DOCTORS say guidelines governing maternal brain death are urgently needed after it emerged that a second brain-dead woman was kept on life support in an Irish hospital because she was pregnant.

The 26-year-old, who was 13 weeks pregnant, was kept artificially alive in a Galway hospital in 2003 to allow the unborn child to develop until it could be delivered.

Life support would have been needed for up to four months to give the foetus a good chance of survival, but it died eight days after the woman was declared brain dead.

This is the second case of its type to be reported in Ireland in five years. In 2001 a brain-dead British woman who was 14 weeks pregnant was kept on life support at Waterford Regional hospital to protect the life of her unborn baby. The foetus survived for only two weeks.

In both cases the health boards involved took legal advice and were told that they should not switch off life support. In Waterford the treatment was reportedly undertaken against the wishes of the woman’s husband. It is understood that the family of the Galway woman agreed to keep her artificially alive.

Leading doctors involved in the cases have called for guidelines because they believe that the situation will arise again. Each case involves complex medical, ethical and legal issues and the fact that there is no clear guidance adds to the distress of families, they say.

The demand for guidelines is being made by Brian Marsh, an intensive care specialist at the Mater hospital, and John Laffey of University College hospital, Galway.

“These are tragic, awful circumstances,” said Marsh. “If the family knows that the medical and legal community have looked at the situation and an expert panel has delivered a set of guidelines then at least they can be comforted that they are getting the best available advice.”

Brain death occurs when a patient’s brain stem function irreversibly stops. But because a patient is on life support, the heart does not stop as in natural death. A ventilator continues breathing for them and other machines keep their vital organs working. In normal circumstances the machines would then be disconnected and actual death would occur.

If a woman is pregnant, switching off life support could possibly be regarded as killing a foetus. In Ireland the right to life of the foetus is enshrined in the constitution.

A medical difficulty arises because it is not possible to predict what will happen either to the mother’s body or to the foetus when maintained artificially for a prolonged period. Doctors have to decide if there is a realistic possibility of delivery of a live baby.

Complex mechanical and chemical support has to be given to the body to keep the organs working properly and these may have side effects on the unborn baby. The chances of survival for the foetus are very slim, particularly at early stages of gestation.

Marsh said: “The overwhelming majority of cases have resulted in foetal death, despite heroic efforts to get that child to survive.”

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