Hospital agrees to withdraw life support from brain-dead pregnant woman

On January 9 I wrote about the sad case of Marline Munoz, a paramedic from Texas who died in November of a pulmonary embolism, but was pregnant at the time. She a living will stating her desire for no artificial means of keeping her alive after brain death, but her pregnancy kept the hospital from turning off the respirator.  According to Texas state law, a woman’s legal prerogative about end-of-life care is overruled if she “is diagnosed with pregnancy.” The hospital stated it would not go against that law.

There was quite a bit of discussion about whether the state had the right to do this, although I argued that the initial wishes of Munoz, and the postmortem wishes of her husband and family—both of whom wanted to take her off life support—trumped any interest or rights of the State of Texas. Munoz is, even now still below the 24-28 weeks threshold that Roe v. Wade suggested for the legal period of abortion. I thus saw it as a legal no-brainer.

Now, according to multiple news sources, a Texas district judge agrees, and has ordered Munoz removed from life support, and the hospital agreed today to abide by the judge’s decision. According to USA Today:

On Friday, State District Judge R.H. Wallace ruled that [Munoz] “is deceased” and therefore not subject to a state law that prohibits withdrawal of treatment from a pregnant person. The judge said the Fort Worth facility, John Peter Smith Hospital, had until 5 p.m. Monday to remove Munoz from life support.

The hospital issued a statement Sunday saying it had kept Munoz on life support to follow “the demands of a state statute” and has decided that “the hospital will follow the court order.”

The only thing that puzzles me is the hospital’s original claim that there was a state statute overruling the wishes of someone who is brain-dead, and yet the judge decided that Munoz could be taken off life support because she is brain-dead.

What makes this case even more bizarre is that medical opinion already suggested strongly that the fetus would not be born either normal or even alive because of Munoz’s condition. But Texas nevertheless persisted:

Both the hospital and the family agree that Marlise Munoz meets the criteria to be considered brain-dead — which means she is dead medically and under Texas law — and that the fetus could not be born alive at the current stage of pregnancy. But the hospital had said that it had a legal duty to protect the fetus.

Munoz’s attorneys have said medical records show the fetus is “distinctly abnormal.”

Move along now, folks: there’s nothing to see here. The wishes of Munoz and her family have been respected, and Texas and its insane restrictions on reproductive rights have lost. The state’s desire to stick its nose where it didn’t belong made the plight of the Munoz family a lot harder.

h/t: Ben Goren

34 Comments

  1. Posted January 26, 2014 at 12:10 pm | Permalink

    “What makes this case even more bizarre is that medical opinion already suggested strongly that the fetus would not be born either normal or even alive because of Munoz’s condition. But Texas nevertheless persisted.”

    I am not surprised that in a place where scientific illiteracy plays high grounds, law makers will ignore medical reality.

    • SA Gould
      Posted January 26, 2014 at 12:30 pm | Permalink

      Wait… are you suggesting that being incubated in a living, breathing, eating woman instead of an artificially preserved, decaying corpse *makes a difference* to the fetus? Wow! Who knew?

    • Diana MacPherson
      Posted January 26, 2014 at 12:45 pm | Permalink

      Yep, the hospital knew the fetus was not viable, but instead of using that information, information based on reasoning and science, they instead turned to religion to inform their decisions. I say religion, because despite the fact that the fetus would not be viable, they felt they had to bring it to term. What laws did they use to support their ill informed decision? Religious laws of course! How do I know they’re religious laws? Because the laws see the fetus as alive in a person sense from conception even when it’s a collection of cells. These laws also talk about the fetus feeling pain, which is questionable when the nervous system isn’t built yet.

      If the hospital wants to make decisions based on religion, why doesn’t it just hire holy men to pray over victims?

      • Posted January 26, 2014 at 12:58 pm | Permalink

        “If the hospital wants to make decisions based on religion, why doesn’t it just hire holy men to pray over victims?”

        Because Rasputin has been murdered, hence the holy men are scared. I guess.

      • Posted January 27, 2014 at 2:42 am | Permalink

        If the hospital wants to make decisions based on religion, why doesn’t it just hire holy men to pray over victims?

        There will be no holy men left because their failure rate will be astronomical. They want to meddle where there is real treatment so they can say the doctors gave medicine and god healed

  2. Godfrey
    Posted January 26, 2014 at 12:11 pm | Permalink

    Finally! Some sanity out of Texas. Aside from Austin, I think we should give Texas back to Mexico.

    • infiniteimprobabilit
      Posted January 26, 2014 at 11:36 pm | Permalink

      Jeez, you Yanks, always dumping on every other country in the world. What’s Mexico ever done to deserve that?
      ;)

  3. Posted January 26, 2014 at 12:14 pm | Permalink

    I’m glad that the poor husband can finally bury his wife. This has to be one of the most horrifically ghoulish medical experiences there could be.

    b&

    • Diana MacPherson
      Posted January 26, 2014 at 12:22 pm | Permalink

      That’s for sure – check out the quote from Erick that I included below. It was an assault and horror imposed on this family.

  4. Posted January 26, 2014 at 12:17 pm | Permalink

    Texas should thoroughly review the Dieu Trompeur amendment before further legislation on such matters.

  5. Posted January 26, 2014 at 12:17 pm | Permalink

    Even more late-breaking news: the corpse has been removed from the ventilator:

    http://www.cnn.com/2014/01/26/health/texas-pregnant-brain-dead-woman/index.html?hpt=hp_t2

    b&

  6. Posted January 26, 2014 at 12:18 pm | Permalink

    By the hospital’s logic, they would have to make a pregnancy test with *every* woman who is or might be dying. Just in case she wasn’t aware of being pregnant.

    • Diana MacPherson
      Posted January 26, 2014 at 12:25 pm | Permalink

      Yes, this is what Erick Munoz’s lawyer argued wrt implications.

  7. Diana MacPherson
    Posted January 26, 2014 at 12:20 pm | Permalink

    According to the New York Times’ article, the hospital’s lawyers made their decision based on:

    Texas Penal Code’s definition of an individual stated that an unborn child was alive at every stage of gestation, from fertilization until birth. And he pointed to a bill backed by Gov. Rick Perry that lawmakers passed last year that banned abortions after 20 weeks of pregnancy, based on the theory that the fetus can feel pain at that stage.

    So, religion allowed this family to suffer. What is perplexing, however is the hospital acknowledged that the fetus was not viable. Again, this is religion that would keep this dead woman as a morbid incubator for a non viable fetus.

    It is pretty horrific, what the hospital put the family through as evidenced in this very poignant quote from Marlise Munoz’s husband, Erick Munoz:

    “When I bend down to kiss her forehead, her usual scent is gone, replaced instead with what I can only describe as the smell of death. As a paramedic, I am very familiar with this smell, and I now recognize it when I kiss my wife. In addition, Marlise’s hands no longer naturally grip mine for an embrace. Her limbs have become so stiff and rigid due to her deteriorating condition that now, when I move her hands, her bones crack, and her legs are nothing more than dead weight.”

    • Richard Olson
      Posted January 26, 2014 at 2:21 pm | Permalink

      This tragic health care gamble, made necessary by blind faith religion very much out of control in the state of Texas, caused a great deal of unnecessary anguish, garnered an enormous amount of negative publicity, diverted hospital resources from legitimate patient care requirements, and cost a big chunk of dough from day 1 (one estimate: $10.7K. Per day.) One hopes the State of Texas forthwith assumes financial responsibility (meaning taxpayers), and doesn’t drag things out trying to place the financial burden on the hospital, or HMO, or worst case the Munoz family, costing all of the aforementioned even more money for legal fees.

      The JPS Health Network internet home page of company officers lists the aptronymic Scott Rules as Chief Risk Officer. I hope for Rules sake he minimized his personal risk by identifying (and noting dates/times he did so, and to whom) most if not all of the pitfalls ahead, and pointed out to CEO/CFO management that following the Texas rules re Munoz entailed both unreasonable and foolhardy risk.

      • Posted January 26, 2014 at 3:21 pm | Permalink

        I was recently admitted to a hosp. for roughly [18hrs] a day, my bill was over 20K. I think 10.7K is wildly optimistic. The bill’s at least a million two by now by my estimates. Their insurance might use the ruling to refuse to cover as a legitimate expense? I’m surprised Texas gave up so easily. We’ll see this again, I’m thinking.

  8. abrotherhoodofman
    Posted January 26, 2014 at 12:32 pm | Permalink

    Here are the “leaders” at the hospital where Munoz received her “treatment.”

    It would be quite interesting to know how this group breaks down in terms of their religious beliefs.

  9. Grania Spingies
    Posted January 26, 2014 at 12:32 pm | Permalink

    Fascinating. The judge basically is saying that laws cannot be applied to dead people. That sounds reasonable to me. But then how did this law get written and passed in the first place? Does the Texas legislature have no competent legal advisers when it writes laws?

    • Jeff D
      Posted January 27, 2014 at 2:24 am | Permalink

      Texas legislators probably do not have competent legal advisers available at all times when new statutes and amendments are being drafted, introduced and enacted, and the political system is structured so that at any given time, and with respect to any given bill, the legislators don’t have to listen (and frequently don’t listen) to the outside experts.

      This is similar to the situation in my home state of Indiana, where less than 30 percent of the legislators are trained lawyers and where a fundamentalist Christian creationist is the chairman of the Senate Education Committee. I have been directly involved in the drafting of various new laws, including health care advance directive statutes, and I have been shocked at the kind of “thinking” exhibited by some legislators. When the political culture and the expressed preferences of the voters do not impose clarity or logic or other constraints, the resulting legislation can be just low-quality, muddled, or confusing, or far worse.

      In the case of the Munoz family and the sovereign state of Texas, the statute that caused all the trouble is section 166.049 of the Texas Health and Safety Code, consisting of a single sentence: “A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient.” This was supposedly drafted by a law professor, and one commenter on the N.Y. Times web site wondered whether the professor got his degree from the Close Cover Before Striking School of Law.

      This very short statute uses the word “patient,” but for a variety of reasons, the Texas Health and Safety Code does not include an explicit definition of “patient” in the context of supplying or withdrawing life sustaining treatment; other words are used to refer to individuals who “require” or are receiving life-sustaining treatment or who can sign or have signed advance directives. “Patient” is defined in the Texas statutes that govern the licensing and “regulation” of abortion facilities, but that definition doesn’t help much here.

      So the “law professor” and the legislators he was “helping” did not think through the implications of using the undefined term “patient.”

      The judge in the Munoz case issued a very short, one-page order and judgment, finding, in essence, that because Mrs. Munoz had died (using the definition of death in Texas Health and Safety Code section 671.001), she was no longer a “patient,” and therefore section 166.049 did not apply.

  10. Posted January 26, 2014 at 12:47 pm | Permalink

    I find it iteresting that a dead body should have the right to not being used by the state as incubator. Some commenters here say that vaccinations should be forced on people for the protection of society. So why can’t a dead person be used for whatever society considers useful eg. organ donation, incubator.

    • Diana MacPherson
      Posted January 26, 2014 at 12:50 pm | Permalink

      In this instance, the fetus wasn’t viable so there was no point. Further, the state shouldn’t impose things like this on families and that goes for abortion too. It should be up to the family and the physician to decide what’s best.

    • Posted January 26, 2014 at 12:55 pm | Permalink

      The simple answer is that the state has no right to appropriate private property in this manner, the woman’s corpse belonging to her husband. And, since the fetus was not a person, the state had no protective interest in it, either.

      On the other hand, unvaccinated people are plague carriers who jeopardize all of society. Quarantine nor exile are not effective nor reasonable options for the unvaccinated, but involuntary vaccination is. (As usual, with all the typical caveats of individual medical suitability for vaccination, with waivers granted for those with specific allergies, compromised immune systems, and the like.)

      Cheers,

      b&

      • Posted January 26, 2014 at 1:14 pm | Permalink

        I agree that the family’s interest should count.
        What if the woman had no relatives would it then be OK for the state to use her body?
        It seems to me that the people of Texas have an interest in fetuses even if they’re abnormal. Why else would they have elected a government that makes such laws?

        I don’t agree with the argument that the “fetus was not a person” and therefor shouldn’t be protected by the state. The state protects a lot of things that are not a person for example animals or buildings.

        • Diana MacPherson
          Posted January 26, 2014 at 1:31 pm | Permalink

          If she had no family and no proxy identified to make those decisions on her behalf, decisions would be made by proxies in the form of the hospital administrators, a court-appointed guardian, or a judge.

        • Posted January 26, 2014 at 1:33 pm | Permalink

          If the woman had no family and no living will or equivalent, then she would have become a ward of the state. Considering the medical nature of the case, it would fall to the presiding physician to make decisions regarding the disposal of her remains, including the harvesting or other use of her organs. But that still leaves no room for legislators — and it’s a radically different case from the one under discussion.

          Cheers,

          b&

          • ladyatheist
            Posted January 26, 2014 at 5:56 pm | Permalink

            Wouldn’t the coroner be the one in charge?

            • Posted January 26, 2014 at 8:44 pm | Permalink

              Not until the corpse is disconnected from the machinery. At least, not traditionally….

              b&

  11. Posted January 26, 2014 at 1:06 pm | Permalink

    I advise holding back on any gloating about the legal loss; the Louie Gohmerts are in charge in Texassville. They’ll find new and novel ways to get her re-hooked-up. If not her, the next poor soul when the question of “reproductive rights” again raises its ugly head in bizarroville.

    Practically the entire State has gone off the rails.

    • mordacious1
      Posted January 26, 2014 at 1:52 pm | Permalink

      Perhaps hooking her up to a lightening rod on the top of the hospital. It worked for Frankenstein.

  12. Slumbery
    Posted January 26, 2014 at 1:23 pm | Permalink

    There was a medically similar case in Hungary last year. The mother got stroke in the 15th week of her pregnancy and her brain functions stopped.
    Significant difference that the father and the other relatives agreed on trying to keep the baby.
    And they were successful, the baby was born 3 months later by caesarean (early birth, but they could not risk to wait more), but healthy.

    Also 5 organs of the mother were used to save other people after the birth of the baby.

    So this is not something impossible to pull successfully, however in this case the doctors knew that the fetus is still alive and at least not obviously damaged (the fact the mother died in the hospital and was already connected to life support probably helped). I agree that this pointless at best if the fetus’s bad condition is already known.

    Just for formality I include a link, but it is Hungarian and I do not recommend Google translate, Hungarian is too tough for that software.

    http://www.dehir.hu/debrecen/csoda-debrecenben-agyhalott-anya-adott-eletet-egy-gyereknek/2013/11/13/

  13. Michael Hart
    Posted January 26, 2014 at 1:48 pm | Permalink

    First line of OP should be ‘Marlise’ not ‘Marline’.

  14. NewEnglandBob
    Posted January 26, 2014 at 1:59 pm | Permalink

    I could see suing the hospital and the state of Texas for violating constitutional rights of both the wife and the husband.

  15. ladyatheist
    Posted January 26, 2014 at 5:39 pm | Permalink

    The Teri Schiavo case got me interested in atheist activism. It was religious bullying to the detriment of real morality. Sadly, religious bullies have snuck in laws that nobody has paid attention to until things like this happen. How ironic that this happened so close to the anniversary of the Roe v Wade decision

  16. Posted January 26, 2014 at 6:45 pm | Permalink

    Its a shame that this was allowed to happen. I feel for that poor family.


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