Life, death, technology, and really hard questions

A tragedy is unfolding in Texas, unfortunately in the public eye, of a 33-year old woman who suffered a severe injury to her brain on November 26th, when she was 14 weeks pregnant. Her brain, we are told, has stopped functioning; her other bodily functions are being maintained artificially. Her now 20-week old fetus is still alive. Her family has asked the hospital that, in accordance with the woman’s previously expressed wishes, her bodily functions no longer be maintained mechanically. The hospital has refused, citing a Texas law that prohibits the removal of life-support for a pregnant woman; the husband has sued the hospital to have the life-support removed.

Here is a tragedy in which all choices are fraught with deep sorrow, and in which difficult questions are legion; if we think we have answered one, seven more spring up to take its place. Before I discuss them any further, let me lay my cards on table: First, I am pro-life. This implies far more than that I am simply against abortion! But I do believe that in most situations, abortion is not the right or best option. Among other reasons, I believe this because I am a physician still enamored of the Hippocratic tradition, and because I am a Christian — that is, I believe Christ’s claims that he is divine, and that therefore his statements such as “Do unto others as you would be done by,” and “Whatever you do to the least of these you do to me,” are more than just suggestions, and apply to how I treat all people, whether in utero or ex utero. However, there are rare instances in which abortion is the “least bad” alternative, such as when continuing a pregnancy places the mother at risk of serious harm or even death (and while this is indeed rare, I have known patients for whom this was judged to be true).

Second, I have some pretty strong beliefs about technology, which readers of this blog may have divined. I do not believe in the technological imperative which states that “Because we can do such-and-such, we are obligated to do it.” I strongly hold that people should be free to choose not to have technological interventions performed upon themselves. Related to this, I believe “Technology creep” is a rampant problem in medicine: techniques designed for one application are indiscriminately generalized and applied everywhere they can be applied, just because they can be, just because they are technology, and because we assume that technology always makes things better — when often all it does is dehumanize the situation.

That said — of all the questions this tragedy raises, the two questions I pose today are, Is stopping life support for the mother equivalent to abortion? And a related question, Does the pro-life position necessitate holding that this woman should be kept on life support for the sake of her unborn baby? The reasons to answer Yes are compelling. There are two people on life support: one who will almost certainly never get off of it alive, and another who has the potential to get off of it alive if the other stays on a little while longer. If the machines are disconnected, two people will die. As far as we can tell, the machines are not a burden to the mother (if she is indeed “brain-dead,” then by definition she isn’t suffering). When she said that she would never want to be maintained on machines, she probably wasn’t considering being pregnant and on machines, and who knows what she would have wanted in that case? It seems it would be better to err on the side of temporarily maintaining her bodily functions for the sake of her unborn child.

And yet there are enough caveats here to make me wonder. Is stopping the life support in this situation tantamount to abortion? I am not sure that it is. By withdrawing the life support, we withdraw a technique and allow the natural course of events to take place; the intention is not to kill the fetus (although that is what surely will happen as a result).  By induced abortion, we introduce a technique to change the natural course of events, with the intention to kill a human being. It seems to me that there is enough of a difference between the two that we should not conflate them. Again – it is well-accepted that there is no ethical difference between withholding treatment and withdrawing treatment. If we are to say that withdrawing the treatment in this case is abortion, does that not imply that withholding (not starting) the treatment in the first place would also be abortion? That smacks of a tyrannical technological imperative, a place I don’t think we want to go. Again –  The second formulation of Kant’s categorical imperative runs something like, “We should never use someone only as a means to someone else’s ends.” I am no philosophy major, but it sure feels like keeping this woman on life support against her express wishes is making her a means without considering her as an end.

If one were to abstract this situation from its context, consider it as a theoretical problem, the “least bad” outcome would be for the woman to be supported until her baby is born. But this is not an abstract, theoretical problem. I have sat at the bedsides of many, many patients who have been trapped in webs woven by dubious uses of technology. I have seen many, many people enduring the “living hell” that this woman’s husband has described experiencing over the last few months. Granted, these experiences of mine don’t carry the weight of rational arguments; but they remind me that these decisions are not carried out in the academic ether. I do not believe that withdrawing the life support for this woman is equivalent to abortion; and, related to that, I don’t believe the pro-life position necessitates holding that keeping this woman’s body functioning in order to allow her baby to reach viability, against the express wishes of her and her family, is the only ethical solution. There are those who will disagree with me, some vehemently; I understand their positions and respect them. (I am not speaking for Trinity International University, so don’t get mad at them!)

I don’t have space to go into all of the other issues this situation raises (one of them being the definition of “brain death” — see here for a thoughtful reflection on the matter). But one more issue I will address: There are a lot of people who have written and said uncharitable and judgmental things about this woman’s husband and family. While I am uncertain about what is the right thing to do in this situation, I’m quite certain that passing judgment on the family is wrong.

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