Karen Ann Quinlan

Karen Ann Quinlan (March 29 1954 – June 11 1985) was an important figure in the history of the right to die debate in United States. When she was 21, Quinlan fell unconscious after coming home from a party, and 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 hit headlines and set significant precedents. Not only was the case groundbreaking legally, it was remarkable for its rare appeal to religious principles. Because she and her family were Catholics, several principles of Catholic moral theology were critical in deciding the case and thus influencing a development in American law, an influence replicated around the world. The case is credited also with the development of the modern field of bioethics. Although Quinlan was removed from active life support in 1976, she lived on in a coma 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. Three 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 life
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 Landing, New Jersey. She was soon joined by two (unadopted) siblings: Mary Ellen (born 1956) and John (born 1957).

Karen Ann and her family lived in Landing for the next two decades uneventfully.

According to some friends, Quinlan lived a wild, reckless lifestyle and used drugs including heroin, cocaine and methadone. However, the evidence regarding her drug use is contradictory and her parents deny she was a drug user.

Collapse
In April 1975, shortly after she turned 21, Karen Quinlan left her parents' home and moved in with two roommates in 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 (50 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 48 hours. At the party, she reportedly drank a few gin and tonics &mdash; and took a tranquilizer, believed to be phenobarbital, but perhaps valium or methaqualone &mdash; when she suddenly felt faint. Shortly thereafter she was taken home and put in 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.

Karen 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.

Coma
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, although her mother has said that the doctors' best guess was that she fell asleep or passed out and aspirated on her own vomit. She was in a coma. Her eyes were "disconjugate" &mdash; that is, they no longer moved in the same direction together &mdash; and her EEG, while not flat, showed only abnormal slow-wave activity.

She was in a very deep and un-recoverable form of unconsciousness called a persistent vegetative state.

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 only kept alive by nasogastric feeding and the constant presence of a ventilator to help her breathe.

Legal battle
After 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 refused. They were probably wary of a recent, well-publicised case where a doctor, Kenneth Edelin had been charged with manslaughter for performing a late-term abortion. The boundaries of the "right to life" was a topical issue and the hospital's lawyers did not want to risk a legal quagmire.

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.

Death
She lived in a persistent vegetative state until her death from pneumonia in 1985. Quinlan was buried at Gate of Heaven Cemetery in East Hanover, New Jersey.

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 as Karen herself was a Catholic. 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 Quinlin" (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 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.

Legacy
Three 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.

Autopsy findings
While Karen Ann was alive but unconscious, the extent of damage to her brainstem could not be precisely determined. However when 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.

Cultural influence
A TV movie was made about Karen Quinlan, with Piper Laurie and Brian Keith playing her parents.

The 1981 film The Verdict, starring Paul Newman and Jack Warden, chronicled the case of a woman in a persistent vegetative state, though in that case the cause was medical negligence.

Taking sedatives with alcohol is often jokingly referred to as having a "Karen Ann Quinlan Cocktail."

Comedian Denis Leary mentions her in the screenplay of his show, No Cure For Cancer. though he does mention she woke up when she was taken off life support, which never happened.