{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:55:14Z","timestamp":1792601714816,"version":"4.5.0"},"reference-count":85,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"unspecified","delay-in-days":104,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Law. Med. Ethics"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Providing physiologic support to a brain-dead pregnant decedent poses complex ethical, legal, and clinical challenges. Understanding these considerations is necessary to navigate complex discussion and provide appropriate medical care. We use a theoretical case to examine these considerations and outline a path forward.<\/jats:p>","DOI":"10.1017\/jme.2026.10260","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T08:10:16Z","timestamp":1776240616000},"page":"290-300","source":"Crossref","is-referenced-by-count":2,"title":["Ethical and Legal Dilemmas in Prolonged Physiologic Support after Brain Death in Previable Pregnancy"],"prefix":"10.1017","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9628-3399","authenticated-orcid":false,"given":"April R.","family":"Dworetz","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03czfpz43","id-type":"ROR","asserted-by":"publisher"}],"name":"Emory University School of Medicine"},{"id":[{"id":"https:\/\/ror.org\/002q1t780","id-type":"ROR","asserted-by":"publisher"}],"name":"Children\u2019s Healthcare of Atlanta Arthur M Blank Hospital"},{"id":[{"id":"https:\/\/ror.org\/03czfpz43","id-type":"ROR","asserted-by":"publisher"}],"name":"Emory University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison M.","family":"Whelan","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03qt6ba18","id-type":"ROR","asserted-by":"publisher"}],"name":"Georgia State University"},{"id":[{"id":"https:\/\/ror.org\/03vek6s52","id-type":"ROR","asserted-by":"publisher"}],"name":"Harvard Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley Waddell","family":"Tingstad","sequence":"additional","affiliation":[{"name":"Wayne State University Law School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara B.","family":"Markham","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01e3m7079","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cincinnati College of Medicine"},{"id":[{"id":"https:\/\/ror.org\/01hcyya48","id-type":"ROR","asserted-by":"publisher"}],"name":"Cincinnati Children\u2019s Hospital Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7555-7829","authenticated-orcid":false,"given":"DonnaMaria E.","family":"Cortezzo","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02der9h97","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Connecticut School of Medicine"},{"id":[{"id":"https:\/\/ror.org\/02der9h97","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Connecticut School of Medicine"},{"id":[{"id":"https:\/\/ror.org\/01a1jjn24","id-type":"ROR","asserted-by":"publisher"}],"name":"Connecticut Children\u2019s Medical Center"},{"id":[{"id":"https:\/\/ror.org\/02der9h97","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Connecticut School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"S1073110526102605_r48","doi-asserted-by":"publisher","DOI":"10.1086\/JCE201425307"},{"key":"S1073110526102605_r43","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-008-0688-8"},{"key":"S1073110526102605_r10","unstructured":"10. \u201cGuidelines for the Determination of Death.\u201d"},{"key":"S1073110526102605_r9","doi-asserted-by":"publisher","DOI":"10.1212\/CPJ.0000000000200189"},{"key":"S1073110526102605_r7","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000006099"},{"key":"S1073110526102605_r14","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2014.925153"},{"key":"S1073110526102605_r31","unstructured":"31. Munoz V. John Peter Smith Hospital. Tarrant County District Court, Texas, 2014."},{"key":"S1073110526102605_r4","volume-title":"Larsen\u2019sHuman Embryology","author":"Schoenwolf","year":"2021"},{"key":"S1073110526102605_r59","unstructured":"59. DeGrazia, \u201cMoral Status.\u201d"},{"key":"S1073110526102605_r63","doi-asserted-by":"publisher","DOI":"10.1136\/jme-2022-108392"},{"key":"S1073110526102605_r33","unstructured":"33. Hellerman, Caleb et al., \u201cBrain-Dead Texas Woman Taken Off Ventilator,\u201d CNN, January 27, 2014, https:\/\/www.cnn.com\/2014\/01\/26\/health\/texas-pregnant-brain-dead-woman."},{"key":"S1073110526102605_r70","doi-asserted-by":"publisher","DOI":"10.1385\/NCC:3:2:099"},{"key":"S1073110526102605_r66","doi-asserted-by":"publisher","DOI":"10.1093\/haschl\/qxae025"},{"key":"S1073110526102605_r64","unstructured":"64. Feinberg, Harm to Others."},{"key":"S1073110526102605_r25","doi-asserted-by":"publisher","DOI":"10.1097\/00006254-200011000-00023"},{"key":"S1073110526102605_r74","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201709-1899OC"},{"key":"S1073110526102605_r55","unstructured":"55. Cartolovni and Habek, \u201cGuidelines for the Management of Social and Ethical Challenges.\u201d"},{"key":"S1073110526102605_r36","unstructured":"36. Guttmacher Institute, \u201cState Legislation Tracker.\u201d"},{"key":"S1073110526102605_r19","unstructured":"19. Dodaro et al., \u201cBrain Death in Pregnancy.\u201d"},{"key":"S1073110526102605_r29","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.2587"},{"key":"S1073110526102605_r68","unstructured":"68. Howard, Aisha et al., \u201cPregnant Georgia Mother on Life Support: Experts Answer Legal, Health Questions,\u201d 11Alive, May 25, 2025, https:\/\/www.11alive.com\/article\/news\/community\/a-closer-look\/adriana-smith-pregnant-expert-insight-georgia\/85-ee59aee2-a4a6-45b7-a800-c83bacc571ba."},{"key":"S1073110526102605_r41","doi-asserted-by":"publisher","DOI":"10.1017\/S0963180108080092"},{"key":"S1073110526102605_r20","unstructured":"20. Esmaeilzadeh et al., \u201cOne Life Ends\u201d; Powner and Bernstein, \u201cExtended Somatic Support\u201d; Staff and Nash, \u201cBrain Death, Pregnancy, and Posthumous Motherhood\u201d; Kantor and Hoskins, \u201cBrain Death in Pregnant Women.\u201d"},{"key":"S1073110526102605_r52","unstructured":"52. Kantor and Hoskins, \u201cBrain Death in Pregnant Women.\u201d"},{"key":"S1073110526102605_r17","unstructured":"17. Dodaro et al., \u201cBrain Death in Pregnancy\u201d; Powner and Bernstein, \u201cExtended Somatic Support\u201d; Cerqueira et al., \u201cHealthy Baby Delivery.\u201d"},{"key":"S1073110526102605_r49","volume-title":"When Fetuses Gain Personhood: Understanding the Impact on IVF, Contraception, Medical Treatment, Criminal Law, Child Support, and Beyond","author":"Fleming","year":"2023"},{"key":"S1073110526102605_r69","unstructured":"69. Howard et al., \u201cPregnant Georgia Mother on Life Support.\u201d"},{"key":"S1073110526102605_r1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.01.033"},{"key":"S1073110526102605_r32","doi-asserted-by":"publisher","DOI":"10.1086\/JCE201425309"},{"key":"S1073110526102605_r76","unstructured":"76. Kerstis and Widarsson, \u201cWhen Life Ceases.\u201d"},{"key":"S1073110526102605_r40","volume-title":"Principles of Biomedical Ethics","author":"Beauchamp","year":"2019"},{"key":"S1073110526102605_r81","doi-asserted-by":"publisher","DOI":"10.1212\/CON.0000000000001109"},{"key":"S1073110526102605_r11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1400930"},{"key":"S1073110526102605_r77","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000254722.50608.2D"},{"key":"S1073110526102605_r18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2024.07.016"},{"key":"S1073110526102605_r44","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1056\/NEJMp2507544","article-title":"Ethical Controversies in the Adriana Smith Case\u201d; Katie Watson, \u201cBrain Death in Pregnancy - Abortion, Advance-Directive, or End-of-Life Law?","volume":"393","author":"Lewis","year":"2025","journal-title":"New England Journal of Medicine"},{"key":"S1073110526102605_r46","unstructured":"46. FIGO Committee, \u201cBrain Death and Pregnancy.\u201d"},{"key":"S1073110526102605_r3","volume-title":"State Bans on Abortion Throughout Pregnancy","author":"Curhan","year":"2026"},{"key":"S1073110526102605_r50","doi-asserted-by":"publisher","DOI":"10.1177\/1751143720918974"},{"key":"S1073110526102605_r38","doi-asserted-by":"publisher","DOI":"10.1007\/s11017-025-09706-5"},{"key":"S1073110526102605_r30","unstructured":"30. Segal, Jeffrey , \u201cLiving Wills and Pregnant Patients: How Are They Treated?\u201d Medical Justice Blog (blog), May 23, 2025. https:\/\/medicaljustice.com\/blog\/living-wills-advance-directives-for-pregnant-patients-are-restricted-in-many-states\/; Elizabeth Villarreal, \u201cPregnancy and Living Wills: A Behavioral Economic Analysis,\u201d The Yale Law Journal Forum (2019): 1052\u201376. https:\/\/www.yalelawjournal.org\/pdf\/Villarreal_huru3n6p.pdf; Christopher M Burkle et al., \u201cMedical, Legal, and Ethical Challenges Associated with Pregnancy and Catastrophic Brain Injury,\u201d Internantional Journal of Gynecology and Obstetrics 129, no. 3 (2015): 276\u201380, https:\/\/doi.org\/10.1016\/j.ijgo.2014.12.011; Rebecca Rosefelt, Guide to State Laws on Advance Directives and Pregnancy: Charts and Links (FindLaw, June 11, 2025), https:\/\/www.findlaw.com\/forms\/resources\/living-will\/guide-to-state-laws-on-advance-directives-and-pregnancy-charts-and-links-2.html"},{"key":"S1073110526102605_r57","unstructured":"57. Feinberg, Harm to Others; Thomas Nagel, \u201cDeath,\u201d Nous 4, no. 1 (1970): 73\u201380, https:\/\/doi.org\/10.2307\/2214297; DeGrazia, David , \u201cMoral Status, Human Identity, and Early Embryos: A Critique of the President\u2019s Approach,\u201d Journal of Law, Medicine & Ethics 34, no. 1 (2006): 49\u201357, https:\/\/doi.org\/10.1111\/j.1748-720X.2006.00008.x; Bonnie Steinbock, \u201cPrenatal Wrongful Death,\u201d Bioethics 1, no. 4 (1987): 301\u201320, https:\/\/doi.org\/10.1111\/j.1467-8519.1987.tb00015.x; Bonnie Steinbock, Life Before Birth: The Moral and Legal Status of Embryos and Fetuses, 2nd ed. (Oxford University Press, 2011)."},{"key":"S1073110526102605_r61","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2022.2160515"},{"key":"S1073110526102605_r24","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000182788.31961.88"},{"key":"S1073110526102605_r56","unstructured":"56. Jaworska, Agnieszka and Tannenbaum, Julie , \u201cThe Grounds of Moral Status\u201d in Stanford Encyclopedia of Philosophy (Stanford University), published March 14, 2013; substantially revised March 3, 2021, https:\/\/plato.stanford.edu\/entries\/grounds-moral-status\/."},{"key":"S1073110526102605_r2","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12871"},{"key":"S1073110526102605_r80","doi-asserted-by":"publisher","DOI":"10.1177\/0024363919874955"},{"key":"S1073110526102605_r47","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-025-02390-2"},{"key":"S1073110526102605_r65","doi-asserted-by":"publisher","DOI":"10.1111\/bioe.12853"},{"key":"S1073110526102605_r12","doi-asserted-by":"publisher","DOI":"10.1007\/s11673-015-9683-z"},{"key":"S1073110526102605_r39","doi-asserted-by":"publisher","DOI":"10.1038\/s41372-025-02394-y"},{"key":"S1073110526102605_r51","unstructured":"51. Gostin, \u201cLegal and Ethical Responsibilities Following Brain Death\u201d; Lewis et al., \u201cPregnancy and Brain Death.\u201d"},{"key":"S1073110526102605_r82","unstructured":"82. Esmaeilzadeh et al., \u201cOne Life Ends.\u201d"},{"key":"S1073110526102605_r6","doi-asserted-by":"publisher","DOI":"10.1093\/jmp\/jhae016"},{"key":"S1073110526102605_r42","unstructured":"42. Kantor and Hoskins, \u201cBrain Death in Pregnant Women.\u201d"},{"key":"S1073110526102605_r60","volume-title":"An Essay Concerning Human Understanding","author":"Locke","year":"1690"},{"key":"S1073110526102605_r53","unstructured":"53. FIGO Committee, \u201cBrain Death and Pregnancy\u201d; Lewis et al., \u201cPregnancy and Brain Death.\u201d"},{"key":"S1073110526102605_r28","unstructured":"28. Unif. Health-Care Decisions Act Mich. Comp. Laws \u00a711(D). (Unif. L. Comm\u2019n 2023), 2025."},{"key":"S1073110526102605_r72","doi-asserted-by":"publisher","DOI":"10.1007\/s11673-019-09943-z"},{"key":"S1073110526102605_r35","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.14739"},{"key":"S1073110526102605_r13","unstructured":"13. Cal. Health & Safety Code \u00a7 1254.4(C)(2);New Jersey S.A. \u00a7\u00a7 26:6a-3, 26:6a-4."},{"key":"S1073110526102605_r58","first-page":"381","article-title":"Controversies in Defining Death: A Case for Choice","volume":"40","author":"Veatch","year":"2019","journal-title":"Theoretical Medicine and Bioethics"},{"key":"S1073110526102605_r5","unstructured":"5. President\u2019s Commission, Defining Death."},{"key":"S1073110526102605_r45","unstructured":"45. Lewis et al., \u201cPregnancy and Brain Death.\u201d"},{"key":"S1073110526102605_r23","unstructured":"23. Dodaro et al., \u201cBrain Death in Pregnancy.\u201d"},{"key":"S1073110526102605_r84","doi-asserted-by":"publisher","DOI":"10.1086\/JCE199304416"},{"key":"S1073110526102605_r37","unstructured":"37. Uniform Determination of Death Act (National Conference of Commissioners on Uniform State Laws,1980), https:\/\/lchc.ucsd.edu\/cogn_150\/Readings\/death_act.pdf"},{"key":"S1073110526102605_r62","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2023.2278561"},{"key":"S1073110526102605_r27","unstructured":"27. Dobbs v. Jackson."},{"key":"S1073110526102605_r85","unstructured":"85. Kantor and Hoskins, \u201cBrain Death in Pregnant Women.\u201d"},{"key":"S1073110526102605_r71","unstructured":"71. Cartolovni and Habek, \u201cGuidelines for the Management of Social and Ethical Challenges.\u201d"},{"key":"S1073110526102605_r8","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000207740"},{"key":"S1073110526102605_r67","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2010.02.016"},{"key":"S1073110526102605_r34","unstructured":"34. \u201cErick Munoz Vs. John Peter Smith Hospital.\u201d https:\/\/thaddeuspope.com\/images\/MUNOZ_202053415-Judges-Order-on-Munoz-Matter.pdf."},{"key":"S1073110526102605_r15","doi-asserted-by":"publisher","DOI":"10.1086\/JCE199304404"},{"key":"S1073110526102605_r22","unstructured":"22. Battarbee et al., \u201cManagement of Previable and Periviable Preterm Prelabor Rupture\u201d; Edwards et al., \u201cSurvival of Infants.\u201d"},{"key":"S1073110526102605_r75","first-page":"4","article-title":"Insights: Ambiguous Loss: Living with Frozen Grief","volume":"16","author":"Boss","year":"1999","journal-title":"Harvard Mental Health Letter"},{"key":"S1073110526102605_r73","unstructured":"73. Kerstis and Widarsson, \u201cWhen Life Ceases.\u201d"},{"key":"S1073110526102605_r79","first-page":"33","article-title":"Moral Distress in Healthcare Practice: The Situation of Nurses","volume":"17","author":"Austin","year":"2005","journal-title":"HealthCare Ethics Committee Forum"},{"key":"S1073110526102605_r78","doi-asserted-by":"publisher","DOI":"10.1097\/00003465-199405000-00006"},{"key":"S1073110526102605_r83","unstructured":"83. Cartolovni and Habek, \u201cGuidelines for the Management of Social and Ethical Challenges.\u201d"},{"key":"S1073110526102605_r16","unstructured":"16. Cartolovni and Habek, \u201cGuidelines for the Management of Social and Ethical Challenges\u201d; Dillon et al., \u201cLife Support.\u201d"},{"key":"S1073110526102605_r26","unstructured":"26. Dobbs v. Jackson; Curhan, \u201cState Bans on Abortion Throughout Pregnancy\u201d; Guttmacher Institute, \u201cState Legislation Tracker.\u201d"},{"key":"S1073110526102605_r21","unstructured":"21. Dodaro et al., \u201cBrain Death in Pregnancy.\u201d"},{"key":"S1073110526102605_r54","unstructured":"54. Kantor and Hoskins, \u201cBrain Death in Pregnant Women.\u201d"}],"container-title":["Journal of Law, Medicine &amp; Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1073110526102605","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:11:11Z","timestamp":1792069871000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1073110526102605\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":85,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"alternative-id":["S1073110526102605"],"URL":"https:\/\/doi.org\/10.1017\/jme.2026.10260","relation":{},"ISSN":["1073-1105","1748-720X"],"issn-type":[{"value":"1073-1105","type":"print"},{"value":"1748-720X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]}}}