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Originally published January 8, 2014 at 7:46 PM | Page modified January 9, 2014 at 3:30 PM

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Texas law keeps brain-dead woman alive despite her wishes

The case of Marlise Munoz has become a strange collision of law, medicine, the ethics of end-of-life care and the issues swirling around abortion: when life begins and how it should be valued.


The New York Times

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FORT WORTH, Texas — The diagnosis was crushing and irrevocable. At 33, Marlise Munoz was brain dead after collapsing on her kitchen floor in November from what appeared to be a blood clot in her lungs.

But as her parents and her husband prepared to say their final goodbyes in the intensive-care unit at John Peter Smith Hospital in Fort Worth and to honor her wish not to be left on life support, they were stunned when a doctor told them the hospital was not going to comply with their instructions.

Munoz was 14 weeks’ pregnant, the doctor said, and Texas is one of more than two dozen states that prohibit, with varying degrees of strictness, medical officials from cutting off life support to a pregnant patient.

More than a month later, Munoz remains connected to life-support machines on the third floor of the ICU, where a medical team monitors the heartbeat of the fetus, now in its 20th week. Her case has become a strange collision of law, medicine, the ethics of end-of-life care and the issues swirling around abortion: when life begins and how it should be valued.

“It’s not a matter of pro-choice and pro-life,” said Munoz’s mother, Lynne Machado, 60. “It’s about a matter of our daughter’s wishes not being honored by the state of Texas.”

Munoz’s father, Ernest Machado, 60, a former police officer and an Air Force veteran, put it more bluntly.

“All she is, is a host for a fetus,” he said Tuesday. “I get angry with the state. What business did they have delving into these areas? Why are they practicing medicine up in Austin?”

Hospital officials maintain that they are following the law, although several experts in medical ethics said they believed the hospital was misinterpreting the law.

A crucial issue is whether the law applies to pregnant patients who are brain dead as opposed to those in a coma or a vegetative state. The law, first passed by the Texas Legislature in 1989 and amended in 1999, states that a person may not withdraw or withhold “life-sustaining treatment” from a pregnant patient.

The Machados said the hospital had made it clear to them that their daughter was brain dead, but hospital officials have declined to comment on Munoz’s care and condition, creating uncertainty over whether the hospital has formally declared her brain dead.

Actions defended

A spokeswoman for the JPS Health Network, the publicly financed hospital district in Tarrant County that runs the 537-bed John Peter Smith (JPS) Hospital, defended the hospital’s actions. “In all cases, JPS will follow the law as it applies to health care in the state of Texas,” the spokeswoman, Jill Labbe, said.

Labbe said that neither she nor the doctors could answer questions about Munoz’s condition because her husband, Erick Munoz, 26, had not signed the paperwork allowing them to speak to the news media about his wife’s care.

The case stands in stark contrast to that of a 13-year-old girl in California whose family fought to keep her on life support after she was declared brain dead. In that case, the hospital wanted to disconnect her from a ventilator, saying the girl is legally dead. After the teen’s family went to court, she was transferred to a long-term-care facility this week.

Legal and ethical expert said they were puzzled by the conflicting accounts of Munoz’s condition. Brain death, an absence of neurological activity, can be readily determined, they said. It is legally death, even if other bodily functions can be maintained.

“If she is dead, I don’t see how she can be a patient, and I don’t see how we can be talking about treatment options for her,” said Thomas Mayo, an expert on health-care law and bioethics at the Southern Methodist University law school in Dallas.

Arthur Caplan, director of medical ethics at NYU Langone Medical Center in New York, agreed. “The Texas Legislature can’t require doctors to do the impossible and try to treat someone who’s dead,” Caplan said. “I don’t think they intended this statute the way the hospital is interpreting it.”

Critics of hospital

Critics of the hospital’s actions also note that the fetus has not reached the point of viability outside the womb and that Munoz would have a constitutional right to an abortion.

In Texas, the law and the hospital’s efforts to abide by it have drawn support among opponents of abortion.

“The unborn child should be recognized as a separate person,” said Joe Pojman, executive director of Texas Alliance for Life. He added: “I would say that, even if she were brain dead, I would favor keeping treatments going to allow the child to continue to survive, with the hope the child could be delivered alive.”

Munoz’s parents and her husband remain in limbo, even as they and other relatives help care for the Munozes’ 15-month-old son, Mateo. Erick Munoz has returned to his job as a firefighter but continues to sit by his wife’s side at the hospital.

She had been due to give birth in mid-May, but the hospital’s plans for the fetus remain unknown.

Ernest Machado said he had been told by the hospital’s medical team that his daughter might have gone an hour or longer without breathing before her husband woke and discovered her, a situation he believes has seriously impaired the fetus.

“We know there’s a heartbeat, but that’s all we know,” he said.

Material from The Associated Press is included in this report.



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