Case: The Matter of Karen Quinlan, (1976). Facts: A 911 dispatch call was received late on the night of April 15, 1975 by the Sussex County, New Jersey police. The call placed by friends of Karen Quinlan stated that she had “collapsed and then stopped breathing”, it was reported to physicians that Karen was apneic on 2 separate occasions that possibly lasted up to 15 minutes. Friends of Karen Ann Quinlan, who at the time was 21, testified that she had been fasting for “several days”, then after returning home from a party she consumed prescription medication (Valium) and drank a ignificant amount of alcohol.
Although doctors were able to resuscitate Karen, she suffered brain damage from the lack of oxygen. This left Karen in a coma that physicians diagnosed as a persistent vegetative state (pvs). Furthermore, by April 16, 1975, physicians and nurses stated that Karen was posturing in a state known as decorticate. Decorticate is defined “as the body’s posture when the cortex of the brain is no longer able to function with the rest of the body. In this state the body’s extremities are all drawn into the core of the body,” (“Decorticate Posture,” 2015).
At the time of the of request Karen weight 115lbs, she remained on the respiratory (under the assumption she no longer had the ability to breath on her own) a foley catheter was placed in her bladder, as well as a feeding tube was inserted into her nares to allow for feedings. From April to November, Karen required full and constant care and she lost forty pounds. Neurologists believed that in this state Karen would not be able to survive without the respirator.
After seven months with no change in Karen’s condition, November 10, 1975, Karen’s father filed a petition ith the New Jersey Superior Court, requesting that he be granted guardianship over his 21 year old daughter that now laid in an ICU in a persistent vegetative state. Mr. Quinlan respectfully requested that the courts grant him the power to disconnect his daughter from all live sustaining equipment, allowing her a peaceful death “with grace and dignity,” – Mr. Quinlan 1975.
Issue: The major legal issue was should Karen be regarded as alive or dead. Years before 1975, the legal definition of death was simple, “the cessation of respiration, heartbeat, and certain indications of central nervous system ctivity, such as respiration and pulsation,” (Pozgar, 2015, p. 129). However, the advancement of medicine with technology has made death a complex and controversial subject. Conversely the previous characterization does not account for all conceptions of death.
In the case of Karen Ann Quinlan testimony from one physician explained the two levels of brain functions found: (1) an “internal vegetative regulation” which controls body temperature, breathing, blood pressure, heart rate, chewing, swallowing, sleeping and walking”; and (2) “a highly developed brain, which is uniquely human, which controls ur relation to the outside world, our capacity to talk, to see, to feel, to sing, to think. ” This is the cognitive or thinking part of the brain. Brain death, the doctor argued, necessarily involves the death of both of these.
While the doctors saw no hope of Karen’s returning to cognitive functioning (to use of the higher brain), they believed that the vegetative part continued to operate (University of Oklahoma, n. d). Documents presented to the court on behave of Miss Quinlan’s family included a Harvard Medical School assessment that includes four criteria: nresponsive to stimuli, no spontaneous movement or breathing, there is no response to reflex testing, and an electroencephalogram is flat. Indicating no brain wave activity.
When neurologist performed the criteria tests they found that Karen at times her extremities would move spontaneously. She had pupillary response with light. She would assist the ventilator with breaths at times. Since Karen passed these tests doctors determined that she had was not brain dead. Holding:. If was deemed that the patient is hopelessly damaged “the family and all colleagues who have anticipated in major decisions oncerning the patient, and all nurses involved, should be so informed” (University of Oklahoma, 1977).
It will then be that death is to be declared. At the time of declaration of death the respirator may be turned off. “The decision to do this and the responsibility for it are to be taken by the physician-in-charge, in consultation with one or more physicians who have been directly involved in the case (Joseph T. Quinlan v. Guardian Ad Litem Thomas R. Curtin. , 1976, slip op. at, p. 5). Allowing the family to make such a decision is illogical and unfavorable.
“To refuse to let her die, Mr. Armstrong said, would be to interfere with the Quinlans’ religious belief “that earthly existence is but one phase of a continuity of life, which reaches perfection after death, (McFadden, 1985). Being a devoted Catholic family, Mr. and Mrs. Quinlan sought the counsel of the church. Monsignor Trapasso supported the family and stated “that church teachings, including a declaration by Pope Pius XII in 1957, held that there was no moral obligation to continue extraordinary means to sustain life when there was no realistic hope of recovery,” (United States Conference of Catholic Bishops, 2009, p. 0).
Lawyers and doctors in defense of the hospital argued, that by Harvard’s definition, Karen was deemed to be medically and legally alive. So it was their moral believe that by disconnecting Miss Quinlan from the ventilator would ultimately result in her death. Defining the action as homicide. The team of physicians involved stated that they had a moral obligation to use their skills to prolong Karen’s life not end it. Majority Opinion Reasoning: The courts appointed a guardian to speak on the behalf of Miss Quinlan.
The guardian told the court that to remove the respirator would constitute homicide, t the very least an act of euthanasia. In 1975 this was prohibited by both law and medical codes of ethics. Ruling: During the trial court the defense concluded that anoxia was the reasoning for Karen’s persistent vegetative state. In this subsequent decortication state she was entirely reliant on a mechanical respirator for breathing. Nonetheless, the trial court on November 10, 1975, denied the plaintiff’s application, siting that Karen was not legally or medically dead.
Thus, Mr. Quinlan was denied the right to authorize termination of “life-assisting apparatus”. Therefore, granted Karen Quinlan’s physicians the ight to continue medical treatment over the objections of the Quinlan family. This ruling was then overturned on March 31, 1976. The New Jersey Supreme Court ruled that “Karen’s “right of privacy” included a right to refuse medical treatment and that her father, under the circumstances, could assume this right in her stead, (Joseph T. Quinlan v. Guardian Ad Litem Thomas R. Curtin. 1976, slip op. at, p 32. ) “The exercise of a constitutional right, such as we here find, is protected from criminal prosecution. We do not question the state’s undoubted power to punish the taking of human life, but hat power does not encompass individuals terminating medical treatment pursuant to their right of privacy” – Justice Richard J. Hughes (1976) Following the overturned ruling by the New Jersey Supreme Court the hospital, Miss Quinlan’s physicians, or the State of New Jersey chose not to pursue an appeal in the matter.
Then in May 1976 Karen Anne Quinlan was removed from the respirator. Significance: Once the respirator was removed Karen remarkably managed to breath on her own. She remained in a coma for another ten year before dying on June 11, 1985. The Matter of Karen Quinlan prompted the adoption f “brain death” as the legal definition of death in some states and the adoption of laws recognizing “living wills” and the “right to die” in other states, as well as the formation of “bioethics” committees in many hospitals.
Almost ten years after the overturned decision in the Matter of Karen Quinlan, the New Jersey Supreme Court, ruled that all life-sustaining medical treatment, to include providing nutritional means could be withheld from “incompetent, terminally ill patients, provided such action was shown to be consistent with the afflicted person’s past wishes,” (Cullen- DuPont, n. d. ).
