Pregnant woman kept alive against family's wishes in Texas
Linda Carroll NBC News contributor


Dec. 24, 2013 at 3:56 PM ET

The last time Erick Munoz saw his pregnant wife conscious, she had gotten up before 2 a.m. to give their son a bottle.

When Marlise didn’t return to bed and with the boy still crying, Erick went in search of her. He found her unresponsive on the kitchen floor, her face blue from lack of oxygen. A short time later, doctors declared her brain dead at a Fort Worth hospital.

Marlise Munoz had been clear about her wishes never to be hooked up to life-support machines if she were fatally injured. But when the unthinkable happened to the 33-year-old mom, doctors told her family that they could not respect her wishes. Because she was 14 weeks pregnant, they would have to follow a Texas statute making it illegal to disconnect life support from a pregnant woman.

“The doctors told us that even if a pregnant woman has a DNR or a living will, the law supersedes that,” Munoz’s mom, Lynne Machado, told NBC News. “So any pregnant woman must be kept alive with life support because of the fetus. We had never heard of this and we wanted to get the information out there. No family should have to go through this. It’s been pure hell.”

Although doctors have been sympathetic to the family’s plight, they feel they have no other choice.

“We follow the state law on this," said J.R. Labbe, vice president of communication and community affairs for JPS Health Network. "We cannot withdraw or withhold life-sustaining treatment from a pregnant patient."

According to a 2012 report by the Center for Women’s Policy Studies, 31 states have laws that allow hospitals to keep women alive against their wishes if they are pregnant.

"What is quite stunning about these statutes for women is that they don't even take into account a woman's pain," said Lynn Paltrow, executive director of the National Advocates for Pregnant Women. "A woman could be in excruciating pain and near death's door and they still would force her to suffer.

"These are extraordinary laws creating separate unequal status for pregnant women in which they lose control of medical decision making, the right to bodily integrity and right to be free of excruciating pain."

No one knows exactly what happened to Munoz before she was found and rushed to the hospital on Nov. 26, but doctors suspect that a blood clot traveled to her lungs and blocked air flow.

“They won’t know for sure until they can perform an autopsy,” Machado said, her voice cracking. “And that can’t happen until she is no longer pregnant—either because she miscarries or the fetus can be delivered.”

When Machado and her husband arrived at the emergency room they found doctors and nurses hovering over their daughter, assessing her condition.

“They did a CAT scan and an EEG and there was no brain activity,” Machado said. “She was clinically declared brain dead. The doctors said she had been without oxygen for well over an hour.”

The family expected at that point that doctors would disconnect life-support and that they would say their goodbyes to Marlise.

When the family was told life support could not be disconnected, “my jaw hit the ground,” Machado said.

Stunned, the Machados and Erick Munoz tried to explain that this was against Marlise’s wishes. They told hospital staff that the family had had many conversations about what should happen if anyone became so ill that there was no chance of recovery.

Marlise’s brother died several years ago, but the subject had come up even before then, her mother said. Marlise and her husband, both paramedics, were well versed in issues of life and death.

“We were all on the same page,” Machado said. “None of us want to be on life support.”

Doctors told them there was nothing to be done, that Marlise Munoz would need to stay on life support until she miscarried or reached 24 weeks, when they could do tests on the fetus. “At that point they would decide whether to start labor, do a C-section, or see if she could go to 34 or 36 weeks when the fetus would be full term,” Machado said.

In the meantime there would be nothing for Marlise Munoz’s family to do. The family doesn’t know the condition of the fetus, and worries about the effects of an hour or more of oxygen deprivation.

“It’s been heart wrenching and we’re all emotionally drained,” Machado said. “It’s one thing if you don’t know what your child would have wanted, but if you do know and then for it not to happen . . . it’s been very frustrating for all of us.”

http://www.nbcnews.com/health/pregnant-woman-kept-alive-against-familys-wishes-texas-2D11792149

I have a ton of questions about this situation:

1. Would the woman have felt differently about DNR when she was pregnant? Did they discuss this scenario?

2. Would she want to give the fetus a chance at life? Maybe. If that were the case, the family would be more at peace with life support.

It's a reminder to revisit such life-changing decisions/directives when a child or pregnancy is involved.

About this:

"The doctors said she had been without oxygen for well over an hour.”

I cannot believe the husband laid in bed for an hour listening to a crying baby before he went to check on the Mom. Did the baby stop crying? Perhaps. Maybe he fell back asleep. Or maybe the time from her O2 deprivation and including the time to do tests was an hour. Not sure about that.

The bottom line is that it's a law, and they must follow it. Sounds like a law passed by the right to "protect the unborn".....at any cost. If the Mom was without O2 for an hour, so was the baby.
I hope that this nightmare ends soon for the family. They need closure, not uproar and uncertainty.

If the mother is without oxygen for any given period of time wouldn't the fetus have also been deprived of oxygen?

Yes, oskar ~

I've been thinking about this nightmare since John first posted it ~ I understand the legislation and think I understand the "why" of the legislation ~ but it goes too far IMO, very similar to strict "zero tolerance" laws/rules ~ I canNOT imagine what the family is experiencing ~ I could maybe understand if the fetus was much closer to viability ~ but I'm willing to bet there is an approximately 0% chance of the fetus surviving, especially if they are forced to wait another 10 weeks before even testing the fetus ~

Sooz

Poorly crafted laws strike again.
It's becoming uncomfortably familiar, eh?

UPDATE ~ such a sad, sad story ~ ~ but I see this as the best decision for all involved ~ Sooz

Judge Orders Brain Dead Texas Woman Be Taken Off Life Support After Lawyers Admit Her Fetus Is ‘Non-Viable’
By Annie-Rose Strasser on January 24, 2014 at 5:46 pm

A federal judge ordered Friday night that Marlise Muñoz, the Texas woman who has been kept on life support against her and her family’s will, be removed from her ventilator and respirator.

Muñoz has been legally dead since she collapsed on her kitchen floor in November, but the state has kept her on a ventilator because she was pregnant. Lawyers for the John Peter Smith Hospital, where Muñoz is being kept, cited an obscure state law that stipulates that hospitals are required not to remove “life-sustaining treatment” from pregnant women to argue that such life support was necessary.

However, lawyers both for Muñoz’s family and for John Peter Smith Hospital acknowledged Friday that the fetus was “non-viable.” Earlier, attorneys simply had indicated that the fetus suffered “abnormalities,” but did not say whether it could viably live outside of the womb.

Muñoz’s case has sparked a conversation about the bodily autonomy of pregnant women when it comes to end-of-life wishes. Texas is one of 12 states that invalidates a woman’s wishes if she is pregnant.

District Judge R.H. Wallace on Friday night sided with Muñoz’s family, and ordered that the woman be taken off life support by 5:00 pm central time Monday.

Update: The hospital has until Monday to remove Muñoz from life support.

http://thinkprogress.org/health/2014/01/24/3205351/marlise-munoz-off-life-support/

Such a sad thing this family has had to go through. Am glad the judge decided to put an end to the misery for all involved.

I'm very relieved that this nightmare is over for Marlise and her family ~ rest in peace for ever and ever, Marlise ~ ~ Sooz

Monday, Jan 27, 2014 08:51 AM CST
Marlise Munoz removed from life support, will finally be laid to rest
The family "will now proceed with the somber task of laying Marlise Muñoz’s body to rest," lawyers said.
Katie Mcdonough

Marlise Munoz, a brain-dead woman who was pregnant at the time of her death in November, was removed from a respirator and other machines on Sunday in compliance with a court order and the wishes of the woman’s husband and parents.

John Peter Smith Hospital in Forth Worth, Texas, refused to honor Erick Munoz’s request to disconnect his deceased wife from the machines for two months. After a long legal battle, a state district judge ruled on Friday that the hospital had wrongly applied a state law barring doctors from withdrawing “life-sustaining treatment” to women who are found to be pregnant because Munoz was medically and legally dead.

In a statement on its compliance with the order, the hospital defended its decision to keep a medically and legally dead woman on a respirator and other machines against the wishes of the family of the deceased. “J.P.S. Health Network has followed what we believed were the demands of a state statute,” said spokeswoman Jill Labbe. “From the onset, J.P.S. has said its role was not to make nor contest law but to follow it.”

Previously, lawyers for the hospital said its actions upheld the Texas Legislature’s “commitment to the life and health of unborn children.”

A statement from attorneys for the Munoz family and the hospital both confirmed during the Friday hearing that the fetus gestating in Munoz’s deceased body was not viable.

“The Muñoz and Machado families will now proceed with the somber task of laying Marlise Muñoz’s body to rest, and grieving over the great loss that has been suffered,” lawyers Heather King and Jessica Janicek said in a statement. “May Marlise Muñoz finally rest in peace, and her family find the strength to complete what has been an unbearably long and arduous journey.”

http://www.salon.com/2014/01/27/marlise_munoz_removed_from_life_support_will_finally_be_laid_to_rest/

Actually, the hospital was in a bind.
They were damned if they did and damned if they didn't due to foolish laws.

I read a statement from the husband somewhere. He said that having to look into her lifeless eyes was horrible and he tried to hold her hand, but it was too stiff. That must have been very hard for him and imo, cruel beyond measure.

I'm happy that the family will finally get closure and can get on with their lives.

I have no clue what insurance does/does not do in situations like this ~ but since the state forced the hospital and the family to keep Marlise Munoz "alive", the state should be responsible for any bills not covered by insurance ~ Sooz

Brain-Dead Texas Woman’s Family May Have To Pay For The Cost Of Keeping Her On Life Support
By Tara Culp-Ressler on January 30, 2014 at 3:26 pm

On Sunday, Marlise Machado Muñoz — the brain-dead women who was forced to remain on life support against her family’s will because she was pregnant — was disconnected from a respirator after a months-long battle with the hospital that was caring for her. John Peter Smith Hospital finally agreed to relinquish her body to her family after a judge ordered it. Now, her husband Erick is finally beginning the process of saying goodbye to Muñoz and her unborn child, who he named Nicole.

But in the aftermath of the family’s personal tragedy, there are still some unanswered questions. It’s not guaranteed that Texas will actually change the arcane state law that allows hospitals to override women’s end-of-life wishes if they are pregnant. And it’s unclear who exactly will be responsible for paying the medical bills that resulted from Muñoz’s hospital stay, which stretched on for about nine weeks.

In an interview with CNN’s Anderson Cooper, Erick Muñoz acknowledged that he has been receiving medical bills at his home — although he’s not sure exactly what he will be expected to pay.

“They have not come to me and said how that’s going to work,” he told CNN. “But I believe I’ve heard several media outlets…saying that they’ve asked about that. They have asked that question. They said they would continue normal billing.”

After ThinkProgress reached out to the John Peter Smith Hospital, a spokesperson explained that billing is part of Muñoz’s medical records, and is therefore covered under privacy laws. The hospital noted that although Eric Muñoz may say whatever he wants on the matter, its officials are not allowed to disclose details about billing unless he agrees to release his deceased wife’s medical records.

Hospital care is often prohibitively expensive for the average American. A recent report on the issue found that bills at hospitals have been steadily rising for nearly two decades, and some facilities now charge patients up to 10 times more than what the service is actually worth. Pregnancy-related care is a good illustration of this dynamic. The cost of giving birth can vary by tens of thousands dollars at different hospitals, and there’s no good reason for the discrepancy. Often, one catastrophic health event is enough to put a family in serious debt — by some estimates, medical bills are the leading cause of U.S. bankruptcies.

http://thinkprogress.org/health/2014/01/30/3228561/brain-dead-texas-bills/

I saw this coming a million miles ago.

It's all a mess. It's not totally fair to make the hospital eat this bill, because their hands were tied in accordance with state law.

Hoping the state has good charity care funding in place.

I think the state should pay the hospital since it's their stupid law. The hospital was just following the law. The family didn't want it done.

Interestingly enough we have exactly the same thing going on here. In this case, though, she is being kept alive because the family wants the baby. This being Canada, they also won't be bankrupted by their choice.

http://globalnews.ca/news/1125347/pregn ... n-be-born/

Not only that, but she was 5 months along when she "died". Makes a huge difference, imo.

Baby Iver has arrived. Mom is gone.

http://news.ca.msn.com/top-stories/roby ... r-and-dies

Welcome to the world Iver!