Erick Munoz wasn't trying to set off a debate about abortion or end-of-life care. He just wanted to comply with the wishes of his wife, who is on life support at JPS Hospital in Fort Worth after suffering an apparent pulmonary embolism two days before Thanksgiving. But because his wife, Marlise Munoz, was 14 weeks pregnant when she went into the hospital, and because Texas law requires doctors to keep a patient alive if she is pregnant, and because Munoz's plight wasfeatured on the news
, an overheated national debate was inevitable.
Hats off to WFAA reporter Jobin Panicker, who managed to fold two of the most divisive issues of our time into one tragic package and for revealing a heretofore obscure provision of Texas law governing advance directives.
The relevant portion reads, in full:
Sec. 166.049. PREGNANT PATIENTS. A person may not withdraw or withhold life-sustaining treatment [procedures] under this subchapter from a pregnant patient.
Even if the woman signed a do-not-resuscitate order, it's no good so long as there's a fetus in her womb. This is spelled out clearly in the state-mandated language of Texas DNRs.
I understand that under Texas law this directive has no effect if I have been diagnosed as pregnant.
Marlise Munoz hadn't signed a DNR order, but she had frank discussions with her family about end-of-life care. Both she and Erick are paramedics, who are regularly confronted with people whose lives have been cut short. Four years ago, after her brother died, Marlise declared she never wanted to be kept alive by a machine, Panicker reports.
That's her fate until one of two things happen, according to Dr. Robert Fine, a medical ethicist at Baylor Hospital. The fetus could reach viability, at which point the baby could be removed by c-section, allowing the Marlise's final wishes to be carried out. Or, the fetus could die inside the womb, allowing the same outcome.
"Thankfully, in my experience cases like this are rare," Fine wrote to Unfair Park in an email. "Somewhat related, we have had a few cases over the years at Baylor in which the pregnant mother was not merely comatose, but actually met all the criteria for brain death, but rather than withdraw all organ support (the patient is dead so we don't call it life support), the organ support was maintained to allow the fetus to reach viability at which point delivery occurred and organ support was halted."
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Good Morning America talked to a medical ethicist at NYU who said that Texas is among a handful of states that include pregnancy riders on DNR forms but that the measure is ethically dubious.
"The basic moral principle with the individual is you do not have to give them care they do not want," he said. "The principle has been established again and again throughout legal cases in the United States."
But lawmakers in Texas have never cared much for letting the rights of a mother outweigh those of a fetus. While the Supreme Court has set fetal viability, traditionally defined as 23-24 weeks, as the limit for abortion, the legislature this year passed a 20-week abortion ban. It also likes to slip fetal personhood into other portions of Texas law. Murder a pregnant woman in Texas, and you'll be charged with two counts of homicide, not just one. So it is with end-of-life care.
Send your story tips to the author, Eric Nicholson.