Medical miracle or abomination

What about Adriana?

Photo by Jan Antonin Kolar on Unsplash

Thankfully, none of us are in charge of what happens to poor Adriana Smith and her baby boy in Georgia. We like to talk as though we are, armed with our outrage and our keyboards and our sense of wrathful powerlessness in the face of the broken things in this world. Adriana Smith was declared brain-dead after suffering catastrophic blood clots in the brain. She was nine weeks pregnant. Can we pause for a moment and recognize the tragedy of this? As some have pointed out, yet another black woman whose concerns were dismissed by her doctors, leading to horrific consequences. And the onlookers have all split predictably down the pro-life and pro-choice faultline, with a couple of notable exceptions.

I may not be writing this if it weren’t for Matthew Lee Anderson, who got me thinking on a deeper level in parts one and two of “Post-Mortem Procreation,” and the fact that both Jennifer Lahl and Abby Johnson have expressed opinions dissenting from the pro-life party line. I would just link to Anderson and leave it at that, but since it’s paywalled I will repeat some of my thoughts here, and add some. (I do recommend a subscription over there if you are looking for reflections on stuff like this at a much more intellectual level than you find here.)¹

The strongest argument in favor of keeping Adriana on life support is obvious (not unlike the argument in favor of IVF/surrogacy): the baby. The baby lives. A seemingly irrefutable argument for one who sees the value in babies, especially ones who already exist.

Yet when people such as Lahl and Johnson speak up, I listen. Like them or not, they are independent thinkers who have done important work on behalf of women and children. (Lahl, on the front of exposing corrupt and exploitative practices of the fertility industry, and Johnson as a former abortion worker who now helps abortion workers heal and find new jobs.) The work of humanizing women and children is real to them, not theoretical. They believe that Adriana and her baby should have been allowed to die a natural death, and she should not have been placed on life support solely for the purpose of gestating. (Johnson also stated that now, with the baby on the cusp of viability, is no longer an appropriate time to remove life support, an opinion that I share.)²

So, how can a pro-life person, someone who sees the value of preborn human life so clearly, argue theoretically for the end of one? This post on X in response to the pro-life shock aimed at Johnson’s dissension put it well.

@pick1oftheabove:

“The pro-life position isn't to blanketly value "life" over "bodily autonomy," but to value bodily integrity, which includes dignity and integrity in natural death. Pro-life debaters understand the difference between ordinary care and extraordinary care, between pulling the plug and purposefully killing. Gestation in a living woman's womb, whether she wants it or not, is ordinary care, with intact bodily integrity for mother and unborn alike. Sustaining a baby in a braindead woman from 9 weeks is an extraordinary experimental condition contrary to nature, and people rightfully find it messed up that the family would have no say in what a braindead body is used for”

Women are not just baby incubators. Those in favor of elective abortion are crystal clear on this fact, and correct about it, and it’s a position that the (thinking) pro-life side normally tries to show their agreement on. We are indeed not just incubators! Not socially, and not physiologically. Those who care to learn the pre-and post-natal science know that the mother-baby dyad is an intricately entwined relationship that goes so far beyond a healthy uterus housing a young of the same species. And the pro-life side (and any effective OBGYN) recognizes that there are two patients here, not one. Not just the mother, not just the baby. Two, woven together until physical maturity loosens those bonds. We cannot let the miracle that is growing a human life overshadow the dignity and integrity of a woman’s body and its natural processes.

I listened in to some of a discussion between Lila Rose and Father Tad Pacholczyk in which he described Adriana as a dead body.³ Here I’d like us to tarry again and dwell on that. A dead body gestating a live one. First, the dismissal of someone whom we believe to be brain dead as being just a vessel should give pause to those who believe in the sanctity of life, humanity made in God’s image, and respect for our physical bodies. Second, can a truly dead body actually grow a baby? Her heart pumps, air is forced into her lungs, her cells metabolize and her body continues to do the most amazing thing human bodies do: procreate. In truth, Adriana is in a liminal place that we struggle to understand or define. But it is presumed that death would come quickly if life support were removed, which means that at best she is dying.⁴

Fr Tad also referred to using this time with Adriana on life support to “shuttle the pregnancy beyond viability,” a utilitarian phrase. We don’t believe in “using” (regardless of dignity and wholeness) bodies for anything, including shuttling pregnancies.⁵ I don’t agree with the argument that a pregnancy under normal circumstances is “using” it, but this is far from a normal circumstance. 

The pro-whole-life concept is the protection of life from conception until natural death. I believe the phrase originated in the fight against euthanasia and assisted suicide. But “natural death” can happen not only later than we might choose, but also sooner, and it is becoming a trickier thing to define and even to allow with medical advances. We cannot box up the concept and only apply it to one thing we don’t like. 

Smith was nine weeks pregnant when she had this medical crisis. A fetus at nine weeks’ gestation is an amazing creature: an inch long, with fingers and toes and facial features, forming organs and muscles, heart audible with a hand-held Doppler. He also has a long way to go before he can survive apart from his mom. Many months of a so-called dead body growing a live one. Now, back to today’s reality and away from keyboard-pounding, it’s a different situation. The Smiths are solidly in the middle of pregnancy and continuing on. Doctors hope to bring her to 32 weeks, in August, before delivery.

It is beginning to seem more clear to me that pregnant women who are dying and whose babies are far from viability “should be comforted on their way to God.” (footnote 4) For those who are near or at viability as the Smith baby is now, the question is not so simple, because they can possibly survive apart from mom. If to continue on is to desecrate the mother’s body but to deliver the baby is to cause him or her more pain and suffering than waiting would, how do you choose? (If this interests you, the principle of double effect may be something to read up on.) The wonders of modern medicine do so much good, and they also occasionally bring us these impossible situations. Perhaps the best thing would be to deliver as soon as possible, with intent to treat him like any other premature baby. Knowing every week of gestation improves health outcomes makes this painful. But consider organ donation (a parallel Father Tad and others have drawn: Adriana as an organ donor for her child) or continuing life support as a stop-gap measure. While we would never leave someone on life support for months in order to harvest their organs at a more appropriate time (so far–maybe only because there’s no need yet)⁶, we might keep them for a short time until their loved ones can arrive to say goodbye, or to prepare for organ donation surgery. Perhaps the accepted timeline for that situation may be an appropriate norm to follow in the case of pregnant women whose babies are near early viability.

I pray that baby boy Smith is born healthy and happy to be alive and grateful for the amazing work his mom did for him even in her present liminal space. That is the best-case scenario at this point. But it doesn’t mean that we can’t examine how we got here, and why people are reacting with disgust and abhorrence to the sad story.

This case is not about abortion, but as in every circumstance where the life of a fetal human is in tension with the state of his mother, it hums in the background. Abortion is a usually avoidable, extraordinary act, violating bodily integrity and normal functions. When there is an issue of such huge importance, it is possible for the sensitivity it rightfully produces to vacuum up every other concern we should have, such as about a politician’s character or how we treat the bodies of mothers. But a pro-life position that stands alone, apart from other convictions and without the guidance of the virtues, is not a sustainable or complete approach to all of the evils this world can throw at us. It’s the kind of thinking that leads to the murder of abortionists, a rare but real act of hypocrisy. The country is watching to see how pro-life thought leaders say we should treat women’s bodies. And I think it is appropriate to question whether we should endorse their use as gestational containers.

1. I don’t have time or knowledge to delve into the legal aspects of this, although I don’t believe them to be as clear-cut as the headlines say. The hospital should clarify publicly which law it is that says they must keep Smith on life support to gestate and why. Even in all of the pro-abortion attempts to expand the use of the term “abortion” in everyday language to include scenarios not normally termed that way outside of medical records (e.g. preferring the clinical term“spontaneous abortion” to the formerly ubiquitous term “miscarriage”; calling a dilation & curettage to remove a dead fetus or even just placenta “an abortion”), I and many others can’t see how allowing the natural death of a pregnant woman could be defined as an abortion.

2. Many of the arguments for and against her life support boil down to “consent”. We don’t know that she didn’t consent. Her lack of explicit consent means that she didn’t. Her family hasn’t had the option to consent or not. It would be different if we knew for sure that she didn’t consent. And the most repeated: this is happening without her family’s consent. They said they wouldn’t necessarily have chosen to remove life support, but they had the choice stripped from them and that’s what matters. What a reminder that consent is wildly inadequate for making life-and-death choices. The consent angle does raise one question though: if consent is the only thing that matters, as is often argued on the pro-choice side, why do they assume that her incapacitation means that she does not consent to being on life support to gestate the baby? She consented to being pregnant beforehand, why not now? So consent is inadequate from that angle as well. And although consent is often named as the issue, I think it’s actually a more deep–seated revulsion at seeing such an unnatural event happening…though it is so deeply unfashionable to refer to things we do with human bodies as “natural” or “unnatural” these days that most can’t name it.

3. Wesley J. Smith at National Review: “Under the law, that means Adriana’s body is a cadaver. The medical team has kept her body functioning so that her baby can continue to gestate. The baby is now at 21-weeks gestation, which is close to viability. (Whether a true corpse can gestate for months is a different question that I won’t address here.)”

4. Anderson writes, “First, as Will Dole observes, the ‘brain death’ criterion is not obviously one that we should accept—but I also don’t think that is doing much work in the moral analysis of what should be done. There has been considerable debate over the ’brain death’ criterion in bioethics in recent years and there are good reasons to question the standard. However, I also think that it is fair to say that those who suffer such irreversible loss of functioning are ‘dying’ (since they would die in the absence of our intervention), and as such they should be comforted on their way to God.”

5. see Christian objections to gestational surrogacy, prostitution, slavery, etc.

6. To be clear, this would be awful and shouldn’t be done if it were to come to it.