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July 26, 2005

Susan Torres

Twisty and Amanda have tackled the Susan Torres story.

Mrs Torres was a 26-year-old woman who died of metastatic melanoma a few weeks ago. At the time of her death she was pregnant. Her body has been sustained on life support ever since. Doctors hope to keep her body going until her fetus is old enough to survive outside the womb.

I have no quarrel with the decision to sustain Mrs. Torres' body until her baby can be born. Her husband is adamant that his wife would have wanted her body to be used this way. As her spouse, he ought to have the final say.

I do object to the crass and sentimental media coverage of this tragic case. What bothers me is that the media insist on describing Mrs. Torres as if she were still alive. This is a critical distinction that the media are overlooking. Keeping a comatose pregnant woman alive is morally uncontroversial, whereas sustaining a dead body gestate a fetus is ethically dicey unless the body's former owner gave permission for such an extraordinary intervention.

Twisty says:

The article contains various repellent concepts, but here’s my personal favorite: “Aside from the tubes and machines she is hooked up to, the tall and athletic Torres looks remarkably well”.

The tall and athletic Torres looks remarkably well! Well, that’s a relief! The woman is teetering at the precipice of hell, pretty much reduced to a warm piece of baby-makin’ brisket, but at least she looks good!

The story of Susan Torres is an ethical dilemma played out as if it were an uncomplicated tale of love and self-sacrifice. A woman died without making any specific arrangements about what would happen to her body if she were to die during her pregnancy. When the unthinkable happened, her husband made the choice on her behalf.

Obviously, he is in a better position to know what she would have wanted than anyone else. Moreover, he is willing to make incredible sacrifices to keep her body going until his daughter can be born. He has even quit his job to fundraise full-time to pay for the upkeep of his dead wife's body. For that, he deserves our admiration.

You'll notice that, unlike its counterparts in the Terri Schiavo case, the left isn't gunning for Mr. Torres because of his good-faith decision about his wife and her wishes. It's not an easy choice. Obviously, we'll never know what Susan Torres would have wanted for herself or her fetus (who will no doubt be born with a significant risk of birth defects due to prematurity and her mother's condition during gestation). Ethically, his decision is nowhere near as straightforward as most media accounts make it out to be. We shouldn't assume that all pregnant women would obviously consent to a similar fate.

Yet, ultimately, we must defer to Mr. Torres' judgment about what's best for his family. That's how these decisions should be handled.

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Comments

I agree. I feel very uncomfortable telling a grieving widower that he is obliged to give up the chance of his wanted child being born. I view this as similiar to organ donation--her body is being donated to bring the baby into the world. But the press should be strung up by their ankles for selling this as another sentimental story of Good Woman Sacrifices for a Man and Then Dies.

This story, when contrasted with Schiavo, does delineate a bright line difference between Republicans and Democrats. The only problem is that using this story to make that point requires one to cross the bright line.

James, I'm not sure I understand your point. As far as I'm concerned, the first bright line is letting families and doctors make their own decisions without legal interference. The second critical distinction is recognizing the "sanctity" of marriage. (I'd prefer to describe that principle as the dignity or the autonomy of the institution, but be that as it may....) The bottom line is that when a couple gets married, each becomes the other's guardian. Marriage should entitle you to speak for a spouse who cannot speak for themselves. Marriage should be a convenient way of designating the person closest to you in the world, the person whom you authorize to make the most intimate decisions on your behalf.

Commenting on the ethics of a particular decision is perfectly fair, especially in a case where the family has sought out media attention and public support for their cause.

I think that Mr. Torres made a defensible, if difficult decision. Ultimately, it doesn't matter what other people think. It's his call to make. As it should be.

What I'm saying is that the media are promoting a distorted view of this difficult case. I think Twisty and Amanda are making similar points.

Let's not overthink this.

typo: "didn't gave"

Thanks, pdf. Fixed.

Mudkitty: Overthink? Our host and many of her guests are trained as philosophers. The word "overthink" makes no sense to us.

"When the unthinkable happened, her husband made the choice on her behalf. Obviously, he is in a better position to know what she would have wanted than anyone else."

I don't think this is the nub of the matter. Unless she specified that she wouldn't want the fetus brought to term in such an eventuality, then the issue is not about making a choice on her behalf, it's about making a choice for himself. It was always his potential child too, and now it's no one else's potential child. You don't have to deny a living woman's right to choice to recognize that. But even if she had wanted to have the fetus destroyed in this eventuality, it's not clear why the once-existing desire of a dead person should trump the actually-existing desire of a living person who has a legitimate stake in the matter.

On-topic update from Australia.

We used to be a whole decade behind you guys, but we're catching up. We've got a Schiavo-esque feeding tube drama unfolding here at the moment.

http://www.smh.com.au/news/national/maria-korps-life-support-now-stopped/2005/07/27/1122143881352.html

Aeolus, are you imagining a case in which the woman explicitly refused to allow her body to be sustained by machines after brain death, but in which her husband insisted that such interventions continue?

In such a case, her husband doesn't have veto power. A person's interest in her own body doesn't end with her death. As Amanda said, it's like organ donation. The wishes of survivors don't count if the deceased has made his or her preferences clear.

Anyone can refuse to be sustained after brain death, regardless of whether they're pregnant. A pregnant woman can also refuse medical treatment that would save her own life and/or the life of a fetus she's carrying. The same standard should apply to the body of a brain dead individual who is pregnant. A husband doesn't inherit his wife's body after her death. Her womb doesn't become his personal property.

Rob,
I know, but my point is philosophical.

Q: are Ms. Torres' organs in any condition to donate? Does her husband have the right to so designate?
Q: does the melanoma "soldier on," as well? ^..^

There is a certain creepiness factor here, still I can't really think of a good reason why the father should be denied. Certainly the mother is beyond harm.
When do you tell the kid it was whelped from a corpse? No water color illustrated children’s books to help you there.
I wonder though, if dedifferentiated melanocytes, being peripatetic as they are, are capable of crossing the placental barrier?
As to mom being "tall and athletic": Do reporters no longer have editors?

cfrost: If they did have editors, the editor's immediate appropriate response would be "Athletic? Do you think she can beat me in a race?"

While I also would side with Lindsay and others regarding this particular case--I think that our best case scenario is that one's spouse gets to make this decision in lieu of no decision having been made by the now-comatose person ahead of time (that we know of), we don't have a whole lot of other choices, on the face of it.

However, I think that there is a danger of oversimplifying, here, too. When Lindsay says "Ultimately, it doesn't matter what other people think. It's his call to make. As it should be," I have to disagree, if only slightly. It's true if we only look at his choice to do this vs., say, letting her parents choose, or her doctors. But then again, this is all under the assumption that it's ok to let somebody make this decision--there are medical ethics questions, at least, that come into play.

For instance, we wouldn't allow her husband to do absolutely anything he wanted regarding his wife's brain dead body, right? In that sense, it does matter what we think, as a society. For instance, let's say he decides he loves his new daughter so much that he wants another kid, so he asks to have his wife kept alive for that (I think that this is the possible scenario which makes the actual scenario sort of creepy). We probably wouldn't say that it was his call to make. The reason I bring this up is that it is possible that we ought to have a moral default in such situations which isn't 'Who chooses whether this kid is born or not?' but rather 'We don't allow children to be born under these circumstances'. This is something we can at least ask, even if we think that, if there is a choice to be made, he is in the best position to make it.

Actually, I'm pretty sure that (at least in the US), even if you've signed an organ donation card, they won't take your organs if your next of kin says no. I don't know what the rules are in the reverse case -- if you've explicitly said not to use your organs, but your next of kin tries to overule you.

For what it's worth, I have a living will (signed years ago), and I explicitly gave permission for my body to be kept functioning if I was pregnant and the fetus had a chance of surviving.

The law about organ donations puzzles me. I've seen ads that warning that your organ donor card is worthless unless you get your family's permission. These were in the Boston subway about 2 years ago.

Two questions: 1) Can your family override your organ donation preferences even if you tell them? (Obviously, in practice they could just lie and say you never brought it up. But are refusing families obliged to make any kind of signed declaration about that issue?) 2) Do you still need family permission if you have a valid organ donor card and a living will?

Lindsay,

This is one of those cases in medical ethics where there is a big disjunct between law and practice. The law has been changed to make it progressively easier for doctors to harvest organs without having to go through next of kin, however precious few doctors have been willing to actually harvest the organs without consulting the family.

The courts have not been helpful either. A 1991 ruling established that the next of kin has property rights to the deceased's body, even though the person has signed an organ donor card.

Some European jurisdictions have even experimented with an opt-out model of organ donation. It hasn't had much effect on the organ supply, because doctors simply aren't willing to take organs without talking to someone in the family.


Family veto is a fact. If you've signed an organ donor card, and there's no dispute about this, most hospitals (in Canada and the US) will defer to the next of kin's wishes.

Also, note that we don't have a system of presumed consent. If you haven't signed an organ donor card, you have not consented to donate. But it's federal law in the U.S. that physicians must ask the next of kin for the organs. So either way, they defer to the next of kin.

I think this is also the case in Spain, where they have presumed consent. They assume you've consented (unless you've specified otherwise), but won't take the organs if the family objects.

There were similar cases in the 1990's. In 1993, Trisha Marshall was declared dead (while 17 weeks pregnant) at Highland General Hospital in Oakland, CA. Her parents and boyfriend wanted her kept on the respirator long enough to do a Caesarian. They kept the relevant organs going for 3 1/2 months. She (or it, since she was deceased) gave birth to a boy.

Also, in Germany in 1992, Marion Ploch was declared dead, but was 13 weeks pregnant. They kept her body going for 5 months. Her parents initially gave consent, but then withdrew it within a week of their daughter's death. The doctors ignored them, saying they had to rescue the baby. This apparently attracted media attention in Germany as the "Erlangen baby" case.

My only source for these stories is *Rethinking Life and Death* by Peter Singer (pp. 9-13).

JP: the woman wasn't "now-comatose". She was dead.

Rob: thanks for your 1:20 points about the American system. I don't know about the European approach. My info is sketchy, but I thought that when Spain first opted for opt-out (or presumed consent), they had a surplus of organs and could send them to other EU nations. Also, I've heard that in Belgium they have surplus organs and actually use this as a hospital revenue-generator -- people from other countries travel there and pay hospitals for the transplant surgery. Finally, an anecdote: a friend in Canada went to Germany to retrieve her brother's body and discovered that they had removed some organs, even though no next of kin were there to be asked at the time.

otherpaul: my source here is Munson *intervention and reflection* 7th ed. Munson's only comment on the European system was that "Critics of the policy point out that it has not, in general, done much to reduce the shortage of transplant organs in those countries."

I think that the overwhelming reason why family's wishes always end up trumping records of the deceased's intention is that the living can sue, and the dead cannot.

When do you tell the kid it was whelped from a corpse? No water color illustrated children’s books to help you there.

I'm sorry, but it's not a corpse. The body is still alive, even if the person isn't.

I might think differently from everyone else, but I don't have any problem with keeping her body alive at all. I don't even consider it creepy. Sad, but not creepy.

I am not convinced the woman is dead even legally speaking. Are you sure her husband can't file their taxes as a married couple?

Even granting she is legally dead I don't see why that makes a big moral difference. Brain death is an arbitrary point along a continuum. Suppose she had severe irreversible brain damage just short of "brain death". Why would keeping her alive to bear a child now be morally uncontroversial?

Equating the current condition of Susan Torres’ body as nothing more than the likes of an incubator is an absolute injustice. No it may not have been put into writing what Susan may have wanted for herself but I have no doubt that the decision that the Torres family made wasn’t any different that what she would have chosen for herself.

As a former student of the University of Dallas- the university that both Jason and Susan graduated from, the culture of Pro-Life thrives. The choice may have been made by Jason to keep Susan’s body sustained to give birth to their daughter, but this decision is only a reflection of the commitment that they made to one another at their wedding. Most people think of the vows “In good times and in bad, in sickness and in health, until death due us part” but there is a part of the Catholic marriage ceremony that clearly states their commitment in having a fruitful union, it is this commitment that brought them to the place they are today.

Susan Torres may have ceased having brain function weeks ago but she was far from dead in that her spirit lives on in her little girl, her son, and yes her husband. Call it romanticized but it was her life that she had dedicated to the advancement of science and through scientific advancement she was sustained to a point that allowed her to bring new life into the world. And most people realize that something cannot come from nothing. Life came from life no matter how unconventional it may seem.

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