By AMAL CHEEMA ’17
As medicine progresses, we are left with a new ethical debate on how far we should go to preserve life. This past week, Marlize Muñoz of Texas was taken off life support after an eight-week, exceedingly controversial legal battle between the Muñoz family and the Texas court system. Muñoz, 33, had been brain-dead since Nov. 26 and was 23 weeks pregnant at the time that she was taken off life support. Tragic and disheartening, the case of Muñoz is the unfortunate consequence of crucial differences between medical, legal and social duties. This case reflects the need to revise laws that are unresponsive to medical diagnoses and familial desires.
In its 59 pages, the Texas Advance Directives Act offers guidance on medical choices for persons unable to make decisions about care, stating that, “A person may not withdraw or withhold life-sustaining treatment…from a pregnant patient.” The John Peter Smith Hospital Network (JPS), which was in charge of Muñoz’s care, decided that, until the courts clarified the statement, JPS could not remove Muñoz from life support until caesarean section could be performed. The hospital referred to the Texas Penal Code, which implicates violators in criminal homicide for the death of a fetus.
Muñoz was found on her kitchen floor after suffering a blood clot in her lungs when she was 14 weeks pregnant. She died shortly after arriving at the hospital. Two days later the hospital declared her clinically brain-dead, and therefore legally dead. However, hospital officials refused to call time of death and grant both Muñoz and her family’s wishes against life support. In the past 30 years, the electronic medical journal BMC Medicine has found that of 30 cases of brain-dead pregnant woman, twelves cases resulted in live births. In the case of Muñoz and her baby, the hospital acknowledged in court papers that the fetus was already not viable, describing accumulation of fluid in the brain, possible heart problems and severe deformities in the lower extremities.
The case of Muñoz is incredibly disarming, and so are the experiences of the Muñoz family. In an affidavit, Mr. Muñoz described his wife: “her limbs have become so stiff and rigid due to her deteriorating condition that now, when I move her hands, her bones crack, and her legs are nothing more than dead weight.” There was no possibility for Ms. Muñoz’s or the fetus’s condition to improve, but, because of unclear law, her body had to remain on life support and could not be buried.
The family’s attorney added, “Quite sadly, [the non-viability of the fetus] is not surprising due to the fact that the fetus, after being deprived of oxygen for an indeterminate length of time, is gestating within a dead and deteriorating body, as a horrified family looks on in absolute anguish, distress and sadness.”
After eight excruciating weeks, the Texas district court finally found that it would be a “misapplication” of the law to keep a deceased woman on life-support. The law about life support for pregnant patients didn’t apply because Muñoz was already legally dead. On Jan. 24, a Texas court issued the verdict to disconnect Muñoz’s body from life-support. On Jan. 26, Muñoz’s body was disconnected and released to her husband.
The case of Muñoz illustrates a need to revise the Texas law. When the mother-to-be is dead and the fetus is nonviable, family decisions against life support must be respected. In any case, there is no clear right or wrong; there was an attempt made to maintain, preserve and protect life. What came too late was the realization that there was no life left to save. What comes now is a long process to revise the law and prevent future legal misapplications and exacerbations of the affected families’ misfortunes. The inadequate Texas law needs to protect the people and not cause psychological distress.