Marlise Munoz

Marlise Munoz collapsed last November as a result of a blood clot in her lungs, which left her on life support.  Her husband and parents were told that, despite the fact that she had not hope of recovery, and had previously expressed a wish not to be left on life support, her life support could not be discontinued.  The reason was that she was 14 weeks pregnant, and a state law covering advance directives prohibits withholding or withdrawing life-sustaining treatment from pregnant women.  Although the hospital has not commented on the case, Munoz’s husband says that he has been told that his wife is brain dead.  According to a story in the New York Times, the hospital sees itself as following the law, but the article also quotes a number of ethicists and lawyers who point out that brain death is legally considered to be death, which means that the concept of “life-sustaining” treatment does not apply.

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A number of people have argued that the concept of “brain death” is conceptually problematic and some have gone so far as to say that it should be abandoned.  Certainly, there is a contradiction in saying that a dead person is being kept alive by a machine. In this case, of course, the real issue is that Munoz’s (legally) dead body contains a (biologically) living fetus.

Senators and Congressmen are not subject to the insider trading rules that most Americans are governed by, for example, Bernie Mad off and many others were sanctioned for insider trading and abuse of other people’s money. generic tadalafil 20mg The nerve signals from the brain cause the muscles of a penis to relax, allowing for an erection. discount viagra india appalachianmagazine.com If you wholesale viagra online want to feel your best and avoid possible harms with too much exercises, make sure you have normal work outs. Let’s discuss 5 psychological problems that reduce sexual desire and hinder the ability to perform in bed. viagra discount store In 1974, Willard Gaylin wrote an article for Harper’s magazine that explored some of the ethical issues that might arise from the then-recent Harvard criteria for brain death.  He envisioned the development of hospital-like centers, which he called “bioemporia,” that housed legally dead, beating-heart cadavers, or “neomorts.”  Neomorts could be kept artificially alive and used for a number of medical or scientific purposes, including harvesting organs or blood, training new doctors to perform complex procedures or ones that could be embarrassing for patients, or manufacturing hormones or antibodies.  He notes, though, that many people will find this whole “philanthropic endeavor” repugnant.

Yet maintaining pregnant women who are brain dead on life support seems for at least some people to be an exception to this response to neomorts.  A systematic review identified 30 reported cases between 1982 and 2010, though the actual number will be higher than this; it is not clear how often these situations are published as case reports. It may well be that some of these women would have gladly had their (biological) life prolonged if it meant a chance for a healthy child to be born.  My concern here, though, is with the broader question of why, for many people (including these women), the kind of revulsion that many people experience when thinking about neomorts, in general, does not occur at the thought of a pregnant neomort maintained in order to gestate.

One possible explanation is that our cultural view of motherhood includes the idea that women should willingly make sacrifices for their children, and this idea is even stronger when it comes to pregnant women making sacrifices for their fetus.  Some ethicists have argued that pregnant women are often viewed as mere “fetal containers”; from here, it is a short step to continuing a pregnancy after the pregnant woman herself has ceased to exist.

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Marlise Munoz — 1 Comment

  1. The reason Gaylin’s proposal revolts me is because it is a typically inhuman utilitarian scheme that would likely be abused for corporate profit to the ‘bioemporia’ operators.

    Possible abuses include lax enforcement of ‘brain death’ criteria for otherwise revivable patients – a problem that already exists in some places with regards to commercial transplant surgery. The procedures that ‘could be embarrassing for patients’ also sounds like a potential abuse of the intent of those who will their bodies to science (a decade or so ago some Australian families were horrified to learn the bodies of their loved ones had been stabbed, shot, slashed, etc in order to train forensic scientists).

    In the case of a pregnant woman being maintained as a neomort it would be a principled ethical decision (i.e. the principle of sustaining life – whether or not you consider the foetus a human life) that would provide at least a form of continued life to the deceased (via her offspring) and possibly some solace to the grieving family.

    If the patient is truly brain dead the notion of ‘making a sacrifice for her foetus’ is bogus. She is dead. She can sacrifice nothing.

    If she is not truly brain dead presumably a different set of laws would apply but I would advocate respecting her advance directive, though it would be trickier if the she obviously had not considered the possibility she would be pregnant when the decision was to be made.

    I guess the lesson in this for fertile women making advance directives is to be explicit regarding the the circumstance of pregnancy.

    There is a reason that after the Nuremberg Doctors’ Trials so many bioethicists came out against utilitarian bioethics, restricting it to areas such as triage. It’s a bit disappointing that so many now seem to have forgotten the lessons of the early 20th Century.

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