RESEARCHER
IN THE CASE OF: KAREN ANN QUINLAN & "THE RIGHT TO DIE"!
Mon Oct 20 19:17:26 2003
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KAREN ANN QUINLAN
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The following summary of In the Matter of Quinlan is from a talk given by her attorney, Paul W. Armstrong, in 1979 at the Medical College of Georgia.

The facts in the Quinlan case are tragically simple. On April 15, 1975, Karen who was then 21 was taken ill. She had difficulty breathing and friends summoned a rescue squad. While awaiting the arrival of help, they attempted to administer artificial respiration to Karen. Then an ambulance took her to Newton Memorial Hospital in Newton, New Jersey. She was in an unresponsive state and showed evidence of brain damage. On April 24, 1975, she was transferred to the Intensive Care Unit of St. Claire's Hospital in Danville, New Jersey where she remained until June 9, 1976. On that day, she was transferred to Morris View Nursing home in Morris Plains, New Jersey where she remained until her death. The physicians who treated Karen were never able to determine what caused her to have her initial breathing difficulties.

Karen's condition was described as a persistent vegetative state. It was the result of extensive and irreparable brain damage brought on by the total loss of cognitive functions. There is no sapient behavior, no awareness of self or surroundings. In addition to being totally unconscious, Karen was unable to breath properly. At times, she did not breathe at all. Because of this, doctors inserted a respirator tube into her trachea through an opening in her throat. The respirator forced air through the tube into her lungs and assisted her ventilation process in essentially two ways. If she breathed on her own, the respirator simply increased the volume of air which reached her lungs; if she did not breathe at all the respirator took over that function entirely.

From the first days of Karen's illness the family was in regular and frequent communication with her two treating physicians. Both said that Karen's condition was hopeless and that she would not survive and one recommended that Karen should be removed from the respirator. Not long before falling ill Karen had on at least three occasions made statements that if she were in a hopeless medical condition she would not want her life prolonged by the futile use of extraordinary medical measures. In late July of 1975 a meeting was held among the Quilans, the treating physicians and the hospital chaplain. It was agreed by all present that the use of the respirator would be discontinued. After the meeting the Quinlans were asked by the hospital authorities to sign a release in favor of the treating physicians and the hospital, which they did.

Within a few days after the meeting, the treating physician informed the Quilans that he wound not honor their wishes. He stated that he could find no medical precedent with regard to such action. If he had found a favorable precedent, he would have honored the request. There is, however, sound medical tradition to the effect that the care of the type then being administered to Karen is properly used only in acute situations where the possibility of a recovery exists. That withdrawal of such treatment in situations like Karen's was medically acceptable and that the family and physicians were properly cooperators in making the necessary decision. (For current professional guidelines see the AMA's Withholding or Withdrawing Life-sustaining Medical Treatment and The Provision of Adequate Health Care.)

Consulting once again with the hospital and his attorney, Mr. Quinlan was advised that as a first step that he would have to be appointed guardian of his daughter in order to be able to authorize the proposed withdrawal of treatment. He would not take it upon himself to act without legal sanction. Accordingly on September 12, 1975, he commenced an action in the Superior Court of New Jersey praying that he be appointed the guardian of his daughter with the expressed power of authorizing the discontinuance of all extraordinary means of sustaining the vital processes of his daughter, Karen Ann Quinlan. A guardian ad litem was appointed for Karen. The Attorney General of the State of New Jersey intervened; the county prosecutor, the treating physicians and the hospital were also made parties to the suit. All opposed the family's prayer.

Briefly, succinctly, and within the context of Karen's plight the following legal arguments were advanced on behalf of the Quinlan family. First, the common law doctrine of guardianship mandates the Court, as supreme guardian of all incompetents who appear before it, find that the withdrawal of treatment administered to Karen Quinlan is the only course of action which will promote her best interests. It was further argued that the right to refuse treatment is protected not only at common law but also by the provision of the United States Constitution. The principal contention of Joseph Quinlan in this regard was that the right of privacy protected by the Constitution enabled him and his family to cause the discontinuance of certain life sustaining medical treatment which Karen was receiving; and it was this argument as will be seen shortly which eventually was adopted by the New Jersey Supreme Court. The third contention which was advanced on behalf of Mr. Quinlan was that the denial of this request would be an impermissible interference with the free exercise of his religion. The First Amendment to the United States Constitution as applied to the States' Fourteenth Amendment prohibits the States from interfering with the free exercise of religious beliefs absent compelling contrary secular [State's] interests. And, lastly, it was argued that the Eighth Amendment's proscription against the imposition of cruel and unusual punishment will be violated by the failure of the Court to grant the prayer of the Quinlan family.

The arguments advanced by the Attorney General for the State of New Jersey, the county prosecutor, the treating physicians, the hospital and the guardian ad litem can be summarized as follows. First, the Court lacks the jurisdiction and power to grant the relief sought by the Quinlan family. Second, it is never in a person's best interest to elect the suspension of medical measures where death is a likely concomitant. Third, there is no constitutional right to die. The State's compelling interest in the preservation of life invariably overrides individual decisions predicated upon the right of privacy and upon the guarantees of the First and Eighth Amendments. Fourth, granting of the Quinlan's request would derogate from prevailing medical standards; and fifth, withdrawal of treatment would constitute homicide should Karen die.

The result was a denial by the lower court of the family's request and the appointment of someone other than Mr . Quinlan as the guardian of his daughter's person. The question was certified for direct appeal by the Supreme Court of New Jersey and weighty issues were argued anew before that seven-member tribunal.

On March 31, 1976, the Supreme Court rendered an unanimous decision providing for the appointment of Joseph Quinlan as personal guardian of his daughter Karen with full power to make decisions regarding the identity of her treating physicians. Upon the concurrence of the guardian and family, if Karen's doctors concluded that there is no reasonable possibility of her emerging from her present comatose condition to a cognitive, sapient state and that her life support apparatus should be withdrawn, they were to consult with the Ethics Committee of the Institution where Karen was then hospitalized. If that consultative body concurred in the prognosis, the life support system could be withdrawn without any civil or criminal liability on the part of any participant whether guardian, physician, hospital or others.

The court based its decision on the constitutional right of privacy enunciated primarily in the United States Supreme Court cases of Griswald v Connecticut and Roe v Wade. The Court in Griswald found the unwritten constitutional right of privacy to exist in that the number of specific guarantees of the Bill of Rights formed by emanations from those guarantees that helped give them life and substance. According to the New Jersey Supreme Court, this right is broad enough to encompass a patient's decision to decline medical treatment under certain circumstances in much the same way as it is broad enough to encompass a woman's decision to terminate pregnancy under certain circumstances. While stressing that such a right is not absolute and, therefore, can give way before a compelling state interest, the Court denied the possibility of such a compelling interest in the instant circumstances. Reasoning that the State's interest weakens and the right of individual privacy becomes stronger as the degree of bodily invasion increases and the prognosis dims, the Court concluded that in Karen's circumstances the degree of bodily invasion was so great and her prognosis so dim that her right to privacy clearly outweighed any arguable State interest. The Court went on to point out that the right of privacy would be illusory in the case of an incompetent like Karen unless it could be exercised by someone on her behalf by those closest to her. If Karen's guardian and family acting as they believe Karen would have acted, chose to terminate treatment the Court felt that such a decision should be accepted by society the majority of whose members would have made the same decision themselves.

In reaching its conclusions, the Court also considered the proper role to be played by those allegedly prevailing medical standards which it had been argued constituted a bar to the withdrawal of treatment. While the doctors on the case had appealed to those standards in refusing to honor the Quinlan's request, the Court found a certain ambiguity in the attitude of the medical profession toward such standards. In addition to the view put forward on behalf of the treating physicians, it found another approach - one which refused to treat the hopeless and dying as if they were curable. The justices concluded that the standards relied on by the treating physicians were neither so consistent nor so rational that they could prevail over the interest and desires of the patient as seen by her father and guardian nor could such standards control the Court in its response to the case with declaratory relief established by Joseph Quinlan.

Finally, in addressing itself to the question of possible homicide, the Court concluded that there is a valid distinction between withdrawing life support systems in cases such as Karen's and the infliction of deadly harm either on one's self or another. It saw a difference between Karen's situation and the unlawful killing which is condemned in statutory law. The court denied that the death following upon the withdrawal of treatment would be homicidal. It would be rather the result of previously existing natural causes not from the withdrawal of treatment; and, even if it were considered homicide, it could not be unlawful if done pursuant to the exercise of an explicitly recognized constitutional right.

In late May of 1976 Karen was weaned from the respirator and in early June, Mr. Quinlan, a father and guardian and within the context of the Supreme Court decision, transferred Karen to the Morris Nursing Home and placed her under the care of the Medical Director of that institution. An ethics committee was formed according to the Supreme Court's guidelines and it concurred in the conclusion reached by Karen's new treating physician that there was no reasonable possibility of her ever emerging from her present comatose condition to a cognitive sapient state and that there were no circumstances that would warrant the use of heroics or extraordinary measures to prolong her life.

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Bob and Mary Schindler plan to file a motion today that asks the U.S. District Court in Tampa to stop their son-in-law from removing life support and force a circuit judge to hold a new trial.
HERE THE DIFFERENCE:

• Just heard that Terri is still awake! — David, Mon Oct 20 20:04