From Quinlan to Jobes: The Courts and the PVS Patient

Abstract

From Quinlan to Jobes: The Courts and the PVS Patient On a rainy October morning in 1975, scores of reporters from as far away as Tokyo fought for scarce seats in the magnificent ceremonial court-room of the 150-year-old New Jersey Superior Court building in Morristown. There, before a chancery judge used to determining routine matters of guardianship and contract law, attorneys for a father were prepared to plead that he could advance his vegetative daughter's constitutional and common law rights to refuse what was believed to be life-sustaining medical treatment. As a case of legal and media first impression, the saga of Karen Ann, Joseph, and Julia Quinlan was guaranteed minutes each night on network newscasts, as well as front-page coverage in newspapers from the New York Times to The Washington Post, from the (Morristown) Daily Record to the Times of London. The Girl in the Coma even made the cover of Newsweek. In advancing their daughter's constitutional right to privacy, an American family lost all of theirs. And it was, unfortunately, necessary for them to do so. For in order for the public to understand issues that up to that time had only been debated in hospital corridors and forums such as the Hastings Center Report, it was necessary for Karen Ann's parents to explain themselves fully to the world. It was not, they insisted, that they wanted their daughter to die. Rather, they wanted her to be free from the tyranny of the machine thouggt to be sustaining her past the point at which she would have wanted to live. Eleven years later, when In re Nancy Ellen Jobes was filed in the same courthouse, there should have been a pandemic of media and public deja vu. Here was yet another unfortunate young woman, who, like Karen Ann Quinlan, was in a persistent vegetative state (PVS). Again, a family, this time led by a twenty-nine-year-old husband, was in the same courthouse asking a different chancery judge for the same relief. The challenged modaility this time was a feeding tube, rather than a Bennett MA-1 respirator, but the issue was identical: physicians and health care facility administrators were refusing to allow the withdrawal of life-supporting medical technology from a patient for whom the treatment offered no hope of improvement--to say nothing of recovery. Beginning with the New Jersey Supreme Court in the Quinlan case, court after court, commission after commission, and even some legislators, have affirmed and reaffirmed the right of an incompetent patient--particularly those in persistent vegetative state--through family members and guardians, to refuse life-sustaining medical treatment. Why, then, has it been necessary for the Jobeses, the Brophys, and other similarly situated families to go through the same public hell endured more than a decade earlier by the Quinlan family? Why have physicians and health care administrators been unwilling to accept the professional freedom and responsibility given them by the courts, legislatures, and public opinion polls? Even more puzzling, why have they so often ignored the ancient admonition to first, do no harm? Surely maintaining what only a vitalist would call the life of a Karen Ann Quinlan, Paul Brophy, or Nancy Ellen Jobes does such a patient no discernible good and, in fact, does great harm to all those who loved those patients when they were able to benefit from that love. Why, eleven years after Quinlan, was there such media interest in the case of Nancy Ellen Jobes? The question, really, is not why the media seemed so intrigued by the case. Rather, it is why there had to be a case in the first place. After all, weren't these same questions settled a decade ago by the highest court in this same state? In fact, hadn't the New Jersey Supreme Court settled these matters yet again in the Conroy case a year earlier? The answer to the first question--why the media interest--is of course both easy and obvious: The Jobes case involved a formerly attractive, vital, young woman, who, after her fetus was killed in an auto accident, was herself made vegetative by a physician's gross error. …