Karen Ann Quinlan
Encyclopedia
Karen Ann Quinlan 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
. After she collapsed and stopped breathing twice for 15 minutes or more, the paramedics arrived and took her to 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 precedent
s. The tribunal 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 guardian
ship 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
.
, 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
. Julia and Joseph produced 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.
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 tonic
s 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.
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. Her mother said the doctors' best guess was that she aspirated
her own vomit while unconscious.
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 hospital and her condition gradually deteriorated. She lost weight - eventually weighing less than 80 pounds. 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.
, 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.
until her death from complications from pneumonia
in 1985. Quinlan was buried at Gate of Heaven Cemetery
in East Hanover, New Jersey
. The Quinlans, with author Phyllis Battelle, wrote a book about their legal battle titled Karen Ann, which was published in 1977.
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:
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.
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
.
and Brian Keith
playing her parents.
The eponymous heroine of Douglas Coupland
's novel Girlfriend in a Coma is also called Karen and collapses after a party. For these reasons (and the frequent nostalgic references to events from the 1970s in Coupland's works) the character is thought to be based on Quinlan.
Right to die
The right to die is the ethical or institutional entitlement of the individual to commit suicide or to undergo voluntary euthanasia. Possession of this right is often understood to mean that a person with a terminal illness should be allowed to commit suicide or assisted suicide or to decline...
controversy in the United States.
When she was 21, Quinlan became unconscious after arriving home from a party. She had consumed diazepam
Diazepam
Diazepam , first marketed as Valium by Hoffmann-La Roche is a benzodiazepine drug. Diazepam is also marketed in Australia as Antenex. It is commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms , restless legs syndrome, alcohol withdrawal,...
, dextropropoxyphene
Dextropropoxyphene
Dextropropoxyphene, manufactured by Eli Lilly and Company, is an analgesic in the opioid category. It is intended to treat mild pain and has, in addition, anti-tussive and local anesthetic effects. It has been taken off the market in Europe and the US due to concerns of fatal overdoses and...
, and alcohol
Ethanol
Ethanol, also called ethyl alcohol, pure alcohol, grain alcohol, or drinking alcohol, is a volatile, flammable, colorless liquid. It is a psychoactive drug and one of the oldest recreational drugs. Best known as the type of alcohol found in alcoholic beverages, it is also used in thermometers, as a...
. After she collapsed and stopped breathing twice for 15 minutes or more, the paramedics arrived and took her to hospital, where she lapsed into a persistent vegetative state
Persistent vegetative state
A persistent vegetative state is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. It is a diagnosis of some uncertainty in that it deals with a syndrome. After four weeks in a vegetative state , the patient is...
. 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 precedent
Precedent
In common law legal systems, a precedent or authority is a principle or rule established in a legal case that a court or other judicial body may apply when deciding subsequent cases with similar issues or facts...
s. The tribunal eventually ruled in her parents' favor.
Although Quinlan was removed from mechanical ventilation
Mechanical ventilation
In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a physician, respiratory therapist or other suitable person compressing a bag or set of bellows...
during 1976, she lived on in a persistent vegetative state for almost a decade until her death from pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
in 1985.
Quinlan's case continues to raise important questions in moral theology
Moral theology
Moral theology is a systematic theological treatment of Christian ethics. It is usually taught on Divinity faculties as a part of the basic curriculum.- External links :*...
, bioethics
Bioethics
Bioethics is the study of controversial ethics brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, and philosophy....
, euthanasia
Euthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
, legal guardian
Legal guardian
A legal guardian is a person who has the legal authority to care for the personal and property interests of another person, called a ward. Usually, a person has the status of guardian because the ward is incapable of caring for his or her own interests due to infancy, incapacity, or disability...
ship and civil rights
Civil rights
Civil and political rights are a class of rights that protect individuals' freedom from unwarranted infringement by governments and private organizations, and ensure one's ability to participate in the civil and political life of the state without discrimination or repression.Civil rights include...
. 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
Living will
An advance health care directive, also known as living will, personal directive, advance directive, or advance decision, are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or...
.
Early life
Karen Ann Quinlan was born on March 29, 1954, in Scranton, PennsylvaniaScranton, Pennsylvania
Scranton is a city in the northeastern part of Pennsylvania, United States. It is the county seat of Lackawanna County and the largest principal city in the Scranton/Wilkes-Barre metropolitan area. Scranton had a population of 76,089 in 2010, according to the U.S...
, to a young unmarried mother
Single parent
Single parent is a term that is mostly used to suggest that one parent has most of the day to day responsibilities in the raising of the child or children, which would categorize them as the dominant caregiver...
of Irish American
Irish American
Irish Americans are citizens of the United States who can trace their ancestry to Ireland. A total of 36,278,332 Americans—estimated at 11.9% of the total population—reported Irish ancestry in the 2008 American Community Survey conducted by the U.S. Census Bureau...
ancestry. A few weeks later, she was adopted by Joseph and Julia Quinlan, devout Roman Catholics who lived in Landing, New Jersey
Landing, New Jersey
Landing is a small settlement and unincorporated area located within Roxbury Township, New Jersey, on the south shore of Lake Hopatcong near Hopatcong State Park...
. Julia and Joseph produced 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.
Collapse
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 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 tonic
Gin and tonic
A gin and tonic is a highball cocktail made with gin and tonic water poured over ice. It is usually garnished with a slice or wedge of lime, or lemon. The amount of gin varies according to taste...
s 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.
Coma
Karen Quinlan had suffered irreversible brain damageBrain damage
"Brain damage" or "brain injury" is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors...
after experiencing an extended period of respiratory failure
Respiratory failure
The term respiratory failure, in medicine, is used to describe inadequate gas exchange by the respiratory system, with the result that arterial oxygen and/or carbon dioxide levels cannot be maintained within their normal ranges. A drop in blood oxygenation is known as hypoxemia; a rise in arterial...
(lasting no more than 15–20 minutes). No precise cause of her respiratory failure has been given. Her mother said the doctors' best guess was that she aspirated
Pulmonary aspiration
Pulmonary aspiration is the entry of material from the oropharynx or gastrointestinal tract into the larynx and lower respiratory tract...
her own vomit while unconscious.
She was in a very deep form of unconsciousness called a persistent vegetative state
Persistent vegetative state
A persistent vegetative state is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. It is a diagnosis of some uncertainty in that it deals with a syndrome. After four weeks in a vegetative state , the patient is...
. Her eyes were "disconjugate" (they no longer moved in the same direction together). Her EEG
EEG
EEG commonly refers to electroencephalography, a measurement of the electrical activity of the brain.EEG may also refer to:* Emperor Entertainment Group, a Hong Kong-based entertainment company...
showed only abnormal slow-wave activity.
Over the next few months she remained in hospital and her condition gradually deteriorated. She lost weight - eventually weighing less than 80 pounds. She was prone to unpredictable, violent thrashing of her limbs. She was given nasogastric feeding
Nasogastric intubation
Nasogastric intubation is a medical process involving the insertion of a plastic tube through the nose, past the throat, and down into the stomach.-Uses:...
and a ventilator to help her breathe, and it was thought that these were the only things keeping her alive.
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 faced with threats by 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 took their case to the New Jersey Supreme CourtNew Jersey Supreme Court
The New Jersey Supreme Court is the highest court in the U.S. state of New Jersey. It has existed in three different forms under the three different state constitutions since the independence of the state in 1776...
, 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 statePersistent vegetative state
A persistent vegetative state is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. It is a diagnosis of some uncertainty in that it deals with a syndrome. After four weeks in a vegetative state , the patient is...
until her death from complications from pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
in 1985. Quinlan was buried at Gate of Heaven Cemetery
Gate of Heaven Cemetery, East Hanover
Gate of Heaven Cemetery is a cemetery located in East Hanover, New Jersey, United States. The cemetery is operated under the auspices of the Roman Catholic Archdiocese of Newark. It opened in 1937 and had 81,000 burials through 2002. 100 of the cemetery's original have been developed. Construction...
in East Hanover, New Jersey
East Hanover, New Jersey
East Hanover Township is a township in Morris County, New Jersey, United States. As of the United States 2000 Census, the township population was 11,393. The town was incorporated in 1928. The headquarters of the Nabisco company and the pharmaceutical company Novartis are located in East...
. The Quinlans, with author Phyllis Battelle, wrote a book about their legal battle titled Karen Ann, which was published in 1977.
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
New Jersey Supreme Court
The New Jersey Supreme Court is the highest court in the U.S. state of New Jersey. It has existed in three different forms under the three different state constitutions since the independence of the state in 1776...
decision on the groundbreaking and precedent-setting case quotes extensively from an address given by Pope Pius XII
Pope Pius XII
The Venerable Pope Pius XII , born Eugenio Maria Giuseppe Giovanni Pacelli , reigned as Pope, head of the Catholic Church and sovereign of Vatican City State, from 2 March 1939 until his death in 1958....
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)
-
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.
Autopsy findings
While Quinlan was alive the extent of damage to her brainstem could not be precisely determined. After she died her entire brainBrain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
and spinal cord
Spinal cord
The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system...
were studied carefully. While her cerebral cortex
Cerebral cortex
The cerebral cortex is a sheet of neural tissue that is outermost to the cerebrum of the mammalian brain. It plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness. It is constituted of up to six horizontal layers, each of which has a different...
had moderate scarring, it seemed that her thalamus
Thalamus
The thalamus is a midline paired symmetrical structure within the brains of vertebrates, including humans. It is situated between the cerebral cortex and midbrain, both in terms of location and neurological connections...
was extensively damaged bilaterally. Her brain stem
Brain stem
In vertebrate anatomy the brainstem is the posterior part of the brain, adjoining and structurally continuous with the spinal cord. The brain stem provides the main motor and sensory innervation to the face and neck via the cranial nerves...
(which controls breathing and cardiac functions) was undamaged. These findings suggest that the thalamus plays a particularly important role in consciousness
Consciousness
Consciousness is a term that refers to the relationship between the mind and the world with which it interacts. It has been defined as: subjectivity, awareness, the ability to experience or to feel, wakefulness, having a sense of selfhood, and the executive control system of the mind...
.
Trivia
A 1977 TV movie, In The Matter of Karen Ann Quinlan was made about Karen Quinlan, with Piper LauriePiper Laurie
Piper Laurie is an American actress of stage and screen known for her roles in the television series Twin Peaks and the films The Hustler, Carrie, and Children of a Lesser God, all of which brought her Academy Award nominations...
and Brian Keith
Brian Keith
Brian Keith was an American film, television, and stage actor who in his four decade-long career gained recognition for his work in movies such as the 1961 Disney family film The Parent Trap, the 1966 comedy The Russians Are Coming, the Russians Are Coming, and the 1975 adventure saga The Wind and...
playing her parents.
The eponymous heroine of Douglas Coupland
Douglas Coupland
Douglas Coupland is a Canadian novelist. His fiction is complemented by recognized works in design and visual art arising from his early formal training. His first novel, the 1991 international bestseller Generation X: Tales for an Accelerated Culture, popularized terms such as McJob and...
's novel Girlfriend in a Coma is also called Karen and collapses after a party. For these reasons (and the frequent nostalgic references to events from the 1970s in Coupland's works) the character is thought to be based on Quinlan.