In the Matter of Karen Ann Quinlan: 1975
In the Matter of Karen Ann Quinlan: 1975
Plaintiff: Joseph T. Quinlan
Defendant: St. Clare's Hospital
Plaintiff Claim: That doctors at St. Clare's Hospital should obey Mr. Quinlan's instructions to disconnect his comatose daughter from her respirator and allow her to die
Chief Defense Lawyers: Ralph Porzio (for Karen Quinlan's physicians), Theodore Einhorn (for the hospital), New Jersey State Attorney General William F. Hyland, and Morris County Prosecutor Donald G. Collester, Jr.
Chief Lawyers for Plaintiff: Paul W. Armstrong and James Crowley
Judge: Robert Muir, Jr.
Place: Morristown, New Jersey
Date of Decision: November 10, 1975
Decision: Denied Mr. Quinlan the right to authorize termination of "life-assisting apparatus" and granted Karen Quinlan's physicians the right to continue medical treatment over the objections of the Quinlan family. Overturned by the New Jersey Supreme Court, which, on March 31, 1976, ruled that Karen's "right of privacy" included a right to refuse medical treatment and that her father, under the circumstances, could assume this right in her stead.
SIGNIFICANCE: This case prompted the adoption of "brain death" as the legal definition of death in some states and the adoption of laws recognizing "living wills" and the "right to die" in other states, as well as the formation of "bioethics" committees in many hospitals. In 1985, the New Jersey Supreme Court ruled that all life-sustaining medical treatment—including artificial feeding—could be withheld from incompetent, terminally ill patients, provided such action was shown to be consistent with the afflicted person's past wishes.
On April 15, 1975, 21-year-old Karen Ann Quinlan passed out and lapsed into a coma after sustaining bruises which were never satisfactorily explained and ingesting tranquilizers "in the therapeutic range" with alcohol. Unable to breathe on her own, she was placed on a respirator.
By the following autumn, Quinlan's family and doctors had given up hope of recovery. Her parents, Julia and Joseph Quinlan, were devout Roman Catholics. The Quinlans consulted their parish priest, Father Thomas Trapasso, and were told that they could, in good conscience, request that Karen be removed from the respirator. The request was made, but Karen's primary physician, Dr. Robert Morse, refused to end the artificial support. Joseph Quinlan went to court.
By the time the trial began on October 20, 1975, a lawyer, Daniel R. Coburn, had become the court-appointed guardian for Karen Quinlan and both Morris County Prosecutor Donald G. Collester, Jr., and State Attorney General William F. Hyland had intervened, or joined the case, in an attempt to uphold New Jersey's homicide statutes. During pretrial interviews, Attorney General Hyland had portrayed the case as a challenge to New Jersey's long-standing definition of death as the "cessation of vital signs" and one which could result in a new definition based on "cerebral" or "brain death."
The week before the trial, however, it was disclosed that Karen Quinlan did not have a "flat" electroencephalograph, a medical test which would have been evidence of a complete absence of brain-wave activity. She also was capable of breathing on her own for short, irregular periods and had occasionally shown muscle activity which some doctors had described as voluntary. It immediately became clear that the trial would not center on New Jersey's definition of death but on an even more complicated question of whether Karen Quinlan had a "right to die."
Accepted Standards vs. Right to Die
Karen Quinlan's neurologist, Dr. Robert Morse, was the first person to testify. He acknowledged that there was virtually no chance that Quinlan would resume a "cognitive, functional existence." However, he said he saw no medical precedent for disconnecting Quinlan from her respirator and said he would not obey a court order to do so. Dr. Arshad Jarved, Quinlan's pulmonary internist, also had refused to act on Joseph Quinlan's request; he also testified that accepted standards of medical practice did not permit the removal of the respirator.
The Quinlans' attorney, Paul Armstrong, argued that the rights of privacy and religious freedom included a right to die. He explained his clients' religious view that the respirator was keeping their daughter from God and heaven: "[T]he earthly phase of Karen Quinlan's life has drawn to a close and she should not be held back from enjoyment of a better, more perfect life."
Karen Quinlan's court-appointed guardian, Daniel Coburn, saw the matter differently: "This isn't a terminal cancer case where someone is going to die. Where there is hope, you cannot just extinguish a life because it becomes an eyesore."
The following day, Armstrong called as an expert witness Dr. Julius Korein, a neurologist at Bellevue hospital and New York University Medical School. He described Karen Quinlan—by now weighing only 75 pounds—as having signs of severe higher brain disfunction. He testified that she had only "stereotyped" responses, such as blinking or rolling her eyes, to stimuli. "This pattern of reactions," he said, "could, in no way, in my opinion, be related to conscious activity." Dr. Korein also described "an accepted but not spoken-of law," according to which physicians withheld aggressive, invasive treatment from patients who were, for example, "riddled with cancer and in pain." He added: "That is the unwritten law and one of the purposes of this trial is to make it the written law."
Then an emotional Joseph Quinlan then took the stand and asked the court: "Take her from the machine and the tubes and let her pass into the hands of the Lord."
On the third day, Karen's mother, Julia Ann Quinlan, testified that Karen had made her wishes known on three occasions, saying, "Mommy, please don't ever let them keep me alive by extraordinary means." The statements were made, Mrs. Quinlan said, when two of Karen's friends and an aunt finally died after long battles with cancer. "Karen loved life, and if there was any way that she could not live life to the fullest she wanted to be able to die in her own surroundings, instead of being kept alive for months or years. I visit her every day and as I see her in her present condition I know in my heart as a mother she would not want to be there. We discussed this many times."
Although the defense lawyers objected to such hearsay evidence, Judge Robert Muir, Jr., permitted Karen's sister and one of her friends to give similar testimony. Judge Muir declined, however, to permit a Roman Catholic priest to give expert testimony regarding the church's view of extraordinary medical intervention. "It is not my role to weigh the merits of what a person believes," he explained. "It is enough that I am convinced he has these beliefs."
On October 23, three neurologists—Dr. Fred Plum of the American Association of Neurologists, Dr. Sidney Diamond of Mount Sinai Hospital, and Dr. Stuart Cook of the New Jersey College of Medicine and Dentistry—gave expert medical testimony. The three concurred that Karen Quinlan's lack of higher brain function was "irreversible" and "irreparable." However, all three agreed that Quinlan was alive by both legal and medical definitions and that it would be improper to remove the respirator.
Decision is Appealed
On November 10, 1975, Judge Muir rendered his decision. He refused permission for the removal of the respirator and appointed Daniel R. Coburn to continue acting as the guardian of Karen's "person." Joseph Quinlan was appointed guardian of his daughter's property. Rejecting the Quinlans' plea that their daughter be allowed to pass into life after death, Muir wrote that disconnecting the respirator "is not something in her best interest, in a temporal sense, and it is in a temporal sense that I must operate, whether I believe in life after death or not. The single most important temporal quality that Karen Ann Quinlan has is life," he continued. "This Court will not authorize that life to be taken away from her."
On November 17, 1975, the Quinlans filed an appeal, which the New Jersey Supreme agreed to hear on an "accelerated schedule."
On January 26, 1976, during a three-hour session, the case was argued before the seven justices of New Jersey's highest court. Their unanimous decision-naming Joseph Quinlan guardian and authorizing him to order removal of the respirator—was rendered on March 31. Chief Justice Richard J. Hughes wrote the opinion. He specifically stated that the ruling was not based on the freedom of religion argument favored by the Quinlans: "Simply stated, the right to religious beliefs is absolute but conduct in pursuance therefore is not wholly immune from governmental restraint."
Instead, Chief Justice Hughes cited the Supreme Court's decision in the Griswold v. Connecticut birth-control case and based the decision on "Karen's right to privacy." It was a right, he continued, that could "be asserted on her behalf by her guardian under the peculiar circumstances here present."
Lastly, Justice Hughes dismissed the attorney general's and the Morris County prosecutor's contentions that the person removing Quinlan's respirator should be charged with homicide upon her death:
[T]he exercise of a constitutional right, such as we here find, is protected from criminal prosecution. We do not question the state's undoubted power to punish the taking of human life, but that power does not encompass individuals terminating medical treatment pursuant to their right of privacy.
Neither the hospital, Karen Quinlan's physicians, nor the State of New Jersey chose to appeal the decision to the Supreme Court. Quinlan's respirator was removed in May 1976. She managed to breathe on her own and remained in a coma for 10 more years. She died on June 11, 1985.
Suggestions for Further Reading
Colen, B.D. Karen Ann Quinlan. New York: Nash, 1976.
New York Times: September 14, 16, 17, 20, 22, 23, 24, 25, 26, 28, 1975; October 1, 3, 8, 10, 11, 12, 13, 14, 15, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 1975; November 2, 5, 8, 9, 11, 12, 16, 18, 21, 23, 25, 26, 28, 29, 1975; December 7, 12, 17, 18, 19, 22, 1975; January 19, 26, 27, 1976; February 25, 1976; March 9, 1976; April 1, 2, 7, 8, 9, 10, 12, 13, 1976; May 2, 6, 7, 22, 24, 25, 26, 27, 28, 29, 30, 1976; June 12, 1985.
Quinlan, Joseph. Karen Ann: The Quinlans Tell Their Story. Garden City, N.Y.: Doubleday & Co., 1977.