Quinlan, Karen Ann

On April 15, 1975, Karen Ann Quinlan, seventeen years old, presumably ingested barbiturates and alcohol at a party. She became comatose and experienced two periods of apnea (absence of breathing) of about fifteen minutes each, which resulted in irreversible brain damage. She was placed on a respirator and was fed nutrition and fluids by a gastrostomy tube. Her parents were told that she was in a persistent vegetative state from which there was no hope of recovery. Her physician, Robert Morse, considered the ventilator medically appropriate. He claimed that allowing a person in a persistent vegetative state to die was in violation of the professional standard of the time. Quinlan was still in a vegetative state five months later. The electroencephalogram (EEG) showed no signs of brain function, and she did not respond to verbal, visual, or even painful stimuli.

The Quinlan family priest told the parents that they had no moral obligation to continue extraordinary means (the respirator) to support their daughter's life, but that artificial feeding and fluids were "ordinary means" and should be maintained. Quinlan's father said he did not want to kill his daughter but merely wanted the respirator removed so that she had the option of dying a natural death. The Quinlans petitioned the New Jersey Superior Court for permission to remove the respirator. On November 10, 1975, that court denied the parents' request based on its contention that people have a constitutional right to life but do not have a parallel constitutional right to death. The lower court decision was appealed to the New Jersey Supreme Court, which in 1976 decided that "refusal of life-saving treatment" fell under the constitutional "right to privacy." They ruled that Quinlan could be removed from the respirator. However, hospital staff had already weaned her from the respirator, so the court decision was moot. She lived for ten years with the aid of artificial nutrition and hydration. She finally died in December 1985 of pneumonia. Since the Quinlan decision, a number of other states have permitted families to withdraw life support from comatose or terminally ill patients.

The Quinlan case is significant for several reasons. The definition of death, once linked to brain damage and the cessation of heart and lung functioning, had to be modified to accommodate technological advances in life support systems. Patients who formerly would have died can now be maintained indefinitely on life support. Further, considerations to maintain or withdraw life support raised moral and legal issues involved in the nationwide debate on abortion rights, patient's rights, and as well as organ and tissue retrieval for the burgeoning field of organ transplantation. The Quinlan case provided a focus for energetic and productive discussion of the complex and interrelated moral, ethical, and legal issues related to the definitions of life and death, the right to die, and the freedom of choice. The Quinlan case therefore stimulated intensive and productive national debate, discussion, and research on the related subjects of physician-assisted suicide, the quality of life, and the quality of dying.

See also: Advance Directives; Cruzan, Nancy; Do Not Resuscitate; Living Will; Natural Death Acts

Bibliography

Angell, M. "After Quinlan: The Dilemma of the Persistent Vegetative State." New England Journal of Medicine 330 (1994):1524–1525.

Gordon, M., and P. Singer. "Decisions and Care at the End of Life." Lancet 346 (1995):163–166.

The Multi-Society Task Force on PVS. Medical Aspects of the Persistent Vegetative State 330 (1994):1499–1508, 1572–1578.

WILLIAM M. LAMERS JR.