The Widdershins

Be at rest Marlise Machado Munoz

Posted on: January 27, 2014

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Marlise and Eric Munoz were both paramedics and familiar with end-of-life issues.  Marlise was fourteen weeks pregnant on November 26th when her husband found her unconscious on the floor of the kitchen in their house.  Marlise was rushed to John Peter Smith hospital in Ft. Worth and doctors there determined that Marlise was brain dead.  Although she did not have a written advanced directive, Eric says that they discussed issues like this and Marlise had stated that she never wanted to b kept alive by mechanical means.  Normally, as next of kin, Eric would be the person to make the decision to remove life support from his wife.  Furthermore, Marlise’s parents, Lynne and Ernest Machado agreed with the decision to remove their daughter from life support.  However, the decision was not up to the husband and parents of this young woman.  Because the family lived in Texas, the hospital believed that they could not remove Marlise from life-support because of a law passed in Texas.  You see, there was a law passed in Texas in 1989 and amended in 1999 that states:

that a person may not withdraw or withhold “life-sustaining treatment” from a pregnant patient.

The hospital states that they are merely following the law.

A spokeswoman for the J.P.S. Health Network, the publicly financed hospital district in Tarrant County that runs the 537-bed John Peter Smith Hospital, defended the hospital’s actions. “In all cases, J.P.S. will follow the law as it applies to health care in the state of Texas,” the spokeswoman, Jill Labbe, said. “Every day, we have patients and families who must make difficult decisions. Our position remains the same. We follow the law.”

It appears that the law might need to be revisited because although pregnant she may have been, Marlise was also brain dead with no hope of recovering.  This was not a case of her being unconscious or in a coma.  Tests showed no brain activity in Marlise.  Her husband and her parents are furious about the situation.

“It’s not a matter of pro-choice and pro-life,” said Mrs. Munoz’s mother, Lynne Machado, 60. “It’s about a matter of our daughter’s wishes not being honored by the state of Texas.”

Mrs. Munoz’s father, Ernest Machado, 60, a former police officer and an Air Force veteran, put it even more bluntly. “All she is is a host for a fetus,” he said on Tuesday. “I get angry with the state. What business did they have delving into these areas? Why are they practicing medicine up in Austin?”

Now Widdershins, you may think the fault is in part due to the fact that Marlise had never written out a living will or medical proxy.  However, you would be wrong.  According to a study done by Center for Women Policy Studies in Washington, there are 37 states that have exclusions to advance directives of women when they are pregnant.

Automatic Invalidation of A Pregnant Woman’s Advance Directive: Currently, 12 state statutes (Alabama, Idaho, Indiana, Kansas, Kentucky, Michigan, Missouri, South Carolina, Texas, Utah, Washington, and Wisconsin) automatically invalidate a woman’s advance directive if she is pregnant, as compared to 22 states with such provisions at the time of the Center’s 1992 report. These are the most restrictive of the pregnancy exclusion statutes, stating that, regardless of the progression of the pregnancy, a woman must remain on life-sustaining treatment until she gives birth.

Most of these statutes are brief declarations; for example, South Carolina’s law states that: “If a declarant has been diagnosed as pregnant, the Declaration is not effective during the course of the declarant’s pregnancy.” None of these statutes makes an exception for patients who will be in prolonged severe pain or who will be physically harmed by continuing life-sustaining treatment.

Some states are silent on the issue of pregnancy and some others use a viability of the fetus clause.  This link will take you to the full report.

It took Erick Munoz finally having to sue the hospital to be able to get his wife removed from life support.

The judge, R. H. Wallace Jr. of 96th District Court in Tarrant County, ruled that Ms. Muñoz, 33, who has been on life support at John Peter Smith Hospital since November and is now 22 weeks pregnant, was legally dead, agreeing with the family’s lawyers that the hospital had erred in its decision to keep her on life support. The hospital had said the Texas law addressing life support for pregnant women prevented it from granting the family’s wish, but the judge said the law did not apply to Ms. Muñoz because she is dead.

In one of those strange legal conundrums, the attorney for the Tarrant County public hospital agreed that Mrs. Munoz was indeed brain dead and therefore dead, but said the laws of the “gret stet of Texas” still applied.

The hospital did not dispute that Ms. Muñoz was brain-dead, saying in court papers that she met the clinical criteria two days after she was first brought to the hospital. But the hospital’s lawyer said the law still applied to her, insisting it was part of the Texas Legislature’s “commitment to the life and health of unborn children.” The lawyer, Larry M. Thompson, pointed to a section of the Texas Penal Code that states a person may commit criminal homicide by causing the death of a fetus.

The law “must convey legislative intent to protect the unborn child, otherwise the Legislature would have simply allowed a pregnant patient to decide to let her life, and the life of her unborn child, end,” wrote Mr. Thompson, with the Tarrant County district attorney’s office, which represented the hospital.

We can hope that the case of Marlise Munoz will cause a discussion to be held on end of life situations where they concern pregnancy issues because in a majority of the states, women are considered chattel to the state’s desires and their choices and decisions do not mean a thing.

This is an open thread.

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29 Responses to "Be at rest Marlise Machado Munoz"

Yet another dinger of a decision touted by the Party of Small Government.

Mind boggling. Chat, how would the fetus get its nutrition if the woman is brain dead? Does iv fluid make for a healthy baby? I can’t grasp this.

From the NYT link:

“Lawyers for Ms. Muñoz’s husband, Erick Muñoz, said they were provided with medical records that showed the fetus was “distinctly abnormal” and suffered from hydrocephalus — an accumulation of fluid in the cavities of the brain — as well as a possible heart problem.

The hospital acknowledged in court documents that the fetus was not viable.”

The article also said that the hospital is considering an appeal!?! The poor man says his wife “smells like death” and that her limbs are “cracking”. The fetus also was without oxygen for a long period. Texas is an insane place. I feel really sorry for the liberals who are stuck there.

As long as the mother receives nutrients – feeding tube, IV, etc – the fetus will be nourished as well.

socal: Yes the fetus was developing abnormalities. When I was writing this at about 4:30/5 this a.m. I had about 4 tabs open with articles on this issue. I forgot to include that. A couple of medical ethicists said the hospital was incorrectly interpreting the law because this was a dead woman being kept alive artificially and not like she was in a coma or just unconscious.

I just saw on fluffpo that the hospital took her off L/S yesterday, so they are not appealing it. Those poor people. I wonder if the husband will get billed for her being there the past two months?

About the feeding tube & IV, if she’s brain dead, how would a feeding tube work? She couldn’t digest food if she’s brain dead could she? When I was pregnant, I made damn sure I ate extremely healthy food and took natural supplements, flaxseed oil, etc and got plenty of exercise and rest so I could do the best I could for my developing baby. I just don’t see how a brain dead person could give a fetus what it needs. I guess I don’t understand life support.

Speaking of which, I wonder how Beata is doing with her Mom.

@socal: The hospital decided not to appeal the decision, thank goodness but they haven’t figured out how they are going to handle the bill. If I were Eric Munoz I’d tell them to shove it.

Regarding the abnormalities, When Eric found Marlise on the kitchen floor they theorized that she probably had a blood clot that moved to either her lungs or maybe brain (?) and she could have been not breathing for an hour or more.

@socal: Yeah, I was wondering about Beata too. Of course she’s had really nasty weather up there in Indiana with “lots” of snow and ice. Hope she and her mom in the n.h. are okay.

@socal: My comment was 3:50 was behind when I hit the post button. I had a phone call so you had already seen from a link that the hosp wasn’t going to appeal and they had taken her off life support.

As I said, I had about 4 or 5 tabs open with article’s on this but the one thing I wanted to get across was that fully 2/3rds of the states have some type of stipulation that will void a woman’s advance directive or medical proxy if she is pregnant. They have it on the forms in AL too but of course it doesn’t affect me.

There is another serious and unresolved legal issue here. In Massachusetts, and probably many other states, EMT’s are legally required to initiate resuscitation measures unless a specific form has been completed waiving those measures. How is anyone supposed to produce two forms in the middle of a medical crisis, and are we supposed to carry them around our neck in a plastic case? EMT’s can pronounce death here in certain circumstances, usually an automobile crash. So basically, your advance directive is meaningless unless somebody can find it, and it is attached to this virtually unknown form you have to get from the state. So you pretty much get automatically intubated here and then pronounced dead at the ER unless you are smashed to smithereens.

@6: Oh, yes. As long as she is on the ventilator, cellular metabolism can continue without significant brain activity.

@Mary Luke: Interesting! I did not know about that. I had always thought they would put an oxygen mask on the patient but didn’t know they would tube someone in the field.

@10 and 12: Correct. A full code with intubation is always the default position.

This story is just awful. For the husband and the woman’s parents – to lose her – and then to continue to lose her for days and weeks and month. This hospital and these doctors are a disgrace. All they did was inflict pain. They are a disgrace.

Fredster, thanks for this post. This is the kind of pseudo-religious insanity that causes women all over the country to suffer. I cannot imagine the twisted, tortured thinking that could make people (medical professionals!) believe that they were doing the right thing by keeping a brain-dead woman, and her non-viable fetus, on life support. The cruelty is mind-blowing.

The crux of the problem here is that the state of Texas does not accept the ,medical definition of death, which is absence of brain activity. Again, another example of legislatures practicing medicine.

@16 – Is this only the case for pregnant wimminz? Because, you know, a brain-dead man is carrying sperm, or potentially could be. Every sperm is sacred….

By the way, if absence of brain activity means death, then I wonder how many Texas legislators should be declared DOA?

@dyb & mb: That’s why I wanted to write this particular piece. Also, I was completely surprised by the number of states that had some kind of restrictions on a woman’s end of life decisions if she is pregnant. That was mind-blowing!!

By the way, if absence of brain activity means death, then I wonder how many Texas legislators should be declared DOA?

ROTFLMAO!!!

@20 – Wow, that is very sad.

R.I.P. Pete Seeger. Age 94

Have you seen the latest from the asshole gallery? http://www.chron.com/news/texas/article/GOP-leaders-Court-erred-in-brain-dead-pregnancy-5177708.php?utm_source=twitterfeed&utm_medium=twitter

Four big-name Republicans running for lieutenant governor said Monday night that a Texas judge erred when he ordered a brain-dead, pregnant woman off life support and vowed if elected to tighten state law so that a similar outcome couldn’t happen again.

Apparently it’s legal to practice medicine as a politician in Texas.
That said, I can foresee a problem in that physicians generally vote Republican, and I don;t see them putting up with interference too much longer..

@8 & 6: My mother has passed away. I have not been online or following the news lately.

I want to thank my Widdershin friends for your support in regards to my mother during these last few years. It has meant a great deal to me.

Dear Beata. I am so sorry for your trouble. Please rest up, stay warm and nourished, and return soon.

Oh Beata! {{{{HUGS}}}}! I hope you are handling things as best you can and I hope your dear mother is at peace and rest now.

We’re here if you need us.

Eek, JJ! I did not see your comment…my bad or rather my internet bad. What a bunch of jerks there in Texas.

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