INDIANAPOLIS -- Tim Bowers got to decide for himself whether he wanted to live or die.

When the avid outdoorsman was badly hurt Saturday in a hunting accident, doctors said he would be paralyzed and could be on a ventilator for life. His family had a unique request: Could he be brought out of sedation to hear his prognosis and decide what he wanted to do?

Doctors said yes, and Bowers chose to take no extra measures to stay alive. He died Sunday, hours after his breathing tube was removed.

"We just asked him, 'Do you want this?' And he shook his head emphatically no," his sister, Jenny Shultz, said of her brother, who was often found hunting, camping or helping his father on his northeastern Indiana farm.

The 32-year-old was deer hunting when he fell 16 feet from a tree and suffered a severe spinal injury that paralyzed him from the shoulders down. Doctors thought he might never breathe on his own again.

Courts have long upheld the rights of patients to refuse life support. But Bowers' case was unusual because it's often family members or surrogates, not the patient, who make end-of-life decisions.

Medical ethicists say it's rare for someone to decide on the spot to be removed from life support, especially so soon after an injury. But standard medical practice is to grant more autonomy to patients.

The heart-wrenching call to remove life support is more often left to relatives. Even when a patient has outlined his wishes for end-of-life care, the decision can tear families apart.


Advertisement

Shultz, an intensive care nurse in Las Vegas, has seen it happen in her job. But her medical training also meant she understood the severity of her brother's injuries. His C3, C4 and C5 vertebrae were crushed.

Though his brain was not injured, his body was irreparably broken. Surgery could fuse the vertebrae, but that would only allow Bowers to sit up. He would never walk or hold his baby. He might live the rest of his life in a rehabilitation hospital, relying on a machine to help him breathe.

Shultz said her brother -- the youngest of four siblings -- wanted to talk but couldn't because the ventilator tube was still in place. If the tube were removed, she told him, doctors were not sure how long he would live. But when she asked if he wanted the tube reinserted if he struggled, Bowers shook his head no.

Doctors asked Bowers the same questions and got the same responses. Then, they removed the tube.

The last five hours of Bowers' life were spent with family and friends, about 75 of whom gathered in the hospital waiting room. They prayed and sang songs.

"I just remember him saying so many times that he loved us all and that he lived a great life," Shultz said. "At one point, he was saying, 'I'm ready. I'm ready.' "

Patients often change their minds after they have had time to meet with spiritual advisers and family, said Art Caplan, director of the medical ethics program at New York University's Langone Medical Center in New York City.