Before Terry Schiavo, there was Karen Ann Quinlan. On April 14, 1975, after an evening out with friends during which she consumed alcohol and sedatives, the 21-year-old New Jersey resident stopped breathing and lapsed into a coma. After five months, doctors diagnosed Quinlan as being in a persistent vegetative state; her parents, who believed there was no chance of her returning to consciousness and who wanted to end her suffering, requested that Quinlan be disconnected from the machines that were sustaining her. When her doctors refused, they took the case to court — in what became one of the the first "right to die" case in U.S. legal history. Based on the right to privacy, the court ruled that "no compelling interest of the state could compel Karen to endure the unendurable" and allowed her to be taken off life support. Her story made headlines and provided the groundwork for numerous similar cases. But Quinlan's story didn't end there: weaned from the respirator, she survived for nearly 10 more years, dying of pulmonary failure on June 11, 1985 in a New Jersey nursing home.
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Karen Ann Quinlan (March 29, 1954 – June 11, 1985) was an important person in the history of the right to die controversy in the United States.
When she was 21, Quinlan became unconscious after arriving home from a party. She had consumed diazepam, dextropropoxyphene, and alcohol. After she collapsed and stopped breathing twice for 15 minutes or more, the paramedics arrived and took her to hospital, where she lapsed into a persistent vegetative state. After she was kept alive on a ventilator for several months without improvement, her parents requested the hospital to discontinue active care and allow her to die. The hospital refused, and the subsequent legal battles made newspaper headlines and set significant precedents. The tribunal eventually ruled in her parents' favor.
Although Quinlan was removed from mechanical ventilation during 1976, she lived on in a persistent vegetative state for almost a decade until her death from pneumonia in 1985.
Quinlan's case continues to raise important questions in moral theology, bioethics, euthanasia, legal guardianship and civil rights. Her case has affected the practice of medicine and law around the world. Two significant outcomes of her case were the development of formal ethics committees in hospitals, nursing homes and hospices, and the development of advance health directives.
Early lifeKaren Ann Quinlan was born on March 29, 1954, in Scranton, Pennsylvania, to a young unmarried mother of Irish American ancestry. A few weeks later, she was adopted by Joseph and Julia Quinlan, devout Roman Catholics who lived in Landing, New Jersey. Julia and Joseph produced a daughter, Mary Ellen, in 1956, and a son, John, in 1957.
Karen Ann and her family lived uneventfully in Landing for the next two decades.
CollapseIn April 1975, shortly after she turned 21, Karen Ann left her parents' home and moved with two roommates into a house a few miles away. Around the same time, she went on a radical diet, reportedly in order to fit into a dress that she had bought. She weighed 115 pounds (52 kilograms) when admitted to the hospital.
On April 15, 1975, a few days after moving into her new house, Quinlan attended a friend's birthday party at a local bar. 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 fifteen 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 St Clare's Hospital, a larger facility.
ComaKaren 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 mother said the doctors' best guess was that she aspirated her own vomit while unconscious.
She was in a very deep form of unconsciousness called 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 hospital and her condition gradually deteriorated. She lost weight - eventually weighing less than 80 pounds (36 kilograms). She was prone to unpredictable, violent thrashing of her limbs. She was given nasogastric feeding and a ventilator to help her breathe, and it was thought that these were the only things keeping her alive.
Legal battleAfter seeing Karen like this for several months, her family finally came to the conclusion that she was beyond hope, and decided to remove her from the ventilator. Hospital officials faced with threats by the Morris County prosecutor to bring homicide charges against them, joined with the Quinlan family in seeking an appropriate protective order from the courts, before allowing the respirator to be removed. The Quinlan family persevered, and in 1976 they took their case to the New Jersey Supreme Court, which ruled in their favor. When she was taken off the respirator, Quinlan surprised many by continuing to breathe unaided, and was fed by artificial nutrition for nine more years.
She lived in a persistent vegetative state until her death from complications from pneumonia in 1985. Quinlan was buried at Gate of Heaven Cemetery in East Hanover, New Jersey. The Quinlans, with author Phyllis Battelle, wrote a book about their legal battle titled Karen Ann, which was published in 1977.
Catholic moral theology and the New Jersey Supreme Court decisionAt 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 positively, 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 groundbreaking and precedent-setting case quotes extensively 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 meansCatholic 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 is beyond the basic care required for the ordinary sustenance of life and dignity, food, water, air, hygiene. A patient always has the right to refuse extraordinary means of treatment even if this will hasten natural death. However, only the patient has this right which may be expressed legally through guardianship or advanced expression of their wishes.
It is to this principle that Karen Quinlan's parents appealed when they requested that the extraordinary means of a respirator be removed. The court honored this principle in finding in their favor.
The requirement of an expressed or implied will of the patient by Catholic moral theology is a guarantee against the undue influence of governmental or other agencies which might not have the patient's best interests as a motivation in such personal matters.