The Texan flautist and the fetus
Imagine that when you woke up this morning, you found yourself lying next to an unconscious stranger. The stranger has a rare life-threatening illness, and unbeknownst to you he was plugged in to your organs during the night. You are now stuck to the stranger. If you disconnect the life support he will die. If, though, you remain connected to him for most of the next year his illness will have recovered, and he can safely ben unplugged. What should you do? Are you obliged to stay attached to the stranger? It might be generous of you to give up your body, and good if you choose to do so, but should we require you to remain connected?
The above story was first published by philosopher Judith Jarvis Thomson in a paper in 1971. It is often referred to as the ‘violinist analogy’ because the stranger in her story happens to be a famous violinist. It is a type of thought experiment, a hypothetical case used by philosophers to test our thinking about different problems. The violinist analogy was written by Thomson to reinforce a pro-choice argument. It would be wrong, argues Thomson, to force someone to remain attached to the unconscious violinist. By analogy, even if a fetus has the same rights as an adult, it would be wrong to force a woman to continue a pregnancy against her will.
There are echoes of Thomson’s strange and unsettling story in the current Texas case of Marlise Munoz. Marlise was 14 weeks pregnant when she had a sudden cardiac arrest. A massive blood clot had travelled to her lungs. Her heart stopped, and she needed extensive resuscitation. Tragically, although her heart could be restarted Marlise had suffered a catastrophic lack of oxygen to her brain. She was brain dead.
Ordinarily at this point life support would be withdrawn. However, Texas has an unusual law that prohibits doctors from stopping life support in pregnant women. Despite being legally dead, and against the wishes of her family, Marlise has remained connected to life-support machines for more than six weeks since her collapse. Her family has been told that treatment must continue until the fetus can be safely delivered.
What should happen in Marlise’s case? Must she remain attached to life support machines for the next 5 months? Her situation is different from Thomson’s analogy in one important respect – the central character is dead. We could reimagine the story in this way
Imagine that you are looking after a patient in a hospital intensive care unit. You come in one morning to discover that they have just died. You are about to disconnect the life support wires, when you discover that unbeknownst to the medical staff a second person, an unconscious flautist, had been attached to her life support during the night. If you disconnect the machines now the stranger will die, but if you continue the machines for some months he can safely be unplugged.
In this version of Thomson’s analogy, it appears less clear that we should disconnect the life support. Because the patient has already died, they have much less at stake. It might go against their previous wishes, it might delay their funeral but arguably we should continue life support in order to give the flautist a chance at life. Indeed it seems plausible that if there is ever a situation in which continuing a pregnancy against a woman’s wishes is justified – it is this situation. She cannot suffer pain or distress or anxiety from the continuing pregnancy. She cannot be put at physical or mental risk.
The above argument might be the sort of thing that Texas lawmakers had in mind when they drafted their legislation. However, it is worth noting one apparent consequence. The Texan law seems to accept that the woman’s interests are reduced by being in a state close to death (or already being dead). It appears to be justified to ignore her previous wishes and to cause distress to her family in order to save the life of another. If this argument is sound, though, it appears to have much wider implications. For though brain death in pregnant women is rare, there are many patients who die in intensive care who could save the lives of others – by donating their organs. Indeed there are more potential lives at stake, since the organs of a patient dying in intensive care may be used to save the life of up to seven other people.
If it is justified to continue life support machines for Marlise Munoz against her and her family’s wishes, it would also appear be justified to remove the organs of dying or brain dead patients in intensive care against their and their family’s wishes. Texas would appear to be committed to organ conscription.