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March 24, 1989

Maternal Brain Death During Pregnancy

JAMA. 1989;261(12):1728. doi:10.1001/jama.1989.03420120060014

To the Editor.—  I find most worrying the statement by Field et al1 that "even a maternal refusal expressed before death does not, in itself, carry weight against the possibility of fetal survival." A similar thought process recently occurred in our nation's capitol. A 27-year-old married woman with a long history of cancer was dying of the disease in the 26th week of pregnancy. As reported in The Lancet, when the court ordered a cesarean section the patient mouthed, "I don't want it done, I don't want it done," and her obstetrician refused to operate. After an appeal to the judge, the surgery nevertheless was performed by another obstetrician on court order, and the nonviable fetus died 2 hours later. The mother subsequently died after 2 days. This was judged by Brahams2 to be an "appalling" case.I believe that an obstetrician's primary obligations are to the mother