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: Celebrate and support the sacred gift of life

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Editor’s Note: This column is adapted from Archbishop Aquila’s remarks to the 2018 Celebrate Life March, which took place on January 13th in front of the Colorado State Capitol building.

As we gather today to celebrate life, we must remember three things: 1) life is a gift, 2) life is sacred, and 3) rebuilding a culture of life requires joy.

We are here today to celebrate our joy over the gift of life. Every minute and every day we live presents us with an abundance of gifts that seem mundane and are often overlooked: our health, the gift of creation, or something as simple as having food on our plates. Above all, we should give thanks for the gift of life!

As people involved in protecting life at every stage, the challenge we face is not just one of providing resources to mothers and fathers in need or ensuring people battling a terminal illness have good palliative care. Our challenge is to also communicate to them that they are loved, that their unborn child or their own lives are gifts, no matter the circumstances.

Many of us fought in 2016 to prevent doctor-assisted suicide from becoming legal in Colorado, and one person who helped in that effort was a courageous man named J.J. Hanson. J.J. was a Marine veteran and father of two young children who was working for a real estate investment firm in Florida when he found out he had glioblastoma multiforme brain cancer. His doctors told him that it was a very aggressive cancer that meant he only had four months to live.

Despite his odds, J.J. resolved to fight. His motto was: “Every single day is a gift, and we can’t let that go.” What’s even more remarkable is the fact that J.J. dedicated his time and energy to fighting the legalization of assisted suicide around the country, all while undergoing chemotherapy and other treatments. There was hardly a speaking engagement or trip to testify before a legislature that J.J. turned down. His conviction that life was a gift propelled him to defend that gift however he could. As pro-life people, we need to have that same conviction.

Just about two weeks ago, on December 30th, J.J. was called home to the Father – three years beyond what doctors told him to expect. St. Anthony of Padua church in upstate New York, where his funeral was held, was filled with people who paid tribute to how J.J. inspired them to embrace every moment of life, no matter its difficulties as a gift, not something to be thrown away.

All of us are called to embrace life as J.J. did, and in doing so we will help recover the culture of life that is being neglected or forgotten as people cast God and truth aside.

I have said that life is a gift, and while that is true, it’s more than that. Life is also sacred. Life is sacred because it comes from God, the God who is love and who has loved us first. Our lives are also sacred because our beings are made in God’s image and likeness.

We are called to participate in the love of God and to see that every human being, from the moment of conception until natural death, is invited into relationship with God. We are called to ensure that life is set aside for God, that it is honored and recognized as sacred.

The struggle for so many today is that they do not even believe in a god; their only god is themselves. They truly do not believe in the God who is love. And because of this limited worldview, a person’s life can lose its value if their “quality of life” declines.

In the words of Pope Francis to participants in the 2013 Day for Life, “All life has inestimable value even the weakest and most vulnerable, the sick, the old, the unborn and the poor, are masterpieces of God’s creation, made in his own image, destined to live forever, and deserving of the utmost reverence and respect.”

When Jesus speaks about the Judgement of the Nations in Matthew 25, he tells us that life is always sacred by saying that when we love the weak and vulnerable, we are loving him.

The more that we can love the sacred gift of life and celebrate it with joy, the more we will contribute to building a true culture of life in the U.S.

A wonderful example of concretely loving the sacred gift of life is a story I recently heard about a 15-year-old Colorado teenager named Missy, who showed up with her parents at an abortion clinic in Albuquerque, New Mexico.

Missy was a sophomore in high school and was in her second trimester of pregnancy. As they approached the clinic, some pro-life volunteers who were parked nearby in a mobile crisis pregnancy van saw them and invited them inside. The volunteers learned that Missy wanted to complete high school and that this desire was pushing her to consider an abortion. One of the volunteers told Missy about how she was faced with the same choice as a teen and chose to keep her child. “It wasn’t easy, but it was amazing,” she reassured Missy.

Missy also worried about the father of the child not being around, to which her dad responded by taking her hand and saying, “I’ll be that man in your child’s life.”

This kind of accompaniment and willingness to heroically support the gift of life is vitally important to forming a culture that welcomes the unborn, the elderly, the disabled and the dying as a gift.

Building a culture of life begins by first receiving the love of the Father, who loves each of us as his sons and daughters. He never abandons us, even though we might abandon him or reject his love.

A culture of life grows when we share his love with others, helping them to embrace life as a gift and a joy, rather than a burden.

Life is a gift, it is sacred and our celebration of the joy of life helps build a culture of life.

I encourage you to be those who are unafraid to give witness to life. Be not afraid to give witness to life. Even though people might ridicule you, yell at you, or reject you, know that Jesus experienced it all so that you might have life, and life abundantly.

May God bless you and help you celebrate life in 2018!