The case of Dax Cowart serves as a paradigmatic example of the issues that form the basis of bioethics. As a result of an explosion in 1973 in Texas, Cowart experienced the burning of over two-thirds of his body, blindness and the loss of function of both of his hands. (Burt, 1998, p. 14) Cowart underwent “extraordinarily painful treatments” for a period of two years, during which he expressed his wish to die by refusing these treatments, a plea that was ignored by medical practitioners, despite a psychiatrist’s diagnosis that Cowart was in fact “competent” when making this request. (Burt, 1998, p. 14) If the case of Cowart is so powerful, it is because it speaks on an intuitive level to the profound suffering any human being can potentially experience and the apparent complete rejection of numerous ethical principles that support the notion that the one suffering should decide his or her own fate.
Cowart’s pain can only be imagined by others, but we nevertheless can, to a degree, relate to this suffering to the extent that we can easily conceive ourselves in a situation where we experience a similar horrible fate as that of Cowart. Framed in this manner, the focus of bioethical concerns should be on the one who is experiencing this suffering. Clearly, the most explicit ethical principle that was being violated when Cowart’s pleas to stop his treatment were rejected is that of autonomy. Cowart expressed his wish to die by refusing treatment. Further, this autonomous decision was confirmed by a psychologist, who established that Cowart’s request was made with a full consciousness and understanding of his choice. In essence, by rejecting Cowart’s request it could be argued that his own dignity as a human being was rejected. The counter-argument would be that to keep Cowart alive is an example of preserving human dignity, by attempting to keep human life living. Yet human dignity potentially is not the same as human life, they are, after all, different concepts.
Dignity appears to be a much more contextual concept: one individual’s conception of dignity may not be shared by another. Yet if we stress the importance of Cowart’s autonomy, and, furthermore, that it was Cowart who was suffering, then dignity here could be re-framed in terms of Cowart’s own understanding of what a dignified life meant: the absence of suffering. This, in other words, is a concept of beneficence, whereby the imperative “to act for the benefit of others” (Johnstone, p. 42) can only occur in understanding what the Other wants. Cowart, in other words, is a specific example of the principle of consent: namely, the priority conferred to the “patient’s informed consent.” (Burt, 1998, p. 17) Cowart did not, in fact, give his consent to the treatments he was receiving, but explicitly opposed them. Cowart’s voice in the future of his own life was completely ignored by doctors and thus he was silenced from the entire ethical debate about his own existence.
Certainly, it can be argued that Texas law did prevent the medical personnel from acting according to Cowart’s autonomy. However, even though the law is by nature subject to interpretation, as Cowart himself states, “there is no legitimate law, there is no legitimate authority, there is no legitimate power anywhere on the face of this earth that can take the right away from a mentally competent human being…to force other kinds of medical treatment upon you without your consent.” (Burt, 1998, p. 16) Thus, whereas under Texas law there is no law allowing euthanasia, Cowart framed his experience in terms of forced non-consensual medical treatment. Even if one opposes euthanasia, the real issue here, as Cowart places it, is an ethical consideration for the desire of the Other that was completely ignored in his case. Not only this, but his own voice was completely denied from the debate. To the extent that we value individual autonomy, that we value that a human being should have a voice in his or her own life path, then the Cowart case demonstrates precisely what occurs when such a voice is taken from an individual life.