In re T.A.C.P.

609 So. 2d 588
CourtSupreme Court of Florida
DecidedNovember 12, 1992
DocketNo. 79582
StatusPublished
Cited by10 cases

This text of 609 So. 2d 588 (In re T.A.C.P.) is published on Counsel Stack Legal Research, covering Supreme Court of Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In re T.A.C.P., 609 So. 2d 588 (Fla. 1992).

Opinion

KOGAN, Justice.

We have for review an order of the trial court certified by the Fourth District Court of Appeal as touching on a matter of great public importance requiring immediate resolution by this Court. We frame the issue as follows:1

Is an anencephalic newborn considered “dead” for purposes of organ donation solely by reason of its congenital deformity?

We have jurisdiction.2 Art. V, § 3(b)(5), Fla. Const.

I. Facts

At or about the eighth month of pregnancy, the parents of the child T.A.C.P. were informed that she would be born with anencephaly. This is a birth defect invariably fatal,3 in which the child typically is born with only a “brain stem” but otherwise lacks a human brain. In T.A.C.P.’s case, the back of the skull was entirely missing and the brain stem was exposed to the air, except for medical bandaging. The risk of infection to the brain stem was considered very high. Anencephalic infants sometimes can survive several days after birth because the brain stem has a. limited capacity to maintain autonomic bodily functions such as breathing and heartbeat. This ability soon ceases, however, in the absence of regulation from the missing brain.

In this case, T.A.C.P. actually survived only a few days after birth. The medical evidence in the record shows that the child T.A.C.P. was incapable of developing any sort of cognitive process, may have been unable to feel pain or experience sensation due to the absence of the upper brain,4 and at least for part of the time was placed on a mechanical ventilator to assist her breathing. At the time of the hearing below, however, the child was breathing unaided, although she died soon thereafter.

On the advice of physicians, the parents continued the pregnancy to term and agreed that the mother would undergo caesarean section during birth. The parents agreed to the caesarean procedure with the express hope that the infant’s organs would be less damaged and could be used for transplant in other sick children. Although T.A.C.P. had no hope of life herself, the parents both testified in court that they wanted to use this opportunity to give life to others. However, when the parents requested that T.A.C.P. be declared legally dead for this purpose, her health care providers refused out of concern that they thereby might incur civil or criminal liability-

The parents then filed a petition in the circuit court asking for a judicial determination. After hearing testimony and argument, the trial court denied the' request on grounds that section 382.009(1), Florida Statutes (1991), would not permit a determination of legal death so long as the child’s brain stem continued to function. On appeal, the Fourth District summarily affirmed but then certified the trial court’s order to this Court for immediate resolution of the issue. We have accepted jurisdiction to resolve this case of first impression.

II. The Medical Nature of Anencephaly

Although appellate courts appear never to have confronted the issue, there already [590]*590is an impressive body of published medical scholarship on anencephaly.5 From our review of this material, we find that anence-phaly is a variable but fairly well defined medical condition. Experts in the field have written that anencephaly is the most common severe birth defect of the central nervous system seen in the United States, although it apparently has existed throughout human history.

A statement by the Medical Task Force on Anencephaly (“Task Force”) printed in the New England Journal of Medicine6 generally described “anencephaly” as “a congenital absence of major portions of the brain, skull, and scalp, with its genesis in the first month of gestation.” David A. Stumpf et ah, The Infant with Anencephaly, 322 New EngJ.Med. 669, 669 (1990). The large opening in the skull accompanied by the absence or severe congenital disruption of the cerebral hemispheres is the characteristic feature of the condition. Id.

The Task Force defined anencephaly as diagnosable only when all of the following four criteria are present:

(1) A large portion of the skull is absent.
(2) The scalp, which extends to the margin of the bone, is absent over the skull defect. (3) Hemorrhagic, fibrotic tissue is exposed because of defects in the skull and scalp. (4) Recognizable cerebral hemispheres are absent.

Id. at 670. Anencephaly is often, though not always, accompanied by defects in various other body organs and systems, some of which may render the child unsuitable for organ transplantation. Id.

Thus, it is clear that anencephaly is distinguishable from some other congenital conditions because its extremity renders it uniformly lethal. Id. Less severe conditions are not “anencephaly.” There has been a tendency by some parties and amici to confuse lethal anencephaly with these less serious conditions, even to the point of describing children as “anencephalic” who have abnormal but otherwise intact skulls and who are several years of age. We emphasize that the child T.A.C.P. clearly met the four criteria described above. The present opinion does not apply to children with less serious conditions; they are not anencephalic because they do not have large openings in their skulls accompanied by the complete or near total absence of normal cerebral hemispheres, which defines “anencephaly.” See id.

The Task Force stated that most reported anencephalic children die within the first few days after birth, with survival any longer being rare. After reviewing all available medical literature, the Task Force found no study in which survival beyond a week exceeded nine percent of children meeting the four criteria. Id. at 671. Two months was the longest confirmed survival of an anencephalic, although there are unconfirmed reports of one surviving three months and another surviving fourteen months. The Task Force reported, however, that these survival rates are confounded somewhat by the variable degrees of medical care afforded to anencephalics. Id. Some such infants may be given considerable life support while others may be given much less care. See id.

The Task Force reported that the medical consequences of anencephaly can be established with some certainty. All anence-phalics by definition are permanently unconscious because they lack the cerebral cortex necessary for conscious thought. Their condition thus is quite similar to that of persons in a persistent vegetative state. Where the brain stem is functioning, as it was here, spontaneous breathing and heartbeat can occur. In addition, such infants may show spontaneous movements of the extremities, “startle” reflexes, and pupils that respond to light. Some may show feeding reflexes, may cough, hiccup, or ex[591]*591hibit eye movements, and may produce facial expressions. Id. at 671-72.

The question of whether such infants actually suffer from pain is somewhat more complex. It involves a distinction between “pain” and “suffering.” The Task Force indicated that anencephaly in some ways is analogous to persons with cerebral brain lesions.

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609 So. 2d 588, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-tacp-fla-1992.