New Jersey’s significance in the book lies chiefly in the Karen Ann Quinlan Case, a landmark legal dispute over whether life-sustaining treatment could be withdrawn from a patient who was not expected to recover. The state’s supreme court allowed the respirator to be turned off on the basis of Quinlan’s constitutional rights to privacy and liberty, exercised by her father. The outcome helped establish refusal of treatment as a matter of patient rights, while Quinlan’s survival after ventilation ended made the case more complicated than a simple transition from treatment to death.

The Quinlan Case

In 1975, the parents of Karen Ann Quinlan, a young woman who had become comatose and suffered brain damage after taking Valium and drinking several gin and tonics, asked doctors to remove her from a ventilator. She was not expected to recover. Her family and friends recalled that she had said she would not want to be kept alive in that condition, but the doctors refused to discontinue life support.

The dispute reached the New Jersey Supreme Court. The court ruled that the respirator could be removed on the basis of Quinlan’s constitutional rights to privacy and liberty, as exercised by her father. The respirator was turned off, but Quinlan breathed on her own and lived for another nine years. That reversal between the expected consequence of stopping ventilation and what followed gave the case lasting force: the decision established a right to refuse treatment without determining that withdrawal would necessarily bring about immediate death.

A Legal Turning Point

The ruling became a landmark in the development of American law on treatment refusal. Later state-court decisions held that the right to refuse medical treatment flowed from established rights to privacy, liberty, self-determination, and informed consent. The book also places this principle alongside the earlier recognition that some Jehovah’s Witnesses could refuse treatment on religious-freedom grounds.

New Jersey’s role therefore concerns the boundary between allowing a patient to refuse medical intervention and intentionally causing death. In the United States, the latter remained illegal, while the debate increasingly centered on withdrawal of life support and the withholding of treatment. The Quinlan decision gave legal footing to that distinction: discontinuing a treatment could be permissible as an exercise of personal rights, rather than automatically treated as active euthanasia.

Contrast with Disaster Decisions

The case’s emphasis on a patient’s wishes and a family member’s authority offers a striking contrast to the crisis at Memorial Medical Center in New Orleans. There, a DNR order—which meant that a patient should not be revived after breathing or heartbeat stopped—was used to place patients last in the evacuation order. One daughter who had approved such an order for her ninety-three-year-old mother objected when she learned that it was being treated as a reason not to rescue her. She asked for it to be canceled, explaining that she had not understood it to mean that her mother would be left behind.

The contrast clarifies the limits of a medical directive: a decision not to resuscitate is not, by itself, a request to forgo rescue or all further care. The Quinlan ruling is part of the legal history that made refusal of treatment intelligible as an exercise of patient autonomy; the Memorial episode shows how a treatment instruction could be stretched beyond its purpose when emergency decisions were made under radically different conditions.