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| Source: nytimes.com Husband of Marlise Munoz, Eric Munoz |
This week, I’d like to take a look at a situation that comes
up frequently in an ethical context—but with a twist. Marlise Munoz was 33 when
she collapsed in her kitchen in Fort Worth Texas this past Friday. A blood clot
in her lungs put her in the ICU at John Peter Smith and eventually led to a
declaration of her brain death. Her family was devastated, but was fully
prepared to carry out Munoz’s previously decided wishes to not be kept on life
support—that is until the State of Texas stopped them. The doctors informed the
family that Munoz was 14 weeks pregnant, and that since Texas law forbids the
removal of life-sustaining care from pregnant women, the doctors could not obey
the family’s wishes to remove Munoz’s life-support.
The State
of Texas is not alone with its stance on this topic. Thirty-one other states
have similar laws restricting physicians’ ability to remove life-sustaining
care from terminally-ill pregnant women. The ethical argument is that unlike
most life-support cases, which are already controversial, these situations
have two lives at stake: the mother’s and the unborn child’s. Texas law is one
among the strictest policies in forbiding life-support termination regardless
of the stage of pregnancy, but the ethical case still stands. Although cases
are few and far between, doctors believe that as long as Munoz is kept alive,
the fetus could still develop normally. R. Phillips Heine, Director of maternal
fetal medicine at Duke University, says of the case “As far as fetal development, as long as we can control delivery of blood
to the fetus and make sure the mother is nutrient-enriched, and as long as the
mother's got enough glucose and oxygen, she can serve as a vessel. . . . If
they can get to a reasonable gestation, there's potential for a very good
outcome”. Ethically, the law claims it is necessary to respect
the unborn fetus’ life as an individual person, and that therefore Munoz must
be kept alive for the pregnancy.
However,
the other perspective to consider is that maintaining Munoz’s life support goes
directly against her own wishes as well as her family’s. Munoz decided before her accident that she
did not want to remain on life-support if she was ever declared brain dead, and
her family not only agrees with this wish but also feels strongly about
carrying it out on behalf of Munoz. Ethically, they claim it is their decision
and that the State of Texas has no right to interfere. Furthermore, they claim
that the hospital is misinterpreting the law to be stricter than intended. The law
calls forbids the removal of “life-sustaining treatment” from a pregnant
patient, which arguably applies to comatose and vegetative patients but not brain-dead
patients like Munoz, who is legally already dead. Either way, the family claims
that it is unethical to disregard their wishes and prolong their agony over their
daughter’s death.
This story has been gaining publicity quickly over the last few days and is prompting
ethical debates among experts all over the country. Texas will likely be receiving
a lot of scrutiny for this as the Munoz family continues to fight the
life-support law in order to comply with their daughter’s wishes. Life-support
is a controversial issue to begin with, but do the specific details of this
case (brain-death, patient’s wishes, pregnancy, etc.) make all the difference?
Hello Katy! What an interesting post! Although I claim myself as pro-choice, I have to see Texas' point in this case. Once a fetus is 14 weeks old, it is technically considered a human being due to brain activity. One cannot put himself in a box labeled as pro-choice or pro-life without looking at science and the various conditions associated with the situation. In Munoz's case, the fetus isn't the reason for her near-death state, but is an unfortunate dilemma to her distraught family. The state is also clearly disregarding Munoz's and her family's desires at least until the baby is born. Surprisingly, I can understand Texas' actions (for once in my life), but that doesn't make Munoz's situation any easier.
ReplyDeleteKaty, this is a very interesting post! What makes this situation especially intriguing to me is the fact that Munoz is brain dead and therefore cannot assess the circumstances as they change and unfold. For example, it seems from the way you described the predicament that the Munoz family was not aware that she was pregnant before she was declared brain-dead. This brings up the question of whether or not Munoz herself was even aware of her pregnancy. If she was not, would this new information change her decision about end-of-life care? The ambiguity around this situation makes me question just how strictly we should adhere to rules and wishes regarding life-support.
ReplyDeleteAdditionally, your post made me think about just how many facets the concept of ethicality has. Some would argue that ensuring the survival and high quality of life for the fetus is the ethical thing to do. Others would argue that adhering completely to the choice of the mother is the ethical thing to do. This very fact is what makes such dilemmas so problematic-- many times, it is impossible to be completely ethical.
Katy, thank you for posting this! I think the most "debatable" aspect to this topic is the extent to which the Texas law should be applied. Does the difference between a comatose state, a vegetative state, or a brain-dead state really matter when considering the wishes of the mother? As a supporter of pro-choice, I believe it is crucial to uphold the wishes of the mother regardless of the condition. That being said, this case is especially frustrating, because the mother will not be able to take care of the child even if it is born. In this case, I believe it is not a matter of pro-choice or pro-life; rather, I think the Texas courts must consider how the baby will be taken care of in the absence of a mother. Thanks again for posting this, Katy!
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