Premium
COGNITIVE DEATH: DIFFERENTIAL PROBLEMS AND LEGAL OVERTONES
Author(s) -
Beresford H. Richard
Publication year - 1978
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.1978.tb50351.x
Subject(s) - cognition , differential (mechanical device) , psychology , medicine , psychiatry , engineering , aerospace engineering
The Quinlan case raised the issue of when physicians may lawfully terminate care for severely brain-damaged adults. The question was not whether Karen Quinlan was dead, for the medical testimony clearly indicated that she did not meet existing criteria for brain death. Instead, the question was whether her physicians and family could take steps that the court thought would lead to her death. The New Jersey court made “cognition” the touchstone of decisionmaking. It formulated a procedure to permit withdrawal of a presumptively life-supporting respirator following a medical determination that cognition was irretrievably lost. The court thus established a legal precedent for terminating care of those adults who, while retaining vegetative neurologic functions, lack the capacity to interact with the external environment. But, although many seem to have applauded the decision, it has some disturbing features which bear mention. To support its judgment, the court stated some conclusions that had limited evidentiary support.2 For example, it flatly assumed that Miss Quinlan herself would have wished the respirator removed if only she could have perceived that there was almost no hope of recovery.* It concluded that she was suffering, despite extensive medical testimony that she lacked the capacity for conscious emotional experience. It suggested that her attending physicians would willingly turn off the respirator if it weren’t for the fear or civil or criminal liability, despite testimony by them that this was not the basis of their reluctance. It concluded that she would not survive withdrawal of the respirator, despite medical testimony that she might survive for an indefinite period after it was removed. It assumed that the capacity of physicians to predict outcome for persons such as Miss Quinlan was well-enough developed to permit the drastic step of withdrawing life-support measures, despite the lack of systematic, statistically validated studies of prognosis in chronic vegetative states. If this seems to be ungracious quibbling that has lost sight of the “good” the court was trying to achieve, let me move the dialogue to another level. Recall that the court was being asked to appoint Miss Quinlan’s father as her guardian for the express purpose of authorizing removal of life support. To