Maintaining life support in pregnant women declared brain death is a question that arises quite often in gynaecology practice and has now been raised again with the news of two recent cases.The first concernsMarlise Muñoz, in Texas, USA, and the other Robyn Benson, in British Columbia (Canada).
The two cases we reported of pregnant women declared brain dead
Muñoz was 33-years-old and 14-weeks pregnant when she was declared dead using neurological criteria. Benson was 32-years-old and 22-weeks pregnant. Both examples can be used to raise the issue under discussion. In the first case, the foetus was very far from being viable; the second was at the limit of viability. What should be done in each case?
Previous experience appears to show that it is highly unlikely that a pregnancy can be maintained beyond 100 days from the date on which the mother was declared brain-dead. That is, it is not easy to attain foetal viability, although it can be done. It is, however, possible if the pregnancy is close to 20 or 21 weeks, according to the article cited (Journal Medical Ethics 14; 48-49).
Therefore, in the opinion of the study authors, if the pregnancy is 24 weeks or close to that date, and family members are convinced that the mother would have wished to continue the pregnancy, the most ethical option is to maintain the mother on life support to try to prolong the pregnancy until the foetus is viable.When the pregnancy is less advanced, the authors are no longer so sure that it should be prolonged, although they believe that this decision should be taken based on any statement that the mother may have made prior to being declared brain-dead.
Our ethical assessment
Our opinion is that an attempt should be made to provide the mother with all the life support measures necessary so that the pregnancy can be prolonged until such times as the foetus can have a reasonable chance of living.
In the case of Marlise Muñoz, the patient’s life support was switched off on 26th January 2014, i.e. at week 22 or 23 of pregnancy, when it was considered that the foetus had a chance, albeit low, of survival.
Maintaining life support in pregnant women declared brain death is a question that arises quite often in gynaecology practice and has now been raised again with the news of two recent cases.The first concernsMarlise Muñoz, in Texas, USA, and the other Robyn Benson, in British Columbia (Canada).
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