Case Study: The Baby in the Body

On a wild December night Donna M, twenty years old, took the curve on River Road a little too fast. She hydroplaned into the oncoming lane and struck a car broadside. The driver of the second car was able to walk away, but Donna M was seriously hurt. She was taken to Clark County Hospital. In the emergency room she was unarousable, and a neurologic exam suggested significant brain injury. She had also sustained a pelvic injury. It was not certain that she would live. The address on her driver's license produced a phone number, which in turn produced her parents--a bewildered, stout woman still in her waitress's uniform and a silent man whose jacket bore the name of the garage where he worked. Donna was their only child, a good girl, not married, a steady boyfriend. Was she dying? They couldn't take in what the resident was telling them: the pelvic X ray had revealed a fetal skeleton. Ultrasound confirmed that Donna was about fifteen weeks pregnant and the fetus was still alive. The next day Donna's boyfriend, Jack, approached the hospital staff to ask them to try to save his baby. He was sure Donna would have wanted them to make the attempt, and he thought his mother and sister would help him give the child a good home. When Mr. and Mrs. M heard of this they insisted that if Donna died, she be taken off the respirator and her body given to them for burial. They were fond of Jack and felt sorry for him, but they said the idea of trying to bring the baby to term was "like a horror movie." Two days later, Donna M was pronounced brain dead. To give the fetus a decent chance at survival, the pregnancy would have to be continued for at least fifteen more weeks. Should the physicians at Clark County Hospital try to sustain the postmortem pregnancy.? What are the parents' duties in this matter? What are the obligations to the father? COMMENTARY I take the central problem to be the apparent disagreement between Jack, the putative father, and Donna's parents. Initial impressions and feelings often are poor guides to someone's deeply considered and durable beliefs. The parents' statement that bringing the baby to term is "like a horror movie" calls for discussion and counseling, not urgent action. While their initial shock at such a proposal would be understandable, it would not be implausible to expect this reaction to moderate with understanding and discussion, particularly if they were assured that Jack could provide a good home for the child. As a general principle, I would urge all participants to avoid doing anything irreversible at the moment of crisis. Since it is bad practice to fail to screen routine pregnancies for some fetal abnormalities, it would be especially imprudent to fail to assess this fetus before embarking on a very arduous and expensive course. Assuming Donna is indeed brain dead, I see little harm to her as a person if life support is maintained for at least a few days while her parents and Jack can be educated and counseled. She can suffer no pain. We have no evidence of an advance directive or other guidance as to her wishes, so there is no reason to believe she would be offended at the prospect of continued biologic existence for a possibly worthy cause. While it is possible to desecrate her body, there is no clear agreement that maintaining life support for a socially important purpose, especially if consented to by her appropriate representatives, constitutes desecration. If further counseling led to consensus among the central participants, including the health care team, there would be little need to determine who had final authority to make the decision. The remaining question, therefore, is how to proceed if disagreement persists, either between Donna's parents and the father of the future child, or between the family and the medical team. We commonly rely on and trust next of kin to make judgments regarding disposition of a person's body after death unless such requests are beyond the bounds of reasonableness, or violate clear laws. …