Tim Bowers gave his family a final gift this week – peace of mind that the decision to disconnect the machines keeping him alive was his own.
In turn, his family’s decision to share details of the Decatur man’s last hours represents an even greater gift to the rest of us – a reminder of the importance of communicating end-of-life wishes and considering all ethical and cultural implications in such situations.
Bowers, 32, apparently fell 16 feet as he climbed a tree stand while hunting last Saturday in Adams County. When he was found, Bowers’ vertebrae were crushed to the point that he would likely spend the rest of his life in a rehabilitation hospital, connected to a ventilator. His brain was not injured, however, so the family asked doctors to take Bowers out of a drug-induced coma to learn what he wanted them to do. He said he had lived a great life and it was time to go.
Abby Bowers said her husband understood that he would never be able to hug or hold the baby she is expecting and that he did not want to spend his life in a wheelchair – a point he had made even before his accident.
Tim Bowers’ clear counsel might have eased his family’s minds even as their hearts were breaking, but it also points to the complexity of such cases, according to Abraham Schwab, a medical ethicist and associate professor of philosophy at IPFW. It also underscores the growing emphasis on honoring a patient’s wishes.
Under the traditional doctrine of medical paternalism, this would have been much harder for the medical professional to do, he said of the decision to end life support. But patients have been given more authority to direct the course of their lives.
Schwab said the role of patient autonomy comes with limits, however. Life-or-death decisions can only be made if the patient is competent to decide.
In Bowers’ case, he had expressed his wishes even before his injury, but such cases aren’t always so clear. Schwab said spinal cord injuries can result in depression, for example.
It might color the decision, he said. Our predictions about how we will feel in the future can be wrong. It’s important to determine if this is a snap judgment or a persistent decision – this is clearly what I want.’
Schwab, speaking from a medical and research ethics conference in Boston, said the tragic case emphasizes the care that must be taken to ensure a patient is competent to make the decision.
For the Bowers family, it is surely the realization of a worst nightmare; for the rest of us it is a reminder that the best time to consider tough questions is well before we face them.