Does a pregnant woman on life support have a right to die?

It emerged just recently that doctors in an Irish hospital are seeking legal advice over whether they can switch off the life support machine of a woman who is 16 weeks pregnant. The woman, believed to be in her mid to late 20s, suffered a head trauma and a clot to the brain a number of weeks ago. The family of the woman—who is reported as clinically “brain dead,” but still undeniably a living human organism*—want the medical team to allow her to die. Even though there’s no chance of revival, doctors and medical staff at the hospital are reluctant to carry out her family’s wishes because she is about 16 weeks pregnant. In order to save the life of the foetus, sustaining the mother until a Caesarean section can be carried out would be required.

Some people have asked why life-support is not turned off in this case.  Conor O’Mahony, a lecturer of law at UCC, wrote in the Irish Examiner that “[w]hile the Supreme Court has held that people have a constitutional right to die a natural death without having life prolonged by artificial means, the Constitution also says the State is obliged to defend and vindicate the right to life of the unborn.  Case law has indicated that the right to life takes priority over other rights, and so it is unclear whether life support could be discontinued in a manner that would be consistent with the unborn’s right to life.”             

In this post, I will briefly consider some of the ethical issues that may arise from this case, and I hope to use it as a starting point for the discussion. I will look at a number of different, but common, arguments for and against abortion—as they normally apply—and then consider how each applies to the case of the pregnant mother who is irreversibly unconscious. Before I begin, though, I will mention a few things: many of the specific details of the above case are still unknown, so I will work within the parameters of what’s presently known. I will also assume, for the sake of argument here, that the pregnant woman would have wished for doctors to allow the life-support to be turned off and thus let her die. Finally, I’m not making the case for any particular position on the ethics of abortion here (I've made that elsewhere); instead the focus will be to look at how different frameworks can approach the issue.   

Firstly, those who support the “pro-life” position normally say an unborn foetus has a right to life and that a mother’s right to her bodily autonomy does not override that fundamental right. Some opponents of this position say a mother has a fundamental right to choose what happens to her body, and the foetus’ right to life cannot outweigh that basic right; it is a basic violation of her right—a form of oppression, if you will—to deny her this form of autonomy.  Normally, it can be difficult for pro-life advocates to make the case defending a foetus’ life over a mother’s right to bodily autonomy, but when she is irreversibly unconscious, with no existing interest, favouring the foetus over the mother seems more persuasive. In other words, her claim to bodily integrity and personal autonomy loses much force if she’s incapable of conscious experience.  

Interestingly, some pro-lifers have also said we are not obliged to keep an irreversibly unconscious being on life-support for several months. An extraordinary means of life support are unnecessary, they argue, when something cannot be achieved without extreme effort in terms of pain, cost, or other demanding factors. The demand usually applies to the person whose life is at stake and to those of whom their wellbeing relies on. For all that, it’s not clear whether saving the foetus’ life would count as an extraordinary means of life support: arguably there’s a reasonable chance the life of the foetus can be saved with a positive outcome, and it is of no emotional inconvenience to the irreversibly unconscious mother. In other circumstances, pro-life proponents often deny women the right to an abortion where it’s extremely bothersome and where there’s little chance the foetus will survive beyond birth. The latter case, by contrast, seems to require a higher degree of extraordinary means of life support than the former. With all this in mind, the standard pro-life argument in favour of a foetus’ life is to a certain extent stronger here than in normal circumstances.

  

Those who endorse the standard “pro-choice” argument—most famously put forward in Judith Jarvis Thomson’s : A Defense of Abortion—often claim that a mother’s rights to complete bodily autonomy overrule any other conflicting interests. Even when the moral status of the foetus is deemed equal to that of a fully self-conscious adult being, she argues, it nonetheless has no right to use its mother’s body. Other philosophers have criticised Thompson’s thesis, as they think the rights of the pregnant woman ought not to go as far is she proposes.

Even if we accept Thompson’s condition, it does not sound as convincing when the mother has irreversibly lost the capacity for conscious experience. The proponent of this position, in this way, will have to explain why the irreversibly unconscious mother’s right also overrides that of the foetus’ right, in spite of the fact she has ceased to exist as a conscious, sentient being. On the other hand, discounting her bodily autonomy, in order to save the foetus’ life, would appear to be defensible since the action is harmless. A self-conscious being, whose autonomy was denied, and resulted in her having to endure suffering, cannot be reasonably compared to the irreversibly unconscious being that does not have the capacity to suffer or feel pain in any relevant sense.

It can be argued by the pro-choice proponent, however, that treating the irreversibly unconscious mother in this way would be objectively demeaning, even if it is subjectively innocuous. We usually try and show respect for people who have ceased to exist and we do what we can to follow their wills. Nearly all of us care what happens to our bodies after we die. It would be demeaning, for example, if someone were to donate his body for the purpose of medical research only for it to be cut to pieces and made an object of contempt by medical students. We could say, by the same token, that the irreversibly unconscious mother should not be subjected to any degrading situation. Yet perhaps a case can be made that sustaining her life for a number of weeks is not degrading—and it cannot be reasonably compared to the person who donated his body for medical research. We ought to respect a person’s wishes after they die, but rare exceptions can be made when significant events depend on it.

The pro-choice proponent could say that all this fails to take into account the wishes of her family, who want to turn off the life-support machine.  This argument extends beyond the conditions of the pro-choice position though. Thompson’s argument only relates to the pregnant mother: she doesn’t say anything about this right being extended to others in the event that the mother dies or becomes irreversibly unconscious. Still, we could say that where someone is permanently unconscious, her next-of-kin has the right to make decisions on her behalf; but it might still be debatable whether they can openly make that decision when it makes an impact on someone else’s life. In all, the pro-choice argument in favour of the mother’s right doesn’t seem to be as forceful or straight forward here as it is in normal circumstances. Nonetheless, this isn’t to say it cannot offer good reasons to allow the life-support machine to be switched off. 

Another approach is to say that the foetus, at present, has little or no moral status. It’s roughly between 23 and 28 weeks when foetuses start to develop a capacity for consciousness. The 16 week foetus in our case falls below this threshold; it also lacks self-awareness, a sense of the past and future, a capacity to relate and communicate to others, and to experience pleasure and pain. But if we accept this, we have to concede that the mother also lacks these qualities, and therefore her moral status would be reduced as well. In short, one is a pre-person and the other is a former person. We might still want to favour the mother over the foetus, since she was once a person, and, as I mentioned above, we usually consider it important to respect a person’s wishes after she has ceased to exist.

All the same, we could argue that the foetus has the potential to become a person and it’s also extremely unlikely that the mother can regain consciousness. On this account, therefore, the foetus has a stronger case than the mother. However, many regard the argument from potential as problematic as it’s not clear exactly why being a potential person has moral significance. (I discuss the argument from potential in more detail in section 6 of this post). Furthermore, when we consider the interests and preferences of the mother’s family, and assuming the foetus hasn’t much (if any) moral status, this adds additional moral weight in favour of letting the mother die. Overall, this final approach seems to give us the most straight forward moral reason not to continue life support.    

Anyway, those are some of my preliminary impressions. No doubt, I will alter some of them on further reflection and in hearing the views of others. Please feel free to comment. 

* The notion of brain death is interesting and more complex, philosophically, than many assume. Some philosophers view the notion of brain death as conceptually problematic and not that relevant (from an ethical point of view anyway).It's even problematic from an empirical point of view: pituitary function sometimes happens after formal criteria for brain death are met. (In response to this, some have gone further and redefined death as 'higher brain death'; but, again, that is conceptually problematic.) Brain Death, what does it actually mean? The complete and irreversible loss of brain function, sure; but is that actually death, or is it something else (e.g. irreversible unconsciousness)? The biological organism seems to be alive: there’s still circulation of the blood, heartbeat, respiration etc. Isn't it strange that we've a different definition of death for humans than non-human animals or plants? What makes us different?

Arguably, death was redefined by the Harvard Brain Death Committee in the late 60s because respirators made it possible for patients to remain alive for several months, even years, after they lost consciousness. And, of course, at this time organ harvesting became more viable. Removing the heart of a living patient would be murder. An earlier (then unpublished) draft by the Committee even states this latter reason. Redefining death was a convenient way to legally permit removing patients from life-support and harvesting their organs, but, at the same time, retaining the sanctity of human life doctrine. This, of course, isn't a problem for those who don't subscribe to the doctrine. Brain Death is really an artificial, contrived definition.