Clinically brain-dead pregnant woman kept alive to save baby against parents wishes

[K_Z]

Why? Mom's already brain dead. Trying to save a life is never unethical or immoral IMO. I don't understand the "lets let it die now cause it might not survive" attitude.
Fetus is 16 wks, mother died of a blood clot.

We had a really lively discussion about all of these issues on the Marlise Munoz threads last winter. I think we have tread carefully in our discussions here, because I don't think mods will want to closely monitor and moderate a contentious thread. (Especially during the holiday season.)

Knowing the mother died of a "blood clot" doesn't provide enough information to make any kind of inferences about her course of illness, resuscitation, and care, or the current condition of the 16 week fetus (or the course of the pregnancy & mother's health before these circumstances). However, we do know that 16 weeks is not even close to viable outside the womb, and we know the family disagrees with the current course of action. Therefore, IMO, this is unconsented, unethical gestational experimentation. I know many don't agree with that, but that is my opinion and belief.

I don't agree with your opinion that "trying to save a life is never unethical or immoral." I will refrain from going into a lot of detail about examples of that, to keep the peace here, but I do believe there are a number of situations where trying to "save" a life is unethical and immoral. (I also think that intentionally lab-creating children intended to be used as organ and tissue donors for ill siblings/ family members is also unethical.)

I don't happen to believe that they are trying to "save" a life in this situation. I believe that this is a gestational experiment. I believe that the non-viable fetus' life was lost when the mother died.

If the fetus is VERY close to viability, or is in clearly viable end weeks of gestation, and tests indicate the fetus appears to be alive and not substantially damaged by the mother's brain death, and the mother's body is relatively stable, then I think it is good to try and gestate a bit longer to try to mature the lungs, etc, before delivering and terminating the mother's organ support-- but only IF the surviving family desires this, and clearly understands and consents to all of the implications.

This decision belongs between families and doctors, not in legislatures, IMO.

I know that there are very strong secular and religious opinions about "life", and how that is defined. I also know that it's almost impossible to persuade anyone to change deeply held opinions on the subject.

I'm very sad to see this situation occurring in Ireland.

 

[TrackerSam]

As I understand, the people of Ireland voted in this law and it's not purely the product of the 'legislature'. Experiment? Pure speculation based on your bias. I hope that child survives and I'm glad they're trying to save this life.

 

[K_Z]

Well, of course I have bias in my opinions—everyone does.

However, in this case, it’s not just my personal bias that terms this course of action to be “experimental.” There is no medical or scientific consensus on how to proceed in gestating first trimester and early second trimester fetuses in brain dead hosts. No research, no experts, no animal models, no protocols, no outcome studies, no pharmacological studies, etc. Nothing at all beyond a very few tragic “anecdotal” cases, borne of (IMO) misplaced optimism, or assertive misinterpretation of statutes, but not grounded in any valid medical practices.

If we as a human society are going to proceed to attempt such undertakings as mandating gestation of very immature fetuses in brain dead hosts, against the expressed wishes of the deceased or their families, then the perinatal community needs to step up and begin to provide the authenticated studies and research necessary to establish this as a new sub-specialty, IMO—just as they do for any other therapeutic intervention. Until that time, this course of action is highly experimental, by any medical definition that exists.

In each of these early gestation/ brain dead mother situation, such as Marlise Munoz’s situation, the docs made their “best guess” on how to proceed in an arguably futile situation, without the benefit of any medical or scientific consensus, or outcome studies—let alone, societal debate and consensus. They were “winging it"-- but with an underlying socio-political agenda/ bias driving decision making, IMO. Opportunistic exploitation forced on the unwilling families. That’s just not how medicine works in 2014 in industrialized nations. That's the very definition of unethical, IMO.

There are no documented “good” outcomes in the very few documented cases like this one, with a substantially immature fetus. This is a 16 weeker, not a 26 weeker, who has sustained a very, very severe insult in the gestational environment, and is not even close to viable under ideal circumstances. This course of action, IMO, is highly unethical, and gravely disrespectful to both the deceased mother, as well as the family. It’s my opinion that the authorities in this case in Ireland, just like the ones in Texas in the case of Marlise Munoz, are taking great liberties in how they interpret the language of what was actually voted on by the people, or their legislatures.

It’s a tremendously sad set of circumstances, compounded by what the authorities are doing to the family and the dead mother, at this point. I think the chance of successfully bringing a 16 weeker to “viability” in a brain dead mother is an exercise in futility, pain, and suffering for a lot of people, the fetus included. JMO—others will vary.

 

[MsFacetious]

What would the MOTHER have wanted?
We see mother's who sacrifice their life by refusing cancer treatment while pregnant.
We often see mother's who put their unborn child's welfare above their own.
It isn't a stretch to believe many mother's would choose to be kept on life support to save their baby.

I know what my family's choice would be in this case, but it wouldn't always agree with the mother's choice.
My father is staunchly pro life in just about every situation.
He would keep his brain dead daughter on machines as long as he needed to in order to save his grandchild.
My older sister would be dead set against that. I know that. I would fight my father because her wishes should come first.

Parents do not always know best. I would be interested to hear what the mother of this baby would have wanted to happen.
Many people have discussed situations like this because of stories in the news. I wonder if she ever had?

If she had not voiced an opinion then I would like to know the father's opinion.
So often a father doesn't get a choice in matters like these... does he want to save the baby?
I would like to see what his opinion is as well. :twocents:

 

[necco]

The rules in NI on abortion are much of a muchness with those in the Republic, the only difference is that the North allows a termination if there is a long term health risk to the mother whereas the Republic allows a termination if there is a risk of suicide. This case would end up being decided by a court on either side of the border, and that is the right way to decide it. Neither the NHS in the UK, nor the HSE in the ROI, allow next of kin a veto on whether a life support machine should be turned off or not - they have the right to be consulted and that's it. So when there's a dispute between the doctors and the next of kin, it should be an impartial judge who decides.

Besides I don't think its right at all to deal with a real life situation which involves a constitutional issue by passing it along to our next door neighbour. The Irish people voted the Eighth Amendment into the constitution and we need to deal with the implications of that ourselves, not pass the buck to another country.

I only meant that if the doctors in this case wanted to honor the parents' wishes, that would be a way around it. I've got no horse in this race as I don't know what the right thing to do is. I'm not even sure if I'm pro-life or pro-choice. I feel for the parents and I feel for the fetus in this situation. I'm sorry if I offended you.

 

[Cappuccino]

I only meant that if the doctors in this case wanted to honor the parents' wishes, that would be a way around it. I've got no horse in this race as I don't know what the right thing to do is. I'm not even sure if I'm pro-life or pro-choice. I feel for the parents and I feel for the fetus in this situation. I'm sorry if I offended you.

You didn't offend me at all, I understand that you're trying to think of it from the parents' point of view, but while I feel desparately sad for them too, this case is a precedent setting one which has implications for how our constitution is applied. Therefore, hard as it seems on this particularly family, Ireland has to be left to deal with it without outside help. If every ethically difficult decision caused by the Eighth Amendment is taken off us and given to the British to solve, Ireland's own laws will never progress.

 

[Cappuccino]

Just heard on the news here that the High Court heard the case today, and will give their judgement on St. Stephen's Day. It seems from the news report that the medical evidence is on the side of the woman's family, in fact one of the doctors quoted echoed a poster in this thread by describing the process as "experimental" and he also described it as grotesque. If the court goes with the medical evidence, I think they will rule that life support should be turned off.

 

[MyBelle]

Just heard on the news here that the High Court heard the case today, and will give their judgement on St. Stephen's Day. It seems from the news report that the medical evidence is on the side of the woman's family, in fact one of the doctors quoted echoed a poster in this thread by describing the process as "experimental" and he also described it as grotesque. If the court goes with the medical evidence, I think they will rule that life support should be turned off.

Thanks for the update. At some point in time, all medical advances have involved research and experimentation. I assume the fetus was conceived in a consensual act and not in a lab. I agree with you that the people determine the law and the Court must sort this out on the basis of the law.

Some day, perhaps there will be an artificial womb and these cases will cease.

 

[Cappuccino]

Thanks for the update. At some point in time, all medical advances have involved research and experimentation. I assume the fetus was conceived in a consensual act and not in a lab. I agree with you that the people determine the law and the Court must sort this out on the basis of the law.

Some day, perhaps there will be an artificial womb and these cases will cease.

Yes, the news report I heard contained the first mention of the unborn child's father, who also gave evidence at the High Court today. He is the woman's live in partner and they have two other children together - he also wants the life support turned off.

 

[MyBelle]

I think this is a very difficult situation. As to why the father is not mentioned? Who knows???? There could be so many reasons, that I don't want to speculate.

I tend to side with the family. I am not pro or anti abortion. I don't care.... I think it is an individual right to choose what you want. Since she cannot choose, I think her family should be able to decide, as with Marlise Munoz. And make no mistake, the decision cannot be easy for the family. I don't believe that at all. Like I said before, very sad all the way around.

Very sad all around. A difference between this case and that of Marlise is that Marlise's husband/father of the fetus wanted life support terminated. The Court agreed with him only after the physicians said the fetus was not developing and not viable. I think that is what it will come down to in this case.

 

[MyBelle]

Yes, the news report I heard contained the first mention of the unborn child's father, who also gave evidence at the High Court today. He is the woman's live in partner and they have two other children together - he also wants the life support turned off.

Thanks for the update. If he's in support, then I think it will come down to whether the fetus is developing or not.

 

[K_Z]

Doctors say brain-dead pregnant Irishwoman should be taken off life support, fetus doomed

DUBLIN - Irish doctors who have been keeping a brain-dead pregnant woman on life support in hope of saving her 17-week-old fetus pleaded in court Tuesday to be permitted to turn off the machines because their treatment was becoming horrific and could not end in a successful birth.

(snipped) All agreed that the fetus appeared doomed.

Dr. Frances Colreavy, an intensive care specialist, said she had inspected the woman's body Monday and found it unrecognizable in comparison to the woman's photo by her bedside.

Colreavy said she had practiced medicine for decades in Ireland and Australia and never witnessed a clinically dead person being kept on life support for so long. She said the woman's blood was becoming increasingly toxic.

Dr. Peter McKenna, former master of Dublin's Rotunda Maternity Hospital, said the treatment, if not stopped now, would go "from the extraordinary to the grotesque."

The three-judge panel said it would hear lawyers' closing arguments on Christmas Eve and give its judgment Friday, an unprecedented measure on what is a national holiday in Ireland, St. Stephen's Day. Different legal teams are representing the woman, her family, the hospital and the fetus.

Doctors said the patient, in her late 20s, suffered a head wound in a bathroom fall while hospitalized Nov. 29, experienced catastrophic fluid buildup in her brain, and was declared clinically dead Dec. 3.

http://www.windsorstar.com/news/ire...nant+woman+must+stay+life/10675816/story.html

Court hears 'no reasonable prospect' of survival for unborn child

Earlier, the court was told that there is no reasonable prospect for survival for the unborn, even if life support was to be continued.

Lawyers for the Health Service Executive told the High Court that the HSE's position was that based on the medical evidence to be called, there was no reasonable prospect of the unborn child being born alive if life support measures were continued.

http://www.rte.ie/news/2014/1223/668596-motherbaby/

Mr McKenna, who is not associated with the Dublin hospital in which she died or the hospital where she is receiving life support treatment, said if the fatal brain trauma suffered by the mother had happened at 24 weeks gestation, he would try to sustain the pregnancy for a couple of weeks in order to deliver the baby.

“I think the picture painted of the patient here today is such that further progress of the pregnancy is becoming increasingly unlikely,” he said. “I would be firmly of the view that the appropriate decision now is not to continue with the support.”

He said he totally agreed they were talking about an extraordinary case and what he had heard in court about the patient’s current treatment, it would be going from the extraordinary to the grotesque to continue with it.

An obstetrician leading the medical team treating the woman said he would have great concern about the unborn’s chance of survival. The woman’s ongoing evolving condition seemed to be getting worse daily.

He had been told when the patient had been moved from Dublin to the country hospital, she was brain dead and had to be kept alive because she was pregnant. “I don’t see much hope for her continuing in the condition she is in. I honestly don’t think there is any hope of the baby surviving.”

The doctor, whose identity might identify the dead woman or the hospital in which she is being treated, said she was deteriorating rapidly. Infection had become overwhelming over the last few days and seemed to be getting worse.

http://www.irishexaminer.com/ireland/grotesque-to-keep-woman-on-life-support-304016.html

 

[K_Z]

Five groups of lawyers representing the woman, her fetus, her parents, her partner and the hospital are taking turns presenting their cases to the Dublin High Court. A specially convened three-judge panel may issue a ruling later Tuesday that could, in turn, be appealed to the nation's highest Supreme Court.

At issue is the Irish constitution's requirement that the life of the woman and of the fetus should enjoy equal protection under the law. In the past, Irish hospitals have kept pregnant women on life support even after they suffered irreversible loss of brain function in hopes of saving the fetus. In the two most recently documented cases, in 2001 and 2003, the fetus died in the womb after a week or two.

In this case, the parents and partner of the woman have filed lawsuits asking for the hospital to switch off her life support.

http://medicalxpress.com/news/2014-12-ireland-pregnant-woman-life.html

More links to articles:

http://www.irishtimes.com/news/crim...-on-life-support-would-be-grotesque-1.2048040

http://www.independent.ie/irish-new...eme-to-the-grotesque-court-told-30859431.html

http://www.bbc.co.uk/news/world-europe-30588495

http://www.theguardian.com/world/2014/dec/23/father-brain-dead-pregnant-woman-irish-court

http://www.dailymail.co.uk/news/art...st-wishes-family-bid-save-17-week-foetus.html

http://www.canada.com/news/world/Ir...+take+pregnant+woman+life/10677460/story.html

 

[K_Z]

Lots of background detail in this article about what happened to cause the brain death, the subsequent transfer to another hospital, etc. Patient was 15 weeks pregnant when diagnosed brain dead Dec 3. She was in hospital from Nov 27, when she fell in the bathroom.

http://www.thejournal.ie/woman-court-unborn-1849766-Dec2014/

“I don’t believe that this unborn can survive,” Marsh said, after giving detailed medical evidence.

"There is a huge abnormality in having a body retain a dead organ,” he said, referring to the woman’s brain.

He said as the woman’s condition continued to deteriorate, the likely impact was “ongoing injury and damage to the fetus”.

Earlier, the woman’s father said his daughter — who had been living with him for the last two years — had been suffering from headaches from October.

She was admitted to the hospital outside Dublin on 27 November for treatment.

On 29 November she suffered a fall in the bathroom, and at 10pm that night was found to be unresponsive, a lawyer representing the family said.

The woman’s father said he had been told his daughter had passed away as he arrived at hospital later that night.

He was taken in to see her, and was told she had been put on ventilation support by a member of hospital staff.

The clinical declaration of death happened at 5.20pm on 3 December after the woman was transferred to Dublin, the court was told.

“Very in-depth care has been undertaken,” since then, Marsh said.

While the body had gone through an initial period of stability after she was declared dead, the specialist said, background infections meant that was likely to change in the near future.

He said that in his best judgement sustaining the patient would not be feasable.

The patient had already been showing signs of pneumonia while in hospital in Dublin, Dr Colreavy said — and she had been treated with increasingly strong grades of antibiotics in recent weeks.

She said the effect on the fetus of all the drugs being pumped into the woman’s body to manage infection, blood pressure, and other issues was unknown.

Dr Colreavy said she had examined a wound in the woman’s head, and could clearly see through her skull that her brain was rotting.

The patient was “very hot,” she said, adding that if the woman’s temperature was being recorded at around 39 degrees “that of the fetus must be around 40″.

Dr Colreavy said that due to “very unusual fungal infections” combined with the other issues, it was “very unlikely” there would be a good outcome if life support continued.

If support measures continued, she said, there was a possibility that the woman’s limbs may start to move, due to the effects caused by the circuitry of the spinal cord.

He said that doctors were in “uncharted territory with the case” and agreed with Dr Colreavy’s assertion that it was not possible to say what effect the drugs being used would have on the fetus.

He said that while he could see why “we are where we are” he didn’t think there was justification to continue any further with with life support.

The chances of the child surviving were very small, he said, and the level of care required would be extraordinary.

Given from what I’ve heard today — for it to be continued, we’d be going from the extraordinary to the grotesque.

senior specialist who is a member of the woman’s current care team said her condition was deteriorating daily.

Given the “storm in her body” he said he didn’t think there was any prospect of the baby surviving.

“I’d be giving up all hope for the baby,” he said, adding that — following consultations with the family — the hospital would not have a issue with turning life support off.

 

[Jan]

As much as I'd like to see this baby survive, its survival and birth in good health seems very unlikely. The kindest thing in this case would be to turn off life support. Letting the mother basically rot away while the baby is kept alive isn't giving her much dignity in her death. It must be awful for her family.

 

[K_Z]

As much as I'd like to see this baby survive, its survival and birth in good health seems very unlikely. The kindest thing in this case would be to turn off life support. Letting the mother basically rot away while the baby is kept alive isn't giving her much dignity in her death. It must be awful for her family.

No one wants to see a case like this at all-- the tragic loss of the mom, and no remotely reasonable hope for the fetus-- hamstrung by a statute that was never intended to apply to these situations. What an agonizing situation for the family of this woman-- her partner, 2 kids, and her parents, AND the hospital staff.

I am hopeful that one good thing can come from this situation-- that her case will add to the growing anecdotal body of knowledge that it is most unwise, if not impossible, and unethical, to attempt to gestate a substantially immature fetus in a brain dead host, AND that these cases have nothing at all to do with elective abortion.

I hope this case can add to the other 2 cases in Ireland, and establish case law for Ireland that these situations are hopeless, and that future unfortunate brain dead pregnant women with non-viable fetuses can be laid to rest with more dignity and peace. It's the only possible good that can come from this terrible and tragic situation. Doctors should not be held hostage, scared of prosecution, for their decisions in situations like this. IMO, it's quite unfortunate that their 8th amendment was worded in such a way as to cause this much confusion for health care professionals and families in true crisis.

My sympathies, thoughts, and condolences for her children, partner, parents, and dedicated health care team. I feel confident the court will make the right decision for this deceased woman, her fetus, and her family, and allow the organ support to be discontinued.

 

[K_Z]

I'd also like to add another thought before retiring for the night.

There is a large "fundamentalist" pro-life population worldwide, which must contain "some" reputable mainstream physicians and scientists, as well as laypeople.

I do not understand why this group has not coalesced and begun to establish a scientific basis for gestation of immature fetuses in brain dead hosts. I understand how difficult (impossible) it would be for a mainstream University to host and fund this kind of research. It would mean that animal model experiments would have to be established, in addition to other substantial research, and the animal rights groups would be mightily opposed to such research. That's why, IMO, no one has gone there.

However, there are other countries where animal model research could be implemented, places where there is little political controversy, and little to no "protest" presence. If there is such a determined attitude toward "mandating" forced experimental gestation of substantially immature fetuses in brain dead hosts, then why not do the hard work to convince the medical establishment, laypeople, and legislatures that it is not only possible, but desirable, with good outcomes?

Do the hard work, publish the research, publish the recommendations and protocols. Do the experiments using non-human primates and xenospecies (like pigs), and PROVE that it's possible to achieve good outcomes in 14 -15 week fetuses. That's my challenge. Use hard science to support these ideologies, and not fairytale idealistic rhetoric. Then you will convince me, and others. There are no healthy (or even "unhealthy") 5 year olds skipping off to kindergarten in this nightmare scenario of brain dead mother/ non-viable and substantially immature fetus. It's harsh, but true.

Until the research and protocols are established using hard and ethical science, these cases are nothing more than opportunistic experimentation and exploitation of the exquisitely vulnerable deceased patients, their fetuses, and surviving families. IMO. They need and deserve societal protection from this tremendously misguided exploitation, IMO. I would not want this medical/ bureaucratic nightmare for myself, my immature fetus, or any of my loved ones. It's horrific, IMO.

 

[Pisces Cloud]

I think letting them go is the best course of action for everyone involved.

 

[K_Z]

I agree, Pisces Cloud. An unspeakably sad Christmas for this woman's small children and family, and difficult memories for the rest of their lives. It's like Marlise Munoz all over again-- husband and parents filing lawsuits to remove the unwanted continued somatic support in the face of futility for both.

I sincerely hope that in Ireland the lawmakers will take this as a wake up call to do something about the language in their 8th amendment, and the way that legal elective abortion and tragically brain dead mothers have been conflated as though the issues were the same. They are not the same issues for the woman, the fetus, her family, or society- and should not be confused as the same issues. That is a tragic misinterpretation, IMO.

Doctors should not be afraid of lawsuits and prosecution each time each time they encounter a tragically brain dead pregnant woman, nor should doctors and hospitals and families have to go through extreme legal measures with the courts every time something like this happens. This is the real tragedy here.

What struck me in reading the articles about the court testimony from the doctors and other experts is how very united they were that the continued organ support was clearly the wrong course of action medically, for both the deceased mother, and the fetus. The hospital, doctors, experts, and family are in complete agreement. The only reason the patient is continuing to be supported is the fear of prosecution, and lawsuits from pro-life groups. That is not a reasonable, scientific, or valid basis for making medical decisions.
There were circumstances that were not well worded or considered in the development of their 8th amendment that need to be assertively addressed, and now, IMO. I hope there are lawmakers there who are brave enough to shepherd the process to re-address the issues in a most forthright and blunt manner in their legislature, and in public discussions. Laypeople should not be lead to believe that a fetus bears no ill effects in the womb from the extraordinary care provided to try to keep a brain dead woman's heart and organs functioning. The womb of a brain dead woman is not a magical little happy place where the early fetus continues to develop unaffected, while the ventilator pumps air into the deceased woman's lungs. It's much, much more complex and difficult than that. Medical experts need to continue to try to explain this to lay people and legislators, to help them clearly understand the harsh realities. IMO.

 

[Supernovae]

On the basis of the latest information, I don't see that the 8th amendment would be a barrier to removing life support, in this particular case (although I see why applying to the courts for an order in individual cases would be wise). It states as follows:

"The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right."

For comparison, most democratic states recognise a right to life for people after birth, this would include the USA, in it's constitution, and the UK, in the Human Rights Act. Yet that doesn't mandate futile medical care.

In general terms, I don't see that it would be unethical to attempt at this kind of gestation, in suitable cases (i.e. not global hypoxic brain injury) if the family were on board and the mother could be kept stable. Medical science would never advance if doctors didn't push the envelope at times. It's not like it's a completely de novo intervention in humans and has been successfully implemented at later gestations, I presume without prior animal models.