Quinlan, in Re

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QUINLAN, IN RE

In Re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976), was the first major judicial decision to hold that life-sustaining medical treatments may be discontinued in appropriate circumstances, even if the patient is unable or incompetent to make the decision. The New Jersey Supreme Court's decision has been followed by nearly every state appellate court to consider the issue. In addition to establishing a patient's right to refuse life-sustaining medical treatments, the Quinlan decision also made clear that a decision to remove or withhold life support systems from an incompetent patient would not constitute homicide or medical malpractice.

In 1975, Karen Ann Quinlan, age twenty-two, stopped breathing and lapsed into a coma. Quinlan's treating physicians determined that in addition to being comatose, Quinlan was in a "chronic persistent vegetative state" and could not survive without the assistance of a respirator. Further, the physicians believed that Quinlan had no chance of recovery and could not

survive for more than a year even with the assistance of the respirator. Although Quinlan was not dead by any legal standard, her family wished to disconnect the respirator. The treating physicians, however, refused. Quinlan's father then sought judicial approval to act as Quinlan's legal guardian and to have the respirator removed.

After a lower court refused to order physicians to remove the respirator, Quinlan's father appealed to the New Jersey Supreme Court. First the court determined that a patient's decision regarding whether to continue with life-sustaining medical treatments implicates the patient's right to privacy, much as a woman's decision to terminate a pregnancy implicates the right to privacy, as established in roe v. wade, 410 U.S. 113, 93 S. Ct. 705, 35 L. Ed. 2d 147 (1973).

The court then proceeded to weigh Quinlan's right to privacy against the state's interest in preserving human life and defending the right of a physician to administer medical treatment according to his or her best judgment. The court found that as the degree of bodily invasion increases and the prognosis for the patient's recovery dims, the patient's right to privacy increases and the state's interest weakens. In Quinlan's case, where the medical procedures were extremely invasive and Quinlan had virtually no chance of recovering from a permanent vegetative state, the court concluded that Quinlan could choose to have the respirator discontinued, even if it meant she would die.

However, Quinlan was unable to make this decision. Thus, the court was faced with the issue of whether Quinlan's father could make the decision on her behalf. The court concluded that Quinlan's father and the rest of her family could decide whether to disconnect the respirator, stating that the "decision should be accepted by a society the overwhelming majority of whose members would, we think, in similar circumstances, exercise such a choice in the same way for themselves or for those closest to them." The court stated that Quinlan's father should act in accordance with his understanding of his daughter's best interests and not necessarily upon what his daughter would have done had she been able to express her wishes.

Although the Quinlan decision is most often cited as the decision that recognized the "right to die," commentators have stated that the decision's most important legacy was offering the medical profession freedom from criminal prosecution and civil liability when removing life support from patients in a chronically vegetative state. The Quinlan court stated that it believed the testimony of Quinlan's doctors who testified that the fear of criminal prosecution or civil liability had nothing to do with their refusal to disconnect Quinlan's respirator at her father's request and that their decision comported with standard medical practices. However, the court also believed that the fear of criminal sanctions and civil liability must have had some bearing on medical standards and practices as they then existed.

Thus, the Quinlan court was faced with the conflict between the patient's right to refuse invasive, life-sustaining medical procedures and the doctors' right to treat their patient as they saw fit. The court believed that the focal point in balancing these rights ought to be the possibility of the patient's returning to a cognitive and fulfilling life, as opposed to the "forced continuance of that biological vegetative existence" to which Quinlan was doomed. In resolving Quinlan's case, the court concluded that if her attending physicians, after consulting with the hospital's ethics committee, concluded that Quinlan had no reasonable possibility of ever emerging from her comatose condition to a cognitive, sapient state, the respirator that was believed to be sustaining her life ought to be removed in accordance with her family's wishes. The physicians could not be subject to criminal or civil liability for that decision.

Ironically, the New Jersey Supreme Court's decision had little impact on Quinlan's fate. Almost six weeks after the Court's ruling, Quinlan was still attached to a respirator and more medical technology was being employed to keep her alive. Eventually Quinlan was weaned off the respirator in accordance with her family's wishes, but she still survived another nine years, although she never emerged from a comatose state.

The Quinlan case has influenced U.S. law by providing the framework for deciding the difficult legal issues that continue to arise as advances in medical technology allow doctors to keep patients alive, even when they have little or no chance of returning to normal life. Nearly every judicial decision since Quinlan has recognized a patient's right to refuse life-sustaining medical treatments. Finally, the courts have agreed with Quinlan that where a patient is incompetent, the right to refuse such treatments may be asserted by the patient's family or guardian.