The recent news story of Tim Bowers consenting to die one day following a traumatic spinal cord injury that required emergency intubation is troubling to say the least. The principle of medical consent is well established, and if news reports about Bowers’ death are to be believed, these principles may not have been followed. The widely circulating news story reported that his family requested that he be brought out of medical sedation, after which he was asked, “Do you want this?” Imagine the state of mind of someone waking for the first time in his life to paralysis from a sedated state with a tube in his mouth that prevented him from talking.
Freedictionary.com states that “consent” in this kind of situation “must be voluntary, competent, and informed. Voluntary means that, when the patient gives consent, he or she is free from extreme duress and is not intoxicated or under the influence of medication and that the doctor has not coerced the patient into giving consent.”
The University of Minnesota website (www.tc.umn.edu) clarifies the meaning of informed consent (underlined in original): “Informed consent could never be more important than when the outcome being considered is death. If the patient and/or the proxies are to give informed consent to death, they must have a complete grasp of all the relevant medical information. And because the medical facts might be difficult for some deciders to grasp, sufficient time must be allowed for all concerned to become educated to whatever extent is possible for them.”
Need I go into the definition of “competent”? While Bowers may have been competent to decide who would benefit from his will, a “complete grasp of all the relevant medical information” pertaining to his spinal cord injury is far more complex and difficult to master. Most doctors and nurses do not know enough about SCI to competently treat a newly-injured person. That is why we have rehabilitation hospitals and model SCI treatment centers. That is where the experts are.
As for having “sufficient time … for all concerned to become educated …” how long after waking from a sedated state of semi-consciousness is sufficient? A few hours, several weeks, a year? While not a quad, I’m in my 48th year since crashing in a plane and sustaining a lower thoracic SCI, and I am still learning new lessons each day about living with SCI. How could Tim Bowers truly understand what might lie ahead for him just minutes after being aroused from a sedated state?
True, his sister, a nurse, had seen quads in ICU, but had she ever visited a rehab hospital or gotten to know quads of a similar level as her brother who had gone on to live fulfilling lives? It’s understandable that his sister and family wanted what they thought was best for him, but was anyone in the family, most of all Bowers himself, competent to truly know his potential as a quad?
What is most reprehensible, in my opinion, is the role the hospital and doctors played, or rather, didn’t play. What was the big hurry in forcing a sedated patient to wake up and make such a decision? Where was the Hippocratic Oath — the moral lynchpin of the medical profession — to first “do no harm,” when it was most needed?