Intensive Care Medicine

, Volume 30, Issue 7, pp 1484–1486 | Cite as

Maternal brain death: medical, ethical and legal issues

  • Alan Lane
  • Andrew Westbrook
  • Deirdre Grady
  • Rory O’Connor
  • Timothy J. Counihan
  • Brian Marsh
  • John G. Laffey
Brief Report

Abstract

Case presentation

We present the case of a pregnant woman who experienced a cerebral venous sinus thrombosis resulting in brain death at 13 weeks gestation. We discuss the management of the mother and foetus following this tragic event. We also discuss the complex medical, legal and ethical issues that arose following maternal brain death. The central question is whether continuing maternal organ supportive measures in an attempt to prolong gestation to attain foetal viability is appropriate, or whether it constitutes futile care.

Discussion

Successful maintenance of maternal brain somatic function to facilitate foetal maturation in utero has been reported. While the gestational age of the foetus is central to resolving this issue, there is no clear upper physiological limit to the prolongation of somatic function following brain death. Furthermore, medical experience regarding prolonged somatic support is limited. Finally, the legal rights conferred on the foetus may vary significantly depending on the jurisdiction in which the maternal brain death occurs and may have important implications.

Conclusions

A consensus building approach, involving the family, is essential to resolving these potentially conflicting issues.

Keywords

Maternal Brain death Brainstem death Foetus Ethics Legal 

Notes

Acknowledgements

The authors wish to acknowledge the legal assistance and advice provided by Padraic Brennan, David Barniville B.L. and Donal O’Donnell S.C.

References

  1. 1.
    Pallis C, Harley DH (1996) From brain death to brainstem death. In: Pallis C, Harley DH (eds) ABC of brainstem death. BMJ, London, pp 8–12Google Scholar
  2. 2.
    Wijdicks EF (2002) Brain death worldwide: accepted fact but no global consensus in diagnostic criteria. Neurology 58:20–25PubMedGoogle Scholar
  3. 3.
    Field DR, Gates EA, Creasy RK, Jonsen AR, Laros RK Jr (1988) Maternal brain death during pregnancy. Medical and ethical issues. JAMA 260:816–822CrossRefPubMedGoogle Scholar
  4. 4.
    Anstotz C (1993) Should a brain-dead pregnant woman carry her child to full term? The case of the “Erlanger baby”. Bioethics 7:340–350PubMedGoogle Scholar
  5. 5.
    Bernstein IM, Watson M, Simmons GM, Catalano PM, Davis G, Collins R (1989) Maternal brain death and prolonged fetal survival. Obstet Gynecol 74:434–437Google Scholar
  6. 6.
    Feldman DM, Borgida AF, Rodis JF, Campbell WA (2000) Irreversible maternal brain injury during pregnancy: a case report and review of the literature. Obstet Gynecol Surv 55:708–714CrossRefPubMedGoogle Scholar
  7. 7.
    Finnerty JJ, Chisholm CA, Chapple H, Login IS, Pinkerton JV (1999) Cerebral arteriovenous malformation in pregnancy: presentation and neurologic, obstetric, and ethical significance. Am J Obstet Gynecol 181:296–303PubMedGoogle Scholar
  8. 8.
    Powner DJ, Bernstein IM (2003) Extended somatic support for pregnant women after brain death. Crit Care Med 31:1241–1249CrossRefPubMedGoogle Scholar
  9. 9.
    Sheikh AA, Cusack DA (2001) Maternal brain death, pregnancy and the foetus: The medicolegal implications. Medico-Legal J Ir 7:75–85Google Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Alan Lane
    • 2
  • Andrew Westbrook
    • 2
  • Deirdre Grady
    • 2
  • Rory O’Connor
    • 3
  • Timothy J. Counihan
    • 4
  • Brian Marsh
    • 5
  • John G. Laffey
    • 1
    • 2
  1. 1.Department of Anaesthesia, Clinical Sciences InstituteNational University of IrelandGalwayIreland
  2. 2.Department of Anaesthesia and Intensive CareUniversity College HospitalGalwayIreland
  3. 3.Department of Obstetrics and GynaecologyUniversity College HospitalGalwayIreland
  4. 4.Department of NeurologyUniversity College HospitalGalwayIreland
  5. 5.Department of Anaesthesia and Intensive CareMater HospitalDublinIreland

Personalised recommendations