Rotation Prep

Published January 4, 2021

  • Quinlan case: In 1975, Karen Ann Quinlan suffered irreversible brain damage from an unintended overdose and was in a persistent vegetative state. Her parents requested that she be disconnected from her ventilator. In 1976, the New Jersey Supreme Court ruled that even though doctors felt that removing the ventilator would conflict with their professional judgment, the constitutional right of privacy includes a person’s decision to forgo life-sustaining medical treatment in certain circumstances. The court also ruled that Joseph Quinlan, her father, could make the decision on her behalf as surrogate decision-maker.

  • Cruzan v. Director, Missouri Department of Health: In 1990, Nancy Cruzan sustained a brain injury from a motor vehicle accident (MVA) and was in a persistent vegetative state. Her parents requested that doctors discontinue artificial nutrition and hydration. The case went to the Supreme Court. While the court already recognized a person’s right to refuse treatment, the court required “clear and convincing” evidence that the patient would agree. Justice Sandra Day O’Connor suggested that a surrogate’s authority would be protected if the surrogate were appointed by the patient in an advance directive. The major result of this case was the development of advance directives.

  • Terry Schiavo case(s): In 1990, Terry Schiavo, a 26-year-old woman, sustained a cardiac arrest at her home. She was resuscitated; however, she remained in a persistent vegetative state. In 1998, Schiavo’s husband and legal guardian argued that Schiavo would not have wanted artificial nutrition and hydration. Schiavo’s parents disputed his assessment. The case involved 14 appeals, five lawsuits in federal court, and political intervention by the governor, president, and Congress. Her feeding tube was finally disconnected in 2005. The case brought about much public conversation regarding care at the end of life.

  • Vacco v. Quill: In 1994, Oregon became the first state to legalize physician-assisted suicide. In response, New York enacted a prohibition against physician-assisted suicide. A group of physicians filed a suit against New York’s attorney general challenging the law. The case went to the Supreme Court, which ruled 9-0 that the state ban on physician-assisted suicide was constitutional.


1. Forty Years of Work on End-of-Life Care — From Patients’ Rights to Systemic Reform. Wolf SM et al. N Engl J Med 2015.
2. Schiavo Dies, Ending Bitter Case Over Feeding Tube. Goodnough A. New York Times 2005.

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