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In Re Karen Ann Quinlan (1976)
- Rutgers University Press
- Chapter
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77 On September 10, 1975, Joseph and Julia Quinlan petitioned the Morris County, New Jersey, court for legal guardianship of their twenty-one-year-old daughter Karen Ann, who was in a persistent vegetative state (PVS). They sought permission to direct removal of the respirator sustaining her life. Approximately six months earlier, Karen had been rushed to the emergency room of Newton Memorial Hospital after suffering a cardiac arrest, being deprived of oxygen to the brain, and falling into a coma. Soon thereafter, Karen’s care was transferred to Saint Clare’s Hospital in Denville, a larger and better-equipped facility known to the Quinlans, where she was being cared for at the time of the petition. PVS is a condition in which all cognitive functions of the brain have been lost, resulting in complete unawareness of self and the environment. At the same time, PVS patients retain some of the brain stem functions that regulate autonomic activities of the body such as breathing. There is virtually no hope of recovery from an accurately diagnosed PVS to a cognitive sapient state. With medical interventions, hospital and nursing home patients have been known to survive in PVS for as long as thirty-seven years. Karen had been adopted as a baby after Julia suffered several miscarriages and a stillbirth. Julia would later give birth to two children who would grow to look up to Karen as their big sister. Her siblings, parents, and many friends knew her as smart, funny, warm, and vibrant—a young girl with a marked streak of independence and a joy for living. The Quinlans were a hardworking, private, middle-class, and devoutly Catholic family, well liked in their community. As they confronted Karen’s dilemma, and theirs, with both profound sadness and extraordinary dignity, they would look often to their faith for guidance. After much private and public agonizing, and many consultations with their parish priest, Father Thomas Trapasso, the Quinlans resolved that Karen would 4 In Re Karen Ann Quinlan (1976) Establishing a Patient’s Right to Die in Dignity ROBERT S. OLICK AND PAUL W. ARMSTRONG 78 ROBERT S. OLICK AND PAUL W. ARMSTRONG not want to have her biological life sustained indefinitely in this unblessed condition and that it was in her best interests to be set free from the tyranny of the machine that forced her to breathe. In keeping with the treating physician’s initial suggestion, they requested that the respirator be removed, allowing her to die. Initially, the hospital agreed to honor their request and asked the Quinlans to sign a consent and release form directing the physician to “discontinue all extraordinary measures, including the use of a respirator” and releasing the physician and the hospital from liability.1 However, the physician and hospital quickly changed their positions. They refused to comply with the parents’ request, setting the stage for the landmark litigation to follow. This was a time when high-technology medicine’s capacity to deploy respirators , feeding tubes, dialysis, and other tools to prolong life and forestall death was growing rapidly, but the nascent field of bioethics had just begun to sprout roots, and the voice of the law was largely silent. In another societal sphere, the civil rights movement was expressing a broad cultural commitment to the rights of the individual. In health care these forces converged in profound questions that to this day reverberate throughout society: How do we die? Is there a right to refuse treatment ? Who should decide for incompetent patients? And on what basis—the patient’s wishes or best interests? Questions surrounding decisions near the end of life quickly became the core of bioethical discourse, and Karen Ann Quinlan’s plight the polestar of the debate. The New Jersey Supreme Court’s seminal opinion remains the most frequently cited case in the annals of American bioethics. The Right to Refuse Treatment on Trial The Quinlans’ petition asserted that Karen had a right to refuse life-sustaining treatment, and sought to have the power to exercise that right reposed in her father with express authority to direct discontinuance of “all extraordinary means” sustaining her life. Karen’s right to refuse treatment was premised on a number of grounds, most significantly the constitutional right of privacy to be free from unwanted medical interventions. Opposing the petition were her physicians, the hospital, the county prosecutor , the state of New Jersey, and the guardian ad litem appointed by the court to represent Karen’s best interests...