End of Life Decisions: The Case of Karen Quilian

End of life decisions: The case of Karen Quilian
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End of life decisions: The case of Karen Quilian
The Supreme Court decision in the case of Karen Quilian raised pertinent issues in the field of euthanasia. As an appeal decision, the Supreme Court provided itself towards the legality of the decision to turn off Karen Quilian's respirator. To give its judgment, the Court considered several critical legal issues that would determine whether it was justifiable to turn off Karen's life support. Was she legally alive or dead? What are the legal criteria for brain death? Below is a summary of the case and the holdings of the Court.
The facts of the case
Karen Quilian was admitted to Saint Clare's Hospital in New Jersey. She stayed in an intensive care unit where she was unconscious and placed on a respirator. She had a catheter inserted into her bladder to drain out the urine. She was also fed with a tube inserted into her nose leading to her stomach. Nurses were constantly moving and positioning her. Doctors were having a hard time pinpointing what the cause for her coma was. The doctors theorized possible neurological damage as she could not maintain necessary bodily functions. She stayed in a persistent vegetative state for seven months. In November of 1975, Karen's father petitioned the Superior Court of New Jersey, asking for the powers of authorizing her daughter to be put off the respirator. The challenge was that doctors did not want to remove Karen from her life-support machine as they felt equivalent to murder. Doctors believed that they had the inherent duty to keep Karen alive.
The issues before the Court and the determination.
Before the Court was the patient's right to die instead of the duty placed on doctors to preserve life, the challenge that faced the Court was determining whether she was alive or dead. The Court required to understand whether she was medically considered dead, which would justify removing the respirator. Death was a bit more complicated in medical definition, as noted by the Court. To guide the Court, the judges applied the Harvard Medical School criteria to the meaning of brain death. According to the requirements, brain death is defined by four criteria. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"6HpvrG13","properties":{"formattedCitation":"({\\i{}In Re Quinlan}, 1975)","plainCitation":"(In Re Quinlan, 1975)","noteIndex":0},"citationItems":[{"id":248,"uris":["http://zotero.org/users/local/WvZUWaY4/items/8GWACV22"],"uri":["http://zotero.org/users/local/WvZUWaY4/items/8GWACV22"],"itemData":{"id":248,"type":"legal_case","authority":"N.J. Super. Ch. Div.","container-title":"N.J.","number":"137","page":"348 A.2d 80","title":"In Re Quinlan","volume":"227","issued":{"date-parts":[["1975"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (In Re Quinlan, 1975)
First, the patient must be utterly unresponsive to stimuli. The stimuli do not evoke any response, even as subtle as the quickening of breath. Second, the patient does not respond to tests of reflexes. These tests include dilation of the pupils when exposed to light or tapping tendons with a reflex hammer. Third, there is no brain wave activity from the patient. Finally, the patient does not show any sign of spontaneous movement or breathing. Patients on respirators must show no attempt at breathing. The tests for brain death must be conducted again after 24 hours, and if the results are the same, then the patient is clinically dead. Once the tests were conducted, Karen responded to painful stimuli and managed to breathe independently once in a while. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"lt78mMSo","properties":{"formattedCitation":"({\\i{}In Re Quinlan}, 1975)","plainCitation":"(In Re Quinlan, 1975)","noteIndex":0},"citationItems":[{"id":248,"uris":["http://zotero.org/users/local/WvZUWaY4/items/8GWACV22"],"uri":["http://zotero.org/users/local/WvZUWaY4/items/8GWACV22"],"itemData":{"id":248,"type":"legal_case","authority":"N.J. Super. Ch. Div.","container-title":"N.J.","number":"137","page":"348 A.2d 80","title":"In Re Quinlan","volume":"227","issued":{"date-parts":[["1975"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (In Re Quinlan, 1975) The Court recognized that the decision was a medical one, and the courts were not best placed to determine such a matter. Judge Hughes, chief justice of the Supreme Court of New Jersey at the time, ruled in favor of Karen's father and appointed him Karen's guardian, and permitted him to authorize the termination of the respirator.
Judge Hughes reasoned that the right to privacy, in this case, outweighed the duty of a physician to keep a patient alive. The courts could not compel Karen to continue suffering in a state with no reasonable possibility of returning to a proper cognitive state. The right to privacy protects the patient's control over her body, and in the particular instance, the right of the guardian.
The parents' actions and beliefs.
Karen's parents petitioned the Court to allow her father to authorize euthanasia as in the State she was; there was no hope of returning to her usual self. Karen was in the non-responsive State for seven months. The doctors could not pinpoint the cause of her coma, which further demoralized her parents. Under their submissions in Court through their lawyer, Karen was already legally dead and was only kept alive by advancing technology. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"H7iE9l8a","properties":{"formattedCitation":"({\\i{}In Re Quinlan}, 1975)","plainCitation":"(In Re Quinlan, 1975)","noteIndex":0},"citationItems":[{"id":248,"uris":["http://zotero.org/users/local/WvZUWaY4/items/8GWACV22"],"uri":["http://zotero.org/users/local/WvZUWaY4/items/8GWACV22"],"itemData":{"id":248,"type":"legal_case","authority":"N.J. Super. Ch. Div.","container-title":"N.J.","number":"137","page":"348 A.2d 80","title":"In Re Quinlan","volume":"227","issued":{"date-parts":[["1975"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (In Re Quinlan, 1975) The definition of death was essential to the parents because it would justify taking away the respirator, and it would not be considered killing. The parents lived with the belief that the doctors were only delaying the inevitable. Karen was suffering by being kept alive with tubes, machines, and catheters. The opinions of Karen's parents align with the beliefs of many proponents of euthanasia that there is no need to prolong suffering. Suppose a person is already in a persistent or permanent vegetative state, defined as being non-responsive for
.six months or higher. In that case, mercy killing eases the pain of the patient. ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"6Z2ZLTpY","properties":{"formattedCitation":"(Nathan, 2015)","plainCitation":"(Nathan, 2015)","noteIndex":0},"citationItems":[{"id":242,"uris":["http://zotero.org/users/local/WvZUWaY4/items/87ZVPGFR"],"uri":["http://zotero.org/users/local/WvZUWaY4/items/87ZVPGFR"],"itemData":{"id":242,"type":"article-journal","container-title":"Sound Decisions","issue":"1","title":"Is Euthanasia Morally Permissible? Why or Why Not?","volume":"1","author":[{"family":"Nathan","given":"Rae"}],"issued":{"date-parts":[["2015"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Nathan, 2015).
The doctor's actions and beliefs.
The doctors were against mercy killing of any kind. As submitted by their lawyers, the doctors have to preserve all life, and the State cannot interfere with that duty. In their view, doctors cannot and should not be compelled to kill any patient. In Karen's case, this was particularly true as she had responded to the ...