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: Q&A: Outcasts documentary a call to action, producer says

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Q&A: Outcasts documentary a call to action, producer says

Film shows suffering of the poor in five countries, hope brought by Franciscan Friars of the Renewal

Roxanne King

Powerful. Disturbing. Beautiful. Inspiring. That’s how viewers are describing award-winning Outcasts, the latest film by Joe Campo, owner and producer of Grassroots Films.

For mature audiences, Outcasts documents the hard, dark struggle of the poor living in New York and New Jersey, Nicaragua, Honduras, England and Ireland, and the light and hope of Christ brought to them through the ministry of the Franciscan Friars of the Renewal (C.F.R.). Seven years in the making, it won “best film” at the Justice Film Festival last fall.

Campo, 65, a Third Order Franciscan, also runs St. Francis House in Brooklyn, N.Y., a home for young men in need of a second chance.

“The film company comes second, the guys come first,” Campo, whose’ Grassroots Films was also responsible for 2008’s award-winning The Human Experience, told the Denver Catholic.

The home Campo oversees was established by his friend, the late Father Benedict Groeschel, C.F.R., who co-founded the Franciscan Friars of the Renewal order in New York in 1987. The friars live in poor neighborhoods around the world and have a two-fold mission: to care for the physical and spiritual needs of the destitute and homeless, and to evangelize.

A July 13 screening of Outcasts at Light of the World Parish in Littleton drew 400 people. Campo recently spoke to the Denver Catholic about the documentary.

DC: Why did you make Outcasts?

JC: I’ve been with the Franciscan Friars of the Renewal since 1988 and I know the work that they do and their great love for the poor, which I share. I thought it would be a call to action — that people would see this film and their hearts would open up. Hopefully, through this film, people will experience things about working with the poor that normally they would never be able to see their entire lives.

DC: What is the film about?

JC: It’s really about the poor. It’s more about the poor than it is about the Franciscan Friars of the Renewal. The friars don’t do any preaching in this film, the poor do. You see the friars, but you don’t hear them. The words of people speaking about God are from the poor: the destitute, the drug addicts, those suffering from HIV.

DC: The trailer features a voiceover from Charlie Chaplin’s The Great Dictator, which is incredibly moving juxtaposed against scenes of people suffering. What was the inspiration for using that speech?

JC: We actually had another trailer for Outcasts, but we ultimately couldn’t use it. We were fortunate to be able to get Charlie Chaplin. It was a comedy of errors, really, which proves that God writes straight with crooked lines.

DC: What do you hope people will take away from the film?

JC: An understanding of the poor. I hope that as people are introduced to the friars through this film their hearts and minds would be changed toward those who are poor or destitute and that they’ll see that these people are victims. When you talk with the poor and experience their lives you begin to realize three things: 1) That it could happen to anyone. 2) None of them planned for their life to turn out this way. 3) All they want is to be accepted — not for what they do, the negative stuff, but as people.

Outcasts producer Joe Campo (center) with some of the Fransiscan Friars of the Renewal who appear in the film. (Photo provided)

A lot of people don’t realize this: the poor will always be with us (Mk 14:7, Jn 12:8, Matt 26:11). So, it’s really our duty — and it should come from our hearts — to help those we can help.

Too, there’s not one person that doesn’t need to find a way to forgive someone or to be forgiven. That’s where we start in all of this — in our families and we go from there.

DC: How would you describe this film?

JC: It’s really a work of evangelization, but we never say that in our films. The world is always telling people: don’t age, don’t die and don’t suffer. But we all experience suffering. And we learn from the poor, from people who are suffering, how to suffer.

DC: The screening of Outcasts at Light of the World in Littleton drew a full house. What was that like?

JC: First, I want to thank Kathryn Nygaard [LOTW communications director], Dakota Leonard [who fundraised the $4,000 screening cost], the pastor Father Matthew Book, [parochial vicar] Father Joseph LaJoie and all the people who attended. I was tremendously overjoyed.

The questions people asked at the Q&A after the screening were fantastic. People could sign up for different ministries after seeing the film: Catholic Charities, [Christ in the City] homeless ministry, prison ministry, [Light of the World parish ministries]. Some did. I was overjoyed. You always want your films to be a call to action.

Outcasts

To view the trailer or to schedule a screening, visit: outcaststhemovie.com