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In hospitals, when it comes to life or death situations, the complexities of medical and moral ethics come into play.
On Nov. 26, 2013, Marlise Munoz collapsed in her home as a result of what doctors believe was a pulmonary embolism. In other words, a blood clot, or some other foreign matter, blocked her pulmonary artery. She was rushed to the hospital where her husband Erick Munoz said the doctors said she was brain-dead. The Munozes were both paramedics and Mr. Munoz said his wife would not have wanted extraordinary measures taken to keep her alive. Normally, this would have been enough, and Mrs. Munoz would have been taken off the ventilators and machines keeping her organs functioning, but this wasn’t a normal case. She was 14 weeks pregnant with the couple’s second child.
John Peter Smith Hospital, where Mrs. Munoz was taken, said because she was pregnant, it was against state law to remove the ventilator keeping her alive. The Texas Advance Directives Acts Sec. 166.049 reads, “A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient.” Under Texas law, a Do Not Resuscitate directive, spoken or written, is invalidated if the patient is pregnant. In the written directive, there is a sentence that states, “I understand that under Texas law, this directive has no effect if I have been diagnosed as pregnant.”
Mr. Munoz is now suing the hospital to take his wife off of life support, so the family can give her a proper burial. Removing the ventilator would significantly endanger the life of the fetus because it would no longer be able to receive oxygen and nutrients from the mother, though there is a chance the baby could live if delivered. The fetus is currently at 22 weeks, and the hospital will decide what to do once the fetus has reached 24 weeks. Hospital workers have told the family that Mrs. Munoz and the fetus may have gone without breathing for an hour before she was found.
The hospital should continue to keep Mrs. Munoz on a ventilator until the fetus is viable, or tests are done to confirm the fetus is not viable. Viability is whether the fetus has a chance to be born successfully.
In a situation like this, the law is the law, and the act clearly states that the hospital “may not withdraw or withhold life-sustaining treatment.”
In this case, the law clearly spells out what is to be done. There is no clarification or misinterpretation about the law or the definition of a patient as Mr. Munoz and his lawyers would claim.
People who sympathize with the Munoz family argue that since Mrs. Munoz is brain-dead, she cannot be considered a patient and the act clearly states it applies only to hospital patients. But in what situation would a patient dependent on life support not be, for all intents and purposes, dead? That argument makes no sense in this situation.
Mrs. Munoz is brain-dead. There is no chance she will recover, and she is only being kept alive by the ventilator, but her organs are working and able to continue nursing the fetus to birth. The fetus has a right to life.
If Mrs. Munoz had not collapsed because of the pulmonary embolism, the fetus would have most likely been carried to term and been born a healthy baby. It’s not fair to the fetus, which is viable at this point, to be deprived of life because Mrs. Munoz is no longer alive. It is rare that a case like this arises, but people shouldn’t use it as a reason to deny life.
Additionally, Mr. Munoz waited until last week to file a lawsuit against the hospital. At this point, the fetus couldn’t be legally aborted anyway.
If he felt so strongly about this, why didn’t he file the lawsuit when his wife was first put on the ventilator, and when he was first informed that they could not take her off of life support as a result of her pregnancy? At that time, he would have had grounds that, under normal circumstances, the fetus could be aborted at 14 weeks. Instead, he waited until the fetus reached 21 weeks and had a small chance of survival. A fetus is not considered medically viable until 24 weeks where it has a 39 percent survival rate.
Opponents to this decision state that Mrs. Munoz’s wishes should not be violated just because of a pregnancy.
Her husband knows her very well, and they have discussed this. Therefore, they’re not making an uninformed decision or not weighing the consequences.
As paramedics, they are exposed to situations such as this daily, and know what a Do Not Resuscitate directive entails. By forcing her to remain on the ventilator, they are not honoring her final wishes.
Unfortunately, the law is the law. If people have a problem with it, they should focus on changing the law for future patients because laws are there for a reason, and by the time anything would get passed, the fetus would reach the age of viability, so it wouldn’t do much good to the family.
The hospital should ensure that the fetus gets carried to viability. The law clearly states what needs to be done, and there is no arguing with it at that point.
As much as it pains her husband and family, there’s no getting around the law.
