A Horrifying Ethical Dilemma

What’s the most humane way to treat a pregnant rape victim who’s in a vegetative state?

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Last month, a 29-year-old woman who’s been in a persistent vegetative state since she was a toddler went into labor and gave birth. An employee of the Arizona health care facility where she’s resided for more than 26 years swears no one had any idea she was pregnant until she started exhibiting signs of physical distress during labor. After testing the DNA of the newborn and male employees at the Hacienda HealthCare facility, law enforcement officials arrested nurse Nathan Sutherland, 36, on counts of sexual assault and vulnerable adult abuse on Wednesday morning.

There is some dispute over the victim’s condition. The chairman of the San Carlos Apache Tribe, of which the woman is a member, has said she is in a vegetative state, as has the Phoenix Police Department. But her family’s lawyer insists that she is neither comatose nor in a vegetative state, but living with “significant intellectual disabilities” that still allow her to move her limbs and face and respond to noises. (None of these capabilities are incompatible with persistent vegetative states.) Medical records reviewed by the New York Times stated that the victim is incapable of communicating or moving. Court records call her “incapacitated” and say she has feeding and breathing tubes; no one has disputed that she is incapable of consenting to sexual activity.

The details of this case are heart-wrenching and infuriating. This woman has spent nearly her whole life confined in an institution, one that is apparently so careless with her body that the team of medical professionals assigned to her care didn’t notice anything out of the ordinary when she was more than eight months pregnant. (Investigators believe Sutherland raped her between February and April; she gave birth Dec. 29.) While bathing her, while checking her for bed sores, while testing her vitals—no one noticed (or has said publicly that they noticed) an expanding waistline or breasts, nor felt a growth the size of a full-term infant in her abdomen. In response to a request for comment, a PR representative for Hacienda HealthCare replied, “Because of federal privacy laws, we are unable to discuss any aspect of this patient’s care.”

In every previous case of pregnancy by rape in vegetative or comatose victims I could find, medical professionals noticed that the victim was pregnant before she gave birth. They noticed in the case of a young Argentinean woman in a coma, whose family declined to initiate a police investigation in 2015. They noticed five months into the pregnancy of a 24-year-old quadriplegic and comatose Massachusetts woman in 1998. And they noticed a little over four months into the pregnancy of Kathy, a 29-year-old woman who spent a decade in a coma in upstate New York before making international headlines for her rape, pregnancy, and birth in 1996.

At the time, bioethicists and physicians called Kathy the first known patient to become pregnant while in a vegetative state. Her case presented a grave and complex ethical dilemma for her family, medical practitioners, and activists for and against reproductive rights. Should Kathy’s parents, who were responsible for her care, authorize an abortion in the second trimester of her pregnancy? Or should they consign her to the health risks of pregnancy and childbirth, the pain of vaginal birth or a cesarean section, and many months of physical discomfort to which her vegetative body cannot adjust?

Kathy’s parents found the decision quite simple. They were Catholic and anti-abortion, and claimed she would never have wanted to terminate a pregnancy. Before the car crash that put her in a coma at 19 years old, she was “always pretty pro-life,” according to a friend who’d heard her express that view in a class on current events at their Catholic high school. According to the family’s lawyer, Kathy’s mother, who ended up adopting and raising her grandchild, said, “I know my daughter, and if she could speak, she would want to have this baby.”

For other observers, the proper course of action was more complicated. Like the cases of Terri Schiavo and Marlise Muñoz, the latter a Texas woman who became brain-dead during the course of her pregnancy in 2013, Kathy’s pregnancy was a flashpoint in larger, ongoing political debates about life, death, and bodily autonomy. In the New York Times, health care lawyer and bioethicist Ellen Moskowitz wondered whether Kathy was being used “as a vessel,” asking, “Does that recognize her humanity? Is this something that offends the natural order?” She also expressed concern that the son Kathy would eventually bear—who the Rochester Democrat and Chronicle recently reported is approaching his 23rd birthday—might suffer “potential harms” from knowing his mother was both raped and forced to give birth with neither her consent nor her knowledge. Health law professor George Annas concurred with the idea that Kathy was being used as a vessel “for the sake of other people”—namely, her parents. In a story published in the Los Angeles Times, he called Kathy an “incubator” and raised the hypothetical scenario of parents wanting to artificially inseminate their vegetative child. “Would you say it’s the family’s prerogative?” Annas asked. “I think most people would be horrified at that notion.”