As Dax described “I do not blame my mother for wanting to keep me alive. However, I feel that she should never have been placed in the difficult position of having to make such decision. I feel that I as a patient should have been the only one to make that decision (Olson, 2015, p 239).

Intelligence: Warner describes intelligence as “the capacity to acquire and apply knowledge- the faculty of thought and reason”. It is a combination of knowledge, experience and perception. So, in other word it can be describes as the knowledge gained for experience and latter proper application through perspective skill. So, Dax has the perception that he will not survive and if he even survive through all these excruciating pain he would never be able to live an independent life and have to depend on other’s mercy for the rest of the life. So, he preferred to die.    

Discipline: Discipline can be referred as “self-control or self-determination derived through a combination of experiences, knowledge and emotional-sets. However to establish discipline one have to have control over his emotion, his fear and frustration. With Dax situation, it was quite impossible to have control over frustration. His emotional stress was high because of current agony and fear of future. As a result, his discipline was scattered and he decided to stop his treatment.   

References:

Kliever, L. D. (1989). Dax's Case: Essays in Medical Ethics and Human Meaning. Southern Methodologist University Press. Texas, USA.

Olson, S. E. (2015). Who lives, who dies, who decides? Abortion, Neonatal Care, Assisted dying and capital punishment. Taylor and Francis Group. Third Avenue, New York.

Warner, D. W. (2002). The basic for ethical conduct, an introduction to the ethical conduct paradigm & ethics for decision making case study. Amberton Press. United States.

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