The ABC reported today that a brain dead woman in Portugal gave birth to a healthy baby. The woman was declared dead on 20 February this year.
What a complicated issue. A terrible decision for family to have to make, and no doubt bitter sweet joy upon the successful delivery of a healthy baby. But what are we to make of the decision to keep a woman as an incubator for a baby?
Many might claim that a pregnant woman would want her baby to survive. This is a widely held understanding of ‘a mother’s sacrifice’. It is offered as justification for what might otherwise be considered a gross invasion of human dignity: not allowing a person to die, and using a human as a means to an end, that end being the birth of a baby. Neither of these propositions is uncomplicated in itself. But before reaching this conclusion, I think that there are still a number of unasked questions that should be exposed before suggesting that the conclusion is correct. Is this sacrifice too great?
The issues might be teased out by imagining different circumstances. A pregnant woman at or close to term who suffers sudden brain death might be rushed to hospital to deliver the baby and briefly kept alive to permit this. In keeping the woman alive, her body is interfered with to a small extent but arguably no more than might otherwise occur, say, to allow family to gather to say their last goodbyes. Her body is otherwise interfered with to deliver the baby, but this occurs in a timely way that aligns with what might have occurred should she have lived.
In contrast, by my calculations the woman in Portugal would have been no more than 16 or 17 weeks pregnant when she was declared brain dead. (The baby was delivered at 32 weeks gestation.) The foetus at this stage would not have survived if it had been born then. The intervening period requires a significant interference with the woman’s body far beyond what might be considered to be contemporaneous with the original medical emergency. Medical interference in this case is not a medical emergency, it is undertaken without the woman’s consent, over an extended period, and is not aimed at quality of life for the woman. Without interference, she would die and so would her foetus.
Consider also the terribly sad case of the 2014 case of an Irish woman who became brain dead while 18 weeks pregnant, but was being kept alive for fear of breaking Ireland’s strict anti-abortion laws. In that case, the family applied to the court to allow the woman’s life support to be switched off. Her body was shutting down and decaying even while she was on life support – causing great distress to her family. Unlike the Portuguese case, the baby of the Irish woman was found to have little chance of surviving.
The Irish case provides an example to counter assumptions that it is necessarily right to keep a woman alive for the purpose of giving birth.
Let’s take this argument to its logical conclusion: any woman of child-bearing age who becomes brain dead must be kept alive until a pregnancy test shows she is not pregnant. If she is pregnant, she must be kept alive until the baby is born. I realise that this is an exaggeration – but if we argue that the Portuguese case is justified because ‘any woman would want her baby to survive’ then where do we draw a line? If the woman is nine months pregnant? Eight? Four? One? How do we decide which foetuses are retained to delivery and which are not? Would we keep the woman on life support even as her body is decaying? What might cause us to change the decision to keep her alive?
My concern in these cases is that women become no more than a vessel for the delivery of babies. The identity of a woman morphs into ‘pregnant woman’ where woman is indivisible from the foetus. This does not simply protect a foetus, it makes the foetus paramount to the exclusion of the woman herself.
Despite personal feelings about what one might do to save one’s baby, this is part of a much wider social and increasingly legal claim over women’s bodies. Rather than affording women reproductive agency, it has the tendency to erase woman from the picture altogether. For example, prosecutions in the US of pregnant women deemed to be harming their babies through their own behaviors, or the recent suggestion in the UK that women should not become pregnant before making appropriate lifestyle choices.
I hope these women are resting in peace, and that their babies bring their families joy. I hope also that we grapple with some of these difficult questions and the implications for all women of the assumptions we make about a mother’s sacrifice.