Should a Brain‐dead Pregnant Woman Carry Her Child to Full Term? The Case of the “Erlanger Baby”

Anstötz, Christoph

doi:10.1111/j.1467-8519.1993.tb00224.x

Cited by 28 publications

(22 citation statements)

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“…The prolongation of corporeal support could be misunderstood by the public as using a cadaver as an incubator, but this line of thinking could be seen to underestimate the mother's invested months of pregnancy, and that continuation would also mean biologic continuity of her life and symbolic continuity of her being . As a result of this misinterpretation, on some occasions these cases have encountered public outrage, whereby the public has been divided among those disgusted with using the deceased mother's body (cadaver) for the interests of the fetus, and those that have defended the fetal right to life; for example, the Erlanger Baby case . Those that are against such praxis argue that it awakes among the public outdated stereotypes of pregnancy as an “architect and bee model”, or that continuation with such a procedure destroys the woman's bodily integrity, desacralizing her body, and preventing her from dying with dignity .…”

Section: Discussionmentioning

confidence: 99%

“…Different arguments have arisen in the literature, even to the extent of a woman who was brain dead being misrepresented as still alive, supporting this with inconsistent language and terminology . Thinking along these lines, some confusion exists in the literature between the rights of a woman who is alive and one who is dead, mainly presented as a conflict of rights between the fetus's right to life and the rights of the woman who is brain dead, in connection with the woman's right to abortion .…”

Section: Introductionmentioning

confidence: 99%

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Guidelines for the management of the social and ethical challenges in brain death during pregnancy

Čartolovni

Habek

2019

Intl J Gynecology & Obste

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The aim of the present study is to assess the ethical, legal, and social issues of brain death in pregnancy through a literature review, and, based on the review results, to provide ethical and social guidelines. A search of PubMed using MeSH terms was conducted and yielded 844 results for the period from 1979 to 2017. After articles were screened based on the title and abstract content, 45 were found to refer to the existing ethical, social, and legal implications in cases of brain death during pregnancy, and 40 articles were selected as the source for our set of ethical and social guidelines. From the findings of the study, issues referring to the legitimacy and justification of performing a corporeal support procedure have been identified, as have the issues focusing on fetus or mother, and, finally, those relating to the decision‐making process. Given the increasing number of successful births after a diagnosis of brain death during pregnancy, there is justification for an ethical duty to continue prolonged corporeal support, even if there is little likelihood of success, despite the apparent absence of a legal duty, and relying on the international jurisdictional discrepancies in the attribution of legal rights to the fetus.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Guidelines for the management of the social and ethical challenges in brain death during pregnancy

Čartolovni

Habek

2019

Intl J Gynecology & Obste

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“…The patient's family should be involved in all decisions and be aware of the responsibility for possible care of a child [10,11]. The situation in question is exceptionally complex and can provoke extremely different emotions and opinions, not only of the relatives but also of society [12,13].…”

Section: Discussionmentioning

confidence: 99%

Utrzymanie ciąży u ciężarnej z krytycznym uszkodzeniem mózgu

Wawrzyniak¹

2015

Anaesthesiol Intensive Ther

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Background: Critical brain injury can lead to brain death, which is medically and legally considered the death of an individual. Further therapy is discontinued, unless organ donation is possible or brain death occurs in a pregnant woman. Case report: A 30-year old woman at 22 weeks gestation developed a subarachnoid haemorrhage from a ruptured cerebral artery aneurysm. The patient was admitted to the Intensive Care Unit in critical condition. On treatment day 3, the symptoms of brain death occurred. Due to possible complications, the apnoea test and instrumental examinations were not performed. Therapy maintaining vital functions was carried out in order to sustain the pregnancy. The patient was ventilated, received cardiac-supportive drugs, hormone replacement therapy, enteral and parenteral feedings and systemic infections were treated as well. At the beginning of the 27 th week of gestation, massive bleeding from the airways developed. A Caesarean section was performed, and a female neonate was born, birth weight 680 g, the Apgar scores 4, 6 and 6 at 1 st , 5 th and 10 th minute, respectively. After 3.5 months, the baby was discharged from the Neonatal Intensive Care Unit. Her development at the age of 8 months is normal. Conclusions: The case described and similar cases reported in the literature demonstrate that the maternal brain death is an interdisciplinary medical challenge. Thanks to intensive care techniques, maternal somatic functions can be maintained, and a healthy child can be delivered.

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“…However, these issues are not relevant as the patient is already dead. [13] Some professionals suggest that if the mother had a previous inclination to donate her organs, extended somatic support is justifiable to preserve the organs. Others argue that such support is still in the experimental stage with suboptimal knowledge about the adverse effects of the medications on the fetus.…”

Section: Discussionmentioning

confidence: 99%

A brain-dead pregnant woman with prolonged somatic support and successful neonatal outcome: A grand rounds case with a detailed review of literature and ethical considerations

Abuhasna

Amer

Masood

et al. 2013

Int J Crit Illn Inj Sci

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There are increased reports in the medical literature of brain death during pregnancy. In these rare cases, the decision was either to consider discontinuing homeostatic support and mechanical ventilation with an understanding that the fetus then will also die, or to continue full support in an attempt to prolong pregnancy for the purpose of maintaining the fetus alive until maturity. We report the first case in the United Arab Emirates and in literature of somatic support that extended up to 110 days with the successful delivery of a viable fetus. A 35-year-old woman suffered intracranial hemorrhage during the 16th week of pregnancy that lead to brain death despite maximal surgical and medical management. Upon confirmation of this diagnosis, the patient received full ventilatory and homeostatic support required to prolong gestation and improve the survival prognosis of her fetus. The status of the patient was discussed in a multidisciplinary approach and with the full involvement of her family. Somatic support continued until the patient was 32 of weeks gestation. Obstetric complications of the patient were frequently assessed and managed. Lower segment cesarean section (LSCS) was then performed. A preterm male in breech presentation was delivered with an average weight of 750 gm, and an Apgar score of 6, 7, and 9 at 1, 5, and 10 minutes, respectively. Prolonging somatic support in a pregnant woman with brain death to allow fetal survival resulted in a successful outcome in terms of saving the life of the fetus. The results are consistent with previous published case reports in the literature on the appropriateness and safety of such a strategy that involved an intensive multidisciplinary approach. Despite being a tragedy, maternal death can represent an opportunity to save the life of the fetus and for organ donation. Consensus future recommendations that can guide the management of similar conditions may also be adapted, especially with the growing medical experience in this context.

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Should a Brain‐dead Pregnant Woman Carry Her Child to Full Term? The Case of the “Erlanger Baby”

Cited by 28 publications

References 0 publications

Guidelines for the management of the social and ethical challenges in brain death during pregnancy

Guidelines for the management of the social and ethical challenges in brain death during pregnancy

Utrzymanie ciąży u ciężarnej z krytycznym uszkodzeniem mózgu

A brain-dead pregnant woman with prolonged somatic support and successful neonatal outcome: A grand rounds case with a detailed review of literature and ethical considerations

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