This blog post discusses whether a brain-dead pregnant woman should be forcibly used like an incubator for the fetus’s life, and how we should view the issues of dignified death and abortion in such a situation.
Long ago, during my university days, I took a course called ‘Bioethics’. This course aimed to address various bioethical issues arising in modern society. After discussing abortion, it proceeded to examine brain death and the right to die with dignity. An intriguing story emerged during this process: the question of what decision should be made when a pregnant woman falls into a brain-dead state. At the time, I thought the likelihood of this happening was extremely low. I viewed it as a hypothetical problem, more for applying learned concepts than based on real events, and simply found it interesting. However, reality proved different.
On November 14, 2013, a child was born at Debrecen National Hospital in Hungary. This child was born after the mother, who was brain dead, gave her life to deliver it. The event became a major issue, gaining worldwide attention and moving many people. Conversely, on January 24, 2014, a Texas state court ruled to discontinue life-sustaining treatment for a woman who had fallen into a brain-dead state during her pregnancy. This was the result of the woman’s family winning a lawsuit against the hospital. While the problem of a brain-dead pregnant woman and her fetus may seem unlikely to occur in reality, it is indeed a real-world issue. Moreover, this problem is intertwined with the issue of the brain-dead pregnant woman’s right to die with dignity and the abortion issue concerning the fetus inside her, sparking significant controversy.
When addressing any issue, one must first identify its core subject. Therefore, before discussing the answer to this problem, it is necessary to discuss what brain death is. Currently, South Korea legally recognizes two states as death. One is cardiac death, which we can readily accept—a state where the heart no longer beats. The other is brain death, a state where the entire brain, particularly the brainstem which plays a central role in sustaining life, is damaged. When the brainstem is damaged, vital functions essential for sustaining life—such as breathing, maintaining body temperature, and regulating blood pressure—cease. Without mechanical support, this leads to cardiac death. Brain death is often confused with a vegetative state. A vegetative state involves damage to the cerebral cortex, resulting in a coma. However, since the brainstem remains intact, breathing and heartbeat persist. There is a low probability, but a possibility, of regaining consciousness. Conversely, if brain death is accurately diagnosed, the probability of regaining consciousness is virtually nonexistent. Therefore, a brain-dead individual is treated as deceased, making organ donation possible. However, a patient in a vegetative state retains the potential for recovery, making organ donation impossible. Ultimately, while brain death differs from cardiac death, it can be considered a definitive state of death. Consequently, a brain-dead body can be regarded as a corpse retaining warmth.
If brain death is recognized as death, what about the issue of fetuses? In reality, the chances of a fetus surviving after the mother is brain dead are extremely low. However, as mentioned earlier, survival cases do exist, so this issue must be addressed. The question of whether abortion is wrong or whether termination should be permitted has sparked intense debate throughout history. Furthermore, the fact that some who support euthanasia oppose abortion, or vice versa, can make this issue appear even more complex. However, this issue is not about the ethical permissibility of abortion, but rather whether the life of the fetus should be respected more than the dignity of the pregnant woman’s death. Framing the issue this way allows for smoother discussion.
In conclusion, there is no reason the life of the fetus should be held in higher regard than the pregnant woman’s life. Let us examine the reasons. Fundamentally, in any society, the use of a corpse is taboo. How a person’s body is handled after death—that is, funeral arrangements—is fundamentally determined by the wishes the person established during their lifetime. Anatomy classes using cadavers or organ donation also cannot occur without the individual’s consent before death or the consent of their family. Considering the number of lives that could be saved through cadaver research or organ donation, shouldn’t this be mandatory rather than optional? So why is consent required for this issue? This stems from the perspective that a corpse is not merely dead flesh, but that the dignity the person possessed in life must be maintained to some degree. Applying this thinking to the current issue, forcibly using a pregnant woman’s brain-dead body to save the fetus’s life is no different than treating the human body as an incubator and is equivalent to forcing organ donation on everyone. Therefore, two main solutions can be considered for this problem.
The first is to follow the wishes expressed by the person during their lifetime to those around them or in a will, in preparation for the possibility of brain death or becoming a vegetative state. The court decision mentioned in the second paragraph was aided by the fact that the woman had requested euthanasia should she fall into a brain-dead state during her lifetime. Similarly, just as body donation is possible with prior consent, the decision to use one’s body for the sake of the fetus within depends on the individual’s will. Thus, the decision on how to use one’s own brain-dead body is best made by the individual themselves.
The second scenario concerns cases where the person falls into a brain-dead state without having made any prior statement. When the person’s thoughts are unknown, the choice ultimately falls to those left behind. In such cases, the family’s decision may differ from the person’s actual wishes and can vary depending on the family’s circumstances. Therefore, a universally applicable method is needed for these situations. I believe that forcibly utilizing a brain-dead body violates human dignity, so I consider forced life extension wrong. The story of a brain-dead mother giving birth and then dying of cardiac arrest may be moving as an example of the greatness of motherhood, but a brain-dead person can no longer feel motherhood.
The second solution, which may provoke opposition as it includes my personal view, is that the most crucial factor is the person’s own will. Therefore, the most ideal solution is for everyone to consider in advance what they would want if they became brain dead and pregnant in that state, and to communicate this to those around them or leave a will. The real concern should be the use of one’s body against their own will.
