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Ashley Toups
Ethical Controversy Research Paper
28 October 2014
Ethical Controversies
There have been many ethical controversies in the past that are still talked about today, and
there will be more in the future. As long as we have people from different cultural backgrounds,
different values, different religions, etcetera we will always have ethical controversies. This
paper will discuss three ethical controversies, which are “patient rights” in the case of Dax
Cowart, “physician-assisted suicide” in the case of Dr. Jack Kevorkian, and the Terri Schindler
Schiavo case.
Donald Dax Cowart was a pilot in the air force reserve. He also had plans to become a
commercial airline pilot. July of 1973, there was a propane gas explosion that killed Dax
Cowart’s father and left Cowart severely burned. Right after the explosion, Cowart was in
severe pain and started crying out for help. A man heard Cowart’s cries and came to his aid.
Cowart asked the man for a gun so he could kill himself and be put out of his misery. The man
politely declined Cowart’s request, but still helped him to a hospital. Cowart says he was
“forcibly treated for fourteen months” (UVA NewsMakers, 2003). Cowart tried to refuse
treatment. He just wanted to die, but his mother would not allow it because of her beliefs. The
doctors listened to Cowart’s mother more than they did to him. He did have a little say over the
matter of amputations, but even then, doctors threatened to take Cowart to court and have a
guardian assigned to him to let the physicians amputate. Some procedures that were used to treat
Cowart’s burns are not even used by doctors in the burn ward now because they are considered
“barbaric” (UVA NewsMakers, 2003).
Cowart wanted to call an attorney to file a writ of Habeas Corpus so he could be allowed to
leave the hospital and go home to die, or at least be kept comfortable in the hospital until he died.

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Cowart asked if he could use a telephone anywhere in the hospital, but they did not want an
attorney to get involved so they refused him a telephone to use. He even said he would pay a
local telephone company to come and put a telephone in his room for him to use. They still
refused him. Dax Cowart did end up recovering even though he lost function in and had to
amputate some of his body parts. He is now a very successful lawyer. Although he lives a very
successful life now, Cowart still wishes the doctors would have let him die (UVA NewsMakers,
2003).
The case of Dax Cowart has sparked the ethical controversy of patients’ rights and
autonomy versus paternalism. Competent patients have the right to refuse and accept treatment.
Sometimes physicians ignore the ethical principle of “autonomy” and practice more of another
ethical principle called “paternalism.” This means that physicians will not listen to or not care
much about what the patient wants, and the physician does what he or she thinks is best for the
patient instead (Annas & Densberger, 1983-1984).
No matter where you go, rights are important. Rights protect one’s values. They also “help
prevent people from being treated as interchangeable, inanimate objects and insist that they be
treated as unique persons. But rights have special importance in hospitals, as they do in other
‘total institutional’ settings” (Annas, 1992, p. 2). The following is a list of some of the rights a
patient is entitled to in the “Model Patient Bill of Rights”:
1. The patient has a right to be informed (Annas, 1992, p. 9).
2. The patient has a right to know about equipment and research that are being used in the
health care facility (Annas, 1992, p. 9).
3. The patient has a right to privacy of the source of compensation for the health care
facility’s and health care provider’s services (Annas, 1992, p. 9).

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4. The patient has the right to know about medical care and procedures that are used in the
health care facility (Annas, 1992, p. 9).
5. In an urgent situation the patient can be assured he or she will receive care quickly and
efficiently (Annas, 1992, p. 10).
6. The patient has a right to know about a procedure, and what the risks, disadvantages, and
advantages of the procedure are. The procedure will not be done until the patient
understands the procedure and what its risks and benefits are. The patient must also sign a
consent form in order to give the physicians permission to do the procedure (Annas,
1992, p. 10).
7. The patient has a right to know his or her own “condition and prognosis” before
consenting to any treatments, tests, or procedures (Annas, 1992, p. 10).
8. The patient has a right to appoint someone to make decisions for him or her if the patient
is unable to make decisions for himself or herself (Annas, 1992, p. 10).
9. The patient has a right to know who all are providing for his or her care and what their
“professional status and experience” is (Annas, 1992, p. 10).
10. The patient has a right not to be prejudiced against (Annas, 1992, p. 10).
11. The patient has a right to an interpreter if he or she is hearing impaired or does not speak
English (Annas, 1992, p. 10).
12. The patient has a right to see his or her medical record while in the health care facility
(Annas, 1992, p. 10).
Although Dax Cowart went through pain and tortuous, cruel treatments, and is now
disfigured, he still should not have been allowed to die. He is now a successful lawyer. If
Cowart would have been allowed to die, think about how many people’s lives would have

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changed. He touched many people with his story. His case was also probably a learning
experience for not just the physicians who worked with him, but physicians everywhere that
have heard about his story. People who have, are, and will suffer like Cowart should not be
allowed to die. Whether one likes it or not, he or she has a role to play in this world. He or she
may change lives or even save lives. He or she may even change the world whether it is through
a “small” gesture such as giving a little food to a homeless person or through something “big”
like establishing world peace. It is not fair to himself or herself or even the rest of us if one takes
his or her life before his or her time. Think about a play. Every character, even the extras, has a
part to play. Everyone has a role, has a purpose. If you take someone away, everything changes.
It does not matter if it makes a big difference or a small difference, there is a difference either
way. Cowart probably could have gotten his wish to die if Dr. Jack Kevorkian would have been
his doctor.
The BBC (British Broadcasting Corporation), wrote in an article titled “Profile: ‘Dr.
Death’,” (1998) that Dr. Jack Kevorkian, also known as Dr. Death, has claimed he has helped
more than 130 people end their own lives. The BBC also said that Dr. Kevorkian’s first suicide
he assisted with was in 1990. The woman’s name was Jane Adkins, and she suffered from
Alzheimer’s disease. Dr. Kevorkian built a ‘suicide machine’ “using $30 worth of scrap parts
from garage sales and hardware stores” to assist in Jane’s suicide. She died in his van.
An e-research and educational publishing company, called Gale, wrote in an article titled
“Jack Kevorkian” (2008) that probably the last suicide Dr. Kevorkian assisted in, and became
infamous for, was with a man named Thomas Youk, who suffered from Lou Gehrig’s disease.
Thomas was afraid of choking to death and so he asked Dr. Kevorkian to help end his life. Dr.
Kevorkian videotaped himself, in 1998, administering the poison to stop Thomas’s heart and end

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his life. Dr. Kevorkian was charged with second-degree murder and sentenced to jail for ten to
twenty-five years. Gale (2008) also says that “Dr. Kevorkian’s goal in life was to overturn
America's laws prohibiting both active euthanasia and assisted suicide.”
Dr. Jack Kevorkian was definitely one of the cases that sparked the debate about physician-assisted
suicide. Assisted suicide is when a physician or family member follows instructions to
help the patient kill himself or herself (Moody & Sasser, 2015, p. 269). A law that went to effect
in 1991 named Patient Self-Determination Act (PSDA) “requires hospitals, nursing homes, and
other health care facilities to advise all patients at the point of admission about their right to
accept or refuse medical treatment” (Moody & Sasser, 2015, p. 277). Like with any other
debate, there are those who support physician-assisted suicide and those who oppose it. One
reason someone might support physician-assisted suicide is that it shortens or takes away the
pain, worry, fear, stress, financial burden, etcetera on the patient and his or her family and
friends (Kevorkian, 1960). Dr. Kevorkian says that “if a physician can be instrumental in
assuring a more merciful death, then that action is perfectly in line with the ideals of medical
practice” (Kevorkian, 1960, p. 48). Another reason to support physician-assisted suicide is it
gives a person control over his or her life. He or she gets to decide when and how he or she will
die, not the disease. One reason to be against physician-assisted suicide is that sometimes people
are falsely diagnosed, and “prognosis prediction is notoriously inaccurate even when predicting
the last 6 months of life” (Finlay, 2005). Another reason to be against physician-assisted suicide
is the patient may feel pressured into doing it so as to not be a “personal or financial burden” on
his or her family and friends (Finlay, 2005). “Coercion is extremely difficult to detect; and that
diagnosing reversible depression (very common among people diagnosed as terminally ill) is
extremely difficult” (Finlay, 2005).

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Coming from a Christian perspective, physician-assisted suicide is wrong. God still has a
purpose and a plan for you in this world if you are still alive. "'For I know the plans I have for
you,” says the Lord. “They are plans for good and not for disaster, to give you a future and a
hope" (Jeremiah 29:11 New Living Translation). One may not understand why he or she is
going through such immense pain and suffering, but this Bible verse should give them hope as
well: "Trust in the Lord with all your heart and do not depend on your own understanding. Seek
His will in all you do, and He will show you which path to take" (Proverbs 3:5-6 New Living
Translation).
People need to understand that pain is temporary. Whether it is through time and treatment
or through death, they will be healed either way. An individual is not himself or herself when
going through pain. Pain makes one somewhat incompetent. Think of a woman giving birth to
her child. She may do and or say things that she would not normally say and or do if she was not
going through such intense pain. This makes the mother partially incompetent in that situation
for some time. Usually mothers think it is worth all that pain to have their children. Fear and
stress can also make someone incompetent. Someone who is afraid or extremely stressed may
make rash decisions that he or she would not normally make. For example, a soldier at war is
stressed out and very afraid for his or her life. He or she hears something from behind, turns
around, and shoots immediately. Right after the soldier shoots, he or she regrets doing it because
it was a comrade that he or she shot. Pain, stress, and fear turns someone into something he or
she is not.
Yes, going through pain is not easy, but what if everyone chose the easy way out through
physician-assisted suicide? There may be one person that does not want the option of physician-assisted
suicide. He or she may feel extremely lonely since no one can fully understand what he

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or she is going through. No one could help or give advice better than someone who has gone
through the same or similar pain and situation he or she is going through. There is always light
at the end of a dark tunnel, and there is always calm at the end of a storm.
Some people may think it is selfish for someone to choose the option of physician-assisted
suicide because they think that he or she is not considering his or her friends’ and or family’s
thoughts and feelings on the matter, and how this decision will impact their lives. Some people
may think it is cowardly for someone to choose the easy way out because others have gone
through what they are going through and chose to work through it. Others may think he or she is
brave to choose that option because he or she is choosing his or her own destiny and fate. The
truth is people will not fully understand what it is like to be in that situation until they are put in
that situation themselves. Some may think, feel, and react differently than they thought they
would in that situation. Here is another Bible verse that gives hope and encouragement to those
who are or will go through this situation: “Don’t be afraid, for I am with you. Don’t be
discouraged, for I am your God. I will strengthen you and help you. I will hold you up with my
victorious right hand” (Isaiah 41:10 New Living Translation). It would be awfully sad, though,
if someone ended his or her life right before a cure was found for whatever that person was
suffering from.
Should Dr. Jack Kevorkian have been convicted of murder for his role in physician-assisted
suicide? Well of course! Some people think he was a very kind and compassionate man to help
end the suffering of those in pain. Some think he was a murderer and probably lazy. He helped
end many people’s lives and seemed pretty at ease about it. Why did Dr. Kevorkian not spend
his time and money trying to find ways to treat those people, or to at least reduce their fear and
pain, but instead used his time and money to think of ways to kill people and build a ‘suicide

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machine’? Dr. Kevorkian should not have even given the option of physician-assisted suicide.
He should have, instead, encouraged them to fight and try to find ways to lessen their suffering.
Dr. Jack Kevorkian was definitely playing God. God has given us dominion over the earth,
but He did not give us the power to decide when someone should die. “Then God said, ‘Let us
make human beings in our image, to be like us. They will reign over the fish in the sea, the birds
in the sky, the livestock, all the wild animals on the earth, and the small animals that scurry along
the ground’” (Genesis 1:26 New Living Translation). “Then God blessed them and said, ‘Be
fruitful and multiply. Fill the earth and govern it. Reign over the fish in the sea, the birds in the
sky, and all the animals that scurry along the ground’” (Genesis 1:28 New Living Translation).
Neither of those verses say that we have the right to judge whether someone lives or dies. Only
God has the right to decide when it is someone’s time. “You have decided the length of our
lives. You know how many months we will live, and we are not given a minute longer” (Job 14:5
New Living Translation). “The Lord gives both death and life; he brings some down to the grave
but raises others up” (1 Samuel 2:6 New Living Translation). God has equipped physicians with
the intelligence and tools they need in order to help us. Some people want to take God’s role so
they can be in “control” of their own lives.
More from the Christian perspective: maybe the suffering is a chance to give God the glory
and show His awesome power. One can give glory to God by giving praise to Him even through
the suffering. God may want to show his glory and mighty power by miraculously healing that
person. Some examples of Jesus healing people to bring glory to God are as follows: Jesus
healed a man with leprosy (Matthew 8:1-4 New Living Translation); Jesus healed a man who
was born blind (John 9 New Living Translation); Jesus raised Lazarus from the dead (John 11:
38-44 New Living Translation). What if Jesus chose to die before He made it to the cross?

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Maybe that man would have died from leprosy, maybe that blind man would have gone the rest
of his life blind, and Lazarus would have never been raised from the dead to enjoy life a little
more. Also, maybe we would still have to sacrifice animals to be forgiven from our sins and we
would not have direct access to God whenever we need it. Think of someone you care about and
imagine they were diagnosed with an incurable fatal disease. Instead of giving up on him or her,
encourage him or her to fight. Pray with him or her for God to bring the suffering to an end
either through death or through a miraculous healing! This should have been done in the next
case with Terri Schindler Schiavo.
Terri Schindler was born on December 3, 1963 (Terri Schiavo Life & Hope Network, n.d.).
She was a funny and “shy” girl who enjoyed animals, hanging out with friends, and the arts.
Terri met Michael Schiavo, in 1983, at Bucks County Community College (Terri Schiavo Life &
Hope Network, n.d.). After a year, Terri and Michael got married at her church at Southampton,
Pennsylvania (Terri Schiavo Life & Hope Network, n.d.). “On February 25, 1990, Terri Schiavo
had a cardiac arrest, triggered by extreme hypokalemia brought on by an eating disorder” (Quill,
2005). After Terri’s heart attack she suffered from brain damage from the lack of oxygen. It
was concluded that Terri was in a permanent vegetative state. But her parents and siblings
thought that her condition could still improve through therapies, even though they had no
evidence to support their claim (Quill, 2005). Terri’s husband, Michael Schiavo, was appointed
as her legal guardian. Michael believed that Terri would have wanted to die and not be kept
alive in her current situation. On the other hand, Terri’s family believed that she would want to
be kept alive (Quill, 2005). Terri’s PEG tube was removed twice, then put back in. The third
removal was permanent and was not put back in (Quill, 2005). “On March 31, 2005, Terri
Schindler Schiavo died of marked dehydration following more than 13 days without nutrition or

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hydration under the order of Circuit Court Judge, George W. Greer of the Pinellas-Pasco's Sixth
Judicial Court” (Terri Schiavo Life & Hope Network, n.d.). Terri Schiavo died at 41 years old
(Terri Schiavo Life & Hope Network, n.d.).
Some people criticized Michael Schiavo and thought that he was “being motivated by
financial greed, and his loyalty to his wife was questioned because he now lives with another
woman, with whom he has two children” (Quill, 2005). Some say that Judge Greer condemned
an innocent woman to death without knowing her actual wishes because she did not have an
advanced directive. Others criticized Terri’s family because some believed they were being
selfish in their feelings, and just could not let Terri go (Quill, 2005). There were many lessons
learned from Terri Schiavo’s case. One lesson is to educate people more about advanced
directives. Physicians need patients to express their wishes if an event like Terri’s occurs and
they are not able to communicate (Hook & Mueller, 2005).
The ethical principles that were violated in this case are “non-maleficence” and
“beneficence.” Non-maleficence means “to do no harm or refrain from abuse” (Starks, n.d.).
Beneficence means “to do good or to benefit” (Starks, n.d.). The principle of “non-maleficence”
was violated because when they took the tube out, she died a slow death from dehydration and
starvation. Even though they said she was “unaware” due to her brain damage, forcibly keeping
water and nourishment from anyone is still harming that person. The principle of “beneficence”
was violated because they let a woman die without being 100 percent sure if that is what she
wanted or not. The principle of “autonomy,” which is the right for an individual to make his o r
her own decisions, could have possibly been violated (Starks, n.d.). Since Terri did not have an
advanced directive and no one knew for sure what her wishes were, it is not known if autonomy
was violated or not since Terri could not make her own decisions.

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Once again coming from a Christian perspective, the feeding tube should not have been
removed in the Terri Schiavo case. Only God has the right to decide when it is time someone’s
life should end, as stated earlier. Timothy Quill stated in an article titled, “Terri Schiavo — A
Tragedy Compounded” (2005), that Terri “showed no signs of emotion” is a lie. There are
pictures and videos of Terri laughing and smiling while interacting with her parents. Smiling
and laughing are usually signs of the emotion called ‘happiness.’ Being in agreement with
Terri’s family, she could have surprised physicians, who thought she would never progress from
her condition, and actually improve from it through the right therapies, and of course, constant
prayer.
The debates on these cases will probably never be settled. They will be argued about until
the end of time. We must educate ourselves so we will be able to handle situations like this
better in the future.

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References
Annas, G. J. (1992). The rights of patients: The basic aclu guide to patient rights. Totowa, NJ:
American Civil Liberties Union.
Annas, G. J., & Densberger, J. E. (1983-1984). Competence to refuse medical treatment:
Autonomy vs. paternalism [Abstract]. HeinOnline. Retrieved November 6, 2014, from
http://heinonline.org/HOL/LandingPage?handle=hein.journals/utol15&div=26&id=&pag
e=
Euthanasia Pros and Cons. (2011). Who was Dr. Jack Kevorkian? Retrieved November 8, 2014,
from http://euthanasia.procon.org/view.answers.php?questionID=000161
Finlay, I. (2005). ‘Assisted suicide’: Is this what we really want? Retrieved November 8, 2014,
from http://bjgp.org/content/55/518/720
Hook, C. C. & Mueller, P. S. (2005). The Terri Schiavo saga: The making of a tragedy and
lessons learned. Mayo Clinic Proceedings, 80(11), 1449-1460. Retrieved November 9,
2014, from http://www.mayoclinicproceedings.org/article/S0025-6196(11)61439-
0/fulltext
Kevorkian, J. (1960). Medical research and the death penalty: A dialogue. New York, NY:
Vantage Press, Inc.
Moody, H. & Sasser, J. (2015). Aging: Concepts and controversies. California: SAGE
Publications.
Quill, T. E. (2005). Terri Schiavo – A tragedy compounded. The New England Journal of
Medicine, 352, 1630-1633. Retrieved November 9, 2014, from
http://www.nejm.org/doi/full/10.1056/NEJMp058062

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Starks, S. Chapter 4 [PowerPoint �ݺ�ߣs]. Retrieved from
http://moodle.ulm.edu/course/view.php?id=50861
Terri Schiavo Life & Hope Network. (n.d.). Terri’s story. Retrieved November 9, 2014, from
http://terrisfight.org/terri-s-story/
UVA NewsMakers. (2003). Dax Cowart. Retrieved November 6, 2014, from
http://www.virginia.edu/uvanewsmakers/newsmakers/cowart.html

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