by Jill Lepore
[CHAPTER 9]
The Gate of Heaven
Just before eight o’clock in the morning on October 20, 1975, Thomas Trapasso left the rectory at Our Lady of the Lake, a stone church perched high on a bluff outside the small town of Mount Arlington, New Jersey. He climbed into his car. Through a driving rain, he drove downhill toward Lake Hopatcong, wended his way along the water for a mile or so, and then turned onto Ryerson Road, where he slowed down in front of a two-story bungalow. He could scarcely have missed it. Forty reporters stood in the yard, huddled beneath trees. Mail reached this house even when it bore no more address than “To Karen Quinlan’s Family, U.S.A.”1
Karen Ann Quinlan, twenty-one years old, was not at home. She was a dozen miles away, at Saint Clare’s, a Catholic hospital in Denville. She was in a bed, contorted, shriveled, and emaciated. Six months earlier, she had collapsed, mysteriously, after a night out with some friends and had stopped breathing. Before she was successfully resuscitated, her brain had been without oxygen for two periods of about fifteen minutes each.2 She had never regained consciousness. Since falling into a coma, she had lost half her weight; she weighed less than seventy pounds. Her eyes opened and shut. She flailed, she grimaced: muscle spasms, and nothing more.3 She had no chance, no conceivable hope, of any sort of recovery at all.4 A feeding tube and a respirator kept her alive. Her parents, Julia and Joseph Quinlan, talked with Trapasso, their parish priest, who was also Julia Quinlan’s boss (she worked in the rectory, as his secretary), and then, in July, they asked their daughter’s doctors to remove the respirator. Her doctors refused.5
In front of the Quinlans’ bungalow on Ryerson Road stood a statue of the Virgin Mary, eyes downcast, arms outspread, palms to the sky. As Trapasso pulled into the driveway, the reporters advanced. When the Quinlans opened a side door, the flashbulbs, Julia Quinlan later remembered, popped like fireworks. “God, see me through this,” she prayed, just before she and her husband, a one-armed World War II veteran, made a dash for the priest’s car.6 Trapasso backed out of the drive. The Quinlans had thirty miles of road to go.
This matter of life and death would not be decided in a stone church, perched on a bluff. It would not be decided in the Quinlans’ bungalow, down by the lake. It wouldn’t even be decided in a hospital room, where a respirator whirred as the rain pattered on the windowpane, sounds Karen Ann Quinlan, who had once taught herself to play the piano by ear, could no longer hear.7 Through that autumn storm, Trapasso drove, east, and then south, to the county seat. The Quinlans were going to court. When they reached Morristown, where George Washington once quartered his troops, Julia Quinlan thought the Morris County Courthouse looked like Tara, the mansion in Gone with the Wind, and the army of reporters camped out front like so many Civil War soldiers, wet, weary, and bedraggled. Inside, a judge was preparing to hear arguments for In the Matter of Karen Quinlan.8 Wrote one reporter for the Washington Post, “Whatever the decision, it is one that will haunt us for years to come.”9
In the Matter of Karen Quinlan marked a fundamental shift in American political history. In the decades following Quinlan, all manner of domestic policy issues were recast as matters of life and death: urgent, uncompromising, and absolute.10 This shift began in 1965, when Life published “Drama of Life Before Birth” and the Supreme Court issued its ruling in Griswold v. Connecticut. In 1968, Pope Paul VI issued “On Human Life,” asserting the sanctity of life from the very first moment captured by Lennart Nilsson’s photographs. Richard Nixon employed this language in 1971, when he reversed his position on abortion as part of a strategy to define the Republican Party around this issue. In 1972, the phrase “sanctity of life” appeared, for the first time, in an opinion of the U.S. Supreme Court, with a death penalty case, Furman v. Georgia. The next year, the court’s ruling in Roe v. Wade galvanized opposition to abortion. In 1975, the Quinlan case brought the right to life and the right to die together, locked in a kind of mortal combat. Reasonable people on all sides agree that profoundly serious and difficult questions lie at the heart of these matters, which is why extremists within the pro-life movement have never managed to tar their opponents as “anti-life” or “pro-death.” Nevertheless, in the wake of Roe and Quinlan, a very small but by no means inconsequential number of people came to believe that Congress, the president, the courts, and assorted unnamed bureaucrats were plotting to deny medical care to the very sick and the very old, to babies born with deformities, to the elderly and infirm, to the ailing and the poor, to the disabled and the insane; that doctors, acting on orders from Washington, would one day soon disconnect respirators, turn off incubators, yank out feeding tubes, unhook IVs, and refuse to renew lifesaving prescriptions; that the machinery of the world’s most powerful nation was being turned to the remorseless and unceasing project of euthanizing the weakest members of society.11 Or something like that. The story changed fairly often. Sometimes it involved organ harvesting. Rarely did Hitler go unmentioned.
For decades, protesters waved poster-sized pictures of Lennart Nilsson’s photographs of fetuses. Riders banning abortion, contraception, and sex education tied up bills in committee, bills that, usually, had nothing to do with abortion or contraception or sex education. Judicial nominees faced “litmus tests,” explicitly or implicitly, over embryo storage, genetic testing, abortion, stem cell research, and palliative care. In the summer of 2009, after the Obama administration proposed a reform of the health care system, former Republican vice presidential nominee Sarah Palin posted her thoughts on her Facebook page: “The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.”12 Iowa senator Chuck Grassley agreed that citizens had “every right to fear” that the government would issue orders about “pulling the plug on grandma”; and street theater Death Panelists paraded on the Mall wearing masks inspired by Edvard Munch’s The Scream and T‑shirts picturing the president as the Grim Reaper.13
The fear that the American government was conspiring to hold the power of life and death over its people kept lingering, and taking on new forms, because however wildly and dangerously preposterous, it was just one feature of a newly configured political landscape. Since the 1960s, what Americans were talking about, even when they seemed to be talking about something else, was a disputed right to life.
In November 1963, just days before John F. Kennedy was shot in Dallas, Richard Hofstadter, a forty-seven-year-old historian from Columbia University, delivered the Herbert Spencer Lecture at Oxford. American politics, Hofstadter argued, is characterized by a “paranoid style.” As he took pains to explain, he didn’t mean that clinically; Americans weren’t, literally, crazy. Instead, by “style,” he meant something like what, in speaking, is usually termed an accent. Americans talk paranoid and think paranoid; they use the language of “heated exaggeration, suspiciousness, and conspiratorial fantasy”; they have a habit of worrying about dark goings-on by unnamed, mysterious plotters who lurk, disguised as honorable public servants, within the very halls of government.14
Hofstadter’s lecture would have resonated back home even if Kennedy hadn’t been assassinated, but, somehow, that tragedy gained for Hofstadter’s account of “angry minds” a special hold on the national psyche. “The Paranoid Style in American Politics” was published in Harper’s in 1964. For quite a long time, it was used to explain a great deal, from Joseph McCarthy, on the floor of Congress in 1951, stirring up fears of Communist infiltrators in postwar Washington (“How can we account for our present situation unless we believe that men high in this government are concerting to deliver us to disaster?”) to theories about the Warren Commission and the grassy knoll to Glenn Beck on national television in 2009, ranting about eugenicists in Barack Obama’s White House (“Do you trust these people enough to give them co
ntrol over who lives and who dies?”).15
The essay endured as a consequence of its audacity, which made it capacious. Hofstadter didn’t so much nail down an argument as float one. Historians, Hofstadter believed, had a “habit of overvaluing facts for facts’ sake.” He had a different idea about what was important. “I believe that a conjecture, an insight, even if it proves wrong, is worth a thousand facts,” he once wrote; if it proved right, that supposition would be “worth ten thousand facts.”16 With characteristic ambition, sensitivity, and aloofness, Hofstadter claimed, in “The Paranoid Style,” to be charting an essentially changeless tradition, worth at least a thousand facts. The essay doesn’t contain much historical detail; that wasn’t its point. Chiefly concerned with the hard American right from McCarthy to Goldwater, Hofstadter deployed a handful of examples from earlier eras, with stops at the eighteenth-century Bavarian Illuminati and the nineteenth-century Know-Nothings, merely to document the depth of the style he was describing. Partisans of all stripes talk and think paranoid, Hofstadter argued, although “the paranoid style has a greater affinity for bad causes than good.” As he saw it, paranoid conservatives of his own day were different from their ideological forebears only in painting their enemies more vividly and attacking them more personally. The Illuminati raved about “little-known papal delegates” undermining democracy, while the people who worried Hofstadter charged FDR himself with heading an international conspiracy to destroy capitalism. What all these people had in common, though, was the belief in “a vast and sinister conspiracy, a gigantic and yet subtle machinery of influence set in motion to undermine and destroy a way of life.”17
Hofstadter was right about very many things. But this particular argument, forever bound to the moment in which he made it, falls something short of ten thousand facts: the paranoid style is not changeless. It was changing, even as, behind a lectern in front of an audience of Oxford dons, he adjusted his inevitable bow tie, tinkered with his eyeglasses, and took out his stack of notes. When Hofstadter delivered that lecture in 1963, he could not possibly have seen that the ground was shifting beneath his feet, a chasm forming, a whole new sort of paranoia growing in America—not over a way of life, but over life itself.
Before Thomas Jefferson stumbled upon the felicitous phrase “the pursuit of happiness,” life, liberty, and property constituted the Enlightenment’s list of natural rights. “The inhabitants of the English colonies in North-America,” the Continental Congress declared in 1774, “are entitled to life, liberty and property.” Jefferson said it better, but his wording didn’t assume anything like the status later accorded it until 1826, when the Declaration of Independence was resurrected for the fiftieth Fourth of July. In 1780, when John Adams drafted the Massachusetts Constitution, he rambled on about the people’s “right of enjoying and defending their lives and liberties; that of acquiring, possessing, and protecting property; in fine, that of seeking and obtaining their safety and happiness.”18 Whether in three words or a hundred and three, life, liberty, and property have been the rights Americans talk about and fight over. Taking a long view of American history, it’s possible to argue that each of these rights has led to a fracture in the body politic, a dispute in which there seemed to be no room for compromise. Urgency, suffering, paranoia, partisanship, violence, political theater, insurrection, and a swirl of disputed ideas have gathered around each of these contested rights. Yet from one era to the next, the ideas have been different. Paranoid may be our enduring political style, but our substance has changed.
In the eighteenth century, colonists on both sides of the struggle for independence worried that their rulers were plotting against their liberties. Americans danced under liberty poles; they sang liberty songs; they wore liberty caps. A conspiracy appeared to be afoot. “A series of occurrences,” the people of Boston resolved, “afford great reason to believe that a deep-laid and desperate plan of imperial despotism has been laid, and partly executed, for the extinction of all civil liberty.” In 1774, Jefferson concluded that “single acts of tyranny may be ascribed to the accidental opinion of a day; but a series of oppressions … too plainly prove a deliberate and systematical plan.” The Declaration of Independence is Jefferson’s list of those acts of tyranny. Liberty, like all natural rights, was so capacious an idea that it could stretch across both sides of the conflict. When the war began, one in three colonists remained loyal to the Crown, insisting that they, not the so-called patriots, were the “true lovers of liberty.”19
In the nineteenth century, Americans worried about a conspiracy against property—a property in people. In 1820, the Missouri Compromise, which prohibited “this species of property” north of the 36th parallel, divided the country in half. Jefferson called it a national “act of suicide.”20 Four years after the Compromise of 1850 redrew the line between slave and free states, Abraham Lincoln blamed the framers, “who forbore to so much as mention the word ‘slave’ or ‘slavery’ ” for the disease festering in the body politic. “Thus,” he continued, “the thing is hid away, in the constitution, just as an afflicted man hides away a wen or cancer, which he dares not cut out at once, lest he bleed to death.”21 In 1857, in Dred Scott v. Sandford, the Supreme Court ruled that the framers had intended to define “the Negro” not as a person but as an item of property, to be “bought and sold and treated as an ordinary article of merchandise.”22 Slave owners feared an abolitionist conspiracy, “a party in the North organized for the express purpose of robbing the citizens of the Southern States of their property.”23 In 1859, John Brown’s raid at Harpers Ferry realized those fears.24 On the floor of the Senate, Jefferson Davis made a threat: “If we are not to be protected in our property and sovereignty, we … will dissever the ties that bind us together, even if it rushes us into a sea of blood.” The next year, South Carolina became the first state to secede, citing, as its cause, the federal government’s failure to honor its “right of property in slaves.”25 The contested right to property led to the Civil War, and six hundred thousand dead.
In the decades since Richard Hofstadter’s day—since right around the time the facts of life went extraterrestrial, with Lennart Nilsson’s photographs, and abortion entered the partisan arena—Americans have been fighting over the right to life. There are only so many cards in this political deck, and life, it would seem, trumps all.
“The curtain rises on one of the most compelling dramas since the Scopes trial sought to establish the roots of human life,” wrote one newsman, filing a report for the New York Daily News the day Karen Ann Quinlan’s trial began.26 Only a handful of spectators managed to get through the courthouse door. Prophet Dan, a man with a long white beard who believed “he could cure the stricken girl,” had waited four hours to get a seat.27 (Faith healers had also been turning up at Saint Clare’s, asking to lay hands on Quinlan, much to the consternation of the nuns who ran the hospital, the Sisters of the Sorrowful Mother.)28 Just before nine o’clock, Julia and Joseph Quinlan and Thomas Trapasso made their way inside and climbed the stairs to the courtroom on the second floor, where they settled onto a cushioned mahogany bench, as straight as any pew. It seemed, at first, as if they had entered a chapel, as if the tall, arched windows were made of stained glass. That, though, was only a trick of the eye: wet autumn leaves, yellow and red, glinting through clear panes as the sun broke through the clouds.29
Of the 137 seats in the courtroom, 100 were taken by reporters. (The week of the trial, the Quinlans received more than a thousand pieces of mail, not just letters but packages: jars of holy water and little boxes crammed with crucifixes.)30 No cameras were allowed, and although a reporter offered the Quinlans $100,000 for a photograph of their daughter in her hospital bed (“That was only a starting figure”), they refused, which is why the iconic image of the trial was Karen Ann Quinlan’s high school yearbook picture, a head shot, striking in its ordinariness, of a pale and unsmiling eighteen-year-old with long, dark hair.31
This story had everything: a pr
etty girl—“Sleeping Beauty,” the press called her—and a handsome young lawyer—the Quinlans’ thirty-year-old attorney, Paul Armstrong, looked like he’d come straight out of the 1973 film The Paper Chase—and just the sort of edge-of-your-seat high-stakes medical drama television viewers tuned in for in prime time, especially Emergency!, NBC’s popular series about Los Angeles paramedics, which ran from 1972 to 1977. Reporters had started covering the story in September, when Armstrong filed papers asking the court to appoint Joseph Quinlan as his daughter’s guardian. “These poor people really need help,” Armstrong told a colleague. “The whole world needs help. It’s man against technology.”32
Intensive care units date only to the 1950s. Dying, which used to happen earlier in life, usually took place at home, and rarely involved an electrical cord. Only beginning in 1958 did the majority of American deaths take place in a hospital. When death moved away from the home, doctors, hospitals, and insurance companies took charge of the end of life.33 This change, when it came, came fast. By the 1960s, 75 percent of the dying spent at least eighty days in a hospital or nursing home during the last year of life.34 The longer we live, the longer we die.