Georgia woman’s case a medical travesty

Opinion

The case of a braindead 30-year-old Georgia woman being kept alive so that her fetus can grow to term has once again raised the spectre of The Handmaid’s Tale in U.S. President Donald Trump’s America.

But cases of maternal somatic support — when a pregnant individual dies and is kept alive until a viable fetus can be delivered – while rare, have been documented since the 1980s. And as medical technology advances, these heart-wrenching stories may become more common, leaving hospitals, ethicists, governments and parents with the need to make difficult decisions.

For those who haven’t been following the story, Adriana Smith, a nurse and mother of one, suffered a blood clot in February while eight weeks pregnant. Because of Georgia’s abortion laws, the hospital made the decision to keep her on life support for months, until the fetus can be delivered safely. Even more discouraging, her family is responsible for all the medical bills which according to some reports are estimated to be upwards of US$800,000.

Research suggests that the longest duration for somatic support, according to the International Journal of Critical Illness and Injury Science was in the United Arab Emirates. In 2013, a 35-year-old woman suffered a hemorrhage and eventual brain death in her 16th week of pregnancy. She was provided medical support to prolong gestation, and the fetus was delivered at 32 weeks – 110 days after the mother’s brain death. According to the journal, the woman’s family was fully involved in the decision-making process and the baby boy was healthy upon delivery.

There have been cases in which maternal somatic support has been provided in Canada too. In Victoria, 32-year-old Robyn Benson was declared braindead following a brain hemorrhage in 2013. She was 22 weeks pregnant and at her husband’s request, she was kept on a ventilator for six weeks until she could deliver a baby boy, premature, but healthy. She was then taken off life support.

In discussions from the UAE case, researchers determined that because of medical technology, gestational age no longer had a significant impact on the health of the fetus. A braindead pregnant person serves as a “natural incubator” so long as the fetus is allowed to develop fully before being delivered. Indeed, concern shifts to whether the fetus will have disabilities if delivered too early.

For many who have been observing the case in the United States, the question becomes who gets to make these decisions? What happens to women’s bodily autonomy if they are viewed as “natural incubator?” Perhaps even more confusing is what exactly constitutes brain death? Even the medical community is divided on that question.

According to researchers Joseph Verheijde, Mohamed Rady and Joan McGregor, there is confusion about what is the difference between brain death and a vegetative state in the medical community. A vegetative state is considered life. Brain death is well, death. What’s the difference? It’s not clear. Removal from support or continuing support becomes as lawyer Sonya Laddon Rahders writes: a “conceptual line.”

Perhaps more alarming, as Laddon Rahders documents, when neurologists from the United States were asked to determine — in a hypothetical case — if they would declare a pregnant patient braindead and withdraw care, six per cent would not make that assessment and instead would continue to keep the patient alive. More surprising, in Canada, a similar survey resulted in 16 per cent stating that they would not assess a pregnant patient as brain dead and would continue to maintain their life. This suggests that personal opinions cloud uniform, clear guidelines regarding the definition of death, and the fetus, rather than the woman, may be considered more important.

What does this mean for any person in Canada considering pregnancy but not wanting to be forced to be a “natural incubator?” Get a personal directive drawn up making it absolutely clear what your wishes are. Discuss with your loved one and your doctor what you want and do not want for your end of life. Don’t leave this in the hands of anyone but yourself. For now, rest in the knowledge that the laws are in place that do provide you with some rights. But back those rights up with clearly outlined legal directions.

What’s happening to Adriana Smith is a travesty. And with medical technology evolving this is just the beginning.

Shannon Sampert is a political scientist. shannon@mediadiva.ca