- Karen became the symbol of abuse of technology in this technological age. She gave both fields, law and medicine, a case they could not avoid. She gave the public an issue that was pertinent to their lives.
For the first time in history, people were made aware of the decisions that had to be made. Moreover, Karen's situation showed us all that what happened to her could happen to anyone at anytime.
Julia Duane Quinlan
My Joy, My Sorrow: Karen Ann's Mother Remembers
Karen Ann Quinlan was born March 29, 1954 in Scranton, Pennsylvania and was adopted by Joseph and Julia Quinlan and raised in Roxbury Township, N.J.
By all reports Karen lived a fairly ordinary life. She was an average student, good at swimming and skiing and was popular with her classmates.
At the time of her collapse in 1975, Karen had moved out of her parents' home and moved in with two roommates. She was twenty-one years old.
No one knows exactly what happened on April 14, 1975. Karen attended a friend's party at a local bar, where she reportedly drank several gin and tonics after possibly taking several tranquilizers.
When she became unconscious and stopped breathing, an ambulance was called. Mouth-to-mouth resuscitation was performed. Karen was given oxygen and put on a respirator.
In the emergency room her pupils did not react, she did not respond to deep painful stimuli and was unable to breathe on her own, indicators of extreme brain injury.
More on Brain Injuries
- Cerebral hypoxia - From ADAM's Health Illustrated Encyclopedia
On April 15, 1975 the Quinlans received a telephone call at 2:00 a.m. advising them that Karen Ann was in the Newton Memorial Hospital in New Jersey. She was admitted in an unconscious state to the intensive care unit.
Nine days later, Karen was transferred to St. Clare's Hospital. By this time her condition had been determined to be an irreversible coma or a persistent vegetative state (PVS), a condition from which she would not recover.
A persistent, irreversible coma is also referred to as a vegetative state.
More on Coma
- Coma - From ADAM's Health Illustrated Encyclopedia
Once the family accepted that Karen was in a persistent vegetative state and would not recover, they met to determine the next step.
The family felt that Karen would not want to be kept alive by machines and artificial methods. They reached the decision to take Karen off the respirator and allow her to return to her "natural state."
With the support of their priest and the Catholic Church, the family met with Karen's doctors and officials at St. Claire's hospital on July 31, 1975. They requested to disconnect Karen from the respirator. The hospital initially agreed, but then changed their minds.
The Quinlans suddenly found themselves going to court to ask permission for Karen to die with grace and dignity.
The Quinlans legal battle started in a Morristown courtroom where they asked to remove their daughter from the respirator. A court-appointed guardian for Karen argued that the parents had no right to propose what amounted to euthanasia. The Quinlans lost this first round in the Superior Court, but eventually won their case when it was heard by the New Jersey Supreme Court.
The case established a patient's right to refuse medical care and control his or her medical treatment.
After the respirator was withdrawn, Quinlan continued to breathe on her own. She was kept alive in a nursing home with artificial nutrition and hydration.
Karen Ann Quinlan died on June 11, 1985 of pneumonia, nine years after being removed from the respirator. She had been a resident at the Morris View Nursing Home in Morris Plains, New Jersey since 1976. Karen Ann Quinlan was 31 years old at the time of her death.
The case changed the way that many look at life, death, what is a livable life and a dignified death.
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1. Ethics Committees - The case led to required ethics committees in all hospitals, nursing homes and hospices.
2. Living Wills/Advanced Care Directives - A document outlining the wishes of a person regarding "extraordinary means" to maintain life.
3. Health Care Proxy - The Supreme Court ruling appointed Karen's Father, Joseph, as her guardian entitled to make health care decisions on her behalf.
4. Karen Ann Quinlan Hospice - Opened in 1980 to provide hospice care in parts of New Jersey and Pennsylvania.
In 1994 Kinney et. al. published the neuropathological findings in the brain of Karen Ann Quinlan. The lesions in the brain were consistent with hypoxia-ischemia, or being deprived of oxygen, following a cardiopulmonary arrest.
They determined there was a excessively severe damage in the thalamus compared with the main cerebral cortex, supporting the hypothesis that the thalamus is needed for awareness, perception and judgment. In other words, the area that allowed her to be aware was damaged by the lack of oxygen to her brain.
More on the Brain:
- Inside Brain Structures - From ADAM's Health Illustrated Encyclopedia
Quinlan JD. Excerpt, My Joy, My Sorrow. Karen Ann’s Mother Remembers. 17 December 2006. <http://www.karenannquinlanhospice.org/My%20Joy%20excerpt.htm>
DeSpelder LA. Strickland AL. 2002. The Last Dance: Encountering Death and Dying. 6th Ed. New York, N.Y.: McGraw Hill. p. 196.
History: Karen Ann Quinlan. 2000. 17 December 2006. <http://www.karenannquinlanhospice.org/History.htm>
Friedrich O. "into the Hands of the Lord" At Last. Karen Ann Quinlan: 1954-1985. Time Magazine. Jun 24, 1985. 17 December 2006. <http://www.time.com/time/magazine/article/0,9171,959445,00.html>
Emanuel E.J. A Review of the Ethical and Legal Aspects of Terminating Medical Care. American Journal of Medicine. 1988;84(2):291-301.
In re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976), cert. denied, 429 U.S. 92 (1976).
Hampson L.A. Emanuel E.J. The Prognosis for Changes in End-of-Life Care After the Schiavo Case. Health Aff. 2005;24(4):972-975.
Kinney H.C. Korein J. Panigrahy A. Dikkes P. Goode R. Neuropathological Findings in the Brain of Karen Ann Quinlan -- The Role of the Thalamus in the Persistent Vegetative State NEJM 1994;330 (21):1469-1475 <http://content.nejm.org/cgi/content/abstract/330/21/1469>
Valenstein E. The Diencephalon. Introduction To Clinical Neurology. University of Florida, College of Medicine. 23 December 2003. 18 December 2006. <http://medinfo.ufl.edu/year2/neuro/review/dienc.html>
Fins JJ. Schiff ND. In Brief: The Afterlife of Terri Schiavo. Hastings Cent Rep. 2005;35(4):8.
