Life support for a dead pregnant woman for the sake of a pre-viable baby

Question

Suppose a pregnant woman dies*, and it's too early in the pregnancy for the baby inside her to have any chance of viability if delivered now, but if the woman's body is kept connected to life-support equipment for a few weeks, there may be a chance of keeping the baby alive inside long enough for it to be delivered as a viable.

(* For the purpose of this question, assume that either a) she has experienced brain-death but not heart-death, and the question is according to those who hold that brain-death is death; or b) she is considered dead according to all opinions, and the technology exists to make her body start working again shortly after death, sufficiently to give the fetus a chance. In other words, assume that there is no question at all of killing or saving the woman; this is just about the baby.)

1. Are new interventions to get/keep the body going (e.g. hooking up life support equipment):

   • required,

   • permitted, or

   • forbidden?

2. Is maintaining the body on life support (e.g. keeping it in the hospital and hooked up to life support equipment):

   • required,

   • permitted, or

   • forbidden?

The two main values I see in conflict here are the potential life of the unborn baby and the tampering with and delayed burial of the body. Of course, answers are welcome to address any other relevant Halachic issues.

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This question was inspired by the current controversy surrounding the case of Marlise Munoz, but note that I am seeking answers to the question as stated, not analysis of that case in particular.

Answer 1

Based on a lecture I'd heard from a Rabbi Weiner of Jerusalem who's a medical ethicist: The probable source to address this one is the discussion found in the Rishonim regarding the mishna in Yoma that a pregnant woman who feels she desperately needs to eat on Yom Kippur should do so. The commentaries there (I think it's the Ran off the top of my head?) say that obviously this would be the case if fasting would threaten the life of the mother; and practically, if it would threaten her pregnancy that would threaten the mother as well (as it's more dangerous to deliver a stillborn than a live baby); but even if we knew the mother would be 100% fine, we would still violate Yom Kippur to save the unborn fetus alone, because it is a "potential life" that we want to allow to develop into a full life.

Answer 2

In cases of total brain stem death lack of blood flow and oxygen to the brain leads to its swelling and disintegration. Patients diagnosed as brain dead using rigid criteria will systemically die within a matter of hours or days. However, with “Extended somatic support” which includes special medical efforts, some bodily function can be maintained for much longer periods of time, and a brain dead pregnant woman can often be kept "alive" until the fetus is viable for C-section (30 weeks).

Shalom is correct that (at least after 40 days) a fetus is considered a nefesh in Halachah and we are Michallel Shabbat to save a fetus in danger even if it is not yet viable. We violate and suspend all Torah law (save the three cardinal sins) to save the life of a fetus. If brain death is considered Halachik death, we must do all we can to save the fetus, including giving the mother extended somatic care, until the fetus is viable and can be safely extracted via a Caesarean section.

According to the opinions that brain death is insufficient to determine death, such a patient is considered a Goses (or safek goses). We may not move the patient, let alone perform a C-section. While the general rule is that we attempt every measure to prolong life, we don’t initiate new treatments that will only extend life for a relatively short period of time and cause additional suffering. it’s not necessarily obligatory (nor recommended) to initiate any extended somatic support to prolong the life of a terminal patient in the process of dying.

Since the child will not reach viability nor be delivered naturally, we don't even take measures to prolong gestation of a fetus that will never be delivered.

Therefore, in this particular case, many would rule that while life support should not be withdrawn, we don’t try to keep the mother alive to save the fetus.