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'Please let me die'

THE BALTIMORE SUN

He is a young man, only 25, although there's no way of knowing this from his appearance. Fire has excavated almost to the bone both his face and body. Still, even in his blunted features, agony has found a way to express itself. The young man's suffering is captured in the flickering black-and-white images of a grainy tape filmed in a Texas hospital 25 years ago.

Once, Donald Cowart was an Air Force pilot who flew jets in and out of Vietnam; a handsome, strong-willed man with a passion for driving fast in his Alfa Romeo.

He is a young man, only 25, and he cries out in pain as other men in surgical masks place his atrophied 80-pound body onto a motorized lift. Slowly they lower him, naked and shivering, into a stainless steel tank of water laced with Clorox. Against the backdrop of his cries, they scrape the dead tissue from his burned body.

Once, Don Cowart was an athlete; a popular, fun-loving student; captain of the football team in high school and a champion rodeo cowboy in college.

He is a young man, only 25, who cannot see his hospital tormentors. His right eye is gone, his left eyelid sewn shut. Nor can he push them away with his maimed hands. But he can hear the ominous clanking noise of the pulley lowering him into the tank; the voices singing a hair-cream jingle on a radio; the water splashing as he enters it. Then the pain blocks out everything.

Once, Donnie Cowart was a towheaded 4-year-old, an independent boy who liked nothing better than riding his horse, Cactus, on the family's cattle ranch in East Texas.

"Oh, easy!" he cries. "Easy, oh, easy! Easy on the back of my leg!" The voice rises in agony: "Oh, God!"

"Sorry," says a masked attendant.

Perhaps the casualness of his response masks the terrifying thought that this could have happened to him.

In silence, the masked men do what they must. And when they finish, Don Cowart is taken back to his hospital room to scream in pain until, exhausted, he passes out.

When he wakens, the agony will begin again. And just as he has done almost daily since the explosion and fire that destroyed his body, Don Cowart will fight for his right to stop life-sustaining treatment and go home to die.

This is my body, he will tell the doctors, and I have the right to decide whether I want to live or die.

We don't believe you really want to die, the doctors will reply. It's just your pain and depression talking. One day you'll thank us for this.

He will plead with his mother and his lawyer to help him get out of the hospital. He will turn to ministers, nurses, family and friends. But no help will come.

It is 1973, and Don Cowart is a lone voice in the emerging struggle to establish a competent patient's right to make treatment decisions. He has experienced what everyone fears: A terrible accident has altered his body, and he has lost control of his life.

Two years will pass before the case of Karen Ann Quinlan focuses the nation's attention on a family's battle to remove their comatose daughter from life support, raising the complicated issues of an individual's right to die and the increasing role

played by medical technology in that dilemma.

It will be another 11 years before Elizabeth Bouvia, a young woman paralyzed by cerebral palsy and seeking to die by starvation, wins a 1986 landmark case in which a California state appeals court affirms her right not to be force-fed.

And not until 1990 will the U.S. Supreme Court affirm for the first time a person's constitutional right to refuse medical treatment in the case of Nancy Cruzan, a young Missouri woman who, after a car accident, lapsed into a vegetative state.

But what of the young man who was forced to live?

What became of Don Cowart, faced with the unimaginable task of inhabiting not only a changed body but a drastically changed life?

Twenty-five years have passed, and Don Cowart no longer exists. He is Dax Cowart now. And his case has become one of the most discussed and debated in the literature of medical ethics, raising profound questions about the issues surrounding a hastened death.

"Dax's case is a Rubik's Cube," says Southern Methodist University religion professor Lonnie D. Kliever, who edited a book of scholarly essays titled "Dax's Case." "If you wanted to design a case that would explore all the complex, ambiguous, insoluble issues facing humankind - medical, religious, ethical, legal, moral, emotional - you couldn't invent a case more eloquent and more daunting than that of Dax Cowart."

And in one of the many ironies that shape his life, Dax Cowart has become a symbol for those who oppose the idea of allowing a patient to decide his fate. They point to him and say: See how successful he is! He is living proof that we did the right thing in preserving his life - even against his wishes.

The problem is: Dax Cowart still doesn't agree.

It was a whim, really, that forever altered Don Cowart's life. And ended his father's.

They were on their way home from Ray Cowart's office late on the afternoon of July 25, 1973. It was the end of a hot, sultry day in Henderson, the small East Texas town where Ray was a rancher and real-estate broker.

Don, or Donnie, as family and friends called him, had recently been discharged from the Air Force, and his future looked bright. He was self-assured, almost cocky, a young man armed with a business degree from the University of Texas and the training of a jet pilot. He had the right stuff, he thought, to become a commercial pilot or a lawyer.

Don's personal life was going well, too. After a brief marriage to his high school sweetheart, he was dating again.

While thinking over his future, Don had decided to spend the summer working with his father in the real-estate business. It was not the first time they had been a team. Until he left for ## college, Don had helped run the family cattle ranch, riding side-by-side with his father during roundups.

But beneath the working camaraderie, the two men had very different views about life.

During his teen years, Don had rebelled against his parents, who were devout members of the Church of Christ. An independent thinker, Don rejected the church's fundamentalist teachings. The decision distressed his parents and puzzled his younger brother and sister.

Still, his sister Beth, 10 years younger, looked up to him. To her, Donnie had "everything the world admires in a young man: intelligence, style, courage, athleticism, personality, a sense of humor and perseverance."

In the eyes of Ada and Ray Cowart, however, their son - who smoked, drank beer and liked going to parties - was living a life that was spiritually bankrupt and sure to end in eternal damnation.

But by the summer of 1973, when Don returned to Henderson, the relationship between father and son had changed. With maturity, Don had discovered a deepening love for his father that he didn't know how to express. He looked forward to the time they spent alone in the car, talking as they traveled to and from the office.

The two were halfway home that hot July afternoon when Ray pulled his Oldsmobile to the side of the road.

"Donnie," he said, "before we go home, why don't we take a look at that property up for sale?"

It was a spontaneous idea, one of those small choices that sometimes have huge consequences.

The sun was slipping behind the pines when they arrived at the 80-acre property between Henderson and Kilgore. It was the first real-estate deal the two men hoped to close together. They parked in the shade beside a creek and set off on foot. After inspecting the land, father and son returned to the car, hungry for dinner.

But the car wouldn't start. Ray got out and lifted the hood. He fiddled with the carburetor, then called to Donnie to try the ignition.

Nothing.

Another try.

Still nothing.

And another. And another.

Just as Don and Ray were about to give up, a flame shot up from beneath the hood. Ray jumped back. The flame disappeared.

What neither man knew was that propane gas was leaking from a corroded underground oil refinery pipe and collecting in a dry creek nearby.

Don waited. Everything seemed normal. He turned the ignition switch again.

Then the whole countryside blew up.

The car's windshield imploded, showering Don with glass. Ray Cowart was thrown backward. Fire was everywhere. Flames leapt from treetop to treetop, and a menacing crackling noise moved through the underbrush. A solid wall of fire ringed the car.

Don, stunned but conscious, opened the door and jumped out, shouting for help. He began to run through the wall of fire.

It was eerie inside the flames. Don felt as though he'd entered a silent, murky world, one where sound and light no longer existed.

He ran, thinking: This isn't really happening.

He came to a clearing. Then another wall of flame.

Then another clearing. Another wall of flame.

Instinctively, he began a drill like one he'd learned in football practice: sprinting until he reached a clearing, then hitting the ground where he rolled to extinguish the flames, then racing through the next blazing wall and doing it all over again.

Through three walls of flame, Don ran.

The pain was intense, unimaginable. But Don was operating on pure instinct. He was running for his life. And for the last time in his life.

For a half-mile Don ran. His eyesight, he noticed, was changing: Although the top half of his vision was clear, the bottom half was blurred; it was as though he were swimming underwater.

But no matter how fast Don ran, the world was speeding away from him. In a way, time stopped inside those flames. And when at the end of his run he collapsed, another clock started, one set to measure the life of the person he had become.

A man out walking with his 12-year-old nephew was the first to see the figure writhing on the ground.

"Oh, my God!," said Ike Garrett, realizing that what he saw was a man badly burned, his eyelids, nostrils and ears almost gone, his fingers charred black.

Garrett immediately sent his nephew home to call an ambulance, then turned his attention to the burned man.

As Garrett grabbed his wrist, Don screamed. He could not bear (( the pain of being touched. Holding onto the buckle of Don's cowboy belt, Garrett dragged him to the side of the road. He placed his coat on the ground, then gently laid Don on top of it.

In excruciating pain and unable to see clearly, Don's instinct to survive now gave way to his sense of reality.

"Get me a gun," Don said.

"What do you want with a gun?" Garrett asked, puzzled.

"Can't you see I'm a dead man? I'm going to die anyway. I've got to put myself out of this misery."

Garrett paused. "I'm sorry," he finally said. "I can't do that."

When help arrived, Don told Garrett for the first time about his father. Garrett rode along with the paramedics to look for Ray Cowart. They found him, clinging to life, on a grassy spot just outside the flames.

Two ambulances took the Cowart men to a hospital in Kilgore. After conferring by telephone, the emergency room doctor decided to transfer them to the high-tech burn unit at Parkland Hospital in Dallas, 140 miles away.

This time the men, both conscious but in terrible pain, rode in the same ambulance.

"I'm sorry, Donnie Boy," the father said, seeing his son for the first time since the

explosion.

And then Don told his father what he'd been wanting to say but hadn't found the words.

"I love you, Daddy, with all my heart."

Ray Cowart was 50 years old when he died on the way to Parkland Hospital. For him, the ordeal was over.

For his son, it had barely begun.

Tomorrow: The nightmare of treatment and a test of competency.

About theis series

Staff writer Alice Steinbach gathered the information for this series through interviews with Dax Cowart, his family members, colleagues, friends, doctors, lawyers and ethicists. Some of the scenes and conversations were witnessed firsthand by the reporter or taken from a videotape; others by necessity are based on people's recollections.

Pub Date: 4/26/98

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