The first time I read the medical consent and authorization. it had
registered in my mind simply as a legal document. Now I began to
understand what it meant. It was a letter of ultimate love and trust.
(Schucking. 1985. p. 268) Ever since Karen Ann Quinlan slipped into
permanent unconsciousness in 1975 and her father agonized publicly over
whether she should remain indefinitely on a respirator (In re Quinlan,
1976), the desires of patients, their families, and their friends to
limit the application of apparently limitless medical technology have
been a pressing concern for ethics, law, and public policy. Ms.
Quinlan's case contained nearly all the elements of the problems we
still face: vague, general, but sincere prior oral statements suggesting
that she would not want continued treatment; a family attempting to do
what they saw as best for her; and physicians uncertain whether to use
medical judgment alone (and if so, what the "right" medical decision
was), to preserve her life at all costs, or to honor the family's
interpretation of their daughter's choice. Most ironically, once she was
removed from her respirator, she did not die. Karen Quinlan - like
dozens of other names made famous by court decisions, newspaper stories,
and television evening news - has come to symbolize a tangled knot of
issues surrounding the end of life and who controls it.