Wednesday, August 3, 2005
From today's AP/Yahoo:
Brain-Dead Woman Dies After Giving Birth
By MATTHEW BARAKAT, Associated Press Writer
ARLINGTON, Va. - A brain-dead woman who was kept alive for three months so she could deliver the child she was carrying was removed from life support Wednesday and died, a day after giving birth. . . .
Susan Torres, a cancer-stricken, 26-year-old researcher at the National Institutes of Health, suffered a stroke in May after the melanoma spread to her brain.
Her family decided to keep her alive to give her fetus a chance. It became a race between the fetus' development and the cancer that was ravaging the woman's body.
Doctors said that Torres' health was deteriorating and that the risk of harm to the fetus finally outweighed the benefits of extending the pregnancy.
Torres gave birth to a daughter, Susan Anne Catherine Torres, by Caesarean section on Tuesday at Virginia Hospital Center. The baby was about two months premature and weighed 1 pound, 13 ounces. She was in the neonatal intensive care unit. . . .
It's a tragic story, but for our purposes, there are at least a couple of points worth noting:
- Keeping a brain-dead patient's organs and metabolic processes tooling along at a level that provided a healthy, supportive environment for the fetus must be close to the record for such things. The last time I remember doing research on this in PubMed (in 2003), the longest period of support for somatic function of a pregnant woman's brain was 107 days, from 15 to 32 weeks' gestation age. As the authors of that meta-analysis stated, "Preservation of uterine/placental blood flow is the most important priority during somatic support. Imprecise autoregulation of the uterine vasculature during maternal hypoxemia or hypotension makes this goal a significant challenge." Crit Care Med. 2003 Apr;31(4):1241-9. A year later, it appeared that the 107-day mark was still the longest period of successful support. Intensive Care Med. 2004 Jul;30(7):1484-6. The 2003 article goes on to discuss "special considerations for nutrition; medication use; cardiovascular, respiratory, or endocrine therapy; fetal monitoring; hormone replacement; and ethical concerns."
- Ah, yes: the "ethical concerns." For almost a generation, ethicists have written about the tendency of the law in at least some jurisdictions to regard women as "fetal containers," usually in the context of treatment disputes involving unwanted C-sections or other recommended interventions. As the technical ability of intensivists and obstetricians to support somatic brain function until 32 weeks improves, will there need to be a similar debate over the development of a new standard of care for brain-dead pregnant women?
- Ah, yes: "brain-dead pregnant women." In Virginia, as in all other states, "brain dead" means "dead." See Virginia Code § 54.1-2972. (Actually, to be "medically and legally dead" in Virginia, a patient must lack "brain stem reflexes, spontaneous brain functions and spontaneous respiratory functions." I'm not sure, but I don't think the third diagnostic criterion adds anything to the first two.) Once dead, a patient can't die again. But, amazingly, 37 years after the Ad Hoc Harvard Medical School report on "irreversible coma," the public's resistance to the notion of neurological criteria for death is curiously persistent.