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The Case of Karen Ann Quinlan

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Nerricka Nalundasan

on 5 November 2014

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Transcript of The Case of Karen Ann Quinlan

Thank You!
Karen Ann Quinlan
Effect of the Drugs
Synergism effect
Suppressed breathing
Loss of oxygen to her brain
After 30 minutes, her higher brain was destroyed
At St. Clare's Hospital in New Jersey, a ventilator was used for Karen Quinlan to keep her breathing
Prevented aspiration of vomit
Also called respirators
Began to be used in the 1960s
Criteria of Death
Traditional definition of death:

where the body stops breathing and the person is declared dead
Persistent Vegetative State (PVS)
Carlo Limbog
Christian Pena
Emily Scott
Nerricka Nalundasan
Mirna Lopez

The Case of Karen Ann Quinlan
Became comatose in April 1975 at the age of 21
Caused from drinking alcohol after taking anti-anxiety drugs
Was also dieting
needed clarification for the Quinlan case

that brain death was inevitable, but now a ventilator prevented this and keeps a person alive
Pulling the Plug or Weaning from a Ventilator?
Serious form of coma
Almost always irreversible
Requires intravenous (IV) or nasogastric feeding tubes for nutrition
Karen's eyes were

and she was thought to be
slow-wave EEGs
Ethical Dilemma

Fall of 1975:
Quinlans decided to remove Karen off the ventilator
Physicians (Robert Morse and Arshad Javed) feared charges of criminal misconduct and malpractice
The ethical dilemma was to decide whether to withdraw medical support from an incompetent individual or continue to provide medical support in the interest of preserving life
Catholic Church influence
The Quinlans insisted that Karen should be allowed to ‘die with dignity’, yet the AMA equated withdrawing the ventilator with euthanasia which was murder

Court Rulings
Initial rulings in N.J. Trial Court denied Quinlan's request to take Karen off the ventilator
"Judicious Neglect"
In January 1976, the N.J. Supreme Court ruled unanimously in favor of the Quinlans.
The right to privacy allowed the family of a dying incompetent patient to let her die by disconnecting her ventilator.
Joseph Quinlan was allowed to become Karen's guardian
Legal immunity granted to physicians for disconnecting ventilator
After the ruling, Karen’s physicians did not simply disconnect Karen’s ventilator. They weaned her from it by gradually training her body to be able to breathe without it, a process that took over four months.

By May 1976, Karen was off the ventilator altogether and lived for another 10 years in PVS. She died of pneumonia in June 1986.
Ethical Terms
– The hospital insisted on keeping Karen alive. Even even when the court ruled in favor of the Quinlans, they decided it would be best to wean her from it so that she could continue to live without it.

Impact On Society
Emphasized the importance of creating a will and appointing a
Health Care Proxy
Set the stage for the use of
substituted judgment
in court, whereby relatives and friends could say what they believed to be the wishes of an incompetent patient
Karen’s parents founded
Karen Ann Quinlan Hospice
, a non-for-profit organization that creates medical services and support to hospice patients


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Journal of Medicine, 330, 1524-1525. Doi: 10.1056/NEJM199405263302110.

Cantor, N. (1976). "In the matter of Karen Quinlan": A comment. BioScience, 26 (4), 257-259.

Kennedy, I. (1976). The Karen Quinlan case: Problems and proposals. Journal Of Medical Ethics, 2(1),


Kinney, H.C., Korein, J., Panigraphy, A., Dirres, P., Groode, R. (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 (21), 1469-1475.

Meisel, A. (2003). Quality of life and end-of-life decision making. Quality of Life Research, 12, 91-94.

Pence, G. (2015). Medical ethics: Accounts of ground-breaking cases, seventh edition. New York, NY:

McGraw-Hill Education, 23-28.

– The hospital wanted to prevent harm by not disconnecting Karen’s ventilator.

– The hospital was abiding by the Hippocratic Oath to do no harm. Karen was vulnerable and needed protection.
– The physicians and nurses were faithful to Karen, from the beginning until the very end.

Under New Jersey Law in 1975, Karen was not brain-dead, because only her higher brain was destroyed and their were some parts that were still functioning.
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