FEU-NRMF

INSTITUTE OF MEDICINE • Justice

Bioethics 2 - Includes equity (the fairness of the decision for other
people), has not so far been considered in the context of
CASE: KAREN ANN QUINLAN treating patients in the permanent vegetative state.
- Continuing to support such a patient denies many other
Historical Background patients access to scarce health resources
• Born: March 29, 1954 - Weaning from extraordinary measures to prolong life is
• Adopted by Joseph and Julia Quinlan, 4 weeks after her birth licit and the health care team should provide ordinary
• Average student at Morris Catholic High School measures to maintain quality life for the patient à
• She dated Tom Flynn and graduated high school in 1972 but Hospice and Palliative care
didn’t pursue a college degree, instead, she took a job at
Mykroy Ceramics Corporation in Ledgewood. Developments
• August 1974 • The case prompted the adoption of “brain death” as the legal
- She was laid off as an employee definition of death in some states and the adoption of laws
- According to her friends, after that incident, she began to recognizing “living wills” and the “right to die” in other states
drift from one job to another and also from her old friends as well as the formation of “bioethics” committees in many
• April 14, 1975 hospitals.
- She took pills and went out drinking with her friends
- She passed out and never regained consciousness • Living will - a written document that declares what life-
- According to the investigators, she had taken a sustaining medical interventions a person wants if she becomes
combination of alcohol and tranquilizer pills which caused terminally ill with little or no hope of recovery and is unable to
her to have ceased breathing for at least two 5-minute communicate her wishes.
periods which resulted to irreversible brain damage
• September 1975 • It is also a way of giving meaning to the doctrine of informed
- The Quinlans asked to remove the respirator consent which requires physicians to obtain the consent of
- Dr. Robert Morse, Karen’s physician, refused the request their patients before beginning any medical treatment
because he claimed that allowing a person in a persistent
vegetative state to die was in violation of the professional • Living wills are narrowly tailored documents that generally
standards. apply only when a person has a terminal illness, although
- The Quinlans petitioned the New Jersey Supreme Court for some states allow living wills to be used when a person is in an
permission to remove the respirator “irreversible coma” or “persistent vegetative state”
• November 1975
- The court denied the request based on its contention that • It does not apply to all types of medical treatment but are
people have constitutional right to life but do not have a limited to life-sustaining treatment or maintenance medical
parallel constitutional right to death. care.
- The lower court decision was appealed to the New Jersey
Supreme Court, which in 1976, decided that “refusal of • The Quinlan case serves as a timely reminder that there is an
life- saving treatment” fell under the constitutional “right urgent need for a code.
to privacy”.
- Based on the right to privacy, the court ruled that “no • There is an urgent need to educate doctors as to their
compelling interest of the state could compel Karen to obligations, not only to avoid all distress of a case such as the
endure the unendurable” and allowed her to be taken off Quinlan case, but also to allay the unwarranted but very real
life support. fears of doctors and patients alike, both of whom, unaware of
• Weaned from the respirator, she survived for nearly 10 more the precise limits of conduct, view the management of
years, dying of pulmonary failure on June 11, 1985 in a New terminal illness with alarm.
Jersey nursing home. Because of this, the court decision was
moot. • “Right to privacy”

Ethical Issues Raised • Ruling on feeding tubes
• Respect for Persons / Autonomy - January 1985, the New Jersey Supreme Court widened its
- “Right to Privacy” standards on the right to die, ruling that all life-sustaining
- Substituted judgment medical treatment, including feeding tubes, could be
- Patient’s autonomy was completely compromised withdrawn from terminally ill patients, as long as that is
- Health care providers should weigh the possibility of the what the patient wanted or would want
patient to be saved or not

• Non-Maleficence and Beneficence
- If the patients is truly unaware, then it is presumably
difficult to do either harm or good.
- The patient has no interest à gain no benefit from
continued treatment given without consent

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