Chicago area experts react to the final decision of Tim Bowers

Tim Bowers, the 32-year-old Indiana hunter who fell 16 feet from a tree and suffered a severe spinal injury that paralyzed him from the shoulders down, chose this week to forego the life-support sustaining him Sunday, and his decision has sparked national dialogue about the rights of patients and the importance of advance care planning. Bowers, whose C3, C4 and C5 vertebrae were crushed in the accident, may never have been able to breathe on his own again. In an unusual occurrence, he was given final say about his medical care after doctors at Fort Wayne’s Lutheran Hospital brought him out of sedation. That way, Bowers could decide for himself whether he wanted to live or die.

“We just asked him, ‘Do you want this?’ And he shook his head emphatically no,” his sister, Jenny Shultz told The Associated Press. “I just remember him saying so many times that he loved us all and that he lived a great life.”

Jean Kosova, a registered nurse and ethicist in Chicago, said Bowers’ final decision should be viewed positively because it demonstrated a competent adult willing and able to state his wishes. “These wishes were supported by his family and the medical staff. The family was relieved of the burden of making the decision to withdraw life support, and hopefully will live without the guilt that many families feel after making such a decision,” she said.

However, Kosova said she understands why some feel disturbed by his decision. “Was he in an optimal condition to make an informed decision? Some might argue that 24 hours after such a devastating accident, one cannot fully comprehend the reality of the present or future issues to be faced,” she added.

Kosova questioned whether the extent of Bowers’ neurological injuries were known in such a short time after his accident.”Without knowing more, we have to assume that the doctors were able to present him with enough facts that led him to understand he was headed for a kind of life that he did not want for himself.”

Craig M. Klugman, a bioethicist and medical anthropologist who currently serves as chair of the department of health sciences at DePaul University, said technology complicates end of life decisions for many Americans, because patients can be kept alive longer than ever before. “Technology in medicine can provide wonderful benefits to extend life, cure disease and improve comfort. It can also create burdens such as having to make difficult ethical choices between life and death,” he said.

Informed choices such as Bowers’ decision are the backbone of clinical ethics, Klugman said, and in making that decision, the patient was exercising his legal right.

“Others may disagree, and other patients would have undoubtedly made different choices,” Klugman said. “In his case, he spent his last hours surrounded by those he loved, celebrating his life, and preparing to leave this world on his own terms with the support of his family and health care team. For him, this was a good death.”

Pastor Rob Zahn of the Evangelical Lutheran Spirit Alive Church in Pleasant Prairie, WI, said religion influences end of life decisions, because most religions have a theology or understanding of what happens after death. “Without a religious influence, more likely than not, there is no ‘after we die.’ In that case, the decision is based only on what life might be like in the here and now. Will I hold my baby again? Will I hold my spouse’s hand? Will I go fishing again? Will I walk again?”

Bowers understood that he would not. “For many people from many faiths there is an understanding that there is more after this, that in some mysterious way that cannot be described, we will see our loved ones again. There is hope for something after death. Hope makes the decision more palatable,” he added.

Eric Price, a donation specialist at Gift of Hope Organ & Tissue Donor Network, said advance care directives are critical to ensuring one’s final wishes are followed through, as Bowers’ case of being brought out of sedation and able to communicate is extremely rare.

“Patient rights have always been defended in the courts and we all have our own right to choose how we want to die,” Price said. “Simple, fill out an advance directive and let those wishes be known to your loved ones. Don’t let your last days be decided by doctors who have never met you, and your loved ones best guesses for you.”