A spokesman for the family of a comatose woman who is five months pregnant said yesterday that the family had decided that "there will be no cessation of the (life-sustaining) machines at any time."
It was initially reported that Rosemarie Maniscalco was being kept alive in the hopes that her 20-week fetus could eventually be born, but attorney Norman Paul Weiss said yesterday that whether or not the baby is born alive, the family and physicians have agreed to try to keep Maniscalco "alive."
While the Brooklyn, N. Y., woman has been described as "brain dead" a condition meaning a complete absence of electrical activity in the brain and absense of any reflexes, Weiss said he was told by physicians that the woman has some very minimal brain function.
If Mrs. Maniscalco were, in fact, brain dead, the attempt to maintain her and her fetus would be hopeless.
According to Dr. Julius Korein, chief of electrocncephalography at New York University-Bellevue Hospital, there have been no reports of anyone who is brain dead being maintained by machines for more than a week.
Mrs. Maniscalco reported became comatose Nov. 23, after jumping up from a table in her home, vomiting and collapsing.
Weiss said yesterday that the Kings County (Brooklyn) district attorney's office is investigating allegations that Mrs. Maniscalco was beaten by her husband, John, an allegation Weiss said Maniscalco denies.
While most speculation surrounding the case has centered on the question of whether the 27-year-old woman could be maintained for the four to six weeks needed to give her fetus time to mature, some persons addressed themselves yesterday to the question of whether she should be so maintained.
This appears to be another example of individuals placing their hope and trust in the promise of technology," said Paul W. Armstrong, an attorney familiar with the legal and ethical questions surrounding the artificial maintenance of life. "Whether that promise can be fulfilled remains to be seen."
Armstrong represented Joseph and Julia Quinlan, who successfully battled through the New Jersey legal system to win the right to have their comatose daughter. Karen Ann Quinlan, removed from the respirator thought to be maintaining her life. She survived that removal, and is alive 13 months later.
Weiss said yesterday that he was told Rosemarie Maniscalco's condition is much worse than Karen Ann Quinlan's Maniscalco's breathing, temperature and heart rate are being maintained by machines. Weiss said, and she could not survive without their aid.
"What's the choice?" responded Dr. Korein, when asked about the ethics of maintaining Maniscalco, who is given no chance of recovery, in order to attempt to save the fetus.
I would have to take a stand that if there's a significant possibility of saving the life of the child, and if there is more than a reasonable chance of this child being normal, you should maintained life.
I'm taking exactly the opposite view as I took with Karen Quinlan," said Korein, who was the principal medical witness for the Quinlan family. "In Karen Quinlan's case I said, 'She is not brain dead,' but the situation is hopeless and irreversible and therefore any treatment is extraordinary. In this case, if this woman is not brain dead, and the possibility of getting a healthy normal child is significant, then I would say that you must use all techniques, procedures and technologies to get a live child out of this."
Korein, who stressed that he has no personal knowledge of the case or of the medical facts involved, speculated that if Maniscalco has sufficient function in her brain stem, that area of the brain that controls the autonomous, or auomatic, functions of the body, it is possible to maintain her as long as necessary to deliver the fetus.
"Put a tube into her stomach and you can feed her anything you want, vitamins, caloric intake, anything. . . This patient in a chronic vegetative state can be a vehicle that can possibly give birth to a child," he said.
The two basic medical problems are maintaining Maniscalco, who Weiss said is in poor condition and whose survival is a "minute to minute" thing, and keeping the fetus alive, something that has only been done once before under similar circumstances, and then only for 48 hours.
Dr. Andre Hellegers, an obstetrician and ethicist, said yesterday he saw no chance for maintaining the fetus for what was earlier reported to be an eight-to 10-week period.
Hellegers, director of the Kennedy Institute for the Study of Human Reproduction and Bioethics at Georgetown University, said, "In principle I think there is nothing new in this attempt, in that postmorem caesarean sections have been done in the past. The difference is that you had to do them in three minutes. Now, all of the sudden, people say maybe you can do it in three months, which is pretty wierd. So now the question is how long can you wait to do a postmortem cesarean section.
"I think that what you enter here is the whole tricky field of so-called respect for dead bodies," said Hellegers. "I think that with organ transplantation and uniform anatomical gift acts, we've tended to say you can take from the dead to give sight, and so on, but nobody's ever thought of donating the fetus.
"What's sort of strange in this case," said Hellegers, "is keeping a dead body around. With eye (donation), it's kind of fast."
In an article in the September, 1974, issue of Harpers magazine, psychiatrist-ethicist Dr. Willard Gaylin wrote a half serious, half tongue-in-cheek proposal that came eerily close to predicting the Maniscalco case.
Referring to the shortage of organs for transplantation, Gaylin, president of the Hastings Institute for Society. Ethics and the Life Sciences, proposed the establishment of a class of living dead he called neo-morts.
The neo-morts would be brain-dead individuals, maintained on machines, whose organs would be used as needed.
"You begin to ask yourself, how long bodies should be kept to serve a useful purpose for others," said Hellegers. "What it leads me think is that there is a problem with the whole business of pronouncing someone dead."
Although the Maniscalco case is but one case short of being unique, Tom Beauchamp, staff philosopher to the Commission for the Protection of Human Subjects, said he does not see the issueas one involving human experimentation.