Karen Ann Quinlan
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|Karen Ann Quinlan|
Karen Ann Quinlan in 1972, prior to her brain injury
March 29, 1954|
|Died||June 11, 1985
Morris Township, New Jersey
Karen Ann Quinlan (March 29, 1954 – June 11, 1985) was an important figure 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 (it's disputed whether any drugs were found in Karen's system). After she collapsed and stopped breathing twice for 15 minutes or more, the paramedics arrived and took her to a 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 New Jersey Supreme Court 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.
Karen 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 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.
Karen Ann and her family lived uneventfully in Landing for the next two decades.
In 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 kg) 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.
Karen 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.
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 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, and it was thought that these were the only things keeping her alive.
After seeing Karen like this for several months, her family wanted her returned to her 'natural state'. Being devoutly Catholic, the Quinlans sought the counsel from their church. They did not want to end Karen's life but to end the "extraordinary means", specifically the ventilator. Hospital officials, faced with threats from 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 appealed a ruling against them 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.
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 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)]
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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 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.
While Quinlan was alive the extent of damage to her brainstem 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.
In popular culture
The eponymous heroine of Douglas Coupland's novel Girlfriend in a Coma is Karen Ann McNeil. She collapses after a party where she has taken Valium as well as some alcohol. Like Karen Ann 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.
- Quinlan, J and Quinlan, J. D. (1977). Karen Ann: The Quinlans Tell Their Story. New York: Bantam Books. ISBN 0-385-12666-2
- "Karen Ann Quinlan dies after 10 years in a coma", St. Petersburg (FL) Evening Independent, June 12, 1985, p1
- "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."
- 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.
- Quinlan, Joseph; Battelle, Julia (1977). Karen Ann: the Quinlans Tell Their Story. Garden City, N.Y.: Doubleday. ISBN 978-0-385-12666-3. OCLC 3259340.
- 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.
- Coupland, Douglas (1998). Girlfriend in a Coma. Toronto: HarperCollins. ISBN 978-0-00-224396-4. OCLC 37983572.
- Sabatino, Charles P. "Advance Directives and Advance Care Planning: Legal and Policy Issues". American Bar Association Commission on Law and Aging. Retrieved October 2007.