Abstract
Karen Ann Quinlan is a woman who lived between March 1954 and June 1985. She was born to a single mother of American Irish ancestry. Later, her mom gave her up for adoption to Joseph and Julia Quinlan; a childless couple at the time. (Quinlan, 1978). At age 21 in 1975, however, after moving away from her adopted parents to live with friends; she encountered the unfortunate experience of becoming unconscious, remaining in a coma for almost ten years. From reports she was dieting, had very little to eat within two days of the incident and was taking tonics and valium; besides drinking gin at a party. (Quinlan, 1978). After months of non responsiveness at efforts of restoring consciousness; the frustrated Quinlans wanted the ventilator to be removed for Karen to die peacefully. A legal battle ensued and they surprisingly won. The ventilator was withdrawn, but Karen continued breathing for nine long years unaided by any life support, eventually succumbing to pneumonia. (Quinlan, 1978). This story had been scrutinized by almost every social justice authority in the nation and perhaps, internationally to the extent that the Quinlans were pressured to tell their side of the story.
Ethical analysis: The Quinlans tell their story - Karen Quinlans
Introduction
In the following analysis of how morally correct it is to remove a ventilator from someone who is still breathing as in the case of Karen Quinlans; an attempt would be made to critically assess the historical and political significance of such as an action; the legality of the procedure and health policy implications involved in making such a decision.
The intention is to open doors for clarity and reasonable alternatives, which could have been chosen. Unlike the expectation of her parents who desired a peaceful ending without undue suffering it did not manifest the way they thought. Therefore, the debate is centered around who has the right to terminate life based on situations similar to Karen Quinlan or even in her case? Did her parents even after gaining permission from the court were morally eligible to make that decision?
Historical Significance
The historical significance of this story is its daring reality that someone may think that they know what is best for another, but after achieving goals either of accomplishing their desires or gaining support for demonstrating it, still, it may not prevent the inevitable from occurring.
In Karen Quinlan’s case the revealed intention of her parents was to save her the prolonged suffering. This is commendable being Catholics who wanted the best for their child. From a legal perspective medical practitioners had to be given permission. Obviously, this was to avoid accusations of “mercy killing” without adequate permission. ( Two Approaches to Right)
Of major historical significance for further considerations; this case from the author’s account projects the need for people to document what they desire before a situation as Karen Quinlan occurs. No one knows if she had remained on the ventilation what the outcome might have been. There are no studies to prove whether she would have suffered more or less had she not been breathing on her own and given up to die.
Who makes the decision to pull the plug for an unconscious patient? This is how significant this case is in the history of medicine where life support technology has now so far advanced, than when Karen Quinlan’s ventilator was removed.
Since then there have been extensive legislations regarding the ‘right to die’ as moral, ethical and legal implications obviously, char the decision of others making that choice. Karen’s Quinlan’s extra-ordinary case has forged tremendous historical analysis regarding the social phenomena. They range from legislations regarding causing premature death; use of life ending drugs in medical practice; right to die included in homicide laws and presumed innocence of the defender. (Two Approaches to Right)
Political Significance
The political significance of this story told by the Quinlans, inevitably, impinges on the politics involved in the ‘right to die.’ Most importantly, what would it cost a family to keep a patient on life support? Is it worth it? What would it have cost the Quinlan’s to keep their daughter on life support in the twentieth century? Was holding on to their financial resources more important than clinching life for their child?
These are the political considerations involved in the Quinlan’s story of deciding that it was worthless to keep Karen on a ventilator. Recent research has revealed that Critical Care is very expensive. According to studies conducted by John Luce and Gordon Rubenfield from “Department of Medicine, University of California, San Francisco, San Francisco, California; and Department of Medicine, University of Washington, Seattle, Washington” (Luce, 2002) of the $900+ billion expended on health care in 1995, 300+ billion went to hospital care of which 20% consisted of critical care allotment.( Luce, 2002)
Further they concluded that patients who die are far more costly than those who survive. Hence, when considering patients who die they concluded that, “The care of nonsurvivors involved a significantly higher average LOS and mean charges than the care of survivors in this study. The relationship between increased resource use and mortality is reliable enough that at least one ICU prognostic tool, the Therapeutic Intervention Severity Score, relies on this relationship to predict outcome. (Cullen, 1974).
In Karen Quinlan’s case her parents certainly predicted the outcome based on the persistence of a “vegetative state.” (Kenny, 1994). Consequently, the state when evaluating the cost of keeping Karen on a ventilator with a non- professional prediction of death supported the Quinlan’s request to remove life support. The conclusive analysis then is that the ‘right to die’ might have serious political implications in terms of the total cost of care.
Legal aspects
The legal aspects of the Quinlan’s story are no different from what occurs today. Legislations related to ‘right to die’ were not as critical as they are in the twenty-first century. However, the Quinlans fought a legal battle, which would have removed the right of making such a decision from the unconscious patient to the father who eventually was awarded guardianship by the court. (Court and end of life)
Historically, it was the first case of this nature to reach a court in the United States of America at the New Jersey district. These parents were requesting life support to be removed from a patient doctors did not consider brain dead, according to Harvard’s criteria, neither for whom there was no prognosis of death.( Court and end of life)
Based on the sequel of the litigation it was difficult to convince the court that these parents be awarded this prerogative. It entailed endless reviews of laws pertaining to Homicide, respect for privacy, morality and medical malpractice. Conclusively, the court suggested that hospitals form ethical committees to help address extraordinary cases such as Karen Quinlan. (Court and end of life )
The court’s decision was based on the premise that Karen Quinlan’s right to privacy be upheld; “modern devices used for prolonging life, such as respirators, had confused the issue of "ordinary" and "extraordinary" measures. Therefore, the court suggested that respirators could be considered "ordinary" care for a curable patient, but "extraordinary" care for irreversibly unconscious patients.” (Court and end of life)
How legitimate was the decision to remove Karen’s respirator even within the parameters of such medical, legal and moral controversies? What does her right to privacy have to do with it? Hence, the importance of people making that decision prior to arriving at this point when someone else has to do it. How could the court, legal profession and her parents be sure that this was what she wanted? No one knew except if it were written as a legal document.
Health policy implications
It is always thinkable to file law suits against hospitals, medical practitioners and people delivering care, generally. In Karen Quinlan’s case clearly, it would have been a contraindication to even think about removing her ventilator upon some request of, perhaps frustrated parents.
According to the Harvard criteria it would have been medical malpractice to engage in such an act. Brain death could not have been established as “Irreversible brain damage and loss of brain function, as evidenced by cessation of breathing and other vital reflexes, unresponsiveness to stimuli, absence of muscle activity, and a flat electroencephalogram for a specific length of time.” (Brain Death).
Analysis of the autopsy revealed that Karen Quinlan continued breathing because her cerebral cortex was moderately scarred. However, the thalamus contained extensive bilateral damage. Medical science at the time could not have estimated the extent of destruction to the brain stem. (Kenny, 1994)
Interestingly the autopsy revealed that there was no damage to the brain stem which controlled breathing and cardiac functions. (Kenny, 1994). As such, a decision to remove the ventilator from such a patient could not have been entertained. Perhaps, the question the Quinlans should have been asking a medical practitioner was how further investigations could be conducted in ascertaining the extent of damage.
Conclusion
This story told by the Quinlans could be considered an attempt to appease a guilty conscience. From a paradigm of mere curiosity one wonders if the Quinlans had birth Karen a decision to pull her off a ventilator; allowing her to die would have been so quickly made. Did they have their own issues with Karen during her upbringing which triggered this decision? Definitely, the odds were against them, the courts, medical profession and public. She survived 9 years after the ventilator was removed. (Quinlan, 1978) Had she not contracted pneumonia life would have continued in her body.
Could it have been that had she remained on the ventilator it could have prevented her from dying of pneumonia because the lungs would have been adequately ventilated? Precisely, if this can be proven it is clear that Karen Quinlan was murdered by her parents with permission from the New Jersey Court.
References
Brain death. Retrieved (2011, June 6) from http://medical-
dictionary.thefreedictionary.com/brain+death
Court and end of life: the right to privacy: Karen Ann Quinlan. Retrieved (2011, June 6) from
http://www.libraryindex.com/pages/582/Court-End-Life-RIGHT-PRIVACY-KAREN-
ANN-QUINLAN.html
Cullen. D. (1974) Therapeutic intervention scoring system: a method for quantitative comparison
of patient care. Crit Care Med. 2(1974), 57-60
Kinney, H. (1994). Neuropathological Findings in the Brain of Karen Ann Quinlan -- The Role of the
Thalamus in the Persistent Vegetative State. The New England Journal of Medicine.
330(1994), 1469-1475.
Luce, J. (2002). Can Health care cost be reduced by limiting intensive care at the end of life?
American Journal of Respiratory and critical Care medicine, 165. 6, Retrieved from
http://ajrccm.atsjournals.org/cgi/content/full/165/.
Quinlan, J. (1978). Karen Ann: The Quinlans Tell Their Story. New York: Bantam.
Two Approaches to Right--To-Die Laws: Retrieved (2011, June 6) from
http://www.tc.umn.edu/~parkx032/CY-2APP.html
