Difficult moral decisions in brain death and pregnancy

Fr. Tadeusz Pacholczyk

CNN recently profiled the case of a woman named Marlise Munoz, who was both pregnant and brain dead. Its report noted that Mrs. Munoz was “33 years old and 14 weeks pregnant with the couple’s second child when her husband found her unconscious on their kitchen floor Nov. 26. Though doctors had pronounced her brain dead and her family had said she did not want to have machines keep her body alive, officials at John Peter Smith Hospital in Fort Worth, Texas, argued state law required them to maintain life-sustaining treatment for a pregnant patient.”

The family sought a court order to have Mrs. Munoz disconnected from the ventilator because she had shared that she never wanted to be on life support. It remained unclear, however, whether Mrs. Munoz would have felt the same way about life support if she knew she were pregnant and nurturing a child.

As weeks on the ventilator turned into months, Mrs. Munoz began to manifest overt signs of death: her skin texture changed, becoming cool and rubbery like a mannequin’s, and her body began to smell of deterioration. Maintaining a mother’s corpse on a ventilator requires significant effort and expense, and imposes real burdens on family members, who would like to be able to grieve their loss, and are not fully able to do so while their loved one remains in a state of suspended animation—deceased, yet not quite ready to be buried because she is still supporting a living child.

Mrs. Munoz’s case raises challenging questions: should the continued use of a ventilator in these circumstances be considered extreme? Could such life-sustaining measures be considered abusive of a corpse? These are hard questions, in part because people can give their bodies over to a variety of uses after they die. Some donate them to science, so students can open them up, look around inside and learn about anatomy. Others donate their organs to help strangers who need transplants. Similarly, a mother’s corpse—no longer useful to her—may be life-saving for her child. Wouldn’t a mother, carrying a child in her womb, and having expended so much effort to foster that new life, naturally want to offer her child this opportunity to live, even after her own death? The medical literature documents several cases where such a child has been delivered later by C-section and fared well. Thus it can clearly be reasonable in certain situations for medical professionals to make a serious effort to shuttle a pregnancy to the point of viability, for the benefit of the sole remaining patient, i.e. the child.
As Mrs. Munoz’s pregnancy approached 22 weeks (with 23 weeks generally being considered “viable” for life outside the womb), lawyers for the family declared that the child was “distinctly abnormal,” with significant deformities in the lower extremities. The child was also reported to suffer from hydrocephalus and a possible heart defect. Some commentators even speculated that the defects of the unborn child may have been “incompatible with life.”

In prenatal cases, depending on the likelihood of survival until viability, efforts may be made to at least offer a C-section and provide baptism. Often the family, with the assistance of perinatal hospice, can hold and name their child right after such a delivery, even as his or her brief life draws to a close. This can provide valuable healing and closure for the family.

Whether Mrs. Munoz’s unborn child (later named Nichole by her father) had defects that were genuinely “incompatible with life,” or whether she would have simply been born with handicaps, is an important question. Extensive prenatal testing was rendered difficult by the machine-driven, ICU-bound body of Mrs. Munoz. The possibility that a child might be born with handicaps, of course, should not become the equivalent of a death sentence for the unborn, as members of the disability community are quick to remind us. We should love and welcome those with disabilities as much as anyone else.

Public reaction to Mrs. Munoz’s case ranged from strong support and hope that her child would be born, to claims that hospital officials were treating her deceased body as an incubator to “preserve the fetus she carried.” In the end, a judge in Fort Worth ordered Mrs. Munoz’s corpse to be disconnected from life support, even though the pregnancy had been successfully maintained for nearly two months and Nichole was a mere stone’s throw from viability. While it was clearly a difficult and heart-wrenching situation for all involved, including the courts, this legal decision seemed questionable, given the uncertainty surrounding Nichole’s actual medical condition and her apparent proximity to being able to be delivered.

Rev. Tadeusz Pacholczyk, Ph.D. earned his doctorate in neuroscience from Yale and did post-doctoral work at Harvard. He is a priest of the diocese of Fall River, Mass., and serves as the Director of Education at The National Catholic Bioethics Center in Philadelphia. See www.ncbcenter.org

COMING UP: Father Jan Mucha remembered for his ‘joy and simplicity’

Sign up for a digital subscription to Denver Catholic!

When Father Marek Ciesla was 11 years old, he encountered a priest in his hometown in northern Poland who was visiting his parish on mission.

“I was impressed,” said Father Ciesla. “A couple of my friends and I were talking about how energetic, how wonderful this priest was. I think in this way he inspired us a little bit to follow the call to the priesthood.”

The priest was Father Jan Mucha, and little did Father Ciesla know that decades later and an ocean away, he would reunite with the man that inspired him and his friend to pursue the priesthood.

In 2010 when Father Mucha was retiring from his role as pastor of St. Joseph Polish Catholic Church in Denver, Father Ciesla was sent from Poland to the Archdiocese of Denver to take his place.

The priests spent two days together, and Father Ciesla was struck by the familiarity of Father Mucha.

“For some reason, the way he was talking and the words he was using, something rang a bell,” he said. “I asked him if he remembers visiting my parish. And he said, ‘Oh, yeah, I had it on my list. I remember.’”

Father Ciesla was amazed that the man he was there to replace was the same one who had impacted his life all those years ago.

“God works in mysterious ways,” said Father Ciesla. “I never thought I would meet him again.”

Father Mucha passed away March 21 after serving the archdiocese for 40 years. He was 88 years old.

Father Mucha was born March 16, 1930 in Gron, Poland to parents Kazimierz and Aniela Mucha. He was one of five children. Father Mucha attended high school in Kraków and went on to study philosophy and theology at a seminary in Tarnów.

Father Mucha was ordained December 19, 1954 in Tarnów by Auxiliary Bishop Karol Pękala. He served at St. Theresa Parish in Lublin, Sacred Heart Parish in Florynka and as a Latin teacher at Sacred Heart Novice House in Mszana Dolna.

He was incardinated into the Archdiocese of Denver on April 20, 1978. Before he was granted retirement status in August of 2010, he served at St. Joseph Polish for nearly 40 years.

“Father Mucha was dedicated to his people and there was a joy about him,” said Msgr. Bernard Schmitz, who had known Father Mucha since his own ordination in 1974 and more recently within his former role as Vicar for Clergy.

“I admired his joy and simplicity,” said Msgr. Schmitz. “He seemed to have no guile and what you saw is what you got. He was very proud of his Polish heritage and was unafraid to be Polish.”

Father Mucha’s move to the United States came about after he visited St. Joseph Polish while on vacation. The pastor at the time was sick, and parishioners asked Father Mucha to stay.

After receiving approval from his superiors in Poland and the archbishop in Denver, Father Mucha did stay, and ended up serving the parish for nearly four decades.

“He was happy to serve here,” said Father Ciesla. “All the time, he was a man of faith. He kept his eye on Jesus.”

Msgr. Schmitz believes Father Mucha’s faithfulness and tenacity as a priest will leave a lasting impression on those he served.

“He was dedicated to the priesthood and didn’t want to retire until he was sure his people would be well taken care of,” said Msgr. Schmitz. “He could come across as tough, but really he was a compassionate person [with] a heart open to the Lord’s work.”