THE QUINLAN DECISION:
Steinfels, Peter
QUINLAN DECISION
PETER STEINFELS
THE drama, the publicity, the sad-ness of the Karen Quinlan case, the unsophisticated nobility of her parents, the gravity of the issues under consideration, all,...
...it is, after all, a "medical decision...
...Yet "cause" is a slippery cortcept, in philosophy as well as in the law...
...In contrast, the court did not simply leave this decision in the hands of medicine generally, as though a consensus might be found among physicians...
...Second, we need to respect the values and choices of the patient and of those, usually the family, whose views and interests are most likely to coincide with the patient's...
...And is their exercise to be limited or scrutinized in ways our own would not be...
...You and I are legally empowered to refuse medical treatment, even life-saving treatment...
...Can others exercise it on our behalf...
...die here, it must be granted, is not of Judge Muir's making...
...If so, who...
...one of them is to have that person declared mentally incompetent, evidence of incompetence simply being his refusal to accept the treatment which others think he "rationally" should...
...QUINLAN DECISION PETER STEINFELS THE drama, the publicity, the sad-ness of the Karen Quinlan case, the unsophisticated nobility of her parents, the gravity of the issues under consideration, all, perhaps, led us to expect of Judge Robert Muir, Jr., something that he was not, that he would emerge a small-town Bran-deis or Frankfurter, that his ruling would clear away the confusions and hammer together a structured argument which, though it might not satisfy everyone, for no ruling could, would at least be the basis for further thought and discussion...
...Though generals are essential to warfare, the decision to declare a war is not essentially a military one...
...The mud...
...Normally, of course, a family could dismiss a physician if they did not think the patient was getting good medical care...
...The court would rule on the "best interests" of the patient, but the burden of proof would fall on the challenger, especially to prior arrangements like the "living will" or appointed spokesperson...
...Taken literally the court's ruling also leads to the absurdity that a treating physician could also turn off a respirator against the stated wishes of parents...
...By citing homicide statutes, and at the price of self-contradiction, Judge Muir has closed off this possibility...
...the authority to decide was vested specifically in the treating physician...
...But the ruling is no freer of difficulties at this point...
...In the absence of such arrangements, the family's decisions should prevail unless challenged in court...
...It is as though untangling the webs of these claims consumed the court's energies and left it exhausted before the remaining problem...
...Under New Jersey law, the judge wrote, "the intentional taking of another's life, regardless of motive, is sufficient grounds for conviction...
...I confess less confidence that some well-meaning physicians, should they be told by courts often enough that these are "medical decisions," might not quietly carry out such actions in the name (Continued on page 604) Steinfels (Cont...
...All decisions to discontinue treatment should be officially recorded, along with the basis on which they have been made, whether "living will" or the consent of a patient's appointed spokesperson or family...
...homicide statutes had already foreclosed the matter...
...First we need a way of reaching decisions in cases like Karen Quinlan's which recognizes and does justice to the particular facts of the case-the patient's suffering or physical deterioration, her prospects for recovery, and above all continuity with her own values and aspirations...
...But that discussion must come later...
...Judge Muir's answers to these questions in the case of Karen Quinlan are uncertain, inconsistent, and incomplete...
...Third, we need safeguards against abuses...
...But what about active euthanasia, I hear someone asking...
...Quinlan's anguish, removed him from control of Karen's day-to-day care...
...Since presumably not even physicians are exempt from homicide charges, in what sense, then, is the continuation of treatment "a medical decision" or dependent on "the treating physician's opinion...
...Yet the need to make such decisions about continuing or refusing treatment frequently arises only when we are unquestionably incompetent and not just entrapped in medico-legal flypaper...
...Can the line be drawn between the causation involved in intentionally "allowing another to die" and that involved in the "intentional taking of another's life...
...Anyone who doubted that the decision was in the best interests of the patient could immediately go to court...
...It does not follow that such a decision is a "medical" one...
...It is a reasonable construction that the law of this state would preclude the removal of Karen Quinlan from the respirator...
...to treat us against our will without legal authorization would be assault and battery...
...Meanwhile the court in New Jersey has left the whole question suspended, like Karen herself, on a ruling which moves us no closer to a resolution.ser to a resolution...
...In practice there are various dubious methods of forcing treatment on someone who doesn't want it...
...In fact they cannot because Judge Muir, referring to Mr...
...I find it difficult to believe that such a line cannot be drawn...
...At this point I can only reply that nothing will serve the cause of active euthanasia better than evidence that traditional positions on refusal of treatment or allowing to die cannot adequately respond to the new conditions created by medical technology...
...I cannot really imagine such a grotesque and immoral, and legally risky, course being taken by physicians...
...That means an opportunity for discretionary judgments, the kind of "best interests" judgments made by courts in several other areas...
...Living wills" written by competent individuals to set a limit on treatment when they can no longer speak for themselves should be given legal force...
...I can think of three general characteristics...
...of humanity without ever consulting families or even conscious but suffering patients...
...Or could the treating physician even take such a step against the wishes of a conscious patient...
...What kind of a nuanced solution do we want...
...Can they therefore choose another treating physician...
...That medical information is crucial to any decision about continuing or discontinuing treatment, that medical personnel are best situated to implement a treatment decision, no one would deny...
...and we do not leave it to generals...
...More important, competent individuals should be able to appoint others with legal power to make decisions on treatment should the first individuals be rendered incompetent...
...In the Quinlan case, we have reached the absurd conclusion that the normal prerogative of a family in a much more clearly medical question (whether care is sufficient) is denied them in a question which is not essentially medical at all...
...Not only are these two lobes of the court's ruling in apparent conflict, each raises its own difficulties...
...The factors involved are personal and moral, and no more within the special ken of a man trained in body systems than deciding how much income should be devoted to my children's education or whom they should marry...
...In this case, does anything remain of our power to refuse treatment...
...To interpret the removal of Karen Quinlan from the respirator as homicide turns on a particular notion of "cause...
...The problem is this...
...If the question of refusing treatment is to admit of a nuanced solution at all, then it must get past the barricade marked homicide, where all discussion ceases...
...If so, how...
...On the other hand, the court seemed to rule that when it came to a decision regarding removal from a respirator, no one could speak for Karen...
...His work was no doubt hampered by the false leads which distracted the public's, and evidently the court's, attention: the early, unfounded claims that this case turned on the "definition of death" or, later, on a "constitutional right to die" or on the Quintans' right to free exercise of their religion...
...Whether or not Karen should be removed from the respirator, the judge wrote, "is a medical decision...
...But the treating physician is only involved because he was either chosen, or approved, by the Quinlans...
...in any case, it follows from the logic of the court's argument that if the treating physician's opinion is to overrule the family's, then the family should not be able to dismiss the treating physician...
...On the one hand, the court seemed to rule that someone could speak for Karen, though oddly enough the choice passed over parents and friends to light upon the treating physician...
...Is the discontinuing of treatment the cause of the death that would follow...
...There is a duty to continue the life-assisting apparatus if, within the treating physician's opinion, it should be done...
Vol. 102 • December 1975 • No. 19
