Theology, Medicine, and Ethics Intersecting in the Case of Brain Dead Pregnancy?
Anna Wright, M.D., Theology, Medicine, and Culture Fellow, Duke Divinity School
A 23 year old 16 week (112 days) pregnant woman presented to the emergency department of a large Catholic medical center unresponsive due to a cocaine overdose. She was resuscitated and admitted to the ICU on mechanical ventilator support. Her condition did not improve and she was declared brain dead. The fetus was developing normally for gestational age. The father of the fetus chose not to be a decision maker. The mother’s family was involved in her care and decision making. The medical staff, hospital ethics committee, and staff priests were conflicted regarding her ongoing care. Medically and legally, the patient was considered dead. However, within the biological container of the patient’s body, was a living fetus. What is the responsibility of the hospital and medical staff? What are the ethical issues at work? What does the Catholic Church teach about care of a brain dead pregnant woman? Legally, what similar precedents exist? Ultimately, the decision was made to remove life support and perform organ harvesting and donation. How does this action, which resulted in the death of the fetus, fit with the moral theology of the Catholic Church? How does it reflect/challenge contemporary law and ethical policy?
Between 1982 and 2010, 30 cases of maternal brain death during pregnancy were reported and 12 viable infants were delivered. Follow-up revealed 6 of the 12 infants developing normally at two years of age, with the other 6 being lost to follow-up. The mean gestational age was 22 weeks at the time of mother’s brain death.1
Medically, there are challenges and complications in caring for the mother, as well as treating complications of the mother without harm to the fetus. What are the emotional and spiritual challenges faced by medical staff caring for this patient?
Ethically, there are numerous issues from the maternal and fetal perspective including: patient autonomy, beneficence, nonmaleficence, right to life of the fetus, and allocation of resources (ICU care and medical costs).
Legally, numerous states have pregnancy exclusion clauses regarding advanced directives that override a pregnant mother’s choice to forgo life sustaining treatments. Does this extend to bodily support after brain death?
Theologically, Catholic teaching states intentional pregnancy termination before viability constitutes abortion and is not permitted. Catholic teaching affirms that the fetus “demands the unconditional respect morally due to the human being in his bodily and spiritual totality” and “must be defended, tended and cared for as far as medical assistance.”2 There is no official statement from the Catholic Church regarding prolonged somatic support for brain death in pregnancy.
The case will be presented with a review of the literature and discussion regarding the medical, ethical, and theological dilemmas. The resolution of this case will be discussed, raising the provocative question--was the organ donation a penance for taking a life?
References
1Esmaeilzadeh M, Dictus C, Kayvanpour E, et al. “One life ends, another begins: Management of a brain-dead pregnant mother- A systematic review.” BMC Med. 2010; 8 (74)
2Domum Vitae at http://www.vatican.va
A 23 year old 16 week (112 days) pregnant woman presented to the emergency department of a large Catholic medical center unresponsive due to a cocaine overdose. She was resuscitated and admitted to the ICU on mechanical ventilator support. Her condition did not improve and she was declared brain dead. The fetus was developing normally for gestational age. The father of the fetus chose not to be a decision maker. The mother’s family was involved in her care and decision making. The medical staff, hospital ethics committee, and staff priests were conflicted regarding her ongoing care. Medically and legally, the patient was considered dead. However, within the biological container of the patient’s body, was a living fetus. What is the responsibility of the hospital and medical staff? What are the ethical issues at work? What does the Catholic Church teach about care of a brain dead pregnant woman? Legally, what similar precedents exist? Ultimately, the decision was made to remove life support and perform organ harvesting and donation. How does this action, which resulted in the death of the fetus, fit with the moral theology of the Catholic Church? How does it reflect/challenge contemporary law and ethical policy?
Between 1982 and 2010, 30 cases of maternal brain death during pregnancy were reported and 12 viable infants were delivered. Follow-up revealed 6 of the 12 infants developing normally at two years of age, with the other 6 being lost to follow-up. The mean gestational age was 22 weeks at the time of mother’s brain death.1
Medically, there are challenges and complications in caring for the mother, as well as treating complications of the mother without harm to the fetus. What are the emotional and spiritual challenges faced by medical staff caring for this patient?
Ethically, there are numerous issues from the maternal and fetal perspective including: patient autonomy, beneficence, nonmaleficence, right to life of the fetus, and allocation of resources (ICU care and medical costs).
Legally, numerous states have pregnancy exclusion clauses regarding advanced directives that override a pregnant mother’s choice to forgo life sustaining treatments. Does this extend to bodily support after brain death?
Theologically, Catholic teaching states intentional pregnancy termination before viability constitutes abortion and is not permitted. Catholic teaching affirms that the fetus “demands the unconditional respect morally due to the human being in his bodily and spiritual totality” and “must be defended, tended and cared for as far as medical assistance.”2 There is no official statement from the Catholic Church regarding prolonged somatic support for brain death in pregnancy.
The case will be presented with a review of the literature and discussion regarding the medical, ethical, and theological dilemmas. The resolution of this case will be discussed, raising the provocative question--was the organ donation a penance for taking a life?
References
1Esmaeilzadeh M, Dictus C, Kayvanpour E, et al. “One life ends, another begins: Management of a brain-dead pregnant mother- A systematic review.” BMC Med. 2010; 8 (74)
2Domum Vitae at http://www.vatican.va