End of Life Decisions: The Case of Karen Ann Quinlan

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Karen Ann Quinlan
Author's Name
Institutional Affiliation

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Introduction
Every other day, there are new drugs and devices developed for use in ICUs to counteract
the effects of fatal diseases. The aim of using sophisticated interventions based on high
technology is to give the patients, his family, and caregivers hope for a longer and better quality
of life. However, the complexity of situations that develop in ICU because of life-sustaining
therapy often raise questions about the quality of life for the patient and the end of life decisions.
Despite the growing awareness and greater emphasis on end-of-life care, the physicians, nurses,
the patient, and his family are not educationally and clinically well prepared to make the end of
life decisions. Excellent communication and support system plus well-established ethics
committees can help address uncertainties in the end-of-life decisions.
End of life decisions
Legal and medical specialists continue to debate the right of individuals if they can take
the decision to end of their lives prematurely and if patients in a vegetative state of mind should
be kept alive. The voluntary workers and nurses involved often get a request for euthanasia from
such patients (Ulrichová, 2016). The law and technology along with the medical-ethical
principles are evolving to catch up with each other. Karen Ann Quinlan’s was the first reported
case for end-of-life decision-making where the Supreme Court stated that Quinlan’s father, who
was her lawful guardian, could allow withdrawal of her ventilator support (Cerminara, 2018). In
the coming years, with more such cases surfacing, work and research began on the legal treatise
on end-of-life decisions. Today, such cases have increased in numbers, and surprisingly, the
Supreme Court’s decision in the Quinlan case remains a strong basis as a guide. The patient
autonomy and his refusal to life-sustaining treatments are essential considerations.
About 20% of deaths take place in ICU, and the maximum of those deaths take place due
to the removal of life support (McGowan, 2011). The healthcare staff and the nurse need to
understand many factors related with the end of life decisions. Although most of the dilemmas
related to end-of-life decisions are resolved without any legal intervention and among the
patients’ families and the medical team, there are some situations where there is a lack of
consensus. The patient and his family see an improved quality of life because of the promises of
technology and cure. As a result, the load of treatment when equated with the advantage often
get overlooked. Moreover, the complication of ICU cases only adds to the uncertainty about
patients’ preferences. The technological intensity of the ICU weakens the relationships and
communication of the patients and their families (Thelen, 2005).
World Medical Association asserts that euthanasia is a conscious act of terminating the
life of another person who is legally competent. The concerned physician carries out the act
based on compassion and the voluntary requests to end the life. The word euthanasia can be
traced to a Greek word that means “good death,” which meant a death without suffering
(Ulrichová, 2016). Currently, euthanasia is a debated topic as it is challenging to decide if the
treatment is causing more suffering or relief for an incurably sick patient. Dysthanasia is the
unnecessary continuation of fully invasive treatment for the prolongation of the dying of a
patient. As asserted by Lamahewa et al. (2018), previous studies reflect how differing views and
varied expectations plus the priorities of families and practitioners can complicate the decisions
related to end of life decisions. According to Lamahewa et al. (2018), the unpredictable nature of
the disease and uncertainty are a core component of the discussions related to the end of life
decisions. The medical practitioners and family members are at a backfoot because of the limited

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comprehension and readiness for the end of life decisions.
The case of Karen Ann Quinlan
In the case of Karen Ann Quinlan, the family had to struggle to get her off the life-
supporting technology once she entered into coma. The case of Quinlan garnered public and
media attention when she stopped breathing in 1975 due to a strong reaction to medicine (Kenny,
2005). She fell into a permanent vegetative state as her brain cells, deprived of oxygen died.
When her parents understood her medical condition and that she would never recover from
coma, they demanded her respirator to be removed. The hospital declined to do so and thus
began a legal battle between the parents and the hospital authorities. Even today, years later, the
Quinlan case is given a place within public debate as well as legal and medical research. The
case of Quinlan changed the relation between medicine and law forever and drew attention to the
face of the end of life decisions as stated by Kenny (2005). Joe and Julia Quinlan’s decision to
take their daughter off the resuscitator bothered the cosmic mechanism that rules the sacredness
of human life (Kenny, 2005). Karen Quinlan got infected with pneumonia in1985 and died. She
was not given antibiotics as it could have prolonged her life but made the quality of her life low
and nobody objected to the decision of the doctors as stated by Ulrichová (2016). Although
Karen became vegetative in 1975, the legal issues went on for about a year and it became the
first “right-to-die” case (Fine, 2005). The doctors refused to remove the mechanical ventilator as
they indicated that doing so would be equivalent of murder and it was their constitutional duty to
protect Karen and keep her alive. The case was referred to the New Jersey Supreme Court,
where the parents were given permission to remove the ventilator in 1976 (Fine, 2005). The
court gave their final verdict based on the right to privacy and felt that the families are acceptable
substitutes to take decisions on behalf of their incapacitated patients. The court also determined
if the physicians should seek a medical balance and consider the quality of life. The judges in the
Quinlan case also contended that such cases require the consultation of a clinical ethics
committee and do not belong in court.
Legal and ethical issues in the case
Kenny (2005) asserts that Karen became the embodiment of concerns and changes in
medical technology an, patient independence. She can be seen as a rhetorical synbol who did not
speak for herself but has become a medium for others to speak through. The hospital was
unwilling to comply with Quinlan’s wishes and wanted to relieve Joe Quinlan as guardian of
Karen and appoint the State as her guardian. According to Kenny (2005), her case led to radical
changes as the news spread around the world and imitated the right-to-die movements. The
source of hospital ethics can be sketched back to her case. Even today, the legal experts, ethical
think tanks and medical authorities use the Karen Quinlan case as a reference point for their
opinions. Her case was to set up a cornerstone for discussions of euthanasia and end of life
decisions.
Karen's father made an appeal to the New Jersey Supreme Court, and with Karen Quinlan
case, the Supreme Court addressed the right of privacy in terminal illness. In its three pages of
opinion, the Court declared that the life support apparatus for Karen could be discontinued, but
on certain conditions. Those conditions included a concurrence among the responsible attending
physicians and agreement by a hospital ethics committee (Horan, 1977). Karen's father
contention about his First Amendment rights of religious beliefs was brushed aside by the court.
However, the Court did find a constitutional right in the right to privacy and the right to reject
medical treatment. The Court concluded that as Karen was incompetent to take her decisions and
exercise that right, those rights were transferred to her guardian "under the peculiar