The BMJ Today: A dignified death at last for brain dead pregnant woman

Doctors in Ireland must be breathing a sigh of relief after judges ruled that a brain dead pregnant woman should be allowed to die.

The case makes for grim reading. The woman, in her late 20s and 18 weeks pregnant, was declared clinically dead on 3 December after a fall. But doctors refused to comply with her family’s wishes to withdraw life support for fear their actions could lead to legal challenges from anti-abortionist campaigners using an amendment to article eight of the Irish constitution, which gives the foetus the same right to life as the mother.

In the end, judges were asked to rule on the case. Intensive care specialist Frances Colreavy told judges that she had never seen a clinically dead person being kept alive for so long. The woman’s blood was becoming increasingly toxic, she said, while another witness said that the case would go “from the extraordinary to the grotesque” if treatment was not stopped.

Judges acknowledged that the foetus could not survive the lethal environment of its mother’s body and said she should be allowed to die. To continue keeping her on life support would deprive her of “dignity in death,” said the judges, and add to the distress of her family.

Some doctors and campaigners have called for the amendment to be abolished. Perhaps the case and the media storm it has caused in Ireland will make that a priority for Irish legislators in 2015.

In another news item, researchers from the United States have reported the three year follow-up results of 25 patients with multiple sclerosis who were treated with high dose immunosuppressive therapy followed by transplantation of their own haematopoietic stem cells. They had all been having relapses with loss of neurological function, but after the treatment 19 out of 24 patients who completed treatment had no MS activity, defined as loss of neurological function, clinical relapse, or new lesions, over the next three years.

The researchers said that the treatment could be a new option for patients who fail on conventional immunotherapy. But editorialists were more cautious and said that: “The jury is still out regarding the appropriateness and indication of HCT [haematopoietic stem cell transplantation] for MS.”

Zosia Kmietowicz is The BMJ’s news editor.