NewsMon Aug 24, 2009 - 12:15 pm EST
Deceased Infant Center of Controversy in Brazilian Supreme Court Abortion Case
By Matthew Cullinan Hoffman, Latin America Correspondent
BRAZIL, August 18, 2009 (LifeSiteNews.com) - As Brazil's Supreme Federal Tribunal (STF) examines a petition to constitutionally legalize abortions for anencephalic babies, the center of attention is a deceased infant named Marcela, whose case has become a cause celebre for the nation's pro-life movement.
Marcela Ferreira died in August of 2008, after living more than a year and eight months with anencephaly, a birth defect that prevents the formation of most of the upper brain. Anencephalic babies are born with an open skull and normally have little more than their brain stem, which allows their organs to function.
Although most infants with anencephaly die before or shortly after birth, Marcela's case has called attention to the fact that some live much longer - for months or even years. Moreover, Marcela, like many other anencephalic babies, exhibited many signs of awareness, signs that have been amply documented in YouTube video accounts (Click here for two-part series. Switch subtitles to English using arrow on lower right.).
Casilda Ferreira's vivid accounts of the meaningful, but short life of her daughter, have become an important element in the Brazilian case. In response, however, pro-abortion forces have striven to discredit her testimony by claiming that Marcela didn't suffer from anencephaly after all.
Numerous Physicians Say Marcela had Anencephaly
However, three American physicians have now examined MRI and CT scans of Marcela's brain, and are stating publicly that, according to U.S. standards, Marcela was indeed anencephalic.
Dr. Paul A. Byrne, Clinical Professor of Pediatrics at the University of Toledo's College of Medicine, has written an open letter obtained by LifeSiteNews stating that, "Marcela de Jesus Galante Ferreira does have anencephaly as approved in the United States by major neurological organizations: The scalp is absent, and the skull is open from the vertex to the foramen magnum. The brain is present but abnormally developed. The orbits are shallow, and the eyes protrude."
According to Byrne, he has been "certified multiple times as an expert in United States of America Courts to evaluate infants with abnormalities of the brain and skull."
His expert opinion is seconded by Dr. Thomas Zabiega, who is certified by the American board of psychiatry and neurology. Zabiega has also written an open letter quoting the standard American definition of anencephaly and noting that "This is exactly what is seen in the imaging study of patient Marcela de Jesus Galante Ferreira. She only has the presence of the medulla oblongata, pons, midbrain, and cerebellum. The rest of her brain is absent."
Both doctors observe that other anencephalic infants have lived even longer than Marcela.
The testimony of the two American physicians directly contradicts that of Brazilian doctors who have claimed that Marcela Ferreira wasn't suffering from anencephaly because she had some upper brain matter in her skull.
However, Dr. Alan Shewmon, assistant professor of pediatrics and neurology at UCLA, notes in a 1988 article that "although the term 'anencephaly' literally means 'no brain,' the actual amount of nervous system tissue compatible with that diagnosis can vary anywhere from only a few grams up to a normal full term brain weight."1
The classical subdivisions of anencephaly, according to Shewmon, are "holo-anencephaly (complete absence of forebrain and cranium) and mero-anencephaly, in which 'the cranium and the brain are present in rudimentary form.'"
Shrewmon has also personally examined Marcela Ferreira's CT and MRI scans and states in an open letter that "this is a classical case of anencephaly."
The Brazilian doctors who initially examined Marcela after her birth expressed their agreement. Her attending physician, Marcia Beani Barcellos, diagnosed her with anencephaly. This diagnosis was confirmed and reiterated by the physicians who conducted various analyses on the child, including Dr. Joao Soares Leite Filho, who performed the cranial MRI, and Dr. Alberto Pulicano Neto, who performed the tomography. Even Marcela's death certificate records "anencephaly" as a cause of death.
Medical Literature Supports Diagnosis
The existence of varying degrees of awareness in anencephalic infants is also well recognized in the medical literature.
In a 1989 article for the prestigious Journal of the American Medical association, a group of physicians from UCLA point out that while newborn infants do have a forebrain, it hardly functions at birth, making the baby similar in its capacities to that of an anencephalic infant. At least one case has been documented of normal development in a baby at 21 months with hydrancephaly, in which the upper brain is generally absent as well.
"Moreover," they write, "the phenomenon of developmental neuroplasticity could, in principle, allow brain-stem structures in the congenital absence of cerebral hemispheres to assume somewhat more complex integrative activity than would ordinarily be the case…"
In other words, the brain stem may be able to assume some of the higher functions of the upper brain, allowing a degree of awareness.2 This may be what happened in the case of Marcela and other anencephalic babies whose mothers have reported responsiveness and low levels of consciousness in their children.
Several Brazilian Doctors Have Used False Criteria to Deny Marcela's Anencephaly
Misunderstandings among Brazilian physicians regarding anencephaly may explain why several of them have denied publicly that Marcela Ferreira had the condition.
A doctor at the University of Sao Paulo decided that Marcela did not have anencephaly because of the presence of a "cerebrovasculosa," and therefore diagnosed her with "merocrania."
"Marcela had merocrania," said Dr. Thomaz Gollop in an interview with Parana Online. "I just finished a meeting with a specialist in anatomy and neurological pediatrics with the examinations on hand. She had a less grave defect in the formation of the cranium and the small piece of brain that is present, in contrast with anencephalics who have nothing, and covered with a membrane called cerebrovasculosa."
Gollop's analysis contradicts Shewmon, who states that varying amounts of brain tissue are compatible with anencephaly, and that "merocrania" or "meroanencephaly" are simply a type of anencephaly, not another syndrome. Shewmon also states that the "cerebrovasculosa" is a normal feature of anencephaly.
Shrewmon explains that in anencephalic babies, the upper brain begins to grow, but is malformed, "resulting in a disorganized mass of primitive glilal, neural, and vascular tissue arising from the upper end of the brainstem. ... During gestation, this tissue typically degenerates, leaving by term only a remnant of varying amount called the cerebrovasculosa."
Marcela's own physician, Dr. Marcia Beani Barcellos, partially retracted her initial diagnoses of anencephaly after media attention became focused on the child, claiming that she "doesn't have classic anencephaly" but rather "another type of anencephaly."
However, Barcellos also cited criteria that contradict the recognized criteria for anencephaly, claiming that Marcela was excluded from "classic anencephaly" because of her longer lifespan and interaction with her environment.
"She is a baby without the encephalus, that region of her brain is filled with liquid, but she isn't an example of anencephaly described in the medical literature because she, in some way, still interacts with her mother, interacts with the environment, her cerebral base carries out functions," she told O Estado do Parana. "A classic case of malformation would not have survived for so much time in a vegetative state, which is not the case with her since her birth."
The conflicting testimony of physicians regarding the case of Marcela Barreira will be resolved by Brazil's Supreme Federal Tribunal in the coming months. However, the judges face an even more fundamental question: regardless of the level of awareness and true lifespan of anencephalic babies, does human life have intrinsic value, or is it only a disposable good whose worth is determined by its functionality and social utility?
The following are the email addresses of the justices (ministers) of the Supreme Federal Tribunal of Brazil.
Instructions: cut and paste all emails into the "To" header of your email client.
[email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected]
1. Shewmon, D. Alan. "Anencephaly: Selected Medical Aspects," Hastings Center Report, October/November 1988
2. D. Alan Shewmon, Alexander M. Capron, Warwick J. Peacock. "The Use of Anencephalic Infants as Organ Donors: A Critique," Journal of the American Medical Association, 1989;261:773-781.