Patient Autonomy vs. The Ethical Obligations of the Medical Community: The Case of Dax Cowart

The judgment from an ethical perspective concerning whether or not the doctors and nurses treating Dax Cowart were ultimately ethical in character depends on deciding whether the autonomy of the patient or the duty of the medical community to save lives takes precedent. This seems to be an irreconcilable conflict when the patient’s wishes contradict the duty of the medical community, in so far as the latter, for example, is founded on ethical commitments to the Hippocratic oath, which denote the obligation to attempt to save the patient’s life. To support Dax’s decision, therefore, can only be argued from the perspective of the patient’s autonomy. However, it seems like this is a symptom of our individualistic culture: everything ultimately comes down to some idealized version of the individual, who is viewed as the basic element of all society. In this case, however, the individual is treated as a sort of “all-knowing” entity. But this is not how our existence itself is structured: it is based on relationships, and conceding patient autonomy above all else replaces this with an almost egotistical individuality. The medical community are experts in the field and therefore have a knowledge of the situation that is in most cases beyond those of the patient: furthermore, the medical community has its clear ethical duties to uphold. In this regard, the decision to save Dax despite his protests, was firstly, the medical community’s fulfilment of their occupational obligations, and thus they acted ethically according to this duty, and, secondly, it is an acknowledgement that some decisions perhaps are too much for an individual to make, especially an individual who has suffered trauma from such a devastating injury.

In this regard, it appears that Kant’s ethical theory, commonly known as deontologistics, can perhaps best argue in favour of Dax’s position. This becomes clear when we interpret that what is crucial in Kant’s theory is a notion of duty. Here, therefore, duty would be defined according to the essence that defines the medical profession, and that is attempting to save lives. The personal opinion of Dax here would have to be viewed in light of this higher duty, because this seems to be the point of Kant’s theory: Kant states repeatedly that we cannot get our ethical principles from experience, since experience is made up of ethical and unethical acts. Therefore, Dax’s own personal opinion was based entirely on how he experienced his injury, and not considering that the medical community has an ethical duty to perform, and which ultimately proved to be the correct decision.

The medical community’s underlying reasoning for deciding to ignore Dax, in my interpretation, can be summed up in terms of 1) the ethical commitments that are the heart of the medical community, that is, saving individual lives, and 2) the reality that patients are unqualified to make diagnoses about their own conditions. Accordingly, this perspective includes both a greater ethical perspective and a very pragmatic approach to diagnosis and treatment, which entrusts the years of study and work of the medical community, and in this sense, appears to be an  entirely legitimate conclusion.

In this regard, the issue of autonomy should not be viewed as the be all and end all of the medical procedure. This overlooks how much individuals depend on others for help, for expertise, for counselling, for advice: namely, it overlooks how intertwined our lives are. Certainly, when it comes down to our most deep personal wishes, autonomy should be respected, and it would seem that the right to decide whether to live or die is the most clear example of such autonomy. However, in the case of Dax’s condition, other factors such as the competent diagnoses and treatment of the medical community, and Dax’s own awareness of his situation, have to be accounted for: in short, autonomy should be considered, but is not in itself a knock-down argument for always listening to the patient’s needs for these aforementioned reasons.