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Brain-Dead Pregnant Mothers

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by

Chelsea Durgan

on 10 May 2014

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Transcript of Brain-Dead Pregnant Mothers

Brain-Dead Pregnant Mothers
Chelsea Durgan
and
Jacky Lopez

Overview
Introduction
Definitions
Background
Laws and Policies
Ethics surrounding mother
Pro arguments
Con arguments
Case study
Discussion questions
Additional questions
Background
Definitions
Laws and Policies
Brain death
Irreversible loss of all function in the brain and brain stem
-Unable to breathe on own
-Need circulatory management
-Artificial nutrition and hydration
-Absence of reflexes

Persistent vegetative state
Loss of function in brain, but brain stem still functions
-Can swallow
-Can breathe on own
-Can be observed to be awake~ sleep cycles
**Differences in brains at rest**
Brain Dead Pregnant Woman (BDPW)
A pregnant woman who has been determined to be brain dead

Somatic support
The physiological support of the body to maintain heartbeat and respiration
-Catheter in bladder
-Respirator tube in trachea
-Nasal-gastro feeding tube in nose and throat
-Antibiotics to prevent infection
-Heat lamps to treat bed sores
-Undergo numerous tests consistently
Definitions continued
1982-2010
30 reports of brain dead pregnant mothers
-4 caused by traumatic brain injury
Motor vehicle accidents
Falls
Assaults
Case Study: The Munoz Family
Requirements for determining brain death
Lack all evidence of responsiveness
-painful stimuli
Absence of brain stem reflexes
-No change in size of pupils
-Unable to elicit cough response

Apnea Test
-
Involves giving the patient oxygen but turning off the ventilator to allow carbon dioxide to build up in the system, which normally triggers an attempt to breathe
-26 caused by non-traumatic brain injury
Meningitis
Stroke
Anoxic injury
Brain tumor
Laws and Policies Continued
In Washington State
Automatic invalidation of advance directive
Found in 11 other states in U.S.
In the United States
Uniform Determination of Death Act
-Individual is dead when circulatory/respiratory or brain/brain stem stop functioning and is irreversible
Ethics: Pro Arguments
Ethics: Con Arguments
Brain dead mother's body
Seen as a "cadaveric incubator" or "fetal container"
Used as an object, rather than a human being

Uniform Determination of Death Act
Brain death is seen legally as death
Shows disrespect for mother
Places child's rights above mother's rights
Ethics: Con Arguments Continued
Religious View
Denies mother to die naturally according to God's plan

Ethics: Pro Arguments Continued
Washington's State Law
Automatic invalidation of advance directive
Leads mother's interests to be outweighed by state's interests
Prolonged Somatic Care
Provides baby with opportunity to live
Grants mother's desire to give life to her baby
Kant's Deontological View
Allows for woman to fulfill duty as a mother to provide life to her child
Mill's Utilitarian View

Prolonging mother's life to maximize happiness
-Previous wishes of mother
-Family members
-Community
Washington's State Law
Automatic invalidation of advance directive
Can serve as a back-up plan for mother's desire for birth of child to be fulfilled
Case Study Questions
What are some future steps the medical field can take to honor the wishes of all pregnant women in chance they become brain dead?

Do you agree with Washington's State Law (automatic invalidation of advance directive)?

In what ways could laws and policies aid pregnant mothers in honoring their wishes?

References
According to the Ethics committee of the American of Obstetricians and Gynecologists, "
Pregnant women’s autonomous (end-of-life) decisions should be respected, and concerns about the impact of those decisions on fetal well-being should be . . . understood within the context of the women’s values" (p. 890).
Full transcript