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Truth Through Combat

Dax’s Case

Issues presented by the film, in roughly chronological order. The major players are highlighted in bold.

  1. Dax argues that the theory that the ends justifies the means is a bad one. Is it unjustified in all cases, however? Note that his argument is anti-utilitarian.
  2. Cowart argues against the application of this theory in this case. He suffered a lot of pain because other people believed in this idea.
  3. His life has been changed as a result of other people’s decisions. It turned out OK, but it could have been worse.
  4. Repeated requests to die and treatment refusals: farmer, ambulance.
  5. Ada Cowart‘s (mom) recollection of the story. Can a good case be made for her decisions and collusion against her son’s wishes? She argues that he was not competent to make decisions at first. But at what point should he have been allowed to do so? Later in the film, she’ll point out that killing him would be unchangeable, but saving him would not be.
  6. Doctor: 65% deep burns; overview of the extent of damage to his body. Use of narcotics. Decision-making process (involving Mom as a decision-maker; Rex Houston’s (lawyer) role). Later discusses Dax’s desire to die. Tries to explain initial requests as those of an incompetent patient. “Later, I felt that most of his expressions to the nurses and other people were just means that this individual used in order to get what he wanted, to gain control of his environment, to get people to manipulate…” Is this doctor’s assessment of Dax’s psychological state relevant?
  7. Rex Houston‘s (lawyer) role as a lawyer required him to proceed as quickly as possible with a lawsuit. Did he commit any ethical wrongs in the process of carrying out his duties to Dax and his family?
  8. Nurse: How should her attitude to Dax’s treatment differ from the doctor’s, if at all? Should she have an attitude that is more in keeping with the patient’s wishes? Should she have helped Dax die? Why didn’t she?
  9. Friend: Remember virtue theory. Does the virtue of compassion require the friend to help Dax die? Would the ends (ending Dax’s suffering) have justified the means (killing him)?
  10. The fact that the decision to keep treating Dax is made by the family in cooperation with the doctors is offensive to the sense of individual autonomy, but is it in keeping with sound family values? How would a culture that valued the family over the individual assess Dax’s case and the way that mom and doctor evaluated his treatment options?
  11. Psychological examination showed no incompetence. “On the other hand,” the psychologist notes that Cowart was essentially healthy and was asking people to contribute toward his suicide. The solution was to persist in treating him until he could take his own life if he still wanted to do so. Psychologist also argues that the outbursts were “recreations of angry little boy feelings,” particularly those against his mother. Recollection of conversation between shrink and Dax…psychologist’s “verbal attack”–“If you want to die, then let me fix your hand…Don’t ask us to…literally kill you.”
  12. “If letting the patient die is characterized as playing God, then keeping the patient alive has to be as well.” — Dax. Later discusses depression that set in after he returned home from the burn unit.
  13. 1984 follow-up with Rex Houston. Beer; getting Dax back to work (real estate, law). Re-affirmation of original decision.
  14. 1984 follow-up with Ada. Her recollection of the time soon after his exit from the burn ward. Influence of religious beliefs. Struggles with apparent suicide attempts. Her re-affirmation of her decisions.
  15. 1984 follow-up with Dax. Source of depression (women, uselessness, shattered self-image, cabin fever, blindness and its role in helping him get back his social life). Student life at Baylor Law School. Subsequent success in life. His re-rejection of the “ends justifies the means” theory. Argument that Ada shouldn’t have been placed in the position of making decisions, and that he alone should have had the right to decide. Discussion of principles of freedom (“individual freedom should never be restricted unless it unreasonably interferes with the rights of other individuals”). Argues that it’s not about death with dignity, but quality of life (and that the individual should be allowed to decide what this means, what an acceptable minimum is–for Dax, the standard is now being unable to listen to music).
  16. 1984 follow-up with Doctor. Not treating a patient is to kill him, and that’s not why he’s in medicine.
  17. The fact that “everything worked out” for Dax — should we take this into account now in evaluating the case? Did time prove that Mom and Doc and Rex made the right decisions in 1974?
  18. Were his post-release suicide attempts just calls for attention?
  19. What should we make of the fact that we know burn victims go through a period of depression? Should this be seen as a reason to consider him incompetent?
  20. At what point after the accident was Dax competent? Was there any time at which he was incompetent?
  21. Online Resources:
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Filed under: Bioethics, Uncategorized

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