The Quinlan decision: problems and legislative alternatives.

Abstract

In the Quinlan decision, a state supreme court authorized removal of a respirator from a person in a chronic vegetative state provided that the attending physicians and an "ethics committee" agreed there was no reasonable possibility of her regaining cognition or sapience. While the decision involves an unusual factual situation and poses some troublesome technical and doctrinal problems, it underscores the need for formal legal standards to guide physicians and families of severely brain-damaged patients. Legislation seems preferable to a series of court decisions. The legislative process allows the public to express views on controversial ethical and religious questions. It also permits extensive deliberations about medical and scientific data relating to brain damage and its prognosis. Legislative alternatives include expanding the concept of brain death, redefining homicide, allocating to physicians and families legally unreviewable discretion to decide on levels of care, mandating procedures for implementing a desired reduction of care, and approving the use of a "living will" as a means of requiring physicians to withdraw or withhold treatment.