Throwback Thursday

In September, legislators sent Gov. Jerry Brown a bill asking that he make California the fifth state to legalize physician-assisted suicide, but 40 years ago, the end-of-life ethical debate of the day revolved around “pulling the plug.”

In 1975, 21-year-old Karen Ann Quinlan fell into a coma. After five months, the New Jersey woman’s parents asked that doctors remove her from the ventilator that assisted her breathing and, presumably, kept her alive.

The ethical debate was one that previously had gone on behind closed doors. When Julia and Joseph Quinlan made their request to hospital physicians, they were told they must petition the court. Losing the initial petition request in New Jersey Superior Court, they took their appeal to the state Supreme Court. New Jersey Supreme Court justices ruled unanimously that Quinlan’s right to privacy included the right to be removed from life support. Quinlan surprised everyone by surviving another nine years, off of ventilation but in a persistent vegetative state. That result, though, does not lessen the historic importance of the case.

Julia Quinlan said that the debate and court ruling “set a precedent for all future cases.”
According to the Karen Ann Quinlan Foundation, “the ruling gave patients and families the right to live each stage of life, including the last stage, with dignity and respect.”

The Foundation points out that the Quinlan case led to having hospitals, hospices and nursing homes establish and maintain ethics committees and led the legal community to create advanced directives, or “living wills.”

Pictured above: The Newsweek cover from November 3, 1975 of Karen Ann Quinlan.

Even today, there is debate and confusion surrounding end-of-life care. A recent study in the Journal of the American Medical Association suggests that patients with do-not-resuscitate orders had lower survival than those without DNR orders, including those with the best prognosis. Additionally, there can be confusion among patients, families and caregivers about various end-of-life directives, such as advanced directives, DNRs, POLSTs — Physician Orders for Life-Sustaining Treatment.

To help, emergency department doctor Michael Barton, M.D., of Heritage Valley Health System in Beaver, Pa. has created an informative video parody that implores health care workers to “take the time to get it right.”

Generally, however, the debate has moved away from the issue of an individual’s rights to direct treatment at the end of life to whether he or she should have the right to end his or her own life. Oregon, Washington, Montana and Vermont have physician-assisted suicide laws on the books. Most other state legislatures have considered and are currently considering assisted-suicide laws.

A May Gallup Poll found that 68 percent of Americans supported legally allowing physicians to assist a patient in committing suicide if the patient has an incurable disease and is in severe pain. This was up 10 percent from 2014. Gallup speculated that the high-profile case of 29-year-old Brittany Maynard may have contributed to the uptick. Maynard ended her life Nov. 1, 2014, in accordance with Oregon’s Death With Dignity Act. Diagnosed with terminal brain cancer, Maynard moved to Oregon and used her story and end-of-life decision to become an advocate for the Death with Dignity movement.