The use and abuse of heroic measures to prolong dying

Abstract

Because of advances in medical technology, some people, who in an earlier era would have died, are today alive and well. Others who would have died are now alive but in a coma or a vegetative state. Medical technology has created as many problems as it has solved. The cover of the November 3, 1975, issue of Newsweek had a small picture of Karen Ann Quinlan and in large letters, the phrase "A Right to Die?" This patient lies in a "persistent vegetative state" in a hospital in New Jersey, her life being maintained by a Bennett respirator. Some physicians openly said they would "pull the plug" to end her life.1 She does not have a flat electroen cephalogram. Even the states, such as California, Kansas, and Maryland, that base their definitions of death on brain activity would not define Miss Quinlan as dead. Yet Superior Court Judge Robert Muir, Jr., was asked by Miss Quinlan's parents to order an end to the use of artificial life supports that have kept the girl alive, but in coma, for six months. The court ruled that to turn off the respirator would be considered murder.* Stirred in part by the Karen Ann Quinlan controversy, "right to die" movements have gained much momentum in the United States and in Europe.2 In Switzerland, a prominent physician has been accused of murder in the deaths of elderly hospitalized patients because he allowed them to die and did not force feed and otherwise treat those in irreversible coma.3 From a hospital room in New York, Charles Lindbergh asked to be flown home to Maui in Hawaii to die of his malignant lymphoma, which was resistant to radiotherapy and chemotherapy.4 He wanted no respirator, defibril lator, or other artificial machinery. None was provided. He received excellent, prompt, responsive nursing care, oxygen when needed, a minimum of analgesia, and a great deal of love and consideration from his family and medical staff.