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Karen Ann Quinlan

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Karen Ann Quinlan
Quinlan's high school graduation photo in 1972
Born(1954-03-29)March 29, 1954
Scranton, Pennsylvania
DiedJune 11, 1985(1985-06-11) (aged 31)
Morris Plains, New Jersey

Karen Ann Quinlan (March 29, 1954 – June 11, 1985) was an American woman who entered a persistent vegetative state and became the center of a legal case that became influential on the medical ethics of end-of-life care in the United States.

When she was 21, Quinlan became unconscious after she consumed diazepam along with alcohol while on a crash diet and lapsed into a coma, followed by a persistent vegetative state. After doctors refused the request of her parents, Joseph and Julia Quinlan, to disconnect Quinlan's respirator, which they believed constituted extraordinary means of prolonging her life, her parents filed suit to disconnect Quinlan from her ventilator.

Quinlan's case continues to raise important questions in. bioethics, euthanasia, legal guardianship, civil rights and moral theology. Her case has affected the practice of medicine and law around the world. A significant outcome of her case was the development of formal ethics committees in hospitals, nursing homes and hospices.[1]

Early life

Quinlan was born on March 29, 1954, in Scranton, Pennsylvania, to a young, unmarried woman of Irish American ancestry. A few weeks later, she was adopted by Joseph and Julia Quinlan, devout Roman Catholics who lived in the Landing section of Roxbury Township, New Jersey. Julia and Joseph also had a daughter, Mary Ellen, in 1956, and a son, John, in 1957.[2] Quinlan was remembered as an average student at Morris Catholic High School in Denville, New Jersey. After graduation, she worked at the Mykroy Ceramics Corporation in Ledgewood, New Jersey, from 1972 to 1974, and worked several jobs over the next year. Quinlan was a singer and her parents remember her as a tomboy.[3]

Collapse and persistent vegetative state

In April 1975, shortly after she turned 21, Quinlan left her parents' home and moved with two roommates into a house a few miles away in Byram Township, New Jersey. Around the same time, she went on a radical diet, reportedly in order to fit into a dress that she had bought. On April 15, 1975, a few days after moving into her new house, Quinlan attended a friend's birthday party at a local bar (then known as Falconer's Lackawanna Inn on Lake Lackawanna in Byram Township, New Jersey). She had eaten almost nothing for two days. At the party she reportedly drank a few gin and tonics and took Valium. Shortly afterwards she felt faint and was quickly taken home and put to bed. When friends checked on her about 15 minutes later, they found she was not breathing. An ambulance was called and mouth-to-mouth resuscitation was attempted. Eventually some color returned to her pallid skin, but she did not regain consciousness. Quinlan was admitted to Newton Memorial Hospital in New Jersey in a coma. She remained there for nine days in an unresponsive condition before being transferred to Saint Clare's Hospital, a larger facility. Quinlan weighed 115 pounds (52 kg) when admitted to the hospital.

Quinlan had suffered irreversible brain damage after experiencing an extended period of respiratory failure (lasting no more than 15–20 minutes). No precise cause of her respiratory failure has been given. Her brain was damaged to the extent that she entered a persistent vegetative state. Her eyes were "disconjugate" (they no longer moved in the same direction together). Her EEG showed only abnormal slow-wave activity. Over the next few months she remained in the hospital and her condition gradually deteriorated. She lost weight—eventually weighing less than 80 pounds (36 kg). She was prone to unpredictable, violent thrashing of her limbs. She was given nasogastric feeding and a ventilator to help her breathe.

Quinlan's parents, Joseph Quinlan and Julia Quinlan, requested that she be disconnected from her ventilator, which they believed constituted extraordinary means of prolonging her life because it caused her pain. Hospital officials, faced with threats from the Morris County prosecutor of bringing homicide charges against them if they complied with the parents request, joined with the Quinlan family in seeking an appropriate protective order from the courts, before allowing the ventilator to be removed.

Suit and appeal

The Quinlans filed a suit on September 12, 1975 to request that the extraordinary means prolonging Quinlan's life be terminated. The Quinlans' lawyer argued that Quinlan's right to make a private decision about her fate superseded the state's right to keep her alive, while Quinlan's court-appointed guardian argued that disconnecting her ventilators would be homicide. The suit was denied by New Jersey Superior Court Judge Robert Muir Jr. in November 1975. Judge Muir cited that Quinlan's doctors did not support removing her from the ventilator, that whether or not to do so was a medical rather than a judicial decision, and that doing so would violate New Jersey homicide statutes.[4]

The Quinlans appealed the decision to the New Jersey Supreme Court. On March 31, 1976, the court granted their appeal, citing that the right to privacy was broad enough to encompass the Quinlans' request on Quinlan's behalf. When she was taken off the ventilator, Quinlan surprised many by continuing to breathe unaided, and was fed by artificial nutrition for nine more years, until her death from respiratory failure in 1985.[5][6] [7]

Catholic moral theology and the New Jersey Supreme Court decision

At the time legal guardianship was assigned by a New Jersey court to her father, Joseph Quinlan, his religious affiliation as a Catholic was taken into consideration, for assessing his conscience and motivations. This brought the Catholic Church's moral teaching to bear on the case as relevant material. The New Jersey Supreme Court decision on the case quotes from an address given by Pope Pius XII to medical professionals on the matter of preservation of life:

"The request of plaintiff for authority to terminate a medical procedure characterized as "an extraordinary means of treatment" would not involve euthanasia. This upon the reasoning expressed by Pope Pius XII in his "allocutio" (address) to anesthesiologists on November 24, 1957, when he dealt with the question:
'Does the anesthesiologist have the right, or is he bound, in all cases of deep unconsciousness, even in those that are completely hopeless in the opinion of the competent doctor, to use modern artificial respiration apparatus, even against the will of the family?'
His answer made the following points:
1. 'In ordinary cases the doctor has the right to act in this manner, but is not bound to do so unless this is the only way of fulfilling another certain moral duty.
2. The doctor, however, has no right independent of the patient. He can act only if the patient explicitly or implicitly, directly or indirectly gives him the permission.
3. The treatment as described in the question constitutes extraordinary means of preserving life and so there is no obligation to use them nor to give the doctor permission to use them.
4. The rights and the duties of the family depend on the presumed will of the unconscious patient if he or she is of legal age, and the family, too, is bound to use only ordinary means.
5. This case is not to be considered euthanasia in any way; that would never be licit. The interruption of attempts at resuscitation, even when it causes the arrest of circulation, is not more than an indirect cause of the cessation of life, and we must apply in this case the principle of double effect.' " [from the text of the New Jersey Supreme Court decision, "On the Matter of Quinlan" (1976)]

Extraordinary means

Catholic moral theology does not require that "extraordinary means" be employed in preserving a patient's life. Such means are any procedure which might place an undue burden on the patient, family or others and would not result in reasonable hope of benefiting the patient. A person (or a person's representative in cases when a person is not able to decide) can refuse extraordinary means of treatment even if this will hasten natural death, and this is considered ethical.[8][9]

It is to this principle that Quinlan's parents appealed when they requested that the extraordinary means of a ventilator be removed, citing a declaration by Pope Pius XII in 1957 [5][10]

Life after the court decision and death

After her parents disconnected her ventilator following the successful appeal, Quinlan's parents continued to allow Quinlan to be fed with a feeding tube. Since this did not cause Quinlan pain her parents did not consider it extraordinary means. Quinlan continued to live in a persistent vegetative state until her death from respiratory failure as a result of complications from pneumonia on June 11, 1985, in Morris Plains, New Jersey. Upon learning that Quinlan was expected to die, her parents requested that no extraordinary means be used to revive her. Quinlan weighed 65 pounds at the time of her death.[11] Quinlan was buried at the Gate of Heaven Cemetery in East Hanover, New Jersey.[12]

Autopsy findings

While Quinlan was alive the extent of damage to her brain stem could not be precisely determined. After she died her entire brain and spinal cord were studied carefully. While her cerebral cortex had moderate scarring, it seemed that her thalamus was extensively damaged bilaterally. Her brain stem (which controls breathing and cardiac functions) was undamaged. These findings suggest that the thalamus plays a particularly important role in consciousness.[13]

Legacy

Joseph and Julia Quinlan opened the Karen Ann Quinlan Hospice and memorial foundation in 1980 to honor their daughter's memory. Her court case is linked to legal changes and hospital practices around the right of people to refuse extraordinary means of treatment, even in situations where cessation of treatment could end a life.[3]

The Quinlans published two books about the case: Karen Ann: The Quinlans Tell Their Story (1977)[14] and My Joy, My Sorrow: Karen Ann's Mother Remembers (2005).[15]

A 1977 TV movie, In The Matter of Karen Ann Quinlan, was made about the Quinlan case, with Piper Laurie and Brian Keith playing Quinlan's parents.

The title character of Douglas Coupland's novel Girlfriend in a Coma[16] is Karen Ann McNeil. She collapses after a party where she has taken Valium as well as some alcohol. Like Quinlan, she also has deliberately stopped eating in order to fit into an outfit (in this case, a bikini). For these reasons (and the frequent nostalgic references to events from the 1970s in Coupland's works) the character is thought to be based loosely on Quinlan. In the novel, Karen awakens after being comatose for nearly eighteen years.

See also

References

  1. ^ McDougall, Jennifer; Gorman, Martha (November 20, 2007). Euthanasia: A Reference Handbook. ABC-CLIO. pp. 141–142. ISBN 978-1598841213.
  2. ^ Quinlan, J. and Quinlan, J. D. (1977). Karen Ann: The Quinlans Tell Their Story. New York: Bantam Books. ISBN 0-385-12666-2
  3. ^ a b Nessman, Ravi (April 7, 1996). "Karen Ann Quinlan's Parents Reflect on Painful Decision 20 Years Later". LA Times. Retrieved August 30, 2015.
  4. ^ Heimer, Carol (December 6, 2012). "The Unstable Alliance of Law and Morality". In Hitlin, Steven; Vaisey, Stephen (eds.). Handbooks of Sociology and Social Research. Springer. pp. 181–182. ISBN 1441968954.
  5. ^ a b Stryker, Jeff (March 31, 1996). "Right to Die; Life After Quinlan". New York Times. Retrieved August 30, 2015.
  6. ^ "Karen Ann Quinlan dies after 10 years in a coma", St. Petersburg (FL) Evening Independent, June 12, 1985, p1[dead link‍]
  7. ^ In Re Quinlan 355 A.2d 647 (NJ 1976)
  8. ^ McCartney, James (1980). "The Development of the Doctrine of Ordinary and Extraordinary Means of Preserving Life in Catholic Moral Theology before the Karen Quinlan Case". Linacre Quarterly. 47 (215).
  9. ^ Coleman, Gerlad (March 1985). "Catholic theology and the right to die". Health Progress. 66 (2): 28=32.
  10. ^ Scheb, John (March 28, 2011). Criminal law. Wadsworth Publishin. p. 85. ISBN 978-1111346959.
  11. ^ McFadden, Robert (June 12, 1985). "Karen Ann Quinlan, 31, Dies; Focus of '76 Right to Die Case". New York Times. {{cite news}}: |access-date= requires |url= (help)
  12. ^ "Tearful Rites for Karen Quinlan", Bergen Record, June 16, 1985. Accessed August 4, 2007. "A procession of about 75 cars then drove to Gate of Heaven Cemetery in East Hanover."
  13. ^ Kinney, H. C., Korein, J., Panigrahy, A., Dikkes, P. and Goode, R. (1994). Neuropathological Findings in the Brain of Karen Ann Quinlan – The Role of the Thalamus in the Persistent Vegetative State. The New England Journal of Medicine. 330:1469–1475.
  14. ^ Quinlan, Joseph; Quinlan, Julia; Battelle, Phyllis (1977). Karen Ann: the Quinlans Tell Their Story. Garden City, NY: Doubleday. ISBN 978-0-385-12666-3. OCLC 3259340.
  15. ^ Quinlan, Julia (2005). My Joy, My Sorrow: Karen Ann's Mother Remembers. Cincinnati, Ohio: St. Anthony Messenger Press. ISBN 978-0-86716-663-7. OCLC 58595022.
  16. ^ Coupland, Douglas (1998). Girlfriend in a Coma. Toronto: HarperCollins. ISBN 978-0-00-224396-4. OCLC 37983572.
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