End of Life Decisions: Karen Ann Quinlan Case Study

Introduction

In the span of human life, everyone goes through situations the require their reasoning. There is no doubt that this occurs all the times ranging from decisions on what to wear, where to go or even career choices. Some situations may be more complicated with uncertainties and assumptions that are risky from a personal perspective. These are the situations that call for in-depth reasoning, and analysis in deciding on the best option after considering all the available alternatives and constraints. In this paper, a contentious topic on end of life decisions is presented. To be specific, this is the Karen Ann Quinlan case and the struggle in granting her end of life decision. Do guardians or parents have the right to exercise death with dignity on their terminally ill children by deciding when they should die? In the analysis of the Karen Ann Quinlan case, different outlooks presented in the case are discussed. There are disagreements with differing opinions on how the matter should have been handled. Each of the opposing viewpoints is addressed to determine which one stands strong and thus has clarity.

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Factual Base in the Karen Quinlan Case

To understand the Quinlan case and its basic perspective requires a brief review of the facts developed from the testimonies and documented by the courts. On the fateful day of April. 15, 1975, Karen attended her friend's birthday party at a local bar where she overdosed on alcoholic beverages and tranquillizers believed to be either methaqualone or valium. Karen ceased breathing for about 15 minutes on two separate episodes. An ambulance took Karen to Newton Memorial Hospital where on examination she had unreactive pupils, lacked responsiveness to pain and registered a temperature of 100 degrees. Three days later, on the request of Dr McGee, Newtons admitting physician, Dr Morse examined Karen and found that she was in a comatose. In such a state, Karen required a respirator to breathe. There was no adequate information on the events that led to Karen's admission at the hospital and relying on the records at Newton Hospital and his examination, Dr Morse diagnosed anoxia, which is lack of oxygen in the bloodstream.

On Karen's transfer to Saint Clare's hospital, she was still in her unconscious state and breathing with the help of a respirator. Further examination, including electroencephalogram, revealed an abnormality in her brain though there was some brain activity registered. Dr Morse together with other expert examining Karen declared that she suffered irreversible brain damage with respiratory failure for an extended period which interfered with the supply of oxygen to her brain leaving her in a deep unconscious state known as a persistent vegetative state (PVS). According to Bender, Jox, Grill, Straube, and Lule (2015) the state can be described best as 'eye opened unconsciousness.' What happens is that there is a disconnection between wakefulness and awareness. A patient might seem to be awake though they are not aware of their surrounding since their upper brain cannot receive or project information.

Since Karen's brain condition affected her respiration, she had to breathe through a respirator. From her arrival at Saint Clare Hospital, an MA-1 ventilator has been helping her. Efforts to wean Karen off the respirator and breathe on her own would all be unsuccessful and were since abandoned. Experts believed that Karen would not survive without the respirator and how long she can live unclear. In other words, there is a risk of further brain damage and a likelihood of dying on the removal of the respirator. Her condition kept worsening with her weight decreasing to 80 pounds resulting in her being placed on feedings tube through her nasal passage.

From all the fact, quite a lot of the primary findings in the physical area are mandated. Karen is in a persistent vegetative state because of brain and associated damages. There is no form of medication available or known to human that can save her condition. As nearly as it may be resolute, her chances of healing are extremely poor and the extent unknown if by any chance it occurs.

Matter Moved to Court, The Hospital and the Parents Actions and Beliefs in the Case

In the fall of 1975, several months after watching their daughter registering no improvement, the Quinlan parents decided to have the respirator removed and let Karen die. They had no idea that such a decision would call for a struggle in two separate courtrooms. Dr Morse and his counterpart in pulmonary medicine Arshad Javed were the physicians assigned to Karen. When the Quinlans asked them to disconnect Karen from her respirator, the two demurred. They referred to the brain death concept, and according to the two doctors, Karen was still alive. The objection was based on the conception of medical standards, ethics, and practices that are described in the medical testimony. No doctor would have failed to provide respiratory support to their patient, and none of them can interrupt its course in saving a life unless in the event of cerebral death. The American Medical Association equates withdrawal of a respirator for death as euthanasia and murder (Kuhse, Schuklenk, & Singer, 2015). As a result, the physicians feared being sued for malpractice in case the Quinlans would change their minds later. Malpractice in medicine is described as a deviation from the usual standards of medical practice and requires that practitioners continue with medication until the last moment of death. Assisting in the death of a patient in a coma would be misconduct.

The issue was taken to the New Jersey Superior court where Paul Armstrong represented Karen Quinlan and her parents. Joseph and Julia Quinlan were seeking the official appointment as the guardians of Karen Ann with the express authority to make decisions on her behalf particularly the power to discontinue all her vital processes as the legal custodians. The Doctors at Saint Clare's Hospital should respect their decision and follow the instructions to disconnect their comatose daughter from her respirator and allow her to die. In addition, the Quinlan parents averred that Karen had mentioned twice that if by any chance something terrible happens to her, she does not want to be kept alive by machines. Two constitutional rights were also presented in the court relative to this case. These are the rights to privacy and freedom to practice one's religion of which the Quinlans believed that denying them the authority to disconnect their daughter's respirator was an abuse of the two provisions.

The arguments presented by both parties, the hospital and its two physicians on one side and Paul Armstrong and the Quinlans on the other side both seem rational. While the doctors were right as well, the pain of seeing a daughter bedridden with no option of ever healing is painful. It was apparent that Karen was never going to recover and the physicians knew this as well. In this case, it would not be wrong to let the Quinlans see their daughter get the eternal rest per their religious convictions. The appeal and suitability of the Quinlans as Karen's parents could not be doubted. Despite not staying together when the incident occurred, they displayed a higher degree of familial love has reached out to be with Karen in her time of misery. This shows their morality in the decision made having collectively agreed as a family.

Laws Employed by Judges in the Case

10th November 1975 Decision

Judge Robert Muir of the New Jersey Superior court handed down his decision on 10 November 1975, denying Karen's father authority to terminate life assisting apparatus. Karen's physicians were given the right to continue with the treatment despite the family objection. Judge Muir recognized that Karen Quinlan was in a persistent vegetative state without cerebral functioning and her chances of ever living a normal life were close to zero. However, he denied the Quinlans their request to be appointed as the official guardians to Ann Karen with the power to authorize the termination of her life-sustaining machines. The Judge insisted that the decision to remove Karen's life-sustaining device is left to the treating physician (Cerminara, 2011). The decision is not a judicial but a medical one. It may appear satisfactory that in such a situation the parents are sole decision makers, but they should not govern Karen's death. This is since, in such a case, there is a dilemma on where the motivation on the parents' decision came from.

To further support the claim that the decision of stopping the life support machine was not to be made by the court, the judge stated that his intervention would be only when in the best interest of an incompetent patient. The termination of Karen's respirator would not be consistent with her best interest. The authorization sought by the Quinlans if approved would lead to Karen's death. Her body is not yet proven to be able to sustain her without the respirator. As a result, the authorization would be to permit the death of Karen. According to Judge Muir, this is not protection and not in line with what would be Karen's interests in a temporal sense. Such an authorization according to the New Jersey state laws is indicated as a homicide.

The Quinlans believed that Karen if competent would have requested the respirator shut down. According to the Quinlans, Karen had made testimonies earlier that hinted to friends and parents her aversion for a lingering death, especially where machines support life. However, Judge Muir rejected the claim pointing out that such expressions are just theoretical and are not persuasive enough to establish enough weight that can convince the court. Her feelings might have been made after seeing other people suffer from ailment and dying without considering her own demise. As a result, the court could not be convinced that Karen would agree with the removal of her respirator.

The Quinlans also contended that the denial would violate their constitutional rights to privacy and the freedom to exercise religion including the right to die. The Quinlans have devoted Catholics who believed that the respirator was keeping their daughter from heaven. Karen should not be held back from enjoying the perfect life ahead. However, Judge Muir responded to this contention citing the interest if the government is preserving the life of its citizens. According to Muir, such interests override any constitutional provision that is at stake in this case. Also, most of the privacy cases involve a claim of a plaintiff's freedom as opposed to the situation here which are parental claims in the place of their incompetent child.

31st March 1976 Decision

The Quinlan case was eventually settled in the New Jersey Supreme Court on March 1976. Unlike the decision the previous year, the Supreme court supported the Quinlans this time around, and they were given the powers to authorize the removal of the respirator. A unanimous decision granted the Quinlans official guardians, and their decision on Karen's care should be accepted by society. This is since an overwhelming number of people would think in a similar line if they were in such a situation. families are acceptable surrogates of their incapacitated patients who did not and in their condition not able to make their wishes known

There was also a new interpretation of the right to privacy and that Karen's interest to have the respirator removed and die exceeds the government interests in life preservation if doctors see that there is no possibility of her recovery. Living wills, which are these days commonly used to determine patients' desires were not commonly applied in the 70s as a means of knowing people...