It is also insane to think that this is a good idea for the baby either. Brain dead patients are extremely, critically ill, with major derangements in their immune, endocrine and organ systems. It's not a normal living body without brain function, brain death causes massive systemic derangement.
There are case reports of people being maintained with viable fetuses until a delivery when the majority of development has already occurred, but only a few case reports of prolonged brain dead maternal support with extremely high rates of fetal loss (about 40%).
We have no idea of the long term impact of this experiment on the fetus. Based on the dozen or so times this has ever happened the children have been born with a high rate of complications. No long term data exists on their health. This is uncontrolled and unethical human experimentation.
The brain dead organ donor is a dangerous host for a fetus. You have pan-hypopituitarism, adrenal insufficiency - causing hypotension and hypothermia, high rate of systemic infection, malnutrition, etc. These can be "managed" but it is essentially incubating a child in a critically-ill host.
I do ethical research on tissues from brain dead organ donors with consent and adherent to Belmont principles and have researched these issues deeply - because the brain dead are not considered human research subjects subject to IRBs. But this is an example of why maybe they should be.
This case alone will generate reams of study in bioethics and we'll probably have some new principles based on such a travesty. The harm from this exploitative practice will also likely be harm to research and organ donation from brain dead organ donors, as this is a massive breach of trust.
I have absolutely no doubt that you’re correct, unfortunately. This is tragic on so many different levels, and those who are responsible for it will have to carry that to the grave. They can hope that they’ll be shown more dignity than they’ve shown this young woman and her family.
The moral injury to those charged with providing care to this patient has got to be unimaginable. I have worked in critical care for 8 years, and I can’t fathom being faced with a situation like this.
The ethical implications of this from long established principles are atrocious - from denial of consent and respect for persons and their wishes, to beneficence with a high rate of harm to the potential child and justice. This is a violation of all 3 Belmont principles of ethical medical care.
Thank you for laying it out so clearly. You summarized the nuances, complexities and ethical implications a lot better than I would have. It is indeed the cruelest form of human experimentation violating multiple basic core ethical principles.
I'm horrified. Hope it didn't come across as ethics-splaining, but I have a whole paper in the hopper about the process and ethics around brain death, research and donation. My research is built on the trust of families that I am using their gift for good and episodes like this could undermine that.
Sir, this is the opposite of ethicsplaining or mansplaining. Thank you for the run-down because knowing it’s horrifying and knowing *how horrifying* it is are two different things.
And it's precisely their critical illness that I'm studying, so the idea that they could be a healthy host for a fetus is nuts. They are not. I study their critical illness in controlled ways to try to bring knowledge to care of living patients, and this abuse of trust really bothers me.
Thank you for laying this all out. I wish the reporting on this case would include this…people need to know this….
Hey, if no one's thanked the very stars above for your existence, today...allow me. And long may your work continue. Seriously.
I learned a lot. Beyond the horror, there are many ethical issues you raised whi i had not fully considered. So I appreciate you taking the time to educate me and others. I am heart broken for this woman and her loved ones.
ethics-splain all you want. We're all horrified, but you have the vocabulary we need.
I take it you have seen the 1978 Original "Coma" movie...or read the book. I'll never forget the scenes of rooms full of bodies hooked up to machines, hundreds of them...and here we are.😧🤬
What really gets me is that she was only 9 weeks pregnant when she died, so the fetus was not even close to being fully developed. Tragic doesn't even begin to cover it...
Just keeping their blood pressure reasonably stable is difficult. I don't want to think about all the pregnancy hormones that are out of balance because of other systems not functioning.
Thank you for this information.