Redefining Death, Reaffirming Life

A pregnant woman is declared “brain dead” and then her body keeps doing things that look unmistakably like life: healing, digesting, fighting infection, and sustaining a growing child. That single fact forces a question most of us would rather avoid: are we naming a biological reality, or drawing a legal line that serves other goals?
 
 We sit down with Dr. William Lyle (OB-GYN), Dr. Jeffrey Bishop (bioethics and philosophy), and Dr. Heidi Klesig (anesthesiology and pain management) to unpack how the modern brain death definition developed, why the 1968 Harvard criteria still spark controversy, and how organ transplantation and ICU ethics shaped the way medicine talks about death. We also dig into the “squishy” historical window where practice, law, and philosophy did not neatly match, and why that matters for end-of-life decisions today. Then we face the hardest test case: a pregnant woman declared brain dead and the medical and moral decisions surrounding continuing life support to give her unborn child a chance. 

If this conversation challenges your assumptions about the definition of death, medical ethics, and pregnancy care, subscribe, share this with a friend, and leave us a review so more people can find it. 

Transcript

Life Support And An Unborn Child

Dr. Lile 0:03

Just the fact that our maternal fetal medicine care is advanced, that even for whatever reason mom has passed away, we can use that mom and use that amazing life support system of the mom to preserve and propagate and then to deliver not just life in the womb, but deliver that life where it can survive outside of the womb. So I find that absolutely fascinating that we can do that.

Victor Nieves 0:37

Welcome to Straight Talk on Life Issues. I'm Victor Nieves, president of Life Issues Institute. Brain death during pregnancy is an exceedingly rare event. In a study of 30 reported cases from 1982 to 2010, the average duration of support was around 38 days, with the longest case lasting 107 days. Notably, 12 of the 19 cases, the reported outcomes, healthy babies were delivered with only one instance of congenital defects. Today we're going to be talking to several experts about brain death and pregnancy. We're joined by Dr. William Lyle. He's board certified in obstetrics and gynecology. He has served as a hospital OBGYN department chair and as an instructor with both the University of Florida and Florida State Medical School OBGYN residency program. We're joined as well by Dr. Jeffrey Bishop, a professor of philosophy and theological studies at St. Louis University, where he holds the tenant-endowed chair in bioethics. Lastly, we're joined by Dr. Heidi Klesig. She received an American Board of Anesthesiologies Board Certification in Anesthesiology and the ABA Certificate of Added Qualification in Pain Management. Dr. Klesig, Dr. Bishop, and Dr. Lyle, thank you all so much for joining us today.

Dr. Klessig 1:49

Thanks so much.

Dr. Lile 1:50

It's an honor to be with you, Victor.

Victor Nieves 2:02

Well, I think the best place for us to start out in this conversation is we need to have something of a working definition of brain death. As I understand it, it's actually a little bit more complicated than some people may think. So if you could provide the listener with a simple understanding, if that's even possible, of brain death, what would it be?

Dr. Klessig 2:21

So brain death was engineered in 1968 by 13 men at Harvard Medical School. They wrote a landmark article in the Journal of the American Medical Association. The title of this article was A Definition of Irreversible Coma. Interestingly, this paper has no scientific references. There were no tests, there was no evidence, there were no studies to suggest that people in a deep coma who heretofore had always been considered to be alive were now somehow dead. In fact, in the paper, the Harvard Committee never makes mention of the fact that they thought these people were dead. In fact, they they described these people as being desperately injured. And they said that these people's lives were a burden to themselves and to others. And the only reason that they put forth as to why comatose people should be considered as dead was uh social utilitarian reasons. They said, first, these if we would declare these uh neurologically injured people to be somehow dead already, it would free up ICU beds. And the second reason they gave was that it would remove the controversy over taking organs out of comatose people to put into somebody else. So brain death from the beginning has been a legal fiction, it's been an ethical choice, masquerading as a medical thing.

Victor Nieves 3:42

Wow. Dr. Bishop, do you have anything that you'd like to add to that?

Dr. Bishop 3:45

Well, there's uh a couple of other things to add. It wasn't until the possibility of heart transplant came on the scene that people began to conceive the possibility of a different way of being dead. By all definitions of death at that time, death was defined as cardiovascular collapse, complete and irreversible cardiovascular collapse. And it is true that people in the similar state, it was actually called, there was a French name for it, it was called coma de passe, P-A-S-S-E, and it meant the beyond coma. And people who were in that state, we think would meet the criteria of brain death that were just developed later. However, the historical work and archival work by a woman named Giacomi just describes the fact that there was no one in coma de passe, no doctors who had patients and this deep coma, this beyond coma, ever questioned whether they were alive. So all of that's true. When do you know someone's dead? Well, when there's a skeleton there, right? Or when there's uh flesh decaying there, or if there's rigor mortis, and people would want to know when someone was dead for purposes of dispatching their property, you know, how the will should be read. So they wanted to know that the person was dead and when they were dead for that reason, and then also for a burial purpose. When is the person dead for burial purposes? And throughout history, prior to any of this, throughout history, there were often long waiting periods after someone seemed to have died just to prove that they had died, so that they wouldn't be put into the grave prematurely or that the property would be dispensed with prematurely. So often it was social utilitarian reasons that we were using the definitions of death were very different. That brings us to the question of whether or not brain death is in fact something that we can discover. And so while it's true that this was and it technically still is a legal fiction, but there are all kinds of legal fictions that we all live by to this day. This is one of those legal fictions by which we live by. We can't say when a patient has died, that's a temporal time and living things are in processes. And when they're in processes, you can't really draw a line when those processes flip from being processes of living and become processes of decaying. So it's really hard to say when someone has died, as if there's a moment in time. We can say that someone has died, for instance, when there's rigor mortis, we can say that the person has died. And then we have, as the society said, that well, we can also say that a person has died when there is whole brain death at that time. So what we've done is removed it from something like rigor mortis to a kind of utilitarian position and moved it back further, closer to something like whole brain death. And so as things developed from 1968 forward, people began to formulate conceptual definitions of death. And then by the time you get the president's commission on ethical issues, they write a whole white paper describing what they mean conceptually by death, and then try to figure out operationally how you then pick out an instance of death in the world. So the later philosophical work for the development of the concept of brain death and then for the operationalization of what counted as dead would take several years to actually unfold. And so then the question is well, were the people under the law dead when they removed their organs between 1968 and 1981 when that commission's uh publication came out. And that's one of the weird little squishy parts within history that there's a lot of contention of.

Adriana Smith And Two Patients

Victor Nieves 7:24

Dr. Lile, I'd like to bring you in on this conversation. You know, in the past, here on the show, we've discussed brain death, you know, just as its own standalone, we've discussed it as it relates to organ harvesting. But I want to talk today about brain death as it relates to pregnant women and whether or not a pregnant woman should be receiving life support. Dr. Lyle, can you weigh in on that for us?

Is This “Using Her Body”?

Dr. Lile 7:44

Sure. And of course, we're thinking about the case that occurred at the Amory Hospital in Atlanta, Georgia, where we had a mom who was about nine weeks pregnant. And bottom line, she was declared brain dead and they didn't see activity. And they had questions about well, can we disconnect or do we have an obligation to provide, you know, nutrition and life support for the baby inside of her womb? And obviously, if she was nine weeks pregnant, uh, her desire was to continue this pregnancy because in in uh Georgia you cannot have an abortion. So all the indications from family and friends would say she had no plans on terminating this pregnancy. I mean, I'm practice obstetrics and gynecology. I've delivered over 5,000 babies in the 30 years I've been here in Florida. Whenever I have a pregnant patient come into my office, I actually have two patients. And if she has twins, I have three patients and I've delivered triplets and quadruplets. And when I had quadruplets, I've got five patients coming in my office every day. And it's not just an image of a baby on the inside of the womb. This truly is a patient now where science has progressed that we always knew they were separate. In fact, half the time it's a different gender from the moment of conception, but 20% of the time the baby can even have a different blood type. And genetically, the baby is always going to be genetically unique from the mom, the dad, and the other 8 billion people on the planet. But it's not just their uniqueness, they are now both medical and surgical patients. Where we are now doing blood transfusions. Cleveland Clinic has done blood transfusions for babies in the womb as early as 15 weeks after the moment of conception. Why would a baby need a blood transfusion? Because the baby has a different blood type often from the mom, and the moms can develop antibodies which will attack the baby's blood, and that blood count will drop. So it's routine. It's called a PUBS, a peri-umbilical blood sampling and transfusion. We're doing open heart surgery for babies in the womb where we see tumors called a cardiac teratoma in the baby's heart, which are growing so quickly that we only have two options. We can either deliver this tiny premi at maybe one pound and then do open heart surgery on the baby, but now we have a one-pound premi that is recovering from open heart surgery. So the Cleveland Clinic has now done open heart surgery to remove tumors from the baby's heart while the baby is still inside the mother's womb. In fact, in this case, the baby actually gets its own anesthesiologist and IV so that the baby doesn't feel pain. So the baby is not moving around. But we're doing brain surgery, spina bifida corrective surgery, laser vascular surgery, correcting cardiac arrhythmias for the babies in the womb. So as a physician, the emphasis is one of the first things you're taught is primo non seri, which means first do no harm. And the second is that all patients have rights. We have laws in all 50 states and federal law that protect the rights of patients. So in this case with the mom who was declared brain dead that still had a baby with a heartbeat on the inside, even though it was only nine weeks, the assumed intention of this mom was to continue with the pregnancy. So we have an obligation to meet her wishes and her desires, which was continue that pregnancy. So the mom was given life support, and the baby continued from nine weeks until right around 25 weeks. And interesting, just last week the baby was finally discharged home after having an extensive stay in the near neonatal intensive care unit. So when we have a pregnant patient, there are two patients, and uh we need to meet the obligations as a physician-patient relationship to preserve all life. The only thing that we can't preserve in, you know, and buy more of is time. You know, Steve Jobs, billionaire, founder of Apple. Yet he died of a liver failure, you know, and it's extremely sad. But even as a billionaire, he couldn't buy any more time. So as a physician, we want to give as much time as possible to our patients. And even if the mom and that body is declared brain dead, and we can discuss that more. But the interesting thing is we were able to keep mom as the life support system for that baby until the baby went to the point where that baby could be delivered in an emergency situation, which was a cesarean section. Sadly, the mom, you know, did not survive, and the mom is dead. But that baby that she had created months earlier is alive and now spent time in the NICU and is now home. That should be what we are celebrating. But there were so many criticisms that of using this mom's body to keep this baby alive. It's like we should be saying, this is amazing. Just the fact that our maternal fetal medicine care is advanced, that even for whatever reason, mom has passed away, we can use that mom and use that amazing life support system of the mom to preserve and propagate and then to deliver not just life in the womb, but deliver that life where it can survive outside of the womb. So I find that absolutely fascinating that we can do that. But a patient's a person, no matter how small, all patients have rights, and we need to support that life in the womb.

Victor Nieves 12:55

Dr. Lile, I'd like to ask you this because one of the most common criticisms that we heard from those on the other side of this issue is they would say it was immoral, it was unethical to keep Adriana alive, that they were essentially turning her into an incubator in their effort to preserve not only her life, but obviously preserve the life of her unborn baby. What would you say to those who, for some reason, believe that this was unethical to keep alive the child in her womb?

Dr. Lile 13:23

I think we were fulfilling her desires and her wish as a patient. I mean, her desire was to have this baby, her desire was to deliver this baby, even though she was not able to communicate with us afterwards. It was obvious that that was her desire, and we use modern medicine to be able to fulfill the desire and goals of our patient to save the life of that second patient that was in the womb.

Victor Nieves 13:46

You know, Dr. Lyle, what you just said there, I think is so important because in the case of Adriana Smith and Baby Chance, there are two patients. It's not just one, it is two patients. And yes, Adriana was in very bad shape. She was injured very badly. However, her son, her unborn baby, was healthy and getting stronger every single day. And never would we say that if you have a patient who's getting stronger and better and healthier every day, you should just stop treating them and allow that patient to die. That would be a terrible thing. But I do have a follow-up question here. You know, we mentioned that this was her wishes. What if it was not her wish? I mean, we know that as human beings, we don't get our right to life based on whether or not somebody wants us. Dr. Lyle, if if she was on her way to go get an abortion when she was injured, put into this state, and then we were evaluating this question, would that change anything to you?

When “Brain Dead” Looks Alive

Dr. Lile 14:43

Well, when it comes to the topic of even bodily autonomy, you know, yes, a woman has bodily autonomy. If she wants to get a tattoo on her face, you know, she can do that. If she wants to get piercings in her ears to her mouth, going down to her belly button, she has bodily autonomy. But from the moment of conception, that one cell is genetically unique from the mom. And so there are actually two bodies that are there. And then when you study fetal development, even going from that embryonic stage, it's amazing. I mean, just the fact that four or five weeks when the heart is just forming, we can actually, there are over 200, almost 250,000 cells that are all doing their own thing. How one single cell can divide into two different parts, and then they have the exact same DNA, they have over 24,000 genes, they have 9 billion base pairs of DNA, and then how miraculously one cell says, I'm gonna start the entire cardiovascular system. Another one says, I'm gonna start the entire neurologic system, and they depart different and they go on a different path is absolutely amazing. That kind of design has a designer, and so we need to defend the lives of all humans, and from that moment of conception, that baby is a human. I'm gonna be speaking at the University of West Florida tomorrow night, and they have a forensic science program there. And one of the questions I'll ask them is if I have one white blood cell, can I identify whom that white blood cell came from? And I know they're gonna answer and say, yeah, absolutely. We can use polymerase chain technology and DNA analysis, and with 99.99%, I can tell you exactly where that one white blood cell came from and which human that is unique from the other 8 billion people on the planet. The same is true for that patient in the womb. It's not just a matter of, well, when did the heartbeat start or when did sentience start? No. If they are a human and they are a human from that moment of conception, then they deserve human rights. And when we have two patients, we want to do absolutely everything to protect the life of patient A, protect the life of patient B, because life is precious. And it's not when we look at scripture, yes, um, you know, God loved us enough that he sent his son, he lived a perfect life, he gave his life, conquered death, and rose again. We're getting ready to celebrate that for resurrection Sunday. Well, who did he do that for? He did it for all sinners, and that's amazing. But then, well, when were we first sinners? Well, some 51.5 says, you know, the psalmist says, Yes, I was the sinner from birth. I was a sinner from the moment my mother conceived me. So when you see the science of an egg and a sperm coming together, and even using that uh, you know, the receptors, and that there's actually a flash of light that we can see. We can see billions of proteins on the surface of that egg, and you can see that flash of light, and you look at light in scripture, that is life when we see that life. But if we are sinners from the moment of our conception and God loved us enough that he sent his son for all sinners, then that's when our soul, I believe, would be part. And so we are saving lives, we are saving souls. And if a mom's pregnant, we have two patients, and I want to do everything for all of my patients. Mom and the baby in the womb.

Victor Nieves 18:04

Well, Dr. Klessig, I'm curious your thoughts. I know that you've been vocal on social media whenever it relates to the case of Adriana Smith. What are your thoughts when it comes to her?

Dr. Klessig 18:12

Well, you know, just as Dr. Lyle is mentioning, you know, that moment of conception, you know, when when the sperm meets egg and God imparts that that soul to the baby, that's that is when life begins. And interestingly, the brain doesn't form until the neural groove which forms the brain doesn't appear until four weeks later. You know, life is clearly preceding the brain. The brain is not the integrator of the body. This actually has been disproved. Uh, Dr. Alan Schumann published a case series of 175 people who hadn't been properly declared brain dead and continued to live one ultimately for more than 20 years. So in 2008, a second president's council was convened and they specifically repudiated the brain as master integrator rationale, implicitly saying all of the brain death diagnoses prior to 2008 had been made on an improper conceptual level. They made up then a new idea, uh, not based on biology, but on a questionable philosophy, which they called the fundamental vital work theory, saying if you met a sort of an arbitrary level of disability, you were as good as dead. If you uh were comatose and not breathing on your own, if you had that level of disability, you weren't able to do the fundamental vital work of being alive, which again is so arbitrary because these people with this level of neurological impairment, such as Adriana Smith, they can deliver healthy babies. They heal their wounds, they fight their infections, they digest food, they excrete waste. Uh, these people are certainly in no way dead. And interestingly, there was a recent review of brain death in pregnancy revealing that of 35 such cases, 27 babies were born alive. Of these, 89% were delivered by cesarean section, the rest being vaginal births, which just blows my mind. Uh, even though the average gestational age of these babies was only 27 weeks at the time of their delivery, 85% were normal and healthy at their 20-month checkouts. And and the photos that we see on social media of little baby Chance, I mean, he'll he's grinning, he's still on oxygen, but his uh his dad, who has custody of him now, says he's a good baby and his brother and everyone loves him. So it's it's a really a wonderful thing that this this little guy has a chance at life, right?

Victor Nieves 20:40

Dr. Klessig, when we look at the children who are in gestation and the parent has been declared to be brain dead, is there anything of great concern for the baby? I mean, we're looking at them as a second patient, obviously. What do people need to know about the health and the wellness of the child in the womb?

Dr. Klessig 20:58

Life support supports life. So you know, they have to support the life of Adriana Smith. The woman is certainly biologically alive, there's no doubt about it. Life support can do nothing for a corpse. She was very ill, and through the amazing impact of modern medicine, with life support, we could support her life.

Victor Nieves 21:16

Dr. Klessig, you know, one of the things that you mentioned that stands out so much, and and I think it's worth highlighting a second time, you were listing some statistics about women who have been declared brain dead and then delivered their children. And if I'm not mistaken, you referenced that there were several natural vaginal births. Did I hear that correctly?

Dr. Klessig 21:34

Well, you know, I don't know how natural they were. I presume oxytocin was employed. I you know, that it surprised me. And I'm I'm certainly not an obstetrician or gynecologist, so you'd have to ask people who know more about that. But it is a matter of record that they weren't all cesarean section births.

Victor Nieves 21:49

Well, that that's just absolutely incredible. Um, Dr. Bishop, Dr. Classic, Dr. Lyle, thank you all so much for joining us. This has been a very interesting program.

Dr. Klessig 21:58

Thank you so much.

Dr. Lile 21:58

Thank you.

Victor Nieves 22:09

As we've seen today, a declaration of brain death has its own moral, ethical, you know, philosophical complications surrounding it. But once you introduce a child into the equation, like we saw in the case of Adriana Smith, things can become complicated, they can become confusing for some people. What we have to keep as the North Star is that every single human being made in the image of God has a right to life. Your right to life is not dependent upon your circumstances. You have that right to life by virtue of what you are, not where you are, not what you can do, but what you are. A child made in the image of God. And in the case of babies like Precious Baby Chance, we have an example of a patient from a medical perspective. It is a patient who every day is continuing to develop. He's getting stronger, healthier, bigger. Of course, we would do everything in our power to make sure that that patient is well taken care of and treated appropriately. If you'd like to learn more about any of the topics that we've discussed here today, be sure to visit our website lifeissues.org. Again, that's lifeissues.org. And be sure to tune in next week for another straight talk on life issues.