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Team Quinlan

A timeline.

Rogelio Figueroa Jr.

on 19 June 2013

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Transcript of Team Quinlan

Karen Ann Quinlan is born.
Bereavement (Also called: Grief)
Bereavement is the period of grief and mourning after a death. When you grieve, it's part of the normal process of reacting to a loss. You may experience grief as a mental, physical, social or emotional reaction. Mental reactions can include anger, guilt, anxiety, sadness and despair. Physical reactions can include sleeping problems, changes in appetite, physical problems or illness.
How long bereavement lasts can depend on how close you were to the person who died, if the person's death was expected and other factors. Friends, family and faith may be sources of support. Grief counseling or grief therapy is also helpful to some people (NIH: National Cancer Institute).
April 1975
April 15, 1975
The Fateful Party
The Family of "Suprises"
Joe and Julia Quinlan were the parents of Karen and were considered an average middle-class family. After Karen's mom, Julia suffered several miscarriages and a still birth, her and her husband, Joe, adopted a baby girl in Scranton, PA. It was a big surprise, when Julia later found that she was able to have children and gave birth to two children, Mary Ellen and John.
On April 15, 1975 Karen Ann Quinlan was at a party where she had consumed diazepam (to treat anxiety, panic attacks or help with insomnia), dextropropoxyphene (to treat mild pain), and alcohol. However, it is disputed whether any drugs were found in Karen’s system. After Karen arrived home, she informed her friends that she was not felling well. Her friends put her to bed and later came back to check on Karen Ann. The friends had found that Karen Ann had collapsed and stopped breathing twice for 15 minutes or more. Karen was taken to the hospital and lapsed into a vegetative state. Karen’s parents were informed by the hospital that Karen has slipped into a coma.
Collapsed then Coma
Hospice Care (Also called: End-of-life)
Hospice care is end-of-life care provided by health professionals and volunteers. They give medical, psychological and spiritual support. The goal of the care is to help people who are dying have peace, comfort and dignity. The caregivers try to control pain and other symptoms so a person can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient's family.
Usually, a hospice patient is expected to live 6 months or less. Hospice care can take place:
o At home
o At a hospice center
o In a hospital
o In a skilled nursing facility

NIH: National Cancer Institute
April 1975
24 April, 1975
Transferred to St. Clare's.
Denville, NJ
Soon after arriving to the hospital and with her health steadily deteriorating, her coma was diagnosed to be irreversible. Karen was then transferred to St. Clare's hospital in Denvile. The doctors deemed that Karen was in a "persistent vegetative" state and would not recover. Karen's body began to thrash wildly at times, blindly resisting treatments, and was unable to communicate nor respond to the voices of loved ones.
Saint Clare's Hospital
Organ Donation
Organ donation takes healthy organs and tissues from one person for transplantation into another. Experts say that the organs from one donor can save or help as many as 50 people. Organs you can donate include:

o Internal organs: Kidneys, heart, liver, pancreas, intestines, lungs
o Skin
o Bone and bone marrow
o Cornea

Most organ and tissue donations occur after the donor has died. But some organs and tissues can be donated while the donor is alive.

People of all ages and background can be organ donors. If you are under age 18, your parent or guardian must give you permission to become a donor. If you are 18 or older you can show you want to be a donor by signing a donor card. You should also let your family know your wishes.

Dept. of Health and Human Services Office on Women's Healthune 23, 1941
July 1975
March 1976
June 1976
June 1985
Decision Made to Remove Life Support
The family was in such pain over what to do about Karen. They made the painstaking decision to remove the life support from Karen but soon found out that the they needed to petition the court because the doctors refused to do as they asked.
July 31, 1975
March 31, 1976
Case before the New Jersey Supreme Court
Suicide is the eleventh most common cause of death in the United States. People may consider suicide when they are hopeless and can't see any other solution to their problems. Often it's related to serious depression, alcohol or substance abuse, or a major stressful event.

People who have the highest risk of suicide are white men. But women and teens report more suicide attempts. If someone talks about suicide, you should take it seriously. Urge them to get help from their doctor or the emergency room, or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). It is available 24/7.

Therapy and medicines can help most people who have suicidal thoughts. Treating mental illnesses and substance abuse can reduce the risk of suicide.
Ethical Issues Related to the Karen Ann Quinlan Case
After several months, her parents requested she be removed from life support but doctors refused because New Jersey had declared they would prosecute anyone who did so with homicide. Karen's father filed suit but was denied by the courts so he appealed to the New Jersey Supreme Court. Karen's father based his case on the First (freedom of religion) and Eighth (cruel and unusual punishment) Amendments. Although the court rejected both arguments, the U.S. Supreme Court later affirmed an individual's right to privacy and also rejected the state's argument that removing life support constituted a homicide, saying that Quinlan's death would result from natural causes.
The Quinlan's brought their case before the New Jersey Supreme Court and on March 31, 1976. It rendered a unanimous decision appointing Joe Quinlan as the personal guardian of their daughter Karen. This gave him the right to to determine her medical treatment, including the right to discontinue all extraordinary means of life support. After much negotiation between the Quinlan's and the hospital staff, Karen was weaned from the ventilator.
Victory in New Jersey
Karen was moved to Morris View Nursing Home in June 1976. She was able to breathe on her own for another nine years.
Morris View Nursing Home
Karen Ann Quinlan
Final Resting Place
June 11, 1985
Death of Karen Ann Quinlan
Karen Ann Quinlan dies on June 11, 1985 of pneumonia. She is buried at the Gate of Heaven Cemetery in East Hanover. Karen's case is the landmark in the ethical debate over the lengths that medical science should go in trying to preserve a life that is deemed irretrievably lost.
This allowed for the removal of Karen’s respirator but she didn’t die. Instead, she lived for another nine years but finally died when she was 31.
Quinlan's case is a milestone, a legal precedent for other right-to-die cases. It is also a milestone in bioethics, touching as it does on a number of moral and ethical issues surrounding the end of life. As a direct result of the Quinlan case, in fact, hospitals and other health care facilities nationwide established ethics committees
The core of this case and other similar ones that deal with end-of-life issues continue to stress each and every one of us who ultimately must address this. Some examples of the ethnically related issues that are related to end-of-life that we should or will be required to address are as follows:
Advance Directives
What kind of medical care would you want if you were too ill or hurt to express your wishes? Advance directives are legal documents that allow you to spell out your decisions about end-of-life care ahead of time. They give you a way to tell your wishes to family, friends, and health care professionals and to avoid confusion later on. A living will tells which treatments you want if you are dying or permanently unconscious. You can accept or refuse medical care. You might want to include instructions on
o The use of dialysis and breathing machines
o If you want to be resuscitated if your breathing or heartbeat stops
o Tube feeding
o Organ or tissue donation
A durable power of attorney for health care is a document that names your health care proxy. Your proxy is someone you trust to make health decisions for you if you are unable to do so. (NIH: National Cancer Institute)
June 11, 1985
The common law of guardianship mandates in cases of incompetent, the withdrawal of treatment is the only course of action to promote her best interest

Right to refuse treatment is protected by common law and US Constitution

Denial of refusal of treatment is impermissible interference with free exercise of religion

Violated the Eight Amendment against imposition of cruel and unusual punishment
Quinlan’s Arguments for Withdrawal of Treatment
Court lacks jurisdiction to grant termination of life as Quinlan’s requested

Never in a person’s best interest to suspend medical measures when result is death

There is no constitutional right to die
New Jersey AG Argument Against Termination of Life
Decide the continuance or cessation of Karen Ann Quinlan’s life
Reverse a lower court ruling prohibiting father from discontinuing medical procedures
Joseph Quinlan (father) seeks appointment as guardian
-Authorize him to discontinue extraordinary medical
-Restrain treating hospital and physicians from interfering
with discontinuing medical procedures
March 31, 1975, New Jersey Supreme Court decision appointed Joseph Quinlan guardian with full authority to decide medical treatment
The Litigation
Double-effect originates in Thomas Aquinas's treatment of homicidal self-defense.

The doctrine (or principle) of double effect originates in Thomas Aquinas's treatment of homicidal self-defense, in his work Summa Theologiae (a summary of theological or an exposition of Christian doctrine), and is often invoked to explain the permissibility of an action that causes a serious harm, such as the death of a human being, as a side effect of promoting some good end. This reasoning is summarized with the claim that sometimes it is permissible to bring about as a merely foreseen side effect a harmful event that it would be impermissible to bring about intentionally.
New Catholic Encyclopedia
ovides four conditions for the application of the principle of double effect:

1. T
he act itself must be morally good or at least indifferent.

2. The agent may not positively will the bad effect but may permit it. If he could attain the good effect
without the bad effect he should do so. The bad effect is sometimes said to be indirectly voluntary.

3. The good effect must flow from the action at least as immediately (in the order of causality, though
not necessarily in the order of time) as the bad effect. In other words the good effect must be
produced directly by the action, not by the bad effect. Otherwise the agent would be using a bad
means to a good end, which is never allowed.

4. The good effect must be sufficiently desirable to compensate for the allowing of the bad effect“
(p. 1021).
Doctrine of Double Effect
Harvard Medical School in 1968 published paper stating, "Death must be defined in terms of destruction of the brain rather than cessation of breathing or respiration".

Dorland's Medical Dictionary defines:
brain d[eath]. irreversible brain damage as manifested by absolute unresponsiveness to all stimuli, absence of all spontaneous muscle activity, including respiration, shivering, etc., and an isoelectric electroencephalogram for 30 minutes, all in the absence of hypothermia or intoxication by central nervous system depressants. Called also irreversible coma and cerebral d[eath]."

Complications of this definition include bioethicists and medical technological advancements. Doctors have even written books such as, "Life, Life Support, and Death" stating that if the definition of brain death contraindicates itself. There have been articles in the Journal of Medical Ethics concerning where does the doctor's obligation to the patient stop?
Current Issues
Decision based on constitutional right of privacy with precedence on Griswald v Connecticut and Roe v Wade
Right of individual privacy becomes paramount as the degree of bodily invasion increases and the prognosis dims
Ambiguity in medical profession’s stance on refusal of medical treatment…refuse to treat hopeless and dying as if they were curable
Valid distinction between life support withdrawal and infliction of deadly harm either to one’s self or another, death following withdrawal of treatment is not homicide
Basis of NJ Supreme Court Decision
WHO DETERMINES DEATH ... Doctors or the Courts?
This is where the case of Karen Quinlan comes in because the courts made a landmark decision and established the "Right to Die" in America.

This is where the courts took the medical observations and prognosis to determine if there is need for an "authority" to be used to determine the next step.

Authority can be Living Will or Designation of Health Care Surrogate. The Health Care Surrogate can be a family member such as the father in the case of Karen Quinlan.

This authority will determine how much will be done and to what extent on the patient. This is where the death or to some euthanasia is determined.

So who determines death? Doctors, the courts, families, and sometimes patients through living wills/advance directives.
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