Case Studies

This case forces us to question the Kanfian principle that human beings Must never be treated solely as a means for the good of others. It also further complicates the already difficult questions surrounding the treatment of infants with anencephaly. Ms. F's request puts herself at risk not to benefit her fetus, who will die regardless of any intervention, but for the potential benefit to another child of her own child's organs. Not only is this fetus to be used to benefit another, but now the mother's own life may be put in danger to benefit a third person. For a variety of reasons, this cesarean section should not be performed. The rationale for refusing the woman's request emerges clearly when we analyze critically the most plausible arguments that might be put forward in favor of a cesarean section under these circumstances. The first, and perhaps most forceful, argument rests on the principle of autonomy. Some, including Ms. F herself, the transplant surgeon, and the potential recipient's family, might argue that the decision whether to have a cesarean section to her fetus is hers, and hers alone. This, in fact, is the very argument that has been made against forcing a woman to undergo a cesarean section against her will to save the life of a (presumably healthy) fetus. By the same token, the United States Supreme Court has upheld the freedom of a woman to have an abortion (within certain limitations) precisely because she has a right to privacy and to make decisions affecting her own body. How, then, can the principle of autonomous decision making by a competent adult be set aside in this case? Autonomy, important as it is, should not be the overriding moral principle in all cases. Indeed, the fact that a person requests a medical therapy is not in itself sufficient reason for the physician to comply. The Physician's decision must be based, first and foremost, on a professional judgment about what course Of action is medically indicated in the particular situation. In this case, there are no compelling medical reasons for Ms. F to have a cesarean section insofar as neither she nor her fetus stand to benefit from the procedure. Ideally, this issue should have been raised and discussed by the physician at the time the initial diagnosis of anencephaly was made. Ms. F would then have known in advance that a cesarean section would be performed only if her life were in jeopardy as, for example, in the case of placenta abruptio. In response, it might be argued that the benefit being sought here is not primarily medical, but emotional. Ms. F wishes to undergo surgery in this case for the psychological benefit she believes will result from finding some good in this tragic situation. Moreover, there are medical benefits (at least potentially) for the organ recipient and his or her family, and these may warrant performing the cesarean. The potential benefits to Ms. F depend on several contingencies, not the least of which is having a liveborn child, which occurs only in approximately 50 percent of cases of anencephaly. Even if a cesarean section were performed and the child delivered alive and not suffering from asphyxia, there is still a high probability that its organs would not be acceptable for transplantation. Not only is there an increased incidence of low birth weight among infants born with anencephaly between 5080% of these infants have a birth weight less than 2500 gm), but also an increased incidence of other congenital malformations of major organs (between 25 and 30% of these infants have gross malformations of at least one other organ). Either one of these factors might render the child's organs unacceptable for transplantation, and thus negate the potential psychological benefit to the mother and the possible medical benefit to the recipient. Finally, even if the child were born alive, of adequate weight and with viable, normal organs, a suitable recipient would have to be found and a successful transplantation performed before the mother could hope to gain any measure of emotional comfort

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• Living in Hope and Desperate for A Miracle

  Open Access•Janet Green•Journal of Religion and Health•2015

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