Brain Death in Pregnancy: When Medicine Forgets the Person

Article by David H. Beyda, MD

Chair and Professor, Department of Bioethics and Medical Humanism

College of Medicine-Phoenix, University of Arizona

Reading “Brain Death in Pregnancy” by Katie Watson, I felt a deep sense of unease. The article lays bare a collision between end-of-life care, abortion politics, and the erosion of patient autonomy and I couldn't help but reflect on what that means for the practice of medicine at its most vulnerable edges. These aren’t just legal debates; they’re moments of real suffering for families and moral injury for clinicians.

To me, brain death is death. I’ve stood at enough bedsides to know that once brain function is gone, we’re no longer talking about preserving life. We’re talking about sustaining biological processes: a body without the person. What happened to Adriana Smith and Marlise Muñoz wasn’t about protecting life. It was about fear, confusion, and control. Denying a family’s wishes in that moment is not just a legal misstep. It’s a moral failure. When a hospital refuses to withdraw a ventilator from someone who is legally dead because of a misreading of abortion law or advance directive statutes, that’s not cautious medicine that’s cruelty.

What I found especially disturbing is how these laws reduce women to vessels. The idea that a woman’s body can be sustained after death against her wishes, or those of her family, strikes me as a complete loss of ethical compass. I’ve always believed medicine is about honoring the dignity of each person in life, and in death. In these cases, that dignity was stripped away. I can only imagine the anguish Adriana’s mother described as “torture,” and I believe her.

I also know how this kind of legal ambiguity puts clinicians in impossible positions. I’ve seen what it does to a team when they’re forced to act in ways that go against their clinical judgment, their training, and their values. The moral distress is real. It doesn’t just stay in the ICU. It stays with people. We owe them better.

I appreciated Katie Watson’s calm but clear reminder that brain death is not a legal or ethical gray zone. These laws, many of which were never designed for this kind of situation need to be read with care and interpreted with courage. I’ve always taught my students that ethical clarity matters most when things feel murky. This is one of those moments. Clinicians need to know how to navigate the law not to avoid it, but to stand up for their patients when it matters most.

And honestly, I don’t believe these laws were written by people who have ever stood next to a grieving parent, or who’ve held the hand of a spouse saying goodbye. If they had, they’d know that presence changes everything. We need those voices. The ones at the bedside shaping policy. Because when we forget the person in front of us, we forget what medicine is for.

Reference: N ENGL J MED 393;4 NEJM.ORG JULY 24, 2025