Plaintiff
Joseph T. Quinlan
Defendant
St. Clare's Hospital
Plaintiff's 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 Lawyers for Plaintiff
Paul W. Armstrong, James Crowley
Chief Defense Lawyers
Ralph Porzio (for Karen Quinlan's physicians), Theodore Einhorn (for the hospital), New Jersey State Attorney General William F. Hyland, Morris County Prosecutor Donald G. Collester, Jr.
Judge
Robert Muir, Jr.
Place
Morristown, New Jersey
Date of Decision
10 November 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 31 March 1976, ruled that Karen's "right of privacy" included a right to refuse medical treatment and that her father, underthe 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 thatall life-sustaining medical treatment, including artificial feeding, could bewithheld from incompetent, terminally ill patients, provided such action wasshown to be consistent with the afflicted person's past wishes.
On 15 April 1975, 21-year-old Karen Ann Quinlan passed out and lapsed into acoma after sustaining bruises which were never satisfactorily explained and ingesting tranquilizers "in the therapeutic range" and 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. In the absence of any other means with which to execute what he believed to be his daughter's wishes, Joseph Quinlan went to court.
By the time of the trial, 20 October 1975, Daniel R. Coburn, an attorney, hadbecome the court-appointed guardian for Karen Quinlan. Morris County Prosecutor Donald G. Collester, Jr., and state Attorney General William F. Hyland joined the case, in an attempt to uphold New Jersey's homicide statutes. Duringpretrial interviews, Attorney General Hyland described 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."
However, one week before the trial 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 ofbreathing 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 ofdeath; rather it would address the 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 refused to obey a court order to do so. Dr. Arshad Jarved, Quinlan's pulmonary internist, also had refused to act on Joseph Quinlan's request and testified that accepted standards of medical practice did not permit the removal of an individual from arespirator.
The Quinlans' attorney, Paul Armstrong, argued that the right to privacy andreligious freedom implied a right to die. He explained his clients' religiousview that the respirator was keeping their daughter from God and heaven: "The 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: "Thisisn'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, aneurologist at Bellevue hospital and New York University Medical School. Hedescribed 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 ofreactions," 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." Shortly thereafter, an emotional Joseph Quinlan took the stand and pleading that the court release his daughter from the machines and deliver her to "the hands of the lord."
On the third day, Karen's mother, Julia Ann Quinlan, testified that Karen hadmade 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." Mrs. Quinlan continued: "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 thismany 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 Catholicpriest to give expert testimony regarding the church's view of extraordinarymedical intervention. "It is not my role to weigh the merits of what a person believes," he explained.
On 23 October 1975, 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 brainfunction 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 her from the respirator.
Decision is Appealed
On 10 November 1975, Judge Muir, rendered his decision. He refused permissionfor the removal of the respirator and appointed Daniel R. Coburn to continueacting 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 disconnectingthe 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 lifeafter death or not. The single most important temporal quality that Karen AnnQuinlan has is life. This Court will not authorize that life to be taken away from her."
On 17 November 1975, the Quinlans filed an appeal, which the New Jersey Supreme Court agreed to hear on an "accelerated schedule." On 26 January 1976, during a three-hour session, the case was argued before the seven justices of New Jersey's highest court. Their unanimous decision named Joseph Quinlan guardian and authorized him to order the removal of the respirator on 31 March 1976. Chief Justice Richard J. Hughes wrote the opinion for the court. He specifically stated that the ruling was not based on the freedom of religion argument favored by the Quinlans "[S]imply 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 the "right to privacy." It was a right, he continued, that could "be exercised by her guardian under the present circumstances."
Lastly, Justice Hughes dismissed the attorney general's and the Morris Countyprosecutor's contention that the person removing Quinlan's respirator shouldbe charged with homicide upon her death:
Neither the hospital, Karen Quinlan's physicians, nor the state of New Jerseychose to appeal the decision to the Supreme Court. Quinlan's respirator wasremoved in May of 1976. She managed to breathe on her own and remained in a coma for ten years. She died on 11 June 1985.
Related Cases
Do States That Allow Assisted Suicide Find an Increase in Intentional Suicide Rates?
Oregon is the first, and the only, state in which physician-assisted suicidesare legal. Oregon has seen a modest increase in the number of intentional suicides since physician-assisted suicides was approved by a 51% majority in 1994. In November of 1997, voters overwhelming rejected a ballot measure that would have repealed the law. The law requires that a physician wait 15-days before assisting a suicide.
Sources
Oregon Center for Health Statistics (State Department of Health).
Joseph T. Quinlan
Defendant
St. Clare's Hospital
Plaintiff's 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 Lawyers for Plaintiff
Paul W. Armstrong, James Crowley
Chief Defense Lawyers
Ralph Porzio (for Karen Quinlan's physicians), Theodore Einhorn (for the hospital), New Jersey State Attorney General William F. Hyland, Morris County Prosecutor Donald G. Collester, Jr.
Judge
Robert Muir, Jr.
Place
Morristown, New Jersey
Date of Decision
10 November 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 31 March 1976, ruled that Karen's "right of privacy" included a right to refuse medical treatment and that her father, underthe 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 thatall life-sustaining medical treatment, including artificial feeding, could bewithheld from incompetent, terminally ill patients, provided such action wasshown to be consistent with the afflicted person's past wishes.
On 15 April 1975, 21-year-old Karen Ann Quinlan passed out and lapsed into acoma after sustaining bruises which were never satisfactorily explained and ingesting tranquilizers "in the therapeutic range" and 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. In the absence of any other means with which to execute what he believed to be his daughter's wishes, Joseph Quinlan went to court.
By the time of the trial, 20 October 1975, Daniel R. Coburn, an attorney, hadbecome the court-appointed guardian for Karen Quinlan. Morris County Prosecutor Donald G. Collester, Jr., and state Attorney General William F. Hyland joined the case, in an attempt to uphold New Jersey's homicide statutes. Duringpretrial interviews, Attorney General Hyland described 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."
However, one week before the trial 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 ofbreathing 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 ofdeath; rather it would address the 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 refused to obey a court order to do so. Dr. Arshad Jarved, Quinlan's pulmonary internist, also had refused to act on Joseph Quinlan's request and testified that accepted standards of medical practice did not permit the removal of an individual from arespirator.
The Quinlans' attorney, Paul Armstrong, argued that the right to privacy andreligious freedom implied a right to die. He explained his clients' religiousview that the respirator was keeping their daughter from God and heaven: "The 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: "Thisisn'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, aneurologist at Bellevue hospital and New York University Medical School. Hedescribed 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 ofreactions," 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." Shortly thereafter, an emotional Joseph Quinlan took the stand and pleading that the court release his daughter from the machines and deliver her to "the hands of the lord."
On the third day, Karen's mother, Julia Ann Quinlan, testified that Karen hadmade 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." Mrs. Quinlan continued: "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 thismany 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 Catholicpriest to give expert testimony regarding the church's view of extraordinarymedical intervention. "It is not my role to weigh the merits of what a person believes," he explained.
On 23 October 1975, 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 brainfunction 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 her from the respirator.
Decision is Appealed
On 10 November 1975, Judge Muir, rendered his decision. He refused permissionfor the removal of the respirator and appointed Daniel R. Coburn to continueacting 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 disconnectingthe 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 lifeafter death or not. The single most important temporal quality that Karen AnnQuinlan has is life. This Court will not authorize that life to be taken away from her."
On 17 November 1975, the Quinlans filed an appeal, which the New Jersey Supreme Court agreed to hear on an "accelerated schedule." On 26 January 1976, during a three-hour session, the case was argued before the seven justices of New Jersey's highest court. Their unanimous decision named Joseph Quinlan guardian and authorized him to order the removal of the respirator on 31 March 1976. Chief Justice Richard J. Hughes wrote the opinion for the court. He specifically stated that the ruling was not based on the freedom of religion argument favored by the Quinlans "[S]imply 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 the "right to privacy." It was a right, he continued, that could "be exercised by her guardian under the present circumstances."
Lastly, Justice Hughes dismissed the attorney general's and the Morris Countyprosecutor's contention that the person removing Quinlan's respirator shouldbe 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 Jerseychose to appeal the decision to the Supreme Court. Quinlan's respirator wasremoved in May of 1976. She managed to breathe on her own and remained in a coma for ten years. She died on 11 June 1985.
Related Cases
- Garger v. New Jersey, 429 U.S. 922 (1976).
- Matter of Conroy, 486 A.2d 1209 (1985).
Do States That Allow Assisted Suicide Find an Increase in Intentional Suicide Rates?
Oregon is the first, and the only, state in which physician-assisted suicidesare legal. Oregon has seen a modest increase in the number of intentional suicides since physician-assisted suicides was approved by a 51% majority in 1994. In November of 1997, voters overwhelming rejected a ballot measure that would have repealed the law. The law requires that a physician wait 15-days before assisting a suicide.
- There were 525 suicides in Oregon in 1994.
- There were 526 suicides in Oregon in 1995.
- There were 533 suicides in Oregon in 1996.
Sources
Oregon Center for Health Statistics (State Department of Health).
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