The Daniel Callahan Young Writer's Prize

Prize Summary 
This post is pleased to announce a new award, The Daniel Callahan Young Writer's Prize, sponsored by Daniel Callahan. Submissions will take the form of essays on a bioethics topic that are written as blog posts, designed for this blog, Bioethx Under 25. From all submissions, a group of finalists will be chosen and then an expert panel of bioethicists, including Daniel Callahan, will read the finalists' essays and award one prize amounting to $500. 

All submissions will be considered for publication on the blog and eligibility to be a finalist or receive the prize is dependent on willingness to edit and revise the essay for publication. Submissions will be judged anonymously. Please see guidelines below for further information. 

Prize Submission Guidelines

- Essays must be 500-1000 words and original submissions to Bioethx Under 25 i.e. never posted before on the blog. 

- Essays must conform to all other submission guidelines for the Bioethx Under 25 blog and thus, be clearly related to bioethics and be written in an accessible manner. Please refer to the blog's About Page for more information. 

- Essays will be accepted from September 10th, 2014 to November 15th, 2014. 

- Any writer who is also a student in high school, college, or a graduate program is eligible to submit. Any writer who is not a student is eligible so long as he/she has not completed a PhD and/or worked more than 5 years in the bioethics field with a terminal degree (e.g. JD or MD). So long as the other guidelines have been met there is no age limitation or requirement for submission. 

- Writers are not eligible if they currently or have previously worked full time for The Hastings Center or Daniel Callahan. Anyone affiliated with Bioethx Under 25 in an editing capacity is also ineligible. 

- To submit, please email bioethicsunder25@gmail.com with your essay attached in word format. In the body of the email please indicate that you are submitting for The Daniel Callahan Young Writers Prize and include your name, phone number, email address, current occupation and place of occupation (if a student, then your school, potential degree, and expected graduation year), and your highest degree attained with the school and year. 

- For any questions please email bioethicsunder25@gmail.com or comment below. 

About Daniel Callahan

Daniel Callahan is Senior Research Scholar and President Emeritus of The Hastings Center. He was its cofounder in 1969 and served as Director and President between 1969 and 1996.  Over the years his research and writing have covered a wide range of issues, from the beginning until the end of life. In recent years, he has focused his attention on ethics and health policy.

He has served as a Senior Lecturer at the Harvard Medical School and is now a Senior Scholar at Yale. He received his B.A. from Yale and a PhD in philosophy from Harvard. He has honorary degrees from the Charles University, Prague, the Czech Republic, the University of Colorado, Williams College, Oregon State University, the State University of New York and the University of Medicine and Dentistry of New Jersey.

Callahan is an elected member of the Institute of Medicine, National Academy of Sciences; a former member of the Director’s Advisory Committee, the Center for Disease Control and Prevention, and of the Advisory Council, Office of Scientific Responsibility, Department of Health and Human Services. He won the 1996 Freedom and Scientific Responsibility Award of the American Association for the Advancement of Science. He is the editor or author of 47 books. 

Hobby Lobby and Freedom from Religious Employers

By Naomi Scheinerman

The decision in Burwell v. Hobby Lobby Stores has been severely scrutinized, from rebukes against corporate personhood to feminists decrying that the Court’s majority, five conservative male judges, devalue and deny women’s personhood. Justice Ginsburg’s scathing dissent and Justices Sotomayor and Kagan’s equally passionate disapproval offer a gendered lens that is impossible to ignore. And further, the Hobby Lobby decision actually does far more harm than good in protecting religious freedoms.

First, Hobby Lobby’s anti-contraception argument relies on fallacious scientific claims that will facilitate further violations of the corporation’s religious beliefs. Hobby Lobby objects to the two IUD’s and Plan B and Ella (emergency contraception) by claiming that using them is akin to having an abortion. This is false. Plan B and Ella prevent ovulation which prevents pregnancy after sex. The International Federation of Gynecology & Obstetrics published a study concluding that because Plan B does not inhibit implantation, it is therefore not an “abortifacient,” a substance that induces abortion. Because Hobby Lobby argued that emergency contraception equals abortions, when in fact emergency contraception does NOT equal abortions, the Court should have thrown out Hobby Lobby’s arguments. As a result of this decision, women who work for Hobby Lobby and are now denied emergency contraception coverage will be much more likely to seek an abortion in their future. Half of women who purchase Plan B do so because of unplanned pregnancy (which includes both consensual and non-consensual sex). Hobby Lobby is paving the way for more abortions, not fewer.

Second, Hobby Lobby’s small closely held corporation’s religious freedoms are being protected at the expense of the freedom from religious imposition on its employees who rely on health insurance to access reproductive freedoms. A closely held company is one in which five or fewer people own the majority of the company. Not only is it strange to treat a corporation as a person with its own convictions, but this decision shows that the Court prefers the religious arguments of a few people in charge over the views of many more who actually work for the corporation. The Religious Freedom Restoration Act of 1993 (RFRA) – the legislation that Hobby Lobby claimed the contraception mandate violated - was originally enacted to protect Native Americans from laws that burdened their exercise of religion. As such, the RFRA was originally constructed to protect employees from theburdensome religious standards of employers and laws. In fact, Catholic and other Christian denominations were even opposed to the RFRA initially because they thought it would protect the “right to a religiously-motivated abortion.” Even if an employee of Hobby Lobby does not have a religious conviction to use contraception, the employers of Hobby Lobby are imposing their religious views by forcing the employees’ actions to align with their own religious practices that forbid abortions. An individual at Hobby Lobby, who is not one of the five people in the entire corporation who wants to prevent contraceptive access, is burdened, something the RFRA was meant to prevent, not allow.

Third, there is real danger in granting religious freedom to corporations that claim exemptions to laws. In Callahan v. Woods, for example, taxpayers used the RFRA to object to the use of social security numbers, arguing that they related to the “mark of the beast.” The Court dismissed this argument. Since the release of the Hobby Lobby decision, many companies have come out of the woodwork, claiming religious exemption to other laws that ban discrimination in hiring or protect women’s reproductive freedoms. The Court ruled that the religious freedom is protected when the law imposes a “substantial burden” on the corporation. This should be interpreted to what the corporation does (its business and goals) rather than how the five or fewer owners feel about the actions of their employees. Is it a substantial burdensome to the selling of paint and brushes to allow female employees to obtain emergency contraption or an IUD?

My last fear is that real and compelling claims of religious exemption, wherein an employer or employee has a true and ethical, religious  belief that a law severely infringes, will become watered down by the numerous unethical claims. About 90% of all American businesses fit the category of closelyheld.  Corporations should not be in the business of determining the appropriate health care package for employees based on religious convictions when it overrides the individual employees’ values. This places an inordinate amount of control on employees’ actions outside the office, such as their reproductive decisions, something the Supreme Court declared was protected by the right to privacy. Employers should not define employee competency by her personal life decisions, but rather based on qualifications and aptitude for the job. This is why employers should not discriminate against gay applicants and should not dictate the sexual freedom of its female employees. Justice Ginsburg accurate identified the dangers of the Hobby Lobby decision: it validates inordinately unethical claims of religious exemption that employers have no right to make.

Naomi Scheinerman is a Research Assistant at The Hastings Center. She graduated Phi Beta Kappa, with high honors and in distinction from the University of Michigan in Ann Arbor, where she received bachelor’s degrees in philosophy, political science, and Hebrew and Jewish Cultural Studies. She contributes a bi-weekly column on reproductive health.

Medical Doctors Should Remain "Medical" Doctors

By Naomi Scheinerman

Earlier this year, Britain’s Faculty of Sexual and Reproductive Health, a faculty of the Royal College of Obstetricians and Gynaecologists (RCOG), issued guidelines establishing that the faculty’s Diploma qualifications include a “willingness to prescribe all forms of hormonal contraception, including emergency contraception, regardless of personal beliefs.” Though welcome to undergo the training, those who “hold moral or religious reservations about any contraceptive method,” will not be able to “complete the syllabus [rendering] candidates ineligible for the award of FSRH Diploma” - a legal requirement to practice obstetrics and gynecology in England. Though clinicians may abstain from both performing and counseling regarding abortions, they are required to provide full information on options for unplanned pregnancy and make “timely arrangements” for the patient to see a doctor who is comfortable counseling on abortions.

In this post, I will address three questions: Does the Faculty have the authority to issue guidelines on this matter? If so, are these the correct guidelines to issue? And should we make exemptions to those who hold conscientious objections for religious reasons?

Does the Faculty have the authority to issue guidelines on this matter?

The medical world offers numerous examples of authoritative bodies passing rules of ethical and appropriate treatment. For example, guidelines have codified that informed consent must be acquired from a patient undergoing a medical procedure or participating in a clinical drug trial. Another example: U.S. federal law (HIPPA) protects a patient’s privacy of personal health information such that doctors may not share information with others without the patient’s permission. The authority of the Faculty to issue program guidelines regarding its training is perfectly consistent with our expectations that the medical community governs practitioners’ medicine to ensure ethical and safe care. Medical care cannot be divorced from value judgments, and thus medical training must be considered alongside medical decision making.

Is requiring willingness to prescribe contraception an acceptable use of the Faculty’s power to dictate appropriate medical practice?

I argue that the job of prescribing birth control has become a central part of the job of a gynecologist, and it should be for a number of reasons. Birth control is an ethical and safe option. Women have the right to control their reproduction, and doctors therefore have an obligation to provide access to the means to do so. Patients do not have unlimited rights to services from their doctor - a doctor could and should refuse to operate on an individual who does not need to be operated on. Contraceptive access, in contrast, is not an extravagance, but rather is an important tenant of women’s health. More than just allowing her to regulate her period and perhaps mitigate the negative and uncomfortable experiences of her “natural” cycle, contraception allows women to practice family planning, which has far reaching implications for her overall wellbeing by affecting her job, income, relationships, social network, and status. These results may also be beneficial for her family relations and friendships, as well as, of course, the wellbeing of a child from a pregnancy she neither planned nor wanted. Furthermore, denying a woman access to birth control denies her valid medical desires. Granted, what constitutes a medical necessity is illusive: ultimately numerous medical and nonmedical treatments lead to better welfare and happiness, but it seems strange to classify them all as necessary. However, because birth control affects the body chemically and hormonally, it should be classified under the purview of medicine, and therefore falls within the medical profession.

Should we make exceptions for conscientious objectors, particularly religious conscience objectors?

Just as a conscientious objector to informed consent should be barred from conducting clinical trials, so too should a gynecologist who refuses birth control to women. First, the merits of an argument for conscientious objections must be evaluated, regardless of whether it is religious or nonreligious. One of the primary arguments against contraception is that they are akin to abortions and therefore immoral. This argument is invalid because it relies on a false claim: contraception prevents pregnancy, it does not terminate it. Take for example the anti-vaccine movement: when deciding whether to allow doctors to refuse to vaccinate children, we should only give weight to arguments that are based on scientific claims regarding the safety of vaccines.

Another argument given against contraception is that it increases the rate of casual sex, in particular sex out of wedlock. First, this is a faulty understanding of statistics: access to birth control neither increases nor decreases rates of sexual intercourse, but instead makes it safer. A similar argument was made in the case against the HPV vaccine trials: developing a vaccine that protects against certain kinds of cervical cancers would make girls more promiscuous. This value-loaded claim attempted to maliciously bar an important way to increase sex safety for women and was then proved to be factually incorrect. Even if contraception did increase the rates of sex, either before or after marriage, the argument must prove why this is negative.

Religious reasoning should be scrutinized as vigorously as nonreligious reasoning. For example, the value of having a family is often cited in opposition to contraceptive use by referring to religious texts. However, one could just as easily interpret the value of family in another way: birth control allows women (and their partners) to choose when to have a family, thereby making a more secure, safe, and well-off household. Religious preferences in the medical world should be tolerated only if they do not harm the patient’s welfare. Denial of birth control can and does cause such harm. Religious objectors claim that a patient could see a different doctor, but there are many examples in which this is unfeasible. For instance, a young teenager who wants to become sexually active and is hiding her doctor’s visit from her parents may not simply be able to switch physicians or may be too intimidated to try after being driven off the first time.

The Faculty’s rules are not only permissible, they are imperative for women’s health. They do not suggest that all women should seek birth control or will, nor do they demand that all gynecologists prescribe birth control to all women. Ultimately, the Faculty’s rules are valid because they demand that doctors provide ethically valid and vital medical options to their patients.

Naomi Scheinerman is a Research Assistant at The Hastings Center. She graduated Phi Beta Kappa, with high honors and in distinction from the University of Michigan in Ann Arbor, where she received bachelor’s degrees in philosophy, political science, and Hebrew and Jewish Cultural Studies. She contributes a bi-weekly column on reproductive health.

Hobby Lobby and its Hypocrisy: Religious Demands on Others and Investment in Contraception

By Naomi Scheinerman 

Last week, the US Supreme Court heard oral arguments from Hobby Lobby (a chain of craft stores) and Conestoga Wood (a cabinetry company) who both claim religious exemptions from the Patient Protection and Affordable Care Act (ACA) contraception coverage. A recent story from Mother Jones reveals that Hobby Lobby has actually “spent millions of dollars on an employee retirement plan that invested in the manufacturers of the same contraception products the firm’s owners cite in their law suit.” In addition, the company also provided insurance plans to its employees that covered the very contraception they now reject for years before the ACA mandate required it. Although this information may not be crucial for the Court in its decision making, these revealed factors call into question the veracity and legitimacy of Hobby Lobby’s religious objection alongside considerations of justice and ethics in potentially granting an exemption.

For example, one concern is whether the Court should consider arguments based on faulty scientific claims. Hobby Lobby argues that they have no moral objection to the use of the majority of the contraceptives required in the mandate and will continue to cover access to these. Rather, they object to the copper and hormonal intrauterine devices (IUDs) and Plan B and Ella, “emergency” contraception taken after intercourse. Hobby Lobby claims that because these prevent a fertilized egg from implanting in the uterus, they function as abortions. Hobby Lobby is sadly not alone in erroneously labeling Plan B and Ella as so-called “abortion pills,” when in fact they do not terminate pregnancy because they work before pregnancy begins. Even if Hobby Lobby has a valid religious objection to abortions, they are fallaciously applying it to this case.

Legally, the Court has also been asked whether corporations can even claim religious exemptions. Hobby Lobby has Christian owners, but its employees are not exclusively Christian and therefore it is hard to define it as a distinct Christian corporation. Although the Court has ruled that corporations operate as individuals in terms of campaign finance laws, it has yet to extend this argument to other realms. This brings me to one of the most pressing questions: Does claiming religious exemption actually impose a religious ruling on others? Though Hobby Lobby claims it does not want to be imposed upon, its attempts to deny coverage of IUDs, Plan B, and Ella impose on its employees because they may have no moral objection to accessing these forms of birth control.

Further, when do religious exemptions to health coverage end? At what point should we consider right of access to be absolute and religious exemptions as inferior claims because they overshadow a more pressing moral concern in society? Can Hobby Lobby claim objections to vaccinations? Cancer treatments? Kidney transplants? Some religious groups do, and the Court would be quite quick to throw out those cases as extreme and an overt denial of rights of access. Hobby Lobby’s claims against IUDs, Plan B, and Ella are not so different. Emergency contraception can be vital for a woman who was raped or just wants the freedom to live a life without a child imposed upon her. Research has shown that unintentional pregnancies are linked with delayed prenatal care, low birth weight, maternal depression, prevention of education and jobs otherwise accessible to the mother, and family violence. These are good health reasons to offer the access and claim any denial of access as an abuse of religious arguments and an imposition on others’ freedoms from religion.

Naomi Scheinerman is a Research Assistant at The Hastings Center. She graduated Phi Beta Kappa, with high honors and in distinction from the University of Michigan in Ann Arbor, where she received bachelor’s degrees in philosophy, political science, and Hebrew and Jewish Cultural Studies. She contributes a bi-weekly column on reproductive health.

4 Months 3 Weeks and 2 Days

By: Ty Bourgoise

This is part of a series on films and other media relevant to bioethics. Like recommendations, these reviews are here to help you find intelligent media you may or may not have heard of. So anything I review here, you can assume, bears my endorsement--go see it, read it, enjoy, and think.

Ceausescu-era Romania is grey, blue, and lit everywhere by the special effect of halfway burnt out bulbs. In the dimness, women throughout Gabita and Otilia’s dorm are concerned with how they look; judging by the number of cosmetics trading hands, beauty is one of those few freedoms an oppressed Romanian woman is allowed. A sane abortion, however, is one they aren’t.

In Christian Mungiu’s Palme d’Or winning film, 4 Months 3 Weeks and 2 Days, we see the extent to which they aren’t, and more. Very much more. The basic premise, though, is that Gabita, who needs an abortion, recruits her smarter and more practical roommate, Otilia, to handle the logistics. What unfolds is focused less on Gabita than Otilia. The result is something more thrilling and horrific than the best thrillers and horrors.

Because abortion is highly illegal, Otilia and Gabita have to make the latter’s a secret. In fact, for the first 35 minutes of the film there isn’t a peep of it. Otilia runs around, paranoid, collects money, doesn’t book a hotel room, books one, sneaks into it, and there haggles with exactly whom you’d expect to sell illegal abortions in 80s Romania: burly, enterprising, and charmless, a one “Mr. Bebe”, with his tools in a briefcase he does not want touched. A hotel bedroom is both his surgical and trading floor. Though, from the look on his, Gabita, and Otilia’s faces, you’d think this was a contract kill. This comparison might even overplay the apparent legitimacy of the procedure.

To “contract kill”, however, is the right comparison. Ceausescu’s regime was notably Orwellian with its conviction that aborting a fetus and murdering a person are morally equivalent. The acts are both relegated to the black market. But, in an odd scene, Otilia buys (presumably taxless) cigarettes from a random black marketer loitering in a hotel lobby. No one complains. Generally, it seems, everyone must tacitly trade in the illegitimate, only no one is willing to discuss or sympathize over this common misfortune. Such is the world that’s unsympathetic to Gabita and Otilia: it is inconsistent, and thereby amplifies the sense of possibility (and terror) that can be used to exploit these women. We know that their and Mr. Bebe’s punishment, if caught, would be draconian and arbitrary. 

After a nightmarish compromise, the success of the Gabita’s procedure is not the end of anyone’s troubles. Foil #2, after Mr. Bebe, is Otilia’s boyfriend, Adi—kind of attractive, kind of a jerk. After the lengths of secrecy we’ve seen Otilia and Gabita go, we’re nervous to see how he’ll react to Otilia’s news (Unwittingly, he partially funded Gabita’s abortion.). What actually happens, while perhaps not insane—he’s plain-vanilla clueless—makes the movie more interesting. We take his misunderstanding as a relief: well at least he didn’t flip out. But what a low bar for a support system! It’s not that Adi wants to call the cops, like others in Romania we presume would. He wants to fix Otilia’s anxiety; he just barely knows how to. “What if you needed [an abortion],” he says parroting Otilia’s question, “but it won’t happen to us!”

His misguided support causes us to wonder at Otilia’s interior state. Just because the Ceacescu has a clear stance on abortions, that doesn’t mean women receiving them have the space to process what they mean. Gabita wants to finish college; Otilia wants Gabita to be able to do so. But when it comes to the fetus itself—what is it? How does the intelligent Otilia comprehend her friend’s situation? After it’s done, Gabita tells Otilia she “got rid of it […] It’s in the bathroom.” From Otilia’s eyes we see that hump of cellular mass, unceremoniously thrown onto a towel in a trash bag on the bathroom floor. The fuller the picture gets, the less Otilia seems to know what she’s seeing. Or she’s horrified by what she sees. Or both, we don’t know: she doesn’t get an opportunity to express her feelings with anyone. Just silence.

The need to be silent is a force in these women’s lives, complicating what’s already complicated. Of note is that the movie has no soundtrack. Silence prevents Otilia from expressing frustration at one of her boyfriend’s family’s bougie dinner party. At said offensively aloof dinner party, Otilia, silently, endures a barrage of classist slights at her background. Silence is even in the very last scene, as Otilia finds Gabita, no longer in shock, treating herself to a platter from a wedding party in the hotel lobby: breaded brains, marrow, liver, and other charcuterie that blurs the reality between offal and delicacy, mirroring the person/thing distinctions that befall a fetus. We can see Otilia wanting to say something, but she’s so misunderstood from all angles, why would she? Intimacy, compassion and understanding seem like such far off longings.

Mungiu is happy to employ twisted ironies to ask questions of law, women’s rights, and biology. You’ll have to watch his movie to find answers, which are bound to be controversial. Though he’s clearly aghast of totalitarianism and exploitation, Mungiu is not merely, I believe, depicting a fight between good and evil. In that way, 4M3W2D doesn’t tie a bow on the morality of abortion. It just views it through x-ray vision.

As an American, I am struck by how easy it is to see 80s Romania as being like where I live. Romanian communism has traces of metaphor for how the US turns a moral and cultural blindeye on women who need abortions. Even in liberal states where abortionists are not murdered, women who opt for the procedure are stigmatized to the point of emotional isolation. But things can be worse, right? In some states, it’s been the path of least political resistance to forfeit women’s rights through legislation, pushing them into other states or just away; out of sight, out of…. Such spaces for women in those states are ripe for, 4M3W2D shows, horrific exploitation. So, best be abstinent, the logic goes, or act like nothing’s wrong. After all, who’s to blame for an unwanted pregnancy but you? Certainly you have no right to be upset about it.

Ok. Well. Mungiu gives Mr. Bebe a great metaphor to condense this attitude. “If the probe comes out, we’re done,” he harps in his medical instructions to Gabita. “You cannot move under any circumstances”. Don’t move. Don’t squirm, don’t cry, don’t cope. Barely express, but preferably don’t at all. Gabita may wail and yelp and nearly fail on all counts, but Otilia “performs,” disturbingly well. 

Ty Bourgoise is a writer living in New York.

Lowered Abortion Rates: Good or Bad Sign?

By: Naomi Scheinerman

On Monday, February 3, 2014, the Guttmacher Institute published a study revealing that U.S. abortion rates are the lowest since the Supreme Court upheld the right to have an abortion in Roe v. Wade (1973). Although the study did not investigate reasons for the decline, it concludes that it was not due to the surge of abortion access restrictions passed from 2011 to 2013, nor was it due to a decreased number of providers. The authors also found that there was a proportional increase of early stage abortion inducements to later surgical procedures.

So, what can we conclude about the study? Why have abortion rates gone down? And, how should we feel about lowered abortion rates? Is this a good thing? What might this indicate about our society?

The Guttmacher Institute’s overarching goal is “to ensure the highest standard of sexual and reproductive health for all people worldwide.” Do lowered abortion rates mean that women are achieving a higher level of sexual and reproductive health in connection with the Institute’s goals? On the one hand, women should have access to means of contraception: the pill, condoms, IUD’s, etc. On the other hand, women should also have access to abortions. It seems that lowered abortion rates indicate a rise in access to contraception, increased freedom for women, and overall awareness of rights, access, and sexual health. So, abortion rates lowering (when it is not due to restrictions or scarcity of providers) is a good thing.

If we peer further, are lowered abortion rates beneficial for reasons other than their indications of other rights (access to contraception) in society? In other words, could they be ethically preferable? 

What differentiates an action between being ethically preferable and permissible? In order to determine ethical preference, it is important to compare the action being evaluated with its alternatives. The relative value of an action must be viewed in context with the array of other possibilities. Ethical permissibility indicates that the action, in isolation, is itself ethically allowed. Planting a tree to help with carbon sequestration is ethically permissible, and can often be ethically preferable (to chopping down a tree, for example), but not ethically preferable to taking public transportation to avoid carbon emissions in the first place.

The act of having an abortion itself is ethically permissible because a woman has the right to determine what happens to her body insofar as she does not harm another living human being. A fetus, until viability, does not have the moral status of a human being. The fetus deserves our respect, but ultimately its life should not be valued above either the physical or emotional welfare of the mother. Thus, for any reason: whether she and her partner’s condom broke or she was raped, a woman should have access to an abortion, and not be compelled to undertake the burden of bringing a life into the world.

Thus, in the case of abortion, the alternatives are often not preferable. If a woman feels she is incapable of having a child or cannot offer that child the best life possible, it is ethically preferable to terminate the pregnancy. However, in light of access to contraception, education, and increased awareness of women’s rights that can avoid an unwanted pregnancy, abortion is not ethically preferable.

As such, we return to the conclusion that lowered abortion rates are good insofar as they indicate increased access to contraception and awareness of women’s rights. Abortions are themselves ethically permissible; therefore, there should not be a huge cause for moral concern if there is an increase of them. However, in light of ethically preferable alternatives, we should celebrate decreased abortion rates, which often herald opting for those alternatives.

Naomi Scheinerman is a Research Assistant at The Hastings Center. She graduated Phi Beta Kappa, with high honors and in distinction from the University of Michigan in Ann Arbor, where she received bachelor’s degrees in philosophy, political science, and Hebrew and Jewish Cultural Studies. She contributes a bi-weekly column on reproductive health. 

Dead Women Are Not Incubators

By Naomi Scheinerman 

On November 26, 2013, Marlise Munoz suffered a pulmonary embolism – a blood clot in the lung – in her Fort Worth, Texas home. Her husband, Erick Munoz, a paramedic, found her on the kitchen floor where she had collapsed and lay unconscious for over an hour. He administered CPR and called an ambulance, which rushed her to John Peter Smith Hospital. The doctors put her on a ventilator and restored her heartbeat, but soon determined that she had suffered “irreversible cessation of all spontaneous brain function,” or brain death. Her husband requested that she be taken off the ventilator, but the doctors refused. Marlise was 14-weeks pregnant and the Texas Advance Directs Act stipulates, “A person may not withdraw or withhold life-sustaining treatment under this chapter from a pregnant patient.” Erick, Marlise’s parents, and several medical and legal experts agreed that the state law should not apply because the ventilator was not “life-sustaining” because brain death is a legally binding definition of death accepted by all 50 states. Finally, after weeks of appeal, on Friday, January 24, Tarrant County District Judge R.H. Wallace ordered the hospital to disconnect Munoz from her ventilator.

Now, why discuss brain death in a reproductive health column?

Here are some of the many questions one should ask about this case: what is the point of an advanced directive if state laws can override them? Can there be any exceptions to our understanding of brain death? Should it matter how long the woman has been pregnant? Does the mandate apply to all pregnant women, regardless of their neurologic condition? I would like to focus on the last question. The short answer is this case is not about defining death as brain death, it’s defining a fetus as a living human being. At the time that Marlise Munoz became brain dead, she was 14-weeks pregnant. Texas’s laws regarding abortions are (coincidentally?) some of the more restrictive in the United States.

In addition, there is a sad irony in this case: the law preserves fetal life to keep a dead woman hooked up to a ventilator at the expense of medical equipment. However, this only fosters a potential individual whose existence will be replete with suffering and sadness. Because Munoz’s fetus was without its mother’s properly circulating blood and therefore oxygen, doctors and lawyers speculated that there would be severe health ramifications. On January 22, Munoz’s lawyers declared the fetus “distinctly abnormal.” For example, gender can normally be determined between 18 and 20 weeks and at 22 weeks, Munoz’s fetus’s “lower extremities [were] deformed to the extent that the gender cannot be determined.” Texan law, as such, was serving to not only keep a dead woman on a ventilator, but to create a human being whose chance at a healthy happy life was completely lost as a result of the law that tried to insure its existence.

One may fairly ask: What if the woman entered persistent vegetative state and the fetus was 30 weeks? According to NPR, the “authors of the Texas Advance Directives Act intended to keep a pregnant woman who was in a persistent vegetative state on a ventilator until she could deliver.” Turns out the authors of the law never intended for the hospital to interpret keeping a dead woman “alive” in order to serve as an incubator for the fetus.

Naomi Scheinerman is a Research Assistant at The Hastings Center. She graduated Phi Beta Kappa, with high honors and in distinction from the University of Michigan in Ann Arbor, where she received bachelor’s degrees in philosophy, political science, and Hebrew and Jewish Cultural Studies. She contributes a bi-weekly column on reproductive health.