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March 24, 1989

Maternal Brain Death During Pregnancy-Reply

JAMA. 1989;261(12):1729. doi:10.1001/jama.1989.03420120060018

In Reply. —  We agree with Dr Goodlin's statement that "an obstetrician's primary obligations are to the mother." In the rare case, such as the one we reported, in which the mother is dead but the fetus remains alive, existing maternal requests should not by themselves dictate management. Fetal and neonatal benefit should be the primary concern. The case that Dr Goodlin cites is one in which refusal of surgical intervention by a living, though terminally ill mother was overridden by the courts.1 This represents a clear violation of the autonomy of the pregnant woman.Two interesting hypothetical scenarios are presented by Drs Wear, Dillon, and Lee. The first of these concerns the case in which "the family refuses maintenance when extended support... would markedly enhance... fetal survival." While acknowledging that in most cases the father of the fetus will be the appropriate decision maker after death of the