Death With Dignity – Part I – Karen Ann Quinlan
It is never easy to decide to withdraw life support. And, without an Advanced Directive, our families may go through very difficult times in figuring out what to do. The problem became very public in 1975, when a young woman’s loving father had to make the hard decision of how to deal with his daughter.
In 1975, Karen Ann Quinlan overdosed on drugs and became comatose. Without going into the sad details of her condition, she entered a state from which there was no hope of recovery. Amazingly, though, her brain maintained a vegetative state; that is to say it kept her lungs breathing and her heart pumping, so the doctors would not declare her brain dead. When her father sought to be appointed her legal guardian in order to have the respirator removed, the doctors, the hospital, the county prosecutor, the state of NJ and the appointed guardian of his daughter all opposed him. The issue was whether there is an obligation to continue extraordinary procedures to prolong life.
In a landmark decision, In Re Quinlan (NJ 1976), the NJ Supreme Court upheld Joseph Quinlan’s right to be appointed her guardian and to terminate the extraordinary procedures, i.e., the respirator.
The Court considered the three intersecting tenets of our lives:
“The right to a natural death is one outstanding area in which the disciplines of theology, medicine and law overlap; or, to put it another way, it is an area in which these three disciplines convene.
Medicine with its combination of advanced technology and professional ethics is both able and inclined to prolong biological life. Law with its felt obligation to protect the life and freedom of the individual seeks to assure each person’s right to live out his human life until its natural and inevitable conclusion. Theology with its acknowledgment of man’s dissatisfaction with biological life as the ultimate source of joy * * * defends the sacredness of human life and defends it from all direct attacks.”
The court concluded that even under Catholic principles, the decision to withdraw extraordinary measures, as opposed to withholding ordinary life saving means, was morally permissible. The Court further recognized the right of privacy allowing an individual to make such a decision about him or herself, although, in this case, the decision was to be made on her behalf by her father, once appointed as her guardian.
Turning to medical standards, the Court recognized that doctors often face a moral dilemma, particularly with the advances in technology that permit life supporting measures that hadn’t existed in the past. The Court concluded, however, that “the focal point of decision should be the prognosis as to the reasonable possibility of return to cognitive and sapient life, as distinguished from the forced continuance of that biological vegetative existence to which Karen seems to be doomed.”
Finally, the Court concluded that ending the extraordinary measures would not create criminal liability. “There is a real and in this case determinative distinction between the unlawful taking of the life of another and the ending of artificial life-support systems as a matter of self-determination.”
Although Karen lived another ten years after the respirator was removed, she never regained consciousness.
Thus, while the Court held that it is acceptable, lawfully, morally, and ethically, to withhold extraordinary measures, we can all do our families a great service by ensuring that we have executed advanced directives and avoid such a public and long fought battle.