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The story of Don Cowart is remarkable in some ways but commonplace in others. A man’s wish to die is rather extraordinary in and of itself; but the pattern of events that shapes such a wish often is woven of the fabric of life’s everyday occurrences. Such is the case with Cowart. Ray and Ada Cowart moved their family from the Rio Grande Valley to the small East Texas town of Henderson in the sixties. Ray prospered over the years as a rancher and real estate agent. Ada became a teacher in the Henderson school district. Their three children—Don, Jim, and Beth—were no different from other kids reared in a close-knit community. In fact, they were ordinary people living ordinary lives. “Donny Boy,” as he came to be called by his father, was popular in school and excelled in athletics. He was captain of his high school football team and performed in rodeos. He liked to take risks, a trait that often dismayed his mother. It was risk taking that would later lure him to skydiving, surfing, and other sports of chance. Don Cowart left Henderson in 1966 to attend the University of Texas at Austin. He had planned to return home at his graduation three years later to join his father in business; however, when notified of his military draft selection, Cowart instead elected to join the U.S. Air Force. He became a pilot and served in Vietnam. He married a high school sweetheart in 1972, but they divorced eight months later. In May 1973 he was discharged from active duty and returned to Henderson, where he began working with his father in real estate. July 23, 1973, seemed no different to Cowart from any other Wednesday. It was hot and sultry as the afternoon sun slipped low along the pine trees From Dax’s Case: Essays in Medical Ethics and Human Mean- ing, edited by Lonnie D. Kliever, Southern Methodist University Press, 1989. Reprinted with permission. Editors’ note: Some text has been cut. Students who want to read the article in its entirety should consult the original. in the countryside near Henderson. Ray and Don had driven out to a ranch to look over some prop- erty being offered for sale by the owner. They parked their car on a bridge over a dry creek and took off by foot. They talked and laughed together as they surveyed points of interest on the land. Their business completed, the Cowarts then returned to their car to go home for dinner. The accident happened with no warning. The Cowart men had returned to their car but had not been able to start the engine. Ray had lifted the hood and removed the air cleaner from the engine. He primed the carburetor by hand and instructed Don to try the ignition. Several tries failed. It seemed to Don that the battery was near exhaus- tion. A final attempt proved fateful, however, as a blue flame shot from the carburetor and ignited a terrible explosion and fire. Ray Cowart was hurled into heavy underbrush by the force of the explosion. The blast rocked the car and showered window glass over Don’s body. Around them, the fireball spread quickly, consuming pine trees and the scrub vegetation in the area. Don reacted quickly. He climbed from the burning car and began running toward the woods. But he was forced to stop by a fear that he would become entan- gled in the underbrush and slowly burn to death. Don wheeled about and decided to chance the dirt road on which they had driven in. He ran through three walls of fire, emerged into a clearing, then fell to the ground and rolled his body to extin- guish the flames. He got back to his feet and resumed running in search of help for his father. It all seemed dreamlike. Don noticed his vision was blurred as though swimming under water. His eyes had been badly burned. Now the pain was coming in waves, and he knew it was real. He kept running. Loud voices filtered through the woods. Don col- lapsed at the roadside as help arrived. He heard the footsteps of a man and then the exclamation, “Oh, my God!” when a farmer found him. Don sent the man after his father and lay wondering how badly he was burned. When the man returned, Don asked him to bring a gun—a gun he would use to kill him- self. The farmer refused. In shock, Don assumed he and his father had caused the explosion by igniting gasoline from the car’s engine. Later he would learn that the explo- sion actually had been caused by a leaking propane gas transmission line in the area where they had parked. It was a freak event. A pocket of propane gas had formed in the dry creek bed. When the car- buretor flamed up, it had ignited the gas. Rescuers took the Cowart men to a hospital in nearby Kilgore. There, a decision was made to transport them by ambulance to a special burn unit at Dallas’s Parkland Hospital. Ray Cowart died en route to Dallas. Don Cowart remembers incredible pain, his begging for pain medication, and the paramedic’s refusal to administer drugs prior to their arrival in Dallas. By this time, Ada Cowart, too, was on her way to Dallas. She had returned home first to pack several changes of clothes. The radio had said the men were badly hurt. She didn’t expect to return to Henderson any time soon. Even as the ambulance sped the 140 miles from Kilgore to Dallas, Don Cowart’s treatment regimen had begun. By telephone, Dr. Charles Baxter, head of Parkland’s burn unit, had directed fluid therapies to help in preventing shock to vital organs. On exami- nation in Dallas, Baxter found Cowart had severe burns over 65 percent of his body. His face suffered third-degree burns and both eyes were severely damaged. His ears and hands were also deeply burned. Fluid therapies continued and were aided by several other measures: the insertion of an inter- tracheal tube to control the airway, catheters placed in every body opening, treatment with antibiotics, cleansing the wounds with antibacterial drugs, and tetanus prophylaxis. Heavy doses of narcotics were given for the pain. In the early days of Don’s 232-day hospitaliza- tion at Parkland, doctors could not predict whether he would survive. It was touch and go for many weeks. Ada Cowart felt helpless; she could do little more than sit in the waiting area outside the intensive care unit with relatives of other burn victims, where she prayed and hoped for the best. Doctors permitted only short visits with her son. Don had given his mother power of attorney in the Parkland emergency room, and she in turn deferred to the medical professionals on treatment decisions. For Cowart, there were countless whirlpool tankings in solutions to cleanse his wounds, proce- dures to remove dead tissue, grafts to protect living tissue, the amputation of badly charred fingers from both hands and the removal of his right eye. The damaged left eye was sewn shut. And there was terrible pain. Through it all, Don had remained constant in his view that he did not want to live. His demands to die had started with the farmer at the accident site. They had continued at the Kilgore hospital, in the ambulance, and now at Parkland. He didn’t want treatment that would extend his misery and he made this known to his mother and family, Dr. Charles Baxter, a nurse named Leslie Kerr, long- time friend Art Rousseau, attorney Rex Houston, and many others. Baxter remained undaunted by Don’s pleas to stop treatment, dismissing them at first as the typi- cal response of burn victims to the pain of their wounds and treatment. In time, however, he openly discussed Cowart’s wish to die with Don, his mother, and his lawyer, considering all the medical and legal ramifications. Failing to get Ada Cowart’s and Rex Houston’s consent to the withdrawal of treatment, Baxter continued to deliver it. For her part, Ada Cowart understood her son’s pain and anguish. She was haunted, nonetheless, by these thoughts: What if treatment were ceased and Don changed his mind in a near-death state? Would it be too late? Furthermore, her religious beliefs sim- ply made mercy killing or suicide deplorable options. These religious constraints were reinforced by her fear that her son had not yet made his “peace with God.” Rex Houston also had mixed feelings about Don’s wishes. On the one hand, he sympathized with Cow- art’s condition—being unable to so much as take medication to end his life without the assistance of others. On the other hand, it was Houston’s duty to reach a favorable resolution of a lawsuit filed against the pipeline owners for Ray Cowart’s death and for Don Cowart’s disability. With regard to the latter, he needed a living plaintiff to achieve the best damage