If we assume no current brain damage on the part of the fetus, you still have the bare minimum 9-10 weeks that they’ll need to maintain the dead mother’s body to hit viability outside of the womb. During this 9-10 weeks, the mother’s hypothalamus and pituitary is going to degrade (if it already hasn’t), which is going to affect circulating levels of pretty much all of the mother’s hormones and the systems they control (which are, not coincidentally, the systems governing body homeostasis). I’m no expert, so doctor or nurse dopers, feel free to correct me if I’m wrong, but I’m pretty sure we can’t replicate the necessary hormone responses for healthy fetal development over that 10 week time period in a brain dead mother.
But even if the fetus survives to that point, a neonate born at week 23 has about a 30% chance of surviving, and a 24 week neonate has about a 50-60% chance of surviving (from the March of Dimes page on neonatal death), and that statistic probably does not come from studies looking at neonates born to a mother who is literally brain dead for about half of the fetus’ development in the womb. Further, thanks to the likely non-functional (or at least incredibly sub-optimal) immune system of the mother during this latter half of this particular neonate’s in-womb development, the newborn would be at incredibly high risk of developing an infection postnataly (be it NEC, sepsis, pneumonia, or meningitis) due to the lower/absent levels of maternal antibodies they likely would have circulating, since those antibodies are normally acquired during the 2nd and 3rd trimester of a normal pregnancy (per the Encyclopaedia Britannica page here).
So, unless my facts are in error, I’d argue that erring on the side of life, in this case, is very likely just going to prolong the heartache and emotional damage this family is already going through.
No. This is not a “fact” at all. With a nod to Barney Frank, On what planet do you spend your time? Under what convoluted logic or ‘Pro-Choice Central Tenet’ :smack: (while, hardly a monolithic group, if you cared to perform a quick google search in support of your sill little claim, you will see the majority of the online pro-choice community in outrage over this case - “Brainless pregnant woman reduced to cadaveric incubator by the state against her advanced directive and the wishes of husband and parents!” Um yeah, NO.) do you think withdrawing “life support” from a woman who has been declared legally and medically dead is undergoing an abortion? It simply does not logically follow. Withdrawing life support can not remotely be characterized as anabortion - “the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability.” Sorry.
The reason this case is making headlines is because 1) it is so rare and 2) many legal analysts believe the hospital is misinterpreting the law.
The more I read about the story, the more it becomes clear that this hospital is misinterpreting the law. The only way a story like this would come up for serious debate in going against a medically and legally dead woman’s advanced directive and family’s wishes is if the fetus was on the cusp of viability, not when the fetus was 14 weeks when the mother was pronounced dead.
I agree with the OP and respectfully withdraw my RO. Ridiculous, if it were not so tragic and gruesome.
You’re mischaracterizing what people on both sides are saying in this thread. Nobody here has said that Marlise Munoz is going to recover. She’s brain dead and she has no quality of life and never will.
As for the status of the foetus, nobody has presented any evidence on its viability. All we have is a statement by the grandfather, who is not a physician, that he surmises the foetus is in the same condition as its mother. If you have information beyond this feel free to share it.
As for Marlise Munoz’s wishes, that’s the subject under debate. She clearly said she did not wish to be kept on indefinite life support - nobody here is arguing that she should be. But she never said she wished to have her pregnancy terminated. So my argument is that her pregnancy should not be terminated without her permission. This is the clearest interpretation of what Marlise Munoz wished to happen.
If that’s the case then I’d say it just reflects the fact that a lot of people mindlessly jump on a bandwagon without really thinking about what they’re saying. If they thought about it, they’d realize I’m the one defending the pro-choice position against people like you who would waive it away. You can’t defend a woman’s right to make her own decisions by saying her husband and parents should be allowed to make those decisions for her.
I’m as pro-choice as they come - to the point that I personally believe a woman should have the right to undergo an elective abortion up until the day she goes into labor.
That being said, I absolutely can’t get behind pulling the plug in this case, and if I were a doctor in a situation where I was called on to do so, I would find it unethical and recuse myself from doing the deed or ordering it to be done.
I think you are projecting. The legal and medical facts of what you are claiming are not on your side, my friend.
Marlise Munoz is legally and medically DEAD. She is not capable of making her own decisions or specifically indicating her wishes. It is absolutely the place for her family to make decisions regarding end of life medical treatment for her now legally deceased body.
No person’s advance directive can possibly account for all the possible, unforeseen, rare and unusual circumstances that may render someone brain dead. To believe so is simply ridiculous. Prolonging this womans final death and subjecting her family to this anguish by being so overly pedantic is beginning to border on the absurd.
If we’re only at week 14 or 15, no evidence of viability needs to be presented. At 15 weeks, it is currently NOT viable, even with the best medicine can offer. So far as I know, the absolute earliest it has a chance of being viable is 21 weeks, 6 days since that is the current earliest age a premature neonate has survived (at least as far as I can find). We still have about 7 weeks to go before that point (and we’re talking a survival rate of less than 17%, probably closer to 10%).
Further, in the case of the 21 week, 6 day baby, it likely survived, per one of the doctors involved (at least, as reported), because her mom was chronically stressed up to that point (corticosteroids speed up lung development and chronic stress would likely bump up mom’s cortisol secretion aiding in the baby’s chances). Unlike that baby’s mom, Marlise Munoz is likely in a state of decreased cortisol secretion and her fetus likely would not get that bump if they attempted to deliver at that point. They certainly could now start pumping her full of corticosteroids in addition to all of the other hormones and vitamins necessary for healthy fetal development between now and then, but that just puts mom and baby at even greater risk for death by infection (among other causes). Even if both father and grandfather are wrong and there is no damage from over an hour of oxygen deprivation to the fetus, we still aren’t left with all that great of a chance that the fetus is even going to survive for the 7-12 weeks necessary to get to a point of either extremely unlikely but possible viability to 50-50 viability, or that the mother’s body won’t die in the meantime from infection or cardiovascular collapse among other causes.
She is no longer alive. She is brain dead. She no longer resides in the organic matter we call her body. While I’m absolutely a staunch supporter of a woman’s right to choose, she is well past the point of being capable of choosing, and barring an astronomically unlikely event, will never again have that ability.
The only information you are going to get is going to come from the family. The hospital won’t even confirm she is brain dead, just that she admitted there in serious condition. The treating physician or the hospital can not make any public statements about Marlise’s condition or the viability the fetus due to HIPAA.
Now, examining medical cases of prolonged maternal support after brain death is grim work because there are only 2 dozen cases in modern history put into case studies, with very little data on the outcome for the infants. Only 12 infants were born and lived through the neonatal period. The average life support duration was less than 1 month (Marlise Munoz is already well over a month) - which indicates the mothers in the case study were likely pronounced brain dead greater than 14 weeks. By the time the fetus is 25 weeks, the mother’s body will likely be teeming with bacteria from fungi and bacteria from the plethora of invasive tubes, like catheters. The body suffering from chronic pneumonia from the ventilator, urinary and kidney infections from the foley. Her body covered in bruises due to constant Heparin shots to prevent blot clots and swollen, with epidermal breakdown (as she is unable to properly metabolize nutrients or maintain body temperature so she will be suffering from chronic hypothermia), huge weeping sores (from paralysis no matter how often she is turned), and a constant oozing fecal discharge from artificial nutrition.
I would have far more ethical concerns medically treating that, than pulling the plug according to the wishes of the family.
She is dead. She is incapable of making those decisions. In this case, as in all other cases, someone else has to make them - either making a best guess as to her wishes, if it’s a power of attorney situation, or deciding what’s best for society, if the state decides.
I notice you refused to answer my question earlier about the hypothetical where the foetus can’t survive but the mother can, and the mother is incapable of deciding. Should they then both die, because of your “ethics”, or should a sensible solution occur where someone can at least make a decision?
Also, as has been repeatedly pointed out, in the particular case we’re discussing, there will be no termination, but a simple cessation of artificial continuance. That’s not the same thing with someone who dies after they’re born, neither should it be the case with a foetus.
But you’re violating her bodily autonomy by keeping her on machines! It’s like you want to say she has the choice of what color shoelaces she wants to wear, and no one else can decide what color shoelaces she wears, and she’s told you she wants to go barefoot. If she doesn’t want shoes, giving her the choice of shoelaces is completely meaningless. Take off her shoes, and the problem of shoelaces goes away!
I’m pro-choice because I’m of the opinion that abortion is a medical procedure, and not burdened with any morality or ethics beyond what an individual assigns it for her/himself, at least until the point of viability of the fetus. I know, it’s a strawman which is often thrown around in abortion debates, but for me, personally, it’s true: having a previable abortion is *morally *no different than having liposuction or trimming your toenails. A lump of tissue bearing human DNA is removed from the body of a person who doesn’t want it there. If that makes the person sad, I’ll hold their hand and grieve with them, but that’s out of compassion for the person, not the fetus.
Ergo, if it’s a medical procedure, then it’s appropriate for a mentally competent woman to accept or refuse it, like any other medical procedure. No one else gets any say into whether I get an appendectomy, and so no one else should get any say into whether I get an abortion. That’s why abortion is a matter of personal choice, just like an appendectomy - because competent adults get to make their own medical decisions. I’d fight just as hard for your right to get your appendix removed, except that no one’s saying you can’t make that decision for yourself.
And if abortion is a medical procedure, a person’s next-of-kin or POAfH to approve or disapprove it, just like any other medical procedure, when that person cannot communicate. And when that person is dead, the decision of whether or not to abort should specifically be shunted to the father, who is now the person responsible for that fetus and its care should it become a person. If and when that fetus becomes a legal person, he is going to be that baby’s legal guardian, next of kin, etc. So whether I look at it from the point of view of his being the mother’s husband, or whether I look at it from the point of view of his being this fetus’ only living parent, the only conclusion I can come to is that this decision is his to make.
I don’t think anyone is an expert in these matters, because they happen so rarely. From what little I know, I agree with your assessment, however. This is just so very unlikely to go well.
No, the clearest interpretation is what she (apparently) said: that she doesn’t want to be kept on machines. Adding caveats related to the pregnancy is putting words into a dead woman’s mouth. If anyone is going to put words into a dead woman’s mouth, I think it should be the man who knew her best, her husband.
Pro-choice doesn’t apply to a corpse. There is, literally, no woman there to make a choice.
If anything, it’s the doctors refusing to discontinue “life support” who are violating the “choice” that nature has made. Were she not near a hospital when this happened, she’d be dead dead, and the fetus dead along with her. This is the ultimate experiment in playing god.
Oh, I see one place you’re having problems – the word “viability”. I mean “viable” in the sense of “alive, implanted, and on the road to getting born”. I meant it in the sense that a fertility specialist, on seeing a fertilized egg is implanted in the womb and developing means “viable”, more or less the opposite of “dead”. You mean “viable outside the womb” which is only one meaning of the term. Do we have that cleared up now?
Correct. Abortion is killing something. That something may or may not have the gravity of killing an adult human being, but it is killing. Even if justified and the best course for all concerned it is still killing something alive.
Unfortunately we’re talking about Texas where neither your view nor mine applies. OK, now that we’ve settled the legal issue – in Texas the state has final say – we’re back to arguing about ethics.
I’m actually pro-choice myself, but part of the problem here is that the person who is supposed to have final say over whether or not pregnancy continues is dead, even if her body is still warm and being ventilated.
Yes, taking the woman’s body off life support IS terminating a pregnancy. I don’t know why this is so puzzling to you. It is, of course, a side effect of removing a brain dead person from machinery but we routinely give weight to side effects in medical decisions.
Or do you just find it shocking that what you see is obvious is not shared by people with differing viewpoints?
If she was at 30 weeks I wouldn’t automatically assume the pregnancy should continue, there are reasons for late term abortions, even into the third trimester. Thank Og those situations are rare, but they do occur.
But, likewise, I don’t assume a 14 week pregnancy should automatically be terminated.
And many of them don’t. My own mother was counseled to abort her sixth pregnancy in the pre-Roe v. Wade days when abortion in Missouri was largely illegal due to risk of death, so you can assume the situation was pretty serious, yet she decided to go through with it anyway and did so successfully, later living to 77. My mom was always pro-choice, even before it was fashionable to be so, yet she freely took on the risks of continuing a high-risk pregnancy.
It is precisely because I am pro-choice I am so leery of prescriptive dictates that run along the lines of “If X then abort”.
No, I am rejecting an argument because I am operating under a slightly different ethical system than you are.
Oh, my – you clearly have never been in a situation such as ensued when my in-laws died. When my FIL died one of the relatives insisted he had intended to donate all his money to a certain charity, despite the written will stating it would all go to his second wife. Which had the kids from his first marriage up in arms, nevermind they hadn’t given him the time of day for decades, he “clearly intended” to give them a slice of the pie.
It was even worse when the MIL died. Of course, having three wills show up for probate didn’t help. Oh, goodness, it was a mess.
No, next of kin isn’t always the best party to speak for the the deceased. It’s not a bad place to start, but I reserve the right to question if the next of kin actually is speaking the intentions of the deceased.
Nope, I’d argue the most obvious being what happens to their material possessions. There are actually a LOT of laws about what you can’t and/or must do with a dead body.
Sure, look to the next of kin, but don’t assume it will be the best method under all circumstances. Also consider that the next of kin under such circumstances may not be thinking as clearly as normal due to emotional overload. That is, in fact, one reason why hospitals have ethical committees.
No. But then I see a distinction between this situation and organ donation that you, apparently, do not.
Actually, I’d be opposed to immediate delivering at 24 weeks if the mother is brain dead. It would be far better to maintain the pregnancy as long as possible in such a case because it vastly improves the post-birth circumstances for the fetus. Even if the pregnancy can’t be maintained for a full term, even a few days can allow for the administration of medications that can help prepare the lungs of a premie for an early switch to air.
I fail to see how that is relevant. Are you suggesting that a woman who won’t live past a child’s first birthday should abort because she won’t see the child grow up or be a parent to that child through adulthood? Women who risk their own deaths to see a pregnancy to the end would seem to contradict that. Would this woman take that risk or not? It’s not clear that she ever stated her thoughts on that.
I don’t view having a disability as a reason to kill someone. Being disabled is not the end of the world, and usually it’s not a fate worse than death. That doesn’t mean it’s never a reason, but I suspect my standard on where that point occurs is considerably different than yours.
Then again, I married someone with a severe congenital defect to their spinal cord so maybe I do have a bias here.
I think pregnancy is an exception to that notion, which I would agree with under most other circumstances.
Irrelevant to this discussion because those people being described are not brain dead. Brain dead people have no dignity. I would feel sorry for anyone having to wipe liquid shit off the ass of a brain dead body but it’s the living I feel bad for there, not the dead, who can no longer suffer.
And, please, I wiped my own mother’s dying ass during her last two months of life, which often came with a hefty dose of rectal bleeding as well as the usual. I’ve been there, too. I still maintain dead people don’t suffer, although the living around them might.
Well, yes, Texas and all – but there’s nothing to really debate on that, the law is what it is. I agree it should be changed but since I live in Indiana I really don’t have any say about what craziness goes on in Texas. I think it’s a bad law and the best thing to do would be to change it. I’m pretty sure the rest of the folks on this thread agree with that statement. Well, OK, then what - end the thread or keep discussing the matter, and clearly the decision has been to keep the conversation going.
The fetus isn’t doing this, the government of Texas is, actually. This is as strange as you saying dead people suffer indignity.
Honestly… I don’t know. But because I don’t know I don’t assume it will be a disaster. I’d be interested in any statistics gathered on outcomes for babies when mom was oxygen-reprieved. I do know that babies in the womb don’t automatically die the moment mom does, if they did, no one would have ever bothered with Cesarian sections, which were originally a way of getting a live baby after mom died. Until the modern era all Cesarian birth babies were, by definition, oxygen deprived yet it wasn’t considered unusual for them to grow up into healthy, functional adults.
Nope. Marlise is dead. The only question here is whether or not it’s worthwhile to maintain her body long enough to produce a living baby.
No way to know at this point.
If the were so easily disregarded no one would be arguing here. Also, which she seems to have been clear about what to do when it was just herself in question it’s not clear she ever considered this in relation to being pregnant. As much as some people would like to pretend otherwise pregnancy does change things.
If maintaining my brain-dead body for a few months would allow my brain-dead body to give birth to a living baby yes I would want that, in no small part because I know how much being a parent would mean to my spouse. I know that my extended family would see that that child is cared for. And when the baby is born turn off the machines. Yes, that would be MY choice. The difference between me and some other people is that I don’t assume that everyone else would make the same choice I would.
Yes, that is true. Attempting to make this work is not a trivial feat.
Quite a bit of the hormonal needs of pregnancy are filled by the placenta, which is half from the fetus and not the mother. If I recall, that’s one reason that miscarriage risk goes down past a certain point, as the placenta can compensate for hormonal issues in the mother to some degree. One of the distinctive hormones of pregnancy, human chorionic gonadotropin, is ONLY produced by the placenta and nothing else. It also supplies estrogen and progesterone.
It is my understanding that the antibody components transferred to the fetus are the long-term ones and should still be present in the mother’s body. There are also ways to compensate for immune system problems, the child can be given donated colustrum, kept isolated until his or her system matures more, and so forth.
Can’t we monitor fetal brain waves? I thought we could. In which case, we can determine at some point if the baby is brain dead or not, can’t we? If the baby is brain dead or shows gross abnormalities for development age then I’d be much more comfortable with shutting everything down and letting the fetus die.
Two points: First, we can administer steroids to the mother to speed up lung maturation. This is, in fact, routine these days when a premature delivery is unavoidable and there is time to administer them. Second: mom is already dead. There is no “increased risk of death” for Marlise because she is dead. Her body can degrade faster or slower, but that’s it. Clearly, in the case of using a dead body as a biological incubator you want the least amount of degradation but the only risk here is to the fetus/baby, not the mom, who is already dead.
While this is a rare case I don’t think it’s entirely unprecedented. How long have other brain dead women been maintained in the hopes of delivering a baby? Has anyone here looked at that, or is everyone riding on gut feeling?
I actually find it comforting when a hospital follows the rules regarding patient privacy.
Thank you, I appreciate the contribution of fact-based data. You describe the average maintenance as 1 month – what was the longest? Do we know the outcome in that case? Can you provide the source for your information? I would like to see if I can use it to find out more.
Strictly speaking, even healthy living people are “teeming” with fungi and bacteria all the time. It’s just that our immune systems keep them in check.
Yes, we all know this isn’t going to be pretty. However, the woman is dead. She is not suffering, and she will not suffer, even as her body rots. She doesn’t matter any more. The only people I’m worried about here are her caregivers, who may well suffer distress over this situation, and her fetus/baby, who may or may not be viable in the sense of “able to survive to birth” even if, at this moment, unable to survive outside the womb. I’m not concerned about the state of mom’s corpse, the only thing I’m worried about is the potential risk to the fetus/baby. How would the treatment the corpse requires impact the baby is the only thing I’m really worried about.
And that’s perfectly cromulent, and were you to address that with your husband and he communicated that was your choice, I’d have no problem keeping you on machines as long as we could in order to try to reach the outcome you wanted.
Does it change anything for you that he’s already a parent, to another baby born to this woman? Does it change anything that he doesn’t want this baby to be saved? Would you thrust that onto your husband if he didn’t want it?
Note, you switched from abortion being an issue of bodily autonomy to an issue of family planning. Bodily autonomy is no longer an issue for this woman, because she is essentially dead already.
Now it’s an issue of family planning, and do we accept abortion as a family planning method, and assign strong rights to abortion on that basis?
No I didn’t switch (at least, I didn’t intend to). I presented two parallel lines of argument for why Mr. Munoz should make the call. One, if we look at this as related to her POAfH or next-of-kin communicating her decisions, or what he believes in good faith her decision would be. That is, if we consider the mother the patient. Two, if we look at this as related to a parent making medical decisions, including abortion, for a previable fetus. That is, if we consider the fetus the patient.
My argument is that, either way you look at it, Husband and Father (who are the same person in this case - thank gods) is the person who should make this decision, as the next of kin to *both *deceased mother and baby-to-be.
One can argue that, from the Mother as Patient side, that her needs are subordinate to the needs of the living.
From the Fetus as Patient side, under what level of POAfH does someone get the right to choose death for the patient, when a full productive life is attainable, and the patient never communicated any desire to not be offered that life?
Conceptually, the person with POAfH is supposed to be acting in the patient’s best interest. Absent data that indicates that this fetus has been irreparably harmed, how is it in the fetus’s best interest to die?
I don’t know if the husband has said anything about their decisions on this matter, but I’m sure they had discussed the possibility of discovering that the fetus would be disabled and what they would do in that case. I’m sure because my husband and I have talked about it a lot and ours is only seven weeks old; if testing reveals certain long term disabilities like Down syndrome we will abort. Pretty much every couple expecting a baby has this discussion because you have to decide if you’re going to test at all, and if so, what tests you’re going to get. Because you don’t test if you aren’t going to do anything about it.
So would the people in this thread who want the fetus brought to term feel the same if it were me? Knowing that while my fetus (well, embyro right now) is very much wanted, there are circumstances under which I and my husband have decided we will abort it? For what we consider very good reasons, like the possibility of having a child who may not have anybody to take care of it after our deaths?
Of course there are conditions we wouldn’t abort for (say, a healthy dwarf, a deaf child, etc.) And yes, it’s unknown what issues this fetus may already have or may acquire. But I certainly wouldn’t want the passage of time in making this decision make it FOR my bereaved husband, who eventually, if nothing is done, is going to be stuck with the outcome no matter what.
And recall, please, that the widower in question already has one very young child to take care of alone.
I really think all the arguments about how the father will have to take care of the baby are a red herring. Abortion rights are not based on the fact that the mother has to take care of the baby if it is born; abortion rights are based on the right of a woman to control what is happening to her body.
Frankly, I’m not sure my husband could hand my dead body being used in that manner. We have quite divergent views on some end-of-life issues and yes, we have discussed this at length, usually while some relative is in the process of dying.
We both agree that following the wishes of the deceased is a good starting point, but if doing so causes sufficient pain to the living their needs take precedence. As an example, my family normally cremates, which my spouse, due to his cultural background, finds extremely upsetting. I have expressed my desire to be cremated after death, but if my spouse would find that psychologically traumatizing he has my permission to do what brings him comfort, even if my own preferences are different.
Then again, we HAVE talked this out, and many in my family have explicit living wills on paper.
No.
I am not convinced he is rational on that point. If there is evidence the baby is severely brain damaged or brain dead then I’d agree with him but if he’s just GUESSING that then no, I’m not convinced he should be the sole party to decide here.
I’ve never considered the question in that context, I’ll have to think about it. Maybe I’ll ask him what he thinks.
Question. Is it possible that the fetus is at such an early stage of development that the lack of oxygen wouldn’t have much effect? I have no idea at what point organs start to really develop. But if the brain wasn’t even developed, is there a real chance that there is no harm to the fetus?