What is life in the womb without mother?

A woman is being kept alive so her baby can be born. Paul Vallely examines the ethical dilemmas
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The Independent Online
Should this baby be allowed to die? It is not a question that many feel easy about raising amid the high emotion generated by a case like that of Karen Battenbough, the 24-year-old woman who is being kept alive despite profound brain damage so that the child in her womb can continue to grow.

The unborn child was 19 weeks old when its mother was terribly injured in a car crash and went into a coma. Persistent vegetative state has been diagnosed for her, but the child has continued to develop. It is now 25 weeks old and doctors intend to sustain Mrs Battenbough in a coma until, at 34 weeks, the baby is capable of independent survival.

Such a case is an ethical minefield. It raises questions about an individual's rights over her own body, society's obligations to the unborn and the moral dimension of resource management. The dilemmas are wide-ranging. When does treatment become more of a burden than a benefit? Is it right wilfully to create a motherless child? How important are considerations about chances of survival or the risk of handicap? How balanced is the desire of doctors to engage in interesting experimentation?

Doctors themselves are not much help. So often they take refuge in narrow clinical judgements. "As a clinician you just have to deal with the situation in front of you without taking into account broad policy," says Dr John Marshall, emeritus professor of neurology at the University of London and an expert in obstetric ethics. Neither is there much guidance from precedence. There are only about six similar cases documented. One, in Germany three years ago, caused consternation when the grandparents of an 18-year-old dental assistant who died in a car crash authorised her sustenance to bring her 14-week-old foetus to term. Local officials of the Roman Catholic church, despite its opposition to abortion, came out against the preservation of this unborn life in a dead mother's body; 33,000 protestors called for the mother's life-support machine to be switched off. "The baby is growing in a grave," outraged protestors pronounced.

That woman was clinically dead. Karen Battenbough is not. In this case the question arises of what are her rights. "Can you use a woman's body for the sake of another person?" asks Pat Walsh, a philosopher with the Centre of Medical Law and Ethics, at King's College, London. She quotes the case of a woman who was recently forced to have a Caesarean. "She said she wanted nature to take its course. The fact was she was going to die and so was the baby. The hospital authorities got a court order within a matter of hours. She was taken into the theatre screaming and shouting."

Such cases are unusual. In Britain, it is rare to impose treatment on a patient. Sadly the baby died anyway.

"The key question is: is the dignity of the woman being offended against?" says Jackie Hawkins, a theologian who is executive editor of the Jesuit magazine The Way. In the case of Karen Battenbough the answer is, probably not. Her family insists that, after four miscarriages, she would support what is being done. The father has rights here, too; though whether he is best placed to properly express them, at a time when his judgement is clouded with grief and his decisions may be subject to the imbalance of sentimentality, is a separate question.

Other scruples are equally unresolved. During the accident, her blood oxygen levels may have fallen to levels which could already have caused brain damage in the child. "We don't know much about the emotional life of a child in the womb," says Bernard Hoose, a moral theologian of Heythrop College. "We have hints - we know that children like to be rocked to sleep because they've been used to the heart beat in the womb. The question is: how much else in the normal functioning of the body is significant?

"The Church does not hold that you must preserve life at all costs. It distinguishes between `ordinary' and `extraordinary' means to preserve life." Even antibiotics could be extraordinary in certain circumstances, if they imposed too much of a burden on the patient or the carers, "and that would even extend to questions of resources - burdensome financially on the family or on the state - the million-dollar transplant may come into that category."

Ms Walsh agrees: "Children born at 34 weeks often have a lot of problems. " As a society, she says, we are inconsistent in our allocation of resources. "We refuse treatment to some people and put a lot into others. People over a certain age routinely can't get treatment. They are told: `There's nothing more we can do for you.' But in fact it's a judgement based on their age."

Likewise, many hospital units have an unpublicised policy of not treating babies born before a certain gestation.

But this case - and its unspoken assumptions - gives an insight into something more deep-rooted in contemporary society. Even the language is revealing. Almost everyone speaks in terms of a baby, reversing the general inclination to refer to a foetus at this period of gestation. Usually it is only the anti-abortionist lobby which speaks of the "baby" in the time up to 22 weeks when abortion is still legal. It is almost as if the implicit supposition is that it is only when a foetus is wanted that it becomes a human being. You do not have to be a dedicated fan of the Pope to realise that the unarticulated logic here is distinctly dodgy.

The case also tells us something about our attitude to children. "There is a strange kind of emotionalism," says Dr Hoose, recalling tabloid editorials at the time of the Child B case, which proclaimed a child should always be saved. "Why should a child's life be more precious than a 24-year-old's?" he asks.

Ms Walsh makes a similar point about little Irma and the children airlifted from Bosnia. "Why just the children?" Perhaps because they represent vulnerability? "No one," she says, "is more vulnerable than mentally handicapped children, yet they constitute grounds for abortion straight away. The truth is that we only want to save certain children - nice children."

There is a similar inconsistency in our attitude to the allocation of resources. "This inconsistency is strange, but it is desirable," says Ms Walsh, "because neither of the two clear-cut policy options - to say either we won't treat anyone whose treatment is hugely expensive or that we will always spend huge amounts on emergencies - is acceptable."

There is, concludes Dr Hoose, "a lot of unclear thinking going on" - which, because it allows us to avoid taking difficult decisions, is perhaps the way we prefer it.