Should we maintain a corpse to rescue a fetus?

Arthur Caplan

September 01, 1993|By Arthur Caplan

IS IT morally right to keep a dead woman who is pregnant attached to life support machines in order to let her fetus live? A recent case in California shows that such a question is not hypothetical.

Trisha Marshall died of a gunshot wound to the head on April 21 while she was 17 weeks pregnant. David Smith, the father, asked hospital officials to do whatever they could to save the fetus. Marshall's body was kept on life support machines at Highland Hospital in Oakland in the hope that her fetus would develop to the point where it could live.

On Aug. 4, a 4-pound, 15-ounce baby boy was delivered four weeks prematurely by Caesarean section. Dr. Richard Fulroth, who headed the team that delivered the child, called him "a miracle baby."

Some, such as the Smith family, see the situation as offering no choice -- if it's possible to save a child by maintaining the mother's corpse, doctors must try. But the idea of maintaining a corpse to rescue a child strikes some as morally abhorrent.

Doubts about the morality of using a cadaver to allow a fetus to develop were much in evidence last year in Germany in a similar case, that of the "Erlanger baby."

The storm of ethical debate that greeted the decision to try to save this fetus is recounted in a fascinating article by Christoph Ansttz in the latest issue of the journal Bioethics.

On Oct. 5, 1992, a young woman named Marion Ploch was driving home from her job as a dental assistant. Somehow, she lost control of her car and hit a tree at high speed. Medical help arrived quickly.

Within 15 minutes, she had been transported by helicopter to the university hospital in the southern German city of Erlanger. She had suffered massive head injuries in the crash.

Her parents were told their daughter had no hope of recovery. They were also told that she was 13 weeks pregnant. No one knew who the father was.

Some of the doctors asked about Ploch's status as an organ donor. Others, however, thought that there might be a chance of saving the fetus if Marion was kept on artificial life support. The parents were not certain what to do.

On Oct. 8, the doctors declared Ploch dead but did not discontinue her life support. A day later, her parents, still uncertain about what to do, spoke with a reporter from a large bTC German newspaper, Bild-Zeitung. The reporter called the hospital to ask what the doctors planned to do. A committee was convened, and on Oct. 11 Ploch's parents and doctors agreed to attempt to continue the pregnancy until the fetus could be delivered safely by Cesarean section.

Once the decision had been made, the doctors were vigorous in defense of it. The assistant medical director told the press, "There really isn't any question whether it should be tried or not . . . We don't see any ethical reason simply to let the embryo die."

The hospital's director, Franz Paul Gall, agreed, saying, "The child's right to live demands also the use of modern and technological aids."

But, as Dr. Ansttz notes in his article, many did not agree with the decision of the parents and the doctors. Opposition to the decision made for some mighty strange bedfellows.

Some doctors condemned the decision to maintain Ploch's body as a "shameless human experiment . . . a perversion of the oath of Hippocrates." The left-wing environmental Green Party organized a petition drive and quickly gathered 7,000 signatures they sent to the Ministry of Justice demanding an immediate halt to "the human experiment."

Hanna Wolf, spokeswoman for women's affairs in the German parliament, said the decision to try to bring Ploch's baby to term "is a scandal and inhuman. The mother is degraded to nutrient fluid, disposable after use." Many other feminists and academics agreed that keeping a woman artificially alive was disrespectful of the dignity of the deceased mother.

Feminist critics and environmentalists were joined by a chorus of theologians. The Catholic chaplain at the hospital, Rainer Denkler, said, "I cannot share in the decision to respirate and nourish a brain-dead young woman for several months in order to make possible the birth of a 14-week-old embryo."

Another prominent Catholic theologian argued that "to allow nature to take its course in this matter and turn off the machines cannot be morally equivalent to a direct killing of human life in the event of an abortion."

A well-known Protestant theologian proclaimed that "the right of the intact living and dying includes the right to a dignified burial, and it is to be accepted that it is the destiny of mother and child to die."

About the strongest praise any theologians and religious leaders could muster for the effort was that it was not "ethically careless." The public apparently had its doubts, too. In a newspaper telephone poll taken late last year asking "Is it right for a dead woman to have a child?" 33,436 respondents said no, while 7,302 said yes.

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