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: John Paul II, youth minister

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Pole that he was, Karol Wojtyla had a well-developed sense of historical irony. So from his present position in the Communion of Saints, he might be struck by the ironic fact that the Synod on “Youth, Faith, and Vocational Discernment,” currently underway in Rome, coincides with the 40th anniversary of his election as Pope John Paul II on October 16, 1978. What’s the irony? The irony is that the most successful papal youth minister in modern history, and perhaps all history, was largely ignored in Synod-2018’s working document. And the Synod leadership under Cardinal Lorenzo Baldisseri seems strangely reluctant to invoke either his teaching or his example.

But let’s get beyond irony. What are some lessons the Synod might draw from John Paul II, pied piper of the young, on this ruby anniversary of his election?

1. The big questions remain the same.

Several bishops at Synod-2018 have remarked that today’s young people are living in a completely different world than when the bishops in question grew up. There’s obviously an element of truth here, but there’s also a confusion between ephemera and the permanent things.

When Cardinal Adam Sapieha assigned young Father Wojtyla to St. Florian’s parish in 1948, in order to start a ministry to the university students who lived nearby, things in Cracow were certainly different than they were when Wojtyla was a student at the Jagiellonian University in 1938-39. In 1948, Poland was in the deep freeze of Stalinism and organized Catholic youth work was banned. The freewheeling social and cultural life in which Wojtyla had reveled before the Nazis shut down the Jagiellonian was no more, and atheistic propaganda was on tap in many classrooms. But Wojtyla knew that the Big Questions that engage young adults — What’s my purpose in life? How do I form lasting friendships? What is noble and what is base? How do I navigate the rocks and shoals of life without making fatal compromises? What makes for true happiness? — are always the same. They always have been, and they always will be.

To tell today’s young adults that they’re completely different is pandering, and it’s a form of disrespect. To help maturing adults ask the big questions and wrestle with the permanent things is to pay them the compliment of taking them seriously. Wojtyla knew that, and so should the bishops of Synod-2018.

2. Walking with young adults should lead somewhere.

Some of the Wojtyla kids from that university ministry at St. Florian’s have become friends of mine, and when I ask them what he was like as a companion, spiritual director, and confessor, they always stress two points: masterful listening that led to penetrating conversations, and an insistence on personal responsibility. As one of them once put it to me, “We’d talk for hours and he’d shed light on a question, but I never heard him say ‘You should do this.’ What he’d always say was, ‘You must choose’.” For Karol Wojtyla, youth minister, gently but persistently compelling serious moral decisions was the real meaning of “accompaniment” (a Synod-2018 buzzword).

3. Heroism is never out of fashion.

When, as pope, John Paul II proposed launching what became World Youth Day, most of the Roman Curia thought he had taken leave of his senses: young adults in the late-20th century just weren’t interested in an international festival involving catechesis, the Way of the Cross, confession, and the Eucharist. John Paul, by contrast, understood that the adventure of leading a life of heroic virtue was just as compelling in late modernity as it had been in his day, and he had confidence that future leaders of the third millennium of Christian history would answer that call to adventure.

That didn’t mean they’d be perfect. But as he said to young people on so many occasions, “Never, ever settle for anything less than the spiritual and moral grandeur that God’s grace makes possible in your life. You’ll fail; we all do. But don’t lower the bar of expectation. Get up, dust yourself off, seek reconciliation. But never, ever settle for anything less than the heroism for which you were born.”

That challenge — that confidence that young adults really yearn to live with an undivided heart — began a renaissance in young adult and campus ministry in the living parts of the world Church. Synod-2018 should ponder this experience and take it very, very seriously.