On November 26, 2013, 33 year old Marlise Munoz collapsed at home, believed to have suffered a pulmonary embolism. Found an hour later by her husband she was transported to a hospital where resuscitation attempts failed and she was declared brain-dead. She was 14 weeks pregnant. The patient and her husband, both paramedics by training, had had extensive discussions regarding end-of-life desires. Both were adamant they did not wish to be maintained on life support with no chance of survival. However, Texas law prevents the discontinuation of life support to a pregnant patient.
This case raises some interesting questions. First, what constitutes the differences between various degrees of unresponsiveness? A patient may be in a coma, a vegetative state, a minimally conscious state or brain-dead. According to USA Today, patients in a coma, vegetative or minimally conscious state are alive but with severely impaired consciousness whereas brain death refers to patients who are no longer alive. In brain dead patients there is absolutely no possibility of recovery. Dead is dead!
Second, what does the Texas law state? Texas, along with at least thirty other states, has a law prohibiting medical providers from discontinuing life support to a pregnant patient. Texas law requires that life-sustaining treatment cannot be withheld or removed from any pregnant patient. One might argue, however, that having been diagnosed “brain dead”, Munoz is no longer a patient. In fact, “brain death” constitutes the legal criteria for being declared “dead.” And, being dead, the term “life support” makes no sense as there is no “life” to “support.”
Third, what is happening now? The NY Times reported on January 7 that Munoz, at the time carrying a 20 week old fetus, remained connected to life support. Her case “has become a strange collision of law, medicine, the ethics of end-of-life care and the issues swirling around abortion – when life begins and how it should be valued.” On January 17 CNN reported that Marlise’s husband, Erick, filed suit in court based on medical records confirming his wife’s brain death. In the motion to the court, Mr. Munoz states “Marlise Munoz is legally dead, and to further conduct surgical procedures on a deceased body is nothing short of outrageous.”
Much of the current debate swirling around this case hinges on whether or not one believes that Munoz is already dead or still living. Ethicists discussing the case note that the term “brain death” is often misunderstood. Many do not grasp the finality of brain death. The term “life support” used in conjunction with “brain death” further confuses the matter. Is the patient dead? If so, how can his/her “life” be supported? Ethicist Arthur Caplan aptly notes that people are given the “impression that dead people can come back to life.” Nothing could be further from the truth.
A 2008 White Paper by the President’s Council on Bioethics, Controversies in the Determination of Death, addresses extensively the neurologic criteria for determining brain death. These criteria rest on the notions that neither respiratory motion nor a beating heart sustained by technological intervention should be considered “signs of life,” but rather simply the continuation of automatic processes. Any functions indicative of life must be not only absent but irreversible. Modern technologies allow automatic bodily processes to be maintained for prolonged periods of time, adding to difficulty in determining when someone is “dead.” In most cases, following brain death the body will suffer cardiac arrest or the decomposition of vital organs, leaving no doubt as to the end of life. Most brain dead patients are kept “alive” long enough for the procurement of organs for donation or the ventilator will be removed because it is understood to be ventilating a corpse. There is no research investigating how long the bodily functions of one deemed brain dead can be maintained before complete system collapse.
Pope John Paul II, in an August 2000 address to the 18th International Conference of Organ Transplant Specialists, deemed as legitimate the use of neurological criteria to determine death. The National Catholic Bioethics Center affirmed this reasoning, noting that, “the determination of death by the rigorous application of the neurological criteria is considered legitimate by the Catholic Church, which accepts the findings of science in such a determination. The Catholic Church does not believe there can be any opposition between faith and science since both are gifts from God, the source of all truth.”
Catholic bioethical reasoning would point to a determination that Marlise Munoz is already dead; she has been diagnosed as brain dead by established neurological methods. The fact that she is pregnant is secondary to the fact that she is already legally dead. Allowing her family to pay their final respects and properly bury their deceased should in no way be construed as a desire to kill her unborn child. The death of Munoz’ unborn child is a foreseen but unintended consequence of allowing her body to reach its logical end – in this case a cessation of automatic processes being artificially maintained by outside support. To argue otherwise relies on faulty reasoning and the assumption that Munoz is still alive – something she clearly is not. As a foreseen but unintended consequence, the death of the unborn child does not violate Catholic teaching or sound Catholic bioethical reasoning.
One might legitimately question the advisability of removing “life” support if the pregnancy was closer to term. That no doubt would be a different discussion, although gestational age of the child does not alter the bioethics involved. Predictably the existence of a pregnancy increases the emotional involvement people feel in conjunction with the case. But to fight the battle between rights of a living mother vs. rights of the unborn is best done elsewhere than over an already declared dead body.
The opinions expressed by the DPS blog authors and those providing comments are theirs alone; they are not necessarily the expressions or beliefs of either the Dead Philosophers Society or Holy Apostles College & Seminary.