Dax's Case in 1973, Donald

Dax's Case In 1973, Donald Cowart and his father were involved in a massive propane gas accident. Donald's father died on the spot; Donald received burns to over sixty-five percent of his body but survived. He spent a grueling 232 days in hospital and many more in rehabilitative centers, undergoing painful treatments and reconstructive surgeries. Even after the treatments, Donald remains blind and disfigured. Throughout his entire stay at hospitals and centers specializing in burns, Donald Cowart begged to die. He even tried to commit suicide on several occasions.

All persons involved in his case ignored his pleas to end his miserable life. Even though Donald, who changed his name to Dax when he was in the hospital, eventually triumphed over his misfortune and became a successful lawyer afterward, he emphatically believes that his rights were trampled on, that he should have been allowed to die as a matter of personal choice, free will, and individual liberty.

"Through it all, Don had remained constant in his view that he did not want to live...He didn't want treatment that would extend his misery and he made this known to his mother and family, Dr. Charles Baxter...attorney Rex Houston, and many others," (5). The responses Cowart received from the people close to him varied from his mom's staunch religiosity to his lawyer's pragmatism to his doctors' varying levels of paternalism and helplessness.

Dax's case, which was made into two films and has caught the attention of all persons involved in bioethics, brings to the fore many key issues of the morality, legality, and practicality of mercy killing. Dax's mom, Ada Cowart initially "felt helpless" when she realized what had happened to her son (5). Having lost her husband in the same accident, Ada clung to Dax's life with hope and conviction. "She prayed and hoped for the best," (5).

Ada Cowart was a religious woman who believed that both suicide and mercy killing were against God's law and God's will. Throughout Dax's case, her position regarding Dax;s pleas remained rooted in her spiritual beliefs. Even as she watched her son suffer, Ada "never lost her religious faith," (10). Moreover, her religious attitude turned paternalistic too: she wanted her son to "realize his responsibility to God and to realize what he should be doing," (36).

Her idea of having Dax obtain "peace with God," however well-meaning, led to significant strife within the mother-son relationship. (6)Even after Donald was released from the hospital, Ada continued to interfere with her son's wishes and in his life. She simply felt she knew what was best for him and for his relationship with God. However, like everyone else involved in Dax's case, Ada Cowart cared deeply about her son and sympathized with his pleas: she "understood her son's pain and anguish," (6).

No mother wants to see her son suffer, yet at the same time no mother wants to see her son die. On some occasions Ada admitted that "maybe it would have been best if Don had died with her husband," (10). However, "her religious beliefs simply made mercy killing or suicide deplorable options," (6). Ada Cowart never gave up faith in either her son's recovery or in his own ability to "find new faith in God," (10).

Ada Cowart's position demonstrates the tricky aspects of dealing with mercy killing on a religious level, as religious beliefs are deeply personal, not shared by all human beings and not formally endorsed by the state. As Donald's relationship with his mother became increasingly more antagonistic and divisive, Don changed his name to "Dax," thereby establishing a new identity, allowing himself to become "born again" in his reconstructed skin. Dax's lawyer Rex Houston was a friend of the family as well as an attorney who represented both Dax and his mother.

The Cowarts were suing the propane company responsible for the explosion, and both mother and son were plaintiffs. The strife between Dax and his mom made representing them difficult. Moreover, the conflict presented a major conundrum for Houston. If Dax was deemed legally competent enough to stand trial in the lawsuit, then surely he was competent enough to make all decisions regarding his medical care. Yet every step of the way, Dax's mother would be consulted about treatment decisions.

Especially during his initial stay at Parkland Hospital, Dax had given his mother power of attorney and so she signed many of his medical forms, even those that were against Dax's express wishes. Therefore, throughout Dax's case, Rex Houston experienced significant conflicts of interest legally, as well as personally. As a friend of the Houston's, he played two simultaneous roles: that of friend and that of attorney.

As a result, Houston's attitude toward Dax likewise grew paternalistic: Houston "adopted an understandably paternalistic position toward Dax's desire to die by refusing treatment or committing suicide," (124). Houston's reasons for denying Dax's wishes were based not on religion or morality as Ada Cowart's were. Rather, Houston's stance was basically pragmatic, based on two main ideas. First, as the Cowart attorney, he was professionally obliged to keep the family's best interests in mind. Doing so demanded that he secure the maximum financial output from the lawsuit against the propane gas company.

In order to secure maximum financial gain from the lawsuit, Dax absolutely had to remain alive, at least during the course of the trial. Thus, he refused to consent to Dax's wishes about ceasing treatment because he frankly needed a "a living plaintiff to achieve the best damage award for the Cowart family," (6). Second, Houston had his own interests in mind. His fees as attorney directly depended on the financial settlement the Cowart's received; Houston actually "stood to recover a large sum of money" through a successful trial," (99).

The more the Cowart's received, the more Houston would receive. Therefore, part of his motives in keeping Dax alive were selfish in origin, but all persons involved in Dax's case had at least partially selfish motives. Houston also contended with the difficulty in representing two antagonistic clients together and considered separating their cases. Perhaps more than any other individual involved in Dax's case, Rex Houston "played multiple roles" as friend and as professional attorney (100).

Like all other persons involved, Houston was "sympathetic and sensitive" to Dax's wishes, and had conflicting and mixed feelings toward Dax's desire to die. Houston did not want to lose a personal friend; nor did he want to jeopardize the Cowart's financial recuperations and his own. His refusal to comply with Dax's wishes was unique in the case, but represent what most attorneys working on similar cases would deal with during the course of their work. Dax Cowart received treatment from a number of different doctors, nurses, and specialists.

All had their own perspectives regarding Dax's case. Donald initially spent 232 days in Parkland hospital. There, Doctor Charles Baxter "remained undaunted by Don's pleas to stop treatment, dismissing them at first as the typical response of burn victims to the pain of their wounds and treatment, (5). However, as the sincerity of Donald's pleas grew evident and the extent of his treatment obviously overwhelming, Dr. Baxter attempted to discuss openly with Ada Cowart and Rex Houston Dax's desire to die. When neither his mother nor lawyer consented to treatment withdrawal, Dr.

Baxter had no option but to continue treatment (6). While Baxter sympathized with Dax's needs, his attitude toward his patient became overtly paternalistic. "Dax perceived his relationship with Dr. Baxter to be that of a prisoner as well as a patient. Dax was not at first taken seriously by Baxter as a person capable of making his own treatment decisions," (121). However, some bioethicists suggest that physicians often assume that "patients are incompetent if they disagree with their doctors," (121).

In a sort of double standard, many doctors treat patients who refuse treatment as automatically incompetent; if they agree with doctor's orders then they are automatically deemed competent. Because of his refusal to accept treatment and because of Dr. Baxter's assumption that his patient was incompetent, Dax's mother and lawyer were consulted for his medical options.

Baxter's motivations were complex; he admittedly ignored Dax's request to die in the first phases of his treatment because many patients in such extreme pain, in shock, and also under the influence of powerful painkilling narcotics "could not be trusted," (121). In some instances, the patient cries out for mercy killing and in retrospect are eternally grateful for the doctors not having consented to their wishes. However, as Dax's treatment timeline lengthened, Dr. Baxter realized "how serious Dax was about wanting to die and that he was rational and competent," (121).

Nevertheless, Baxter felt his duty as Dax's doctor was to keep him alive, to deliver to him the best possible treatment so.