Last Saturday Tim Bowers was paralyzed from the shoulders down when he fell out of a tree and crushed his C3-5 vertebrae. The next day, when his paralysis was explained to him, he chose to have his breathing tube removed and end his life. Bowers, age 32, an avid outdoorsman and recently married, father-to-be from Decatur, Indiana, was deer hunting when the accident occurred. He was put on a ventilator and medical sedation.
According to an article in my way, doctors explained to the family that he would be paralyzed and could be on a ventilator for life. The article says he would never walk or hold his baby and might live the rest of his life in a hospital. His sister, Jenny Shultz, said that her brother previously had talked with his wife about never wanting to spend his life in a wheelchair.
The day after his injury, at the request of his family, doctors brought Bowers out of sedation and told him of his prognosis and asked him if he wanted to decide what he wanted to do. Bowers wanted his breathing tube removed so he could talk. Doctors explained they were not sure how long he would live without the tube. Bowers said he understood. Doctors asked him if he wanted the tube reinserted if he had trouble breathing. Bowers shook his head no.
He died five hours later, surrounded by friends and family.
I can’t imagine how gut wrenching this must be for Bowers’ family, yet the story, which has been covered by over 100 media outlets worldwide, leaves more questions than answers.
Did the doctors tell the family that Bowers would surely be paralyzed for life? If they did, how did they know just one day post-injury? New Mobility editor Tim Gilmer points out that doctors have no way of knowing for sure the ultimate outcome of a spinal cord injury in the first few weeks, months, or in some cases, even years post-injury.
Although with a severe SCI, recovery is highly unlikely, it does happen. I have a friend who crushed his C4-6 vertebrae in an accident and was told he was a complete C4 quad. Against all odds, two weeks later, the swelling in his spinal cord and spinal shock went away, and he woke up with complete sensation and movement.
Did the doctors provide the Bowers with information about possibilities of a fulfilling life, and were they familiar with examples of high quads living active lives, even if there is no return?
The article doesn’t explain why Bowers chose to die so soon, while he and his family were still in shock. Wouldn’t it have been better to at least explore the possibilities? Was it a financial decision? Could he have been uninsured, underinsured, in a difficult financial situation or unable to imagine how he might make a living or otherwise provide for his family? It isn’t uncommon for a severely injured person, especially when the injury is so new, to feel pressure to go off life support and leave his family with any savings they might have.
In my opinion, this story smacks of the “Million Dollar Baby” bias, where a fighter becomes a quadriplegic and asks her trainer to kill her — which he does. I feel that movies like this and media portrayals of high-level paralysis are in large part to blame for this kind of snap decision. And with this highly influential movie, the tragic character was a fictional invention.
In real life, I am fortunate to know many complete, high quads with amazing lives who have been fulfilled through participating in outdoor athletics, including sailing and skydiving, broadcasting Olympic Games, traveling the world, finding love and adventure. Case in point: Jim Finch — a C1 quad — who breathes on his own with the help of phrenic nerve stimulator implants. He became an amazing designer of adaptive equipment, traveled the country and explored the outdoors.
Medical ethicist Arthur L. Caplan of New York University provided his two cents’ worth on CNN, saying he was OK with Bowers’ decision because of the conversation he had had with his family about a month earlier when he was adamant that he didn’t want to live a life in a wheelchair, didn’t want to be paralyzed. “That makes me far more comfortable with this,” says Caplan, who leaves us with a cringe-worthy holiday message: “Thanksgiving is coming, use this case, talk to your friends, talk to your family, say this is what I’d want — I’d want everything, or I’m not a person that would want to be wheelchair-bound.”
Wheelchair-bound? Does Caplan even know what that ill-chosen, misleading term means to those of us who are paralyzed — including many high quads living useful, active lives? What makes him an expert on spinal cord injury?
Choosing to end our life is something that can only be exercised once. Do you think the Bowers were given enough information to make this decision?
New Mobility editor Tim Gilmer has also written about the death of Tim Bowers here.