For weeks, life-support machines have been hooked to the body of a brain-dead woman against the wishes of her family. Thirty-three-year-old Marlise Munoz is pregnant, and the hospital in Fort Worth, Texas, says state law prohibits from cutting life support from a pregnant woman. A medical team monitors the 20-week-old fetus in the I.C.U., in many cases acting as the brain that no longer functions in Munoz's body.
While the case is a lightning rod for medical ethicists -- bringing some of the most complex issues in current medical ethics into play -- it also raises the scientific question of how well technology can replace the functions of a mother's body.
"As far as fetal development, as long as we can control delivery of blood to the fetus and make sure the mother is nutrient-enriched, and as long as the mother's got enough glucose and oxygen, she can serve as a vessel," said R. Phillips Heine, director of maternal fetal medicine at Duke University. "If they can get to a reasonable gestation, there's potential for a very good outcome [for the fetus], so it would be a reasonable option. But I don't want that to sound like I'm not supportive of the family's wishes."
Complicating that decision in this particular case is the way Munoz died: Doctors think a blood clot in her lungs caused her to collapse; she may have gone an hour or more without breathing before her husband found her.
"If the mother was down for an hour, you don't know what happened in utero, how big a hit that kid took," Heine said.
Cases like Munoz's are rare, but not unprecedented: In a 2010 review, researchers found 30 cases of brain-dead pregnant women between 1982 and 2010. Twelve of the fetuses were born and survived the neonatal period.
"Manifold physiological changes occurring during pregnancy and brain death, as well as the prolonged hospital stay after brain death, present enormous challenges, however, both for the treating clinicians and for the family," the authors wrote.