Every few years a case comes along that makes us question the meaning of life and death and look at how much control we have over our own bodies when it comes to end of life decisions. Often times these cases involve brain death. This irreversible loss of all brain functions means that a person is both legally and clinically dead but somehow — since their heart may still beat and their lungs may still breathe and other organs may still work — less dead than other dead people. “Brain death”, “coma”, and “persistent vegetative state” are terms that are poorly described and easily confused and that are always brought up when names like Terri Schiavo and Karen Quinlan are mentioned in discussions about these kinds of things.
Recently, we’ve had two new names to add to our collective conversation about life and death and brain death — Marlise Munoz and Robyn Benson– and a new subtopic to argue about. Both Ms. Munoz and Ms. Benson were pregnant at the time they were declared brain dead. Both were kept on life support because of their pregnancies. There are other similarities between these women: both women were in their early 30’s, both found unresponsive by their husbands, and both were pregnant with a fetus that was not yet viable. An important distinction is that, at 22 weeks gestation, Ms. Benson’s fetus was much closer to viability than Ms. Munoz’s (she was 14 weeks pregnant at the time of her death.) The cut-off date for viability varies from state to state and country to country but generally hovers around 23 – 25 weeks gestation.
Ms. Munoz’s and Ms. Benson’s husbands had different ideas about what their wives would want. Mr. Munoz and his wife had discussed the issue before and he was sure that she would not want life sustaining treatment, even in the case of pregnancy. Conversely, Mr. Benson was sure that his wife would want treatment to sustain both her life and the pregnancy.
As you may expect, Ms. Munoz’s and Ms. Benson’s cases differed drastically in their outcomes.
Doctors told Ms. Munoz’s family that they could not remove her from life support because of a state law that prohibited them from stopping life-sustaining treatment for pregnant women. The Munoz family ultimately sued the hospital. Over nine weeks after she was declared dead, and after ultrasound revealed multiple fetal anomalies, Ms. Munoz was removed from life support.
Doctors told Ms. Benson’s family that they could keep her “alive” until her fetus was old enough to be delivered. Last week, baby Iver was born. His mother was removed from life support shortly thereafter.
I had different reactions to each case. I’m in the healthcare field and usually view cases like these through medically biased eyes. I had a visceral reaction to the Munoz case. How could they do this to her? I thought. It’s monstrous. It’s disrespectful. It’s reanimating a corpse. I worried about how policies like those that kept Ms. Munoz on life support completely disregarded the wishes of pregnant women and almost treated them solely as vessels to carry children. I felt relief wash over me when I heard that she’d been removed from life support and that her family could finally grieve.
My reaction to Ms. Benson’s case was very similar at first. Right up until I heard that this is what Ms. Benson would want. I had to put my biases aside and quickly. I still wondered how could they do this? But I also started to wonder if I would do this if I was ever in that situation. What would I want? I’m in my early 30’s. I haven’t had children yet but pregnancy is something that I’m already thinking about and death is inevitability. What can I do to make sure that my wishes are carried out if the two come at once?
Does it make a difference if a woman is pregnant when we’re talking about life and death? Who gets to determine what death means when you have more than one life to consider?
Cases like these are important if only because they get us all talking about what we would do (and what we would want our families, our doctors, and our policymakers to do) in cases like these. These things aren’t easy to talk about and we may never agree upon just one answer for every question. What’s important is that we ask these questions of ourselves, create our own answers, and work together to ensure that we all are able to transition from life into death as easily as possible.
Want to learn more about either case?
The Strange Case Of Marlise Munoz And John Peter Smith Hospital http://www.npr.org/blogs/health/2014/01/28strange-case-of-marlise-munoz-and-john-peter-smith-hospital
Dylan Benson’s blog http://www.misterbenson.com/
Want to learn more about medical ethics and cases of severe brain injury?
“From Quinlan to Schiavo: medical, ethical, and legal issues in severe brain injury” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1255938/