Dax’s Case Redux: When Comes the End of the Day?

• Published in: Narrative inquiry in bioethics Vol. 4; no. 2; pp. 171 - 177
• Main Authors: Hurst, Ashley R, Mahanes, Dea, Marshall, Mary Faith
• Format: Journal Article
• Language: English
• Published: United States Johns Hopkins University Press 01.06.2014
• Subjects: Bioethics; Burns - diagnosis; Burns - therapy; Case studies; Consultants; Cowart, Dax; Critical Illness - therapy; Debridement - methods; Decision making; Decision Making - ethics; Ethics; Humans; Injury Severity Score; Intensive Care Units; Male; Medical prognosis; Medical treatment; Middle Aged; Moral Obligations; Narration; Nurse practitioners; Nurses; Ostomy; Pain; Pain Measurement; Palliative care; Patients; Physician-Patient Relations - ethics; Physicians; Right to Die - ethics; Right to Die - legislation & jurisprudence; Social workers; Surgery; Terminal Care - ethics; Terminal Care - methods; Treatment Refusal - ethics; Ventilators; Wound healing; United States > US
• ISSN: 2157-1732; 2157-1740; 2157-1740
• DOI: 10.1353/nib.2014.0029

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.