Dax Cowart: Case Study

Should a patient be allowed to deny life-saving care if they wish to die? Is there a difference between killing and letting die? Is there any amount of pain that could be equivalent to death? These questions, and more, arise when discussing the case of Dax Cowart (1947 - 2019), a former Air Force pilot, attorney, and notable figure in medical ethics. 

In 1973, after visiting a plot of land to possibly purchase along with his father, Dax's life changed forever. An underground pipe near where their car had been parked was leaking propane gas, prompting a freak explosion when they attempted to start the car. Dax's father perished almost immediately, declared dead en route to the hospital. Dax, however, attempted to fight. After making his way out of the car, covered in shattered glass from the windshield, he bolted into the forest, running through three walls of fire, collapsing after a mile and a half with exhaustion and third-degree burns on his face and 65% of his total body surface area. 

Dax begged a farmer, who was the first to arrive at the scene, to let him die.  

"Get me a gun. Can't you see I'm a dead man. I'm going to die anyway." 

The farmer refused, and soon after paramedics arrived. Dax spent 14 months receiving treatment, ranging from skin grafts to chlorinated baths, many of which Dax likened to being "skinned alive". During his treatment, Dax begged doctors to let him die, and even attempted suicide multiple times. But his pleas were ignored, even after he was deemed by a psychiatrist to have proper decision-making capacity. 

Dax left the hospital with only a fragment of his thumb, both his hands having to be amputated due to the burns, and impaired hearing due to damage to his ears. 

Dax's case begs questions about what it means to have proper decision-making capacity, whether or not a patient should be able to refuse life-saving care, and the role of a medical professional, specifically when it comes to listening to the patient and considering their wishes. In Dax's situation, during his treatment, he repeatedly tried to emphasize the fact that he wished to die rather than continue living with his ailments and pain, but was not listened to. However, as a result of his living, Dax was able to go to law school, become an attorney, and continue to help other people. 

Had Dax's wishes been granted following his accident, the long and productive life he had been able to live would not have occurred. However, his case raises concerns about the paternalistic nature of many medical professionals and the autonomy of many burn patients. 

To read a full case study on Dax Cowart, as well as other burn victims, check out this article from the American Medical Association Journal of Ethics. What are your thoughts on Dax's case, how do you believe proper decision-making capacity should be determined, and what would you have done in the position of one of Dax's medical professionals?