The Herald Bulletin

Morning Update

Nation & World

January 24, 2014

Judge: Remove life support for pregnant woman

FORT WORTH, Texas — A judge on Friday ordered a Texas hospital to remove life support for a pregnant, brain-dead woman whose family had argued that she would not want to be kept in that condition.

Judge R. H. Wallace Jr. issued the ruling in the case of Marlise Munoz. John Peter Smith Hospital in Fort Worth has been keeping Munoz on life support against her family’s wishes. The judge gave the hospital until 5 p.m. CST Monday to remove life support. The hospital did not immediately say Friday whether it would appeal.

Munoz was 14 weeks pregnant when her husband, Erick Munoz, found her unconscious Nov. 26, possibly due to a blood clot. Both the hospital and the family agree that she meets the criteria to be considered brain-dead — which means she is dead both medically and under Texas law — and that the fetus could not be born alive at this point.

But the hospital had not pronounced her dead and continues to treat her over the objections of both Erick Munoz and her parents, who sat together in court Friday.

“Mrs. Munoz is dead,” Wallace said in issuing his ruling, adding that meant the hospital was misapplying a state law that prohibits the removal of life-sustaining treatment from a pregnant patient.

Larry Thompson, a state’s attorney representing the public hospital, had told the judge the hospital had a legal responsibility to protect the unborn fetus.

“There is a life involved, and the life is the unborn child,” Thompson said.

But Jessica Hall Janicek and Heather King, Erick Munoz’s attorneys, accused the hospital of conducting a “science experiment” and warned of the dangerous precedent her case could set, raising the specter of special ICUs for brain-dead women carrying babies.

“There is an infant, and a dead person serving as a dysfunctional incubator,” King said.

Erick Munoz said he and his wife are paramedics who were clear that they didn’t want life support in this type of situation. Her parents agreed. He declined to comment as he left the courtroom, and King and Janicek did not say what they would do next, pending a potential appeal by the hospital.

The hospital said in a statement Friday that it “appreciates the potential impact of the consequences of the order on all parties involved” and was deciding whether to appeal.

The case has raised questions about end-of-life care and whether a pregnant woman who is considered legally and medically dead should be kept on life support for the sake of a fetus. It also has gripped attention on both sides of the abortion debate, with anti-abortion groups arguing Munoz’s fetus deserves a chance to be born. Several anti-abortion advocates attended Friday’s hearing.

Hospital officials have said they were bound by the Texas Advance Directives Act, which prohibits withdrawal of treatment from a pregnant patient. Several experts interviewed by The Associated Press, including two who helped draft the legislation, have said the hospital is misapplying the law because Marlise Munoz would be considered legally and medically dead.

“Marlise Munoz is dead, and she gave clear instructions to her husband and family — Marlise was not to remain on any type of artificial ‘life sustaining treatment’, ventilators or the like,” the lawsuit said. “There is no reason JPS should be allowed to continue treatment on Marlise Munoz’s dead body, and this Court should order JPS to immediately discontinue such.”

Earlier this week, Erick Munoz’s attorneys said that the fetus, now believed to be at about 22 weeks’ gestation, is “distinctly abnormal.” They attorneys said they based that statement on medical records they received from the hospital.

The hospital argued in a court filing Thursday that there was little evidence of what state lawmakers and courts thought of this issue, but recent laws passed by the Republican-controlled Legislature to restrict abortion made it clear that they wanted to preserve a fetus’ rights.

The Advance Directives Act “must convey legislative intent to protect the unborn child,” the hospital said in its filing. “Otherwise the Legislature would have simply allowed a pregnant patient to decide to let her life, and the life of her unborn child, end.”

Not much is known about fetal survival when mothers suffer brain death during pregnancy. German doctors who searched for such cases found 30 of them in nearly 30 years, according to an article published in the journal BMC Medicine in 2010.

Those mothers were further along in pregnancy — 22 weeks on average — when brain death occurred than in the Texas case. Birth results were available for 19 cases. In 12, a viable child was born. Follow-up results were available for six, all of whom developed normally.

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