Written by Mackenzie Chen

One tragic night in April 1975, a young woman named Karen Ann Quinlan fell into a coma after drinking excessively and taking Valium at a friend’s birthday party. She had felt faint after returning home and retired to bed. Fifteen minutes later, when her friends came to check on her, they made an alarming discovery: Quinlan was not breathing. 

While her friends administered mouth-to-mouth resuscitation, they called an ambulance, and Quinlan was quickly taken to Newton Memorial Hospital. There, she remained in an unresponsive state for nine days before being moved to another hospital. 

Quinlan suffered extensive brain damage due to a prolonged lack of successful respiratory function. The effects of her irreversible brain damage were severe and debilitating: she was in a persistent vegetative state, only partially aware of her surroundings. Her eyes no longer moved in a synchronized manner, and her health greatly declined. She lost significant weight and had to rely on a ventilator to breathe. 

Her parents wanted her to be removed from the ventilator, believing it was causing her unnecessary pain. However, the hospital caring for Quinlan at the time was threatened with potential homicide charges by the Morris County, New Jersey prosecutor if they complied with the request–even if the patient could survive without the ventilator. This launched a legal battle that would determine whether removing someone from a ventilator was murder or mercy. 

Up until the 19th century, most people died peacefully at home, surrounded by family and friends. However, in the 20th century, with advances in medications for diseases and the growth of hospitals, there was increased hope that more people could be cured. In fact, it was seen as a failure if a patient died while under a doctor’s care, let alone if a physician allowed a patient to be removed from a ventilator. 

Many medical institutions believe in the importance of maximizing the number of patients saved. However, at a certain point, the physician and the patient must decide whether it is more important to prioritize the number of lives saved or the number of quality lives saved. If a physician is merely prolonging a patient’s pain by not removing them from a ventilator, it raises the question: Is the physician still saving the patient?

This case became the first of its kind; it forced America to truly consider the fundamental questions of whether or not people had the right to death and who had the right to decide who died and who lived. As the country grappled with these bioethical debates, Quinlan’s parents battled in court for their right to remove their daughter from her ventilator. While they lost their petition in Superior Court, they subsequently took their case to the New Jersey Supreme Court. The court ruled in favor of the Quinlans, and the case set many legal and medical precedents that are still adhered to today. First, the court decided that removing someone from a ventilator would not be considered homicide so long as the individual could not recover if kept on the ventilator. This eliminated the possibility of the hospital being sued for removing Quinlan from her ventilator. Additionally, the court decided that Quinlan’s family could have a say in her medical treatment, including the decision to remove her from her ventilator. This enabled any patient’s family members to contribute to their treatment plan. 

To everyone’s surprise, Quinlan was able to breathe on her own without the ventilator. She was transferred to the Morris View Nursing Home, where she resided for approximately ten more years. During this time, she was fed through a nasogastric tube and underwent physical therapy, as her limbs were retracting towards her body. She ultimately died from respiratory failure caused by acute pneumonia. However, the struggle and pain her family endured to establish their right to be with her during her final moments had a lasting national impact. 

The court strongly encouraged medical professionals and institutions to use this case as a precedent, giving grieving family members the opportunity to decide whether to withhold extraordinary measures to save a patient. In response, hospitals, nursing homes, and hospices created their own ethics committees. The case also encouraged the establishment of “living wills,” allowing individuals to prepare for the hypothetical scenario of a coma by personally stating their preferences regarding life support, such as whether they would want to be removed from a ventilator. 

The effects of the Quinlan case have been felt throughout history and continue to resonate today. A recent instance of removing patients from ventilators occurred during the COVID-19 pandemic, when hospitals had to decide whether to restrict or permit access to ventilators for patients to effectively allocate their limited resources. To this day, questions remain about what defines a morally right or wrong action in complex issues such as saving lives or bringing peace. 

Edited by Aisha Hassan