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Conficts of Interest. The authors report no conflicts of interests.
Abstract. Forty years after Dax Cowart fought to have his voice heard regarding his medical treatment, patient autonomy and rights are at the heart of patient care today. Yet, despite its centrality in patient care, the tension between a severely burned patient's right to stop treatment and the physician's role in saving a life has not abated. As this case study explores, barriers remain to hearing and respecting a patient's treatment decisions. Dismantling these barriers involves dispelling the myths that burn patients must grin and bear intense pain to recover and that a patient's choice to discontinue treatment equals physician failure. Moreover, in these situations, sustained, direct engagement between physician and patient can reduce the moral distress of all involved and enable physicians to hear and better accept when a patient is calling for the end of the day.
Key Words. Dax Cowart, Ethics Consultation, Moral Distress, Palliative Care, Patient Autonomy
"Please Let Me Die."
Forty years ago, Dax Cowart's plea sparked a revolution in the health care community and the burgeoning field of bioethics. "Dax's Case" exempli- fied the battle between medical paternalism and the growing demand for patient autonomy and respect. Since then, a sea change has occurred in patient care and rights lulling us to believe that Dax's case could not happen in 2013. Yet, as the case study below demonstrates, the ethical questions raised when a person with severe but survivable burns wishes to stop treatment are as pertinent and equally complex today as they were 40 years ago.
The setting was ideal. An unexpectedly warm spring afternoon cried out for an all-American back- yard cookout, complete with hamburgers, chips, and beer. After inviting several neighbors over, Carl Olson built a small fire pit in the backyard. Unaware that a helpful neighbor had already squirted lighter fluid on the burning coals, Carl grabbed a nearby can of denatured alcohol to perk up the fire. The hamburgers were waiting.
With a simple shake of alcohol on the fire, lives irrevocably changed. A flame leapt up and engulfed Carl. Carl rolled on the ground to beat out the flames, but the damage was extensive. One of his neighbors rushed to call...