DALLAS (AP) — The fate of a brain-dead, pregnant Texas woman and her fetus likely will be decided in a courtroom after the woman's husband sued the hospital keeping her on life-support against his wishes.
Erick Munoz filed a lawsuit in state district court in Fort Worth, where his wife, Marlise Munoz, has been on life-support since he found her unconscious in their North Texas home on Nov. 26. She was 14 weeks pregnant at the time. Her family says the exact cause of her condition isn't known, though a blood clot is a possibility.
Erick and Marlise Munoz, both paramedics, had seen life and death up close, and Erick has said that his wife was clear with him: If she fell into a condition like this, pull life-support and let her die.
But doctors at John Peter Smith Hospital in Fort Worth, however, insist that they can't take Marlise Munoz off machines, pointing to a state law that says because the fetus still has a heartbeat, the mother must be kept alive.
Munoz's lawsuit says that law doesn't apply because Marlise Munoz is 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 (the hospital) should be allowed to continue treatment on Marlise Munoz's dead body, and this court should order JPS to immediately discontinue such.”
The Tarrant County District Attorney's Office, which is representing the public hospital, said its attorneys were reviewing the lawsuit and had no immediate response Tuesday. Hospital spokeswoman J.R. Labbe previously has said hospital officials stand by their position: “This is not a difficult decision for us. We are following the law.”
The Texas Advance Directives Act reads in part that, “A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient.”
But experts say the hospital is incorrectly applying the law because Munoz is brain-dead and beyond any chance of recovery.
“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.”
Texas is one of 12 states across a wide political spectrum that automatically invalidate a pregnant woman's advance health care directive. The others are: Alabama, Idaho, Indiana, Kansas, Kentucky, Michigan, Missouri, South Carolina, Utah, Washington and Wisconsin, according to a 2012 report by the Center for Women Policy Studies, an advocacy group that supports abortion rights.
“This one, I think, will probably be, of course, very painful but also might set some precedents,” said Leslie Wolfe, the center's president. Wolfe said she could not recall a similar case in recent years.
Erick Munoz's attorneys have asked for an expedited ruling in a case that most likely needs to be resolved in weeks, not months.
There is some precedent for the successful delivery of a child in similar situations. 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.
The article said a fetus has about a 20 to 30 percent chance of survival at 24 weeks of gestation — a milestone believed to be about three weeks away — but a much higher chance, 80 percent, at 28 weeks, and a 98 percent chance at 32 weeks.
The Munoz family has said it does not know the condition of the fetus, and the family's attorneys did not respond to requests for interviews after the lawsuit was filed Tuesday. Marlise Munoz is believed to have been without oxygen for some time before her husband found her.
Doctors have told Erick Munoz that they are monitoring the fetus, but Munoz has said he's uncertain about how healthy the fetus will be. “You know what kind of damage my wife sustained, and what kind of possible damage the baby inside her sustained,” he said.
Erick says that at 2 a.m. on Nov. 26, he awoke to find Marlise unconscious on their kitchen floor. Erick began performing CPR on his wife and dialed 911. She was then taken by ambulance to JPS, where doctors told Erick his wife has “lost all activity in her brain stem, and was for all purposes brain dead,” says the suit.
This report includes material from McClatchy Newspapers.
Copyright 2013 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
No clear answer to situation in Nebraska, either
Nebraska law is complicated on the issue of continuing life-support to a pregnant woman, and perhaps contradictory.
State law says a competent adult may designate (in written or spoken words, or based on what the person believes and values) another person to make medical treatment decisions for that individual if he becomes incapable of making those decisions.
Rebecca Anderson, a University of Nebraska Medical Center medical ethicist and attorney, said the proxy decision-maker shouldn't stray from the person's wishes.
State law also says, though, that a physician shouldn't withhold or withdraw treatment from a pregnant woman in accordance with a living will “so long as it is probable that the fetus will develop to the point of live birth with continued application of life-sustaining treatment.”
Dr. Neil Hamill, a maternal fetal medicine specialist with Methodist Health System in Omaha, said the fetus' brain conceivably could survive some oxygen deprivation in a catastrophic episode that kills the mother's brain.
But the fetus' brain probably would be severely compromised and the baby likely would be born with profound handicaps.
"It presents a moral dilemma – a moral and legal dilemma," Hamill said.
— Rick Ruggles