January 15

Fate of brain-dead Texas woman, fetus left to court

She would want life support ended, her spouse says. The hospital refuses, citing the law. Now it’s up to a judge.

By Nomaan Merchant
The Associated Press

DALLAS — 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 that is 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, although a blood clot is a possibility.

Erick and Marlise Munoz, both paramedics, had seen life and death up close, and he previously told The Associated Press that his wife was clear with him: If she fell into a condition like this, pull life support and let her die.

John Peter Smith Hospital in Fort Worth, however, has refused to take Marlise Munoz off machines, citing a state law that the hospital says requires it to continue treating a pregnant patient.

Munoz’s lawsuit says that law doesn’t apply because Marlise Munoz is legally and medically dead. The condition of her fetus is unclear.

“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.”

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 statute because Munoz is brain-dead and beyond any chance of recovery.

“This patient is neither terminally nor irreversibly ill,” Dr. Robert Fine, clinical director of the office of clinical ethics and palliative care for Baylor Health Care System, said in an interview earlier this month. “Under Texas law, this patient is legally dead.”

Erick Munoz’s attorneys have asked for an expedited ruling in a case that likely needs to be resolved in weeks, not months. No hearing was set as of Tuesday afternoon.

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. The journal found post-birth data for two years on only six of them – all of whom developed normally.

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.

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