Another side of brain death

A few days ago, I wrote a post about the ordeal and complexities faced by the family of Jahi McMath, and the issues of brain death in a pediatric patient. While this scenario is playing out in California, there is another drama playing out in a hospital in Texas, where a dead pregnant woman is being supported over the objections of her husband and the father of the unborn child who at this point is a 19-week old fetus; too young to be able to survive outside the mother's womb.

According to the Associated Press story,

Munoz found his wife unconscious in the early morning hours of Nov. 26. The family says it doesn't know the exact cause, though a pulmonary embolism is a possibility. Marlise Munoz was 14 weeks pregnant at the time.

He and his wife had both agreed that they did not want aggressive measures performed if they were ever terminally ill, but a Texas law prohibits those advanced directives from being followed in the case of a pregnant woman. So the hospital is continuing to support the body of this dead woman in order to "obey the law."


the law does not address the issue of continuing mechanical ventilation in someone who is brain dead. And since it appears that the woman has been declared dead following the tragedy that occured, is it reasonable for the hospital to continue to artificially maintain this woman for the sake of the fetus?

And what of the fetus?

It will be months until the baby is mature enough to be delivered without a high risk of having to be cared for in a high-level neonatal intensive care unit. And, oh by the way, since no one knows how long the mother was depleted of oxygen when she collapsed, there is no way to tell right now how severely the infant might be affected. And, since there is good evidence to show that maternal breast milk is advantageous for premature newborns, would someone want to continue to support this woman's body so her breasts can be induced to produce milk? How far will we go to prevent a death from progressing in a natural and dignified manner?

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I will admit, I have raised a pretty far-fetched issue, but I am convinced that our society is allowing definitions to be clouded, and we are acting out of fear of the law overpowering compassion, empathy, respect and beneficence. This poor woman is neither terminally nor irreversibly ill: she is dead. Her husband understands she is dead, and knows furthermore that his wife would NOT have wanted to be maintained in such a manner if she were alive. Is the hospital acting out of fear of being sued? Out of fear of criminal charges due to the law that governs the terminally ill? Could they be facing a "wrongful birth" suit by the father if the child is born with severe brain damage or other complications from the initial event?

Looking at both the Jahi McMath situation, and this one at the same time makes it pretty clear we need to be having much more open discussions about end of life issues, and we need to be teaching these definitions in our high schools and colleges, in parenting classes, and certainly educating our national, state and local legislators on the implications of our decisions.


Physicians, nurses and others need better training in communicating bad news, and leading discussions about options and opportunities. The mainstream media must be involved, so our society can move on to a more sophisticated understanding of the physiological issues. Even if some of the spiritual issues cannot be answered, at least we can help people understand what happens in death, what does it mean to lose all of one's brain function, and how that is different from a terminal illness, a persistent vegetative state, and being in a coma.

As always, I look forward to your comments to help further elucidate this issue, and I welcome the discussion that you will foster.


photo credit:

Premie: mbohlmann via photopin cc

About Dr. Ackerman

Alice Ackerman, MD, MBA, FAAP, FCCM is the Chair of the Department of Pediatrics at Carilion Clinic and Professor and Founding Chair of Pediatrics at the Virginia Tech Carilion School of Medicine. Dr. Ackerman is recognized nationally as an expert in pediatric critical care.

She has been at Carilion Clinic since June of 2007. Her primary goals are to enhance the health care of children in the Roanoke Valley and Southwest Virginia, and is actively working to do this both as physician in chief of the children's hospital, as well as through involvement with many state-wide initiatives.

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