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Maternal brain death: medical, ethical and legal issues

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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.

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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.

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Authors and Affiliations

  1. Department of Anaesthesia, Clinical Sciences Institute, National University of Ireland, Galway, Ireland

    John G. Laffey

  2. Department of Anaesthesia and Intensive Care, University College Hospital, Galway, Ireland

    Alan Lane, Andrew Westbrook, Deirdre Grady & John G. Laffey

  3. Department of Obstetrics and Gynaecology, University College Hospital, Galway, Ireland

    Rory O’Connor

  4. Department of Neurology, University College Hospital, Galway, Ireland

    Timothy J. Counihan

  5. Department of Anaesthesia and Intensive Care, Mater Hospital, Dublin, Ireland

    Brian Marsh

Authors
  1. Alan Lane
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  2. Andrew Westbrook
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  3. Deirdre Grady
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  4. Rory O’Connor
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  5. Timothy J. Counihan
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  6. Brian Marsh
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  7. John G. Laffey
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Corresponding author

Correspondence to John G. Laffey.

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Lane, A., Westbrook, A., Grady, D. et al. Maternal brain death: medical, ethical and legal issues. Intensive Care Med 30, 1484–1486 (2004). https://doi.org/10.1007/s00134-004-2305-6

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  • DOI: https://doi.org/10.1007/s00134-004-2305-6

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