Dax Cowart, Burn Victim Who Still Wishes He'd Died, Talks To Margaret Engel; Ten years ago, the life of Dax Cowart, 35, of Henderson, Tex., changed completely. A former Air Force pilot, high school athlete, golfer, surfer and rodeo rider, Cowart was working in his father's real estate business that July day. A freak propane gas leak on a property he and his father were appraising caused an explosion. The blast killed his father. It left Cowart blind, with his hearing impaired, and with limited use of his arms. His burns have disfigured his once-handsome face and only one joint of one thumb remains on his hands. Cowart spent the 14 months after the explosion in excrutiating pain, caused particularly by daily immersions to sterilize his burns. From his first communication with ambulence parademics to doctors, ministers, nurses, as well as lawyers he hired against his family's wishes, Cowart repeatedly insisted that he be allowed to leave the hospital and die. "I didn't intend to die from infection, but intended to commit suicide," Cowart said. "The nightmares and pain involved in the first few months were so bad, I can barely remember it myself. I couldn't tell what was really happening and what was a dream. I was convinced one of the interns was using me as one of his guina pigs. I was burned bad enough I didn't want to live." Despite the fact that 1973 marked the year the American Medical Association endorsed the right of a competent patient to decide whether to continue life-prolonging treatment, Cowart's wish was never granted. Since his hospital discharge, Cowart has taken some graduate courses in law and business construction, but was forced to drop out because of his physical limitations. He married a high-school acquaintance in February, now runs a seasonal small business and directs a local Chamber of Commerce committee. Despite his reentry into society, he still insists that he should have been allowed to die.; Margaret Engel covers health issues and government for The Washington Post.
Q: Why didn't you commit suicide as soon as you were released?
A: I was watched practically every minute. I did not have very much use of my hands. I could not see to get things that I needed, especially being watched as much as I was.
Q: You said you felt a virtual prisoner of some of the doctors you worked with. Why do you think that they ignored your request to refuse treatment?
A: The doctors knew that I would not die from the injuries. I had a chance of being able to walk again. Their thinking, I'm sure, was that if they forced me to receive treatment, at some point I would want to live. I would change my mind after I had an opportunity to adjust. They felt like it would be the best thing for me in the long run.
Q: Why were those motives wrong?
A: The motives weren't wrong. What was wrong was the actual forcing of me to undertake the treatment. I had full use of my mind. I demonstrated that I could think. That I could reason. That I had given it some thought. I knew I was burned bad enough, I didn't want to live. There's no way I wanted to go on as a blind and a cripple. When a patient is forced to undergo this treatment against his or her will, they are really forced to accept whatever treatment the doctors want. The person is completely at the mercy of the doctors on how much attention is given to pain control. The vast majority of people do not know what freedoms they can lose when they become physically incapacitated. Once you're inside a hospital's walls, things are different. With all the emphasis on civil rights, regardless of my feelings, if I wasn't willing to go to the tank, I was picked up bodily anyway and put on the stretcher. Why is it right to be subjected to painful treatment against someone's wishes, especially if he's demonstrated an ability to reason?
Q: Why do you think helpless patients are put in this position?
A: It's just a result of the doctors having the power. The doctors' interest has been to preserve life and also to benefit the patient. But they're trying to benefit the patient on their own terms rather than the patient's. My case was an example of where the two are not the same.
Q: How many operations did you go through?
A: I couldn't even count. I don't remember.
Q: Why did you want to die?
A: Because of the extreme amount of pain. I had to undergo many painful procedures day after day after day. Every day seemed like a year. The passage of time was so slow. Also, I simply did not feel that the quality of life that I would have upon recovering would be such that I would want to continue.
Q: How do you feel about that now?
A: In terms of how happy I am now, I have a very good quality of life. There's many things that have happened every day that are just extremely frustrating. Things that you take for granted (that I can't) -- putting on clothes or going to the restroom or getting in the car or walking down to the store. Reading your mail. Reading the newspaper. It's a really sinking feeling. I've always been real independent. Now I have to rely on someone else to feed me -- for all my private functions. Things like that are very frustrating.
Q: Frustration, however, is different from not being able to do it at all. Do you still wish you had been allowed to die?
A: I don't know how anyone can say -- at least I can't -- that it's worth it. The best way I know how to answer that question is that I have had some very, very good experiences and happy experiences that I of course would not have had if I had died. My contention is that I should have been the one to make that choice at that time. And if I had made that choice I would have refused treatment. To me it's saying that the ends justify the means and I just don't happen to believe that way.
Q: Is the point you're trying to make that nothing in your later life can be traded off with what you went through?
A: Yeah. If it happened again tomorrow, would I still do the same thing? I know that definitely the answer is yes. If I were burned again today? Had to go through this again but at the end of the road 10 years from now, I know it's going to be worth it? Knowing that, would I make a different decision? The answer is no.
Q: You would still opt to die?
A: Yes. I have a life that I did not have then. I might not make the decision as readily. I might be able to endure more pain and push myself to the outer edge. But I still do not want to be forced. I still want to remain in control. I want it to be my decision and not someone else's.
Q: Is your wife ever insulted when you say that you wish you had been allowed to die?
A: I don't think she's insulted. Someone might think that it cast a reflection on her, but it's not. I am happy now. I think what you're thinking is what many people say -- well doesn't the fact that I am happy now and I am enjoying life, doesn't that mean that the doctors did the right thing in forcing me to receive treatment?
Q: And how do you answer that?
A: Well, it's not.
Q: When you thought about your life when you were in the various hospital beds you were in, what did you see in your future? Did you ever predict that you would be married?
A: I really didn't.
Q: Did you think you would be going back to school?
A: My thoughts were that I would be doing practically nothing. Stay at home and sit.
Q: Do you hold any malice toward those doctors and nurses?
A: I don't really hold malice. Even with some of the individuals that I was the angriest with. I'd be the last one to say that they're just bad individuals and I'm still just totally hostile. There are things that I'd still be outraged about if it were happening to me again. Nurses taking food out of the patient's refrigerator and eating it. A little boy that was burned from electrical shock and had both arms amputated -- nurses that set his food down next to him, walked off without feeding him. Just leaving it there. Telling him to do it himself. Then there were nurses that would stay 30 minutes -- sometimes an hour -- after their shift was over, just sit and talk.
Q: One of the medical articles about you said that you didn't really want to die, you simply wanted control. You wanted to assert your rights. What do you think about that theory?
A: He was right on the second assumption, wrong on the first. I wanted both. I wanted the right to control, like I always have wanted the right to control everything in my life possible, ever since I was born. But I also wanted to die. I wanted to be free from the pain. It wasn't just one or the other. It was both.
Q: Why didn't your doctors heed your instructions?
A: While I was adamantly opposed to the treatment, my mother was just as adamantly opposed to their stopping.
Q: How does she feel about it now?
A: She knows the amount of pain I went through. I have not asked her, but knowing everything that she knows now, she would probably make the same decision she made.
Q: When the doctors had the attitude of "We know what's best for you and you'll thank us later on," did you ever feel as if they had stopped thinking of you as a real person? Your mother and brother and sister, too? They weren't thinking of you as Dax, the quite independent, strong-minded individual that you had been up to that point, but as a patient who needed to be cared for?
A: Some doctors are as good as people you'll ever find anywhere. And there are some rotten ones. As far as my family, it reverted back so many ways. It's just like going back in time to where I was a young child and had really no say-so about anything. Unless it just happened to coincide with what they wish. I had very little control. Even after I got out of the hospital.
Q: You don't remember wanting to live during that time?
Q: Did you ever try to take your life?
A: Once about two years after I was released from the hospital I took a large overdose of tranquilizers and sleeping medications, anything I could find. Slashing my wrists, taking aspirin beforehand. Unsuccessful with that, too.
Q: What was your mother's reaction after that last suicide attempt?
A: My mother was always extremely supportive in helping me do most things unless it's something she disagrees with.
Q: Her reaction might have been something along the lines of getting you through very rough years and then having you kill yourself then. Was she angry about this?
A: If she was angry about it, I didn't know it.
Q: Do you think that you would try to take your life in the future?
A: No, I don't think so.
Q: What's the change?
A: If I were in the state of people that I know right now -- who are in a nursing home completely paralyzed in a fetal position with their fingers curled backwards and and cannot move anything but open their eyes -- I would certainly want to die. If things ever return to the point that I could just not function such as the point where I could not sleep --. I just put so much effort into trying to achieve something. Then it all came tumbling down --. If that were to happen -- I don't expect it to, at least for the foreseeable future -- I might possibly --.
Q: You've spent long hours reflecting on your fate and your life. Do you have a vision of what constitutes a human life? Has it changed your views on abortion? Has it changed your views on death?
A: People who are terminally ill, today it is insane for anyone to require that person to undergo cancer chemotherapy or whatever if that is not that person's wishes. What we're doing is not preserving life, we're really just drawing out the dying process. If any given patient wants to receive whatever treatment's available, I think that every effort should be made to accommodate him or her. But if we force people to undergo treatment, what we're doing is putting the individual at the mercy of whatever medical and scientific technology comes into being in the future. We may preserve, if you put it in quotes "life," but what is left of the patient may be only the shell. No quality of life left. No ability to function -- even think. If you define life as just the fact that the individual is not decaying, it's not any life that anyone I know would have an interest in maintaining.
Q: Do you think that medical technology should stop that quest to prolong life?
A: So many of the things that are done to preserve or prolong life can, in many cases, be beneficial. So I don't think the quest should be stopped. But it's something that should be chosen by the patient and not forced upon him or her. One thing I feel that is absolutely wrong, is when we maintain (terminal) individuals in an intensive care unit, in a nursing home, at expense to the public, while we're denying funds that could be saving children that may need certain surgery to preserve their lives. We're not a bottomless pit when it comes to financial resources in our country. I think it's wrong to deny people medical attention while shelling out millions and millions of dollars to keep people in that kind of state alive. And those individuals often have no interest in continuing.
Q: Do you have any idea how much the total for all of your hospital treatment was?
A: I don't even know a ballpark figure but I would not be surprised if it was $200,000 or $300,000.
Q: When did you get to the point of deciding not to take your life?
A: In 1980, when I was able to get some sleep and function on a day-to-day basis, at least partially.
Q: You simply couldn't sleep?
A: I could not get to sleep at night. While I was in the hospital I was a very belligerent patient. I was given some pretty strong tranquilizers to keep me calm. I also was given sleeping pills. As most everyone knows, sleeping medication available at that time -- hell, they can't sleep with it, they can't sleep without it, either. I was still on all this medication while I was at the hospital and I just built up a tolerance to it and I could not sleep until 2 or 3 o'clock in the morning. It made it very difficult to go to class or to function the next day. It made it much harder to think quickly and to commit things to memory. I would be having my sleep real well for awhile. Things would be going well in school and I did not wish to die. Then things hit the bottom of the roller coaster ride and I would not sleep, did not function -- .
Q: What was your name?
A: My given name was Don.
Q: Why did you change that (to Dax)?
A: The primary reason was I was constantly answering to someone that was not addressing me. I do not hear well, especially if there's a little bit of background noise. They can say John or Ron or anything close and I respond. I was trying to think of some way of handling that problem. It was happening all the time. I came up with changing my name to something that would not be confused with someone else.
Q: It's a very distinguished Texas name. It sounds like something that Carson McCullers would use for her main character.
A: Well, to be more precise it was in Harold Robbins "The Adventurers."
Q: What has this experience taught you about your personal strength?
A: I think that I had a lot of strength before the accident. I'm very calm by nature. Very analytical. Look at things and try to solve the problems and not get excited or hyper while in an emergency. But I feel without a doubt I have more mental strength than I did before. How much of it is a result of being 10 years older and more mature and how much is a result of the accident I don't know.