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: Vietnamese parish community raises $80,000 for storm relief

Sign up for a digital subscription to Denver Catholic!

About 800 Vietnamese refugees, immigrants and their relatives gathered on Veterans Day at Queen of Vietnamese Martyrs Catholic Parish event center in Wheat Ridge, raising more than $80,000 for survivors of recent storms in Texas, Florida and central Vietnam.

“We dedicate this event to God, and to Mary,” said co-organizer Viet Hua. “We’ve been praying and asking for help, in God’s way, to glorify him in our effort to help those who suffer.”

It was an evening of food, music, dance and auction goods that sold for thousands more than market value in the spirit of exceeding an ambitious $75,000, one-night fundraising goal. Half the money will go to Gulf Coast recovery, and half will go to Vietnam.

Hua, a member of the parish’s Knights of Columbus chapter, said at least 100 men, women and children volunteered to organize and operate the event.

Denver-area businesses with Catholic and Vietnamese owners, managers and employees minimized overhead with donations of food, beverages, services and auction items.

It touches my heart now to help others – from a place where I can exercise my faith, where I can succeed, and where I can gather with community.”

“This is faith, fellowship and compassion at its finest hour,” said Sang Truong, marketing director of Denver’s Beverage World Specialties, which donated cases of Chilean Paso del Sol wine.

Two major hurricanes wreaked havoc along the Gulf of Mexico this year. As of Veterans Day, 12 tropical storms and typhoons had devastated parts of Vietnam.

Typhoon Damrey struck central Vietnam November 4, destroying nearly 3,500 homes, flooding 138,000 homes, killing 123 people and leaving 395,000 Vietnamese in need of assistance.

The scene is painfully familiar to most who head the 1,800 families that comprise Queen of Vietnamese Martyrs. They endured killer typhoons in the 1960s and ’70s, as communists invaded.

“Communists took over in 1975, and these people came here because they love freedom and they want to practice their faith,” said Pastor Louis Ha Pham, who escaped Vietnam in 1975 with 350 other members of the Congregation of the Mother Co-redemptrix religious community. “They want to use their freedom and faith to help others who suffer and lack the advantages of everything we have here.”

Co-organizer Hua barely survived a typhoon that slammed into his South Vietnamese village when he was a young child in the 1960s.

As water filled the family’s bamboo hut, Hua escaped with his mother and siblings to a neighboring residence. Water soon rushed into that hut, forcing Hua and other occupants to punch through the roof.

“We’re yelling for our lives in the middle of the night,” Hua recalled.

South Vietnamese soldiers pulled them from the water and onto a boat, but the suffering had only begun when Hua and his family reached dry ground in the mountains.

“You have no clothes, no food, and no fresh water. You have nothing,” Hua said. “So it touches my heart now to help others – from a place where I can exercise my faith, where I can succeed, and where I can gather with community.”

Hua escaped Vietnam by himself as a sophomore in high school in 1975. Communists had killed his father. They had threatened him and his family with machine guns.

“I remember they had us lined up, and my grandfather stood there telling them to shoot him,” Hua said. “He lifted up his dirty white t-shirt and said ‘shoot me. Just do it.’ I’m glad they didn’t, because that would have really messed me up as a child.”

Hua built his American life around Our Lady of Vietnamese Martyrs, thanking God each day for liberties the communists took from his homeland.

“I thank God, and I thank Americans for the opportunity to be here with resources to help people back home,” Hua said. “We thank you Americans so much for helping the Vietnamese to migrate here and live free.”

Que Truong, lead organizer of the event, said all Hurricane recovery is hard. It is worse in a dictatorship.

Items were auctioned off as part of a fundraiser held at Queen of Vietnamese Martyrs Parish on Veteran’s Day to help raise money to provide aid to Vietnam, Florida and Texas, which were all recently hit by storms. In total, the parish raised over $80,000 in one evening. (Photos by Dede Laugesen)

“It is terrible over there,” Truong said. “In south Vietnam, we are not free to do anything. There, most people are poor. It’s a different story here, so we are very eager to help.”

Joining the Catholic parishioners were Vietnamese dancers and others from Denver’s Nhu Lia Buddhist Temple. Vietnamese from a Baptist church also participated.

“This is the first time we have all sat down and had dinner together,” said parish Vice President Hung Vu. “Refugees of any religion know how it is to have nothing – to have empty hands and empty stomachs.”

Vu’s father starved to death after a typhoon devastated the family’s village in 1978. Communists ruled the family’s church. Everyone in Vu’s life suffered deprivation of basic needs.

At age 8, Vu fled while working on a fishing boat.

“The boat next to ours planned to escape,” Vu recounted. “They waved me over. In an instant, without a moment to think about it, I jumped out and swam to their boat. They pulled me up and we started sailing out of the China Sea.”

The narrow, 35-foot vessel contained 97 “boat people” crammed together in fetal position. They quickly ran out of food and water, finally obtaining supplies from a passing ship.

“We wanted freedom of religion, and opportunity, and were willing to die trying to get it,” Vu said. “We have suffered. Now, we are so blessed to be here in the United States with all we have. We are so thankful for the veterans who have defended this way of life. This church is my family, and this family is blessed to help those trying to recover in Texas, Florida and Vietnam.”