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Originally published Friday, January 3, 2014 at 6:39 PM

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Pregnant, brain-dead woman kept on life support

Marlise Munoz lies in a North Texas hospital, 19 weeks pregnant but with no chance of seeing her child born.


Associated Press

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DALLAS —

Marlise Munoz lies in a North Texas hospital, 19 weeks pregnant but with no chance of seeing her child born.

Her husband, Erick Munoz, says a doctor told him she's brain dead, but John Peter Smith Hospital is refusing to allow him to take her off of life support. The hospital says Texas law prohibits it from following a family directive when a pregnancy is involved, although three experts say the hospital is misreading the law in question.

The case is raising questions about end-of-life care and stands in stark contrast to that of a 13-year-old girl in California whose family is trying to keep her on life support after she was declared brain dead. In that case, the hospital wants to disconnect her from a ventilator, saying the girl is legally dead.

In the Texas case, Munoz said he and his wife both worked as paramedics and have seen life and death up close.

"It's our decision that we didn't want to live in that condition," he said in a phone interview Friday from his wife's hospital room.

Munoz found his wife unconscious in the early morning hours of Nov. 26. The family says it doesn't know the exact cause, though a pulmonary embolism is a possibility. Marlise Munoz was 14 weeks pregnant at the time.

Erick Munoz described his personal conflict as the father of a 14-month-old boy who wanted another child, but as a medical professional who didn't know if the fetus could survive or how much it had suffered.

Marlise Munoz's case appears to be rare. A 2010 article in the journal BMC Medicine found 30 cases of brain-dead pregnant women over about 30 years. Of 19 reported results, the journal found 12 in which a viable child was born and had post-birth data for two years on only six of them -- all of whom developed normally, according to the journal.

Hospital spokeswoman J.R. Labbe said she isn't permitted to confirm that Marlise Munoz had been declared brain-dead, only that she was pregnant and hospitalized in serious condition.

"We are following the law of the state of Texas," Labbe said. "This is not a difficult decision for us. We are following the law."

But three experts interviewed by The Associated Press, including two who helped draft the law, said a brain-dead patient's case wouldn't be covered by the law.

"This patient is neither terminally nor irreversibly ill," said Dr. Robert Fine, clinical director of the office of clinical ethics and palliative care for Baylor Health Care System. "Under Texas law, this patient is legally dead."

John Peter Smith Hospital in Fort Worth is pointing to a provision of the Texas Advance Directives Act that reads: "A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient."

Tom Mayo, a Southern Methodist University law professor, said he did not believe the law applied in this case. He said the hospital would not have absolute immunity from a civil or criminal case if it went outside the subchapter referenced by the law, but noted that "most medical decisions" are made without immunity.

While not ruling out legal action, Erick Munoz said Friday that he was more concerned about letting others know about his family's ordeal and possibly pushing for a change to state law to clarify it.

"If anything good is to come of this, we want to inform people," Munoz said.

In the meantime, Munoz said he continues to deal with what he called a "roller coaster of emotions." He balances work and taking care of his son with visits to his wife's hospital bed, where he talks to her about the life they once shared.

"I tell her, 'Hey, our boy is doing OK,'" Munoz said. "'He's healthy and he's growing.'

"It's joyful stuff that I'm letting her know of, but at the same time, I wish she was there to witness it herself."

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Follow Nomaan Merchant on Twitter at http://www.twitter.com/nomaanmerchant.



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