Marlise Muñoz has been allowed to die. In an era when we are able to prolong life infinitesimally – as it seems – it is comforting to hear of a case where a patient is no longer forcibly being kept alive by machines. The Fort Worth hospital announced last Sunday that they will follow court order, cutting off life support to Marlise Muñoz. It seems that humanity has won. Marlise Muñoz and her baby will rest in peace and in time we will forget the debate around these two human beings – until another pregnant woman is pronounced brain dead.
We do have to face the fact that in an era of permanent evolution in medicine, not only physicians but also nurses have to debate difficult ethical decisions. And no matter how we decide, the decisions will remain difficult. For many people the case surrounding Marlise Muñoz sounded quite easy; the woman is dead, so allow her to die. But there was still the fetus to consider: a human being welcomed by his/her parents, able to inherit in case of a parent's death, and a person with legal rights. This person was still alive while the mother on whom she/he was still dependent was dead. Furthermore the mother had declared long ago that she wouldn't want to be kept alive by machines. But had she anticipated that she might carry a baby when this occasion would occur? Are we able to anticipate every possibility? Is respect for the wishes of a dead woman more important than the baby's right to live? Don't we have to anticipate that a mother, who wants to be pregnant, would do everything to save her child?
Several argued that the baby would have been born with disabilities had the mother been kept on life support until birth. This sparked a surprising reaction: many people who might otherwise have fought for this child's life, started to agree with the family’s wishes to let mother and child die. Here we enter the field of eugenics and selection. This switch in opinion shows that disabled children still only have a second class right to live. For me, as a German nursing historian who does research on nurses and midwives under the Nazi regime, this path of thinking leads down a very dangerous path.
The Code of Ethics by the International Council of Nurses demands that we take special care of our most vulnerable patients. Among these, I count dying persons. We have to ask ourselves whether we allow patients to die in grace and peace, whether we enable families to say good-bye, and whether we offer spiritual care. But as long as we use brain dead patients as carriers of organs, we do have to defend those babies who might survive inside their mothers' wombs – no matter if they are disabled or not. They are the most vulnerable of our patients.
Updated: Last weekend, before Ms. Muñoz, died, the hospital announced that the fetus would not have survived. In this case it would indeed have been cruel to the family to keep Ms. Muñoz alive. My arguments above refer to those cases when the baby - with or without disability - may be saved.
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