Cognitive Death: Differential Problems and Legal Overtones

315 Annals in New York Academy of Sciences 339 (1978). 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 decision-making. 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.