Guest Columnists

Difficult Decision in Brain Death and Pregnancy

by Father Tadeusz Pacholczyk

CNN recently profiled the case of Marlise Munoz, who was both pregnant and brain dead. Its report noted that Munoz was “33 years old and 14 weeks pregnant with the couple’s second child when her husband found her unconscious on their kitchen floor on November 26. Though doctors had pronounced her brain dead and her family had said she did not want to have machines keep her body alive, officials at John Peter Smith Hospital in Fort Worth, Texas, argued state law required them to maintain life-sustaining treatment for a pregnant patient.”

The family sought a court order to have Munoz disconnected from the ventilator because she had shared that she never wanted to be on life support. It remained unclear, however, whether Munoz would have felt the same way about life support if she knew she were pregnant and nurturing a child.

As weeks turned into months, Munoz began to manifest overt signs of death: Her skin texture changed, becoming cool and rubbery, and her body began to smell of deterioration. Maintaining a mother’s corpse on a ventilator requires effort and expense and imposes burdens on family members, who would like to grieve their loss and are not able to do so while their loved one remains in a state of suspended animation – deceased, yet not ready to be buried because she is supporting a living child.

Munoz’s case raises challenging questions: Should the continued use of a ventilator in these circumstances be considered extreme? Could such life-sustaining measures be considered abusive of a corpse? These are hard questions, in part because people can give their bodies over to a variety of uses after they die. Some donate them to science. Others donate their organs to help strangers who need transplants.

Similarly, a mother’s corpse – no longer useful to her – may be life-saving for her child. Wouldn’t a mother, carrying a child in her womb and having expended effort to foster that new life, naturally want to offer her child this opportunity to live, even after her own death? The medical literature documents several cases where such a child has been delivered later by C-section and fared well. Thus, it can clearly be reasonable in certain situations for medical professionals to make a serious effort to shuttle a pregnancy to the point of viability, for the benefit of the sole remaining patient, i.e. the child.

As Munoz’s pregnancy approached 22 weeks (with 23 weeks generally being considered “viable” for life outside the womb), the family’s lawyers declared that the child was “distinctly abnormal,” with significant deformities in the lower extremities. The child was also reported to suffer from hydrocephalus and a possible heart defect. Some commentators speculated that the defects of the unborn child may have been “incompatible with life.”

In prenatal cases, depending on the likelihood of survival until viability, efforts may be made to at least offer a C-section and provide baptism. This can provide valuable healing and closure for the family.

Whether Munoz’s unborn child (later named Nichole by her father) had defects that were “incompatible with life,” or whether she would have been born with handicaps, is a vital question. Extensive prenatal testing was rendered difficult by the machine-driven, ICU-bound body of Munoz. The possibility that a child might be born with handicaps, of course, should not become the equivalent of a death sentence for the unborn.

Public reaction to the case ranged from strong support and hope that her child would be born to claims that hospital officials were treating her deceased body as an incubator to “preserve the fetus she carried.”

In the end, a judge in Fort Worth ordered Munoz’s corpse to be disconnected from life support, even though the pregnancy was maintained for nearly two months and Nichole was a mere stone’s throw from viability.

While it was a difficult and heart-wrenching situation for all involved, including the courts, this legal decision seemed questionable, given the uncertainty surrounding Nichole’s actual medical condition and her apparent proximity to being able to be delivered.

Father Tadeusz Pacholczyk, Ph.D., a priest of the Diocese of Fall River, Mass., serves as director of education at The National Catholic Bioethics Center in Philadelphia.


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