Chapter 3

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Wayne State University *

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1110

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Electrical Engineering

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Feb 20, 2024

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Labiba Rahman Section 003 Chapter 3: Comas: Karen Quinlan, Nancy Cruzan, and Terri Schiavo 1. Be able to discuss Karen Quinlan’s case by answering the following questions: a. What's the best explanation of why Karen Quinlan went into a coma? b. How did the use of ventilators cause the need to clarify the criteria of death? c. Describe Karen’s physical appearance/behavior. d. What are the conflicts that arose when the Quinlan’s went to court? e. What right was cited in the following US Supreme Court cases: Oklahoma vs. Skinner (1942), Griswold vs. Connecticut (1965), and Roe vs. Wade (1973)? f. How did the New Jersey Supreme Court cite this right in Quinlan and what did they rule? g. "Physicians pulled the plug on Karen, but she didn't die." What happened? How long did she live? Who cared for her during this time? a) The deprivation of oxygen caused her to fall into coma, she used tranquilizers and alcohol (62-63). b) It was because ventilators were often used in cases of trauma and emergency uses (62- 63). c) Karen’s sister described her as shaking her head, making noises, and moving around (62). d) The right to decline medical treatment (63). e) That regarding the 9th amendment, they had the right to privacy (63). f) They ruled in her favor and gave her family the ability to unplug the ventilator as it was their right of privacy. It was controversial because it held the life of the patient in the hands of their family (64-65). g) She continued to breathe on her own for 10 years, but her brain was damaged too great by the anoxia. Her family cared for her during that time (65). 2. Be able to discuss Nancy Cruzan’s case by answering the following questions: a. Describe how Nancy was injured, revived, and her physical condition afterwards. b. How did the use of an artificial feeding tube cause an ethical dilemma in Cruzan’s case? c. What three things were declared in the Cruzan case by the U. S. Supreme Court? a) Nancy got into a car accident, the emergency staff performed CPR and placed her on life support, but she sadly would be determined brain dead (65-66). b) It caused an ethical dilemma because it caused the death of Cruzan (66). c) Three things that were declared were the choice for a competent patient to decline medical treatment, withdrawing the feeding-tube regarding the 9th amendment wasn’t the

parents choice, and a state was allowed to pass a statute requiring hard evidence about what the patient would’ve wanted (67). 3. Be able to discuss Terri Schiavo’s case by answering the following questions: a. How long did Michael try to rehabilitate Terri before he sought a court order to remove her feeding tube? How long was Terri in a coma before a court allowed her feeding tube to be removed? b. Describe the controversy between Michael Schiavo and her parents, the Schindlers. c. Why did disability advocates claim that Terri Schiavo was a victim of discrimination against the disabled? a) He tried for 8 years to rehabilitate, and it was 10 years after Terri was in a coma before the court allowed the feeding tube to be removed (68). b) Michael wanted the tube removed while the parents didn’t (68-69). c) They claimed that her condition was similar to autism, which therefore included her as someone with a disability. They inferred based on their claims that it must have been discrimination against her due to the disability (70-72). 4. Describe the 3 standards of declaring someone dead (Harvard, cognitive, and irreversibility). How are the terms "brain-death" and "life-support" misleading?  Harvard: When someone can’t move, no brain activities, no reflexes, no breathing, and 2 isoelectric EEG readings within 24 hours apart (74).  Cognitive: When someone doesn’t have a sense of reason, memory, self-awareness, and other philosophical traits/properties (74).  Irreversibility: Its basis is between those of Cognitive and Harvard, simply put, it’s when someone’s consciousness is irreversible. It makes it seem there are different levels of death (74). 5. What is a persistent vegetative state (“PVS”)? a. Is PVS the same as brain death? b. Explain what is meant by a “minimally conscious state”? c. How does Descartes explain one would assess another's consciousness? a) It is not the same thing (75-76). b) Someone who shows only slight signs of awareness (76). c) There are many different methods on judging the levels and may vary from person to person (76). 6. Describe what is meant by medical futility. How did the Wanglie and Gilgunn cases involve medical futility? With whom do judges usually side with in cases involving medical futility?

Wanglie: The staff decided to withdraw treatment because the attempts were futile (80-81)> Gilgunn: The staff were sued when they decided to withdraw medical treatment as it was futile due her still wanting to be on life-support (80-81). 7. What is the distinction between ordinary and extraordinary treatment in medical ethics? a. How did Pope John Paul II cause controversy in Catholic hospitals by his remarks on withdrawing feeding tubes for PVS patients? b. What has happened since? c. Explain 2 misconceptions about artificial nutrition and hydration? a) He claimed that it was euthanasia from omission (79). b) People believed that feeding tubes shouldn’t be used to prolong life (79). c) Neither dehydration nor starvation distresses semiconscious, dying patients. Patients near death not on nutritional support seem more comfortable than patients on whom such support is forced. One important national commission noted in 1983 that loss of appetite is “almost the norm in the latter stages of terminal illness” and concluded, “Only rarely should a dying patient be fed by tube or intravenously.” Indeed, such feeding may actually make the patient suffer and thus harm him or her (81-82). 8. What is an advance directive? What are the 2 major challenges with advance directives? Advance directive is a legal document that’s essentially a will that states the wishes of the person regarding medical care decisions. Advance directives contain two major problems. First, as the SUPPORT study showed, most people do not accurately predict their own future preferences. 7Second, evidence has grown that spouses designated as legal proxies do not accurately predict the wishes of previously competent but now incompetent spouses. As frequently as they wrongly predict a desire for mere palliative care, they just as frequently wrongly predict desires for aggressive treatment (83).

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