Late last month, a local Spanish-language publication in Argentina published an account of an almost uniquely awful case in medical history: A woman became pregnant due to rape while in a coma.
The woman has not been identified in the media in order to protect her and her family's privacy, and it's not clear who assaulted her or where, since she was recently moved from one healthcare facility to another and has been in contact with multiple male staff members and relatives. The family is not pressing charges in the case, which means the police will not investigate.
The remaining question in the case is one that does not often need to be asked: What do you do when an unconscious person becomes pregnant?
I posed the query to bioethicist Arthur Caplan, the Head of the Division of Medical Ethics at the NYU Medical School. "Could a person in a coma have a baby? Yes, and they have," he said, adding that while this particular case is very strange, it's not unheard of for a pregnant woman to become comatose.
"A person could be in a coma, which means they may wake up, or they may be permanently unconscious, or they may be brain dead," said Caplan. "In all three of those cases, it's possible to bring a fetus to term, but it depends on how far you are in the pregnancy. If you're at 28 weeks, you could probably have a C-section. But if you were only two weeks pregnant, I don't think many hospitals would try that, because it could harm the fetus."
Comatose pregnancies are extremely rare, but there is some precedent. In 2001, a woman named Chastity Cooper fell into a coma after suffering head injuries from a car crash. Routine testing at the hospital revealed that she was two weeks pregnant, and Cooper remained comatose throughout the duration of her pregnancy—one of the only cases in which this has ever happened—but eventually, she had a normal vaginal delivery (C-section was ruled out given the risk of administering anesthesia to a comatose person). Somewhat miraculously, the baby was born perfectly healthy, clocking in at seven pounds and seven ounces.
Still, cases like Cooper's are extremely rare. When she gave birth, a doctor of maternal fetal medicine told the Associated Press that he could find only eight cases of comatose pregnancies in the US in the medical literature, none of which were carried to full term. (Caplan estimated there have been around 50 cases in the past decade.)
When pregnant women become comatose, doctors often decide to deliver their babies prematurely to avoid pregnancy complications. Christine Bolden, a 26-year-old in Michigan, gave birth to twins in 2012 after suffering two brain aneurysms and being declared brain dead. The twins, who were delivered by C-section, each weighed a little over one pound at birth—but managed to survive, while Bolden was eventually removed from life support.
Still, none of these cases involve the most disturbing part of the Argentine woman's pregnancy, which is that it occurred after she was already in a coma. The decision of what to do with the baby is laden with as many ethical issues as medical ones. What do you do with a pregnancy that is not only medically risky, but the result of rape?
The fact that the duration of this woman's pregnancy would be in a permanent coma is concerning from a medical perspective, according to Caplan, since it could compromise the health of the fetus. But the decision is not purely medical, he noted: "Maybe the family wants the baby because they've lost their daughter?"
In 1996, the New York Times reported on the case of a 29-year-old woman—identified only by her first name, Kathy—who had become pregnant after being in a coma for ten years. When she later gave birth to a baby boy, it was cited as "the only known case of someone becoming pregnant and giving birth in a comalike state."
Kathy died about a year later, just a few weeks before her rapist—who had been a nursing aide—was convicted for the assault. The baby was raised by Kathy's mother, who also pushed for legislation in New York State that would require background checks for nursing aides and provide other safeguards against abuse in nursing facilities. That law, known as "Kathy's Law," was put into effect in 1998.
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