The ethics of taking a brain-dead pregnant patient off of life-support

A wrenching court fight—about who is alive, who is dead, and how the presence of an unborn child changes the equation—came to a very sad end in late January when a brain-dead, pregnant Texas woman was taken off a ventilator. There are, surprisingly, a couple of ethical and Biblically-acceptable choices here for those of us who are Christians.

First of all, a review of the case, at least according to CNN News:

Munoz was 14 weeks pregnant with the couple’s second child when her husband found her unconscious on their kitchen floor last November.

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 had said state law required them to maintain life-sustaining treatment for a pregnant patient.

The hospital’s action came two days after a judge in Fort Worth ordered the hospital to remove any artificial means of life support from Munoz.

The hospital acknowledged that Munoz, 33, had been brain dead since November 28 and that the fetus she carried was not viable.

Her husband, Erick Munoz, had argued that sustaining her body artificially amounted to “the cruel and obscene mutilation of a deceased body” against her wishes and those of her family.

Marlise Munoz didn’t leave any written directives regarding end-of-life care, but her husband and other family members said she had told them she didn’t want machines to keep her blood pumping.

Christians have had varied responses to the ruling. Here are two very thoughtful responses from  friends of mine. The first is from David Stevens, MD, MA (Ethics), the CEO of the Christian Medical and Dental Associations:

“While the medical technology being applied to Mrs. Munoz’s body might be considered “organ support” for her, it was “life support” for her unborn child. At the time of her death the baby was a few days from reaching 24-weeks gestation when survival rates approach 50%. Every day of continued life support improved the odds of the baby’s survival.

“… on February 9th, Robyn Benson had a premature baby boy. Just after Christmas she suffered a cerebral hemorrhage resulting in her own brain death. She was maintained on life support until her baby was delivered. The ventilator was disconnected the day after her child was born. According to reports, the baby is doing well in the NICU.

“I don’t have access to the medical records in either of these cases, but a CNN article on the Benson case makes an inadequate effort to ethically differentiate between her baby’s situation and Mrs. Munoz’s.

“First, they let you know that one child was wanted by its father but the other was not. The worth of a human being does not depend on whether it is wanted or not.

“Secondly, the Munoz lawyer’s reported that an incomplete ultrasound had shown the baby had hydrocephalus and possibly other malformations. We should recognize that disposing of the disabled is unethical and simply eugenics. Who decides when a person is disabled enough for elimination?

“CMDA does not have an official ethics statement dealing with this complex issue. Maybe we should. “

And here’s another view from my friend Bob Orr, MD, CM, who is a Clinical Ethicist and a CMDA Trustee:

“Marlise Munoz was dead, but her 14-week old fetus was alive. If Mom’s organs could be successfully perfused for another 12-14 weeks, her unborn baby could survive and be delivered by C-section. It is possible, though clinically very challenging. But should it be done?

“Marlise’s family did not want artificial support continued, and they were convinced she would not want it. The hospital believed Texas law prohibited removing life support from a pregnant woman. The legal issue was straightforward: Marlise was dead, therefore the support was not ‘life support’ for her, but ‘organ support’ for the benefit of the fetus. Continued support was legally optional.

“But what about the ethical dilemma? Who should decide? What factors should be considered? Some believe it is morally obligatory to do everything possible to prevent fetal death. Others believe that ‘doing everything’ is not always obligatory, making this comparable to high risk, high burden prenatal fetal surgery, i.e., optional, decided by her family based on their understanding of her wishes and values.

“Not all believers will agree. We will agree that we are stewards of our lives, our bodies and our resources. And we will likely agree it is immoral to intentionally end prenatal life for trivial reasons. The intention in continuation was to possibly benefit a second life. The intention in stopping was to discontinue ineffective and unwanted treatment. I personally believe continued support in this case was discretionary. And I believe we should not harshly judge the Munoz family’s decision.”

I hope you’ll take the time to share your thoughts on this very difficult case.

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This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician.  If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.

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