Health
5:30 pm
Thu January 9, 2014

Pregnant Woman Kept On Life Support Despite Family's Wishes

Originally published on Tue January 14, 2014 4:13 pm

A 33-year-old Texas woman named Marlise Munoz has been connected to life support machines for more than a month, after she collapsed on the kitchen floor of her home.

Her husband says she would not have wanted to be kept alive this way, but the hospital has refused to follow that wish, citing a Texas law that forbids medical officials from cutting off life support to a pregnant patient.

The New York Times calls this case “a strange collision of law, medicine, the ethics of end-of-life care and the issues swirling around abortion — when life begins and how it should be valued.”

“I think the law is unconstitutional,” bioethicist Art Caplan tells Here & Now’s Robin Young. “I don’t think women in Texas or anywhere should be compelled to have to go as long as nine months on machines when they are dead because they were one day pregnant. I think the legislature also has written it too broadly: premature fetus, unviable fetus. You’ve got to take those factors into account.”

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Transcript

ROBIN YOUNG, HOST:

From NPR and WBUR Boston, I'm Robin Young.

MEGHNA CHAKRABARTI, HOST:

I'm Meghna Chakrabarti. It's HERE AND NOW. In a moment, machines changed the world during the Industrial Revolution, but we'll look at why that may be nothing compared to the way they're changing our lives now.

YOUNG: Well, speaking of which, first we take up a petition that's been started in Texas in support of a family's wish to remove a pregnant woman from life support. Thirty-three-year-old Marlise Munoz was 14 weeks pregnant when she collapsed in November from what appeared to be a blood clot. We spoke to her mother, Lynne Machado, this morning.

She reiterated what the family said they were told then, that doctors at John Peter Smith Hospital in Fort Worth said Marlise was brain dead, that the family was preparing to say goodbye, honoring her wish not to be kept alive on life support when hospital officials then told them Texas law trumped Marlise's directives.

Texas is one of more than two dozen states that prohibit medical officials from cutting life support to a pregnant patient. But her parents and her husband all say the state law is denying her legal wishes. The fetus is now at 20 weeks and would not be viable outside the womb.

The case is being watched by lawyers, end-of-life activists, those on both side of the abortion divide and ethicists. So let's bring in Art Caplan, head of medical ethics at New York University's Langone Medical Center. Art, we reported recently on the young girl declared brain dead in California. At that time ethicists told us that doctors can't legally be required to treat a brain-dead patient.

Here we have parents saying they were told their daughter was brain dead but the hospital not confirming that. Start there.

ART CAPLAN: Well, I think the hospital, if it believes that this woman is dead, and certainly that sounds like it was conveyed to the family pretty definitively, they are under no obligation to treat the dead. That is a bright line. Brain death is death. If this poor woman is dead, then Texas, even the Texas legislature can't get doctors to treat the dead.

YOUNG: Does the Texas law specifically say brain dead is excluded? Does it say it's for vegetative or terminally ill or in a coma?

CAPLAN: It's interesting. What is says is your living will is void if you are pregnant, and you are on life support. However, the way to really read that and understand it is life support means you're alive, and so that doesn't apply, and if your advance directive is void, it's certainly void when you're dead.

YOUNG: But what about the right-to-life advocates, and obviously others in Texas, who are saying but the fetus is viable, the fetus is alive, if you will, the fetus is not dead.

CAPLAN: Well, here I think we've got to pay attention to what the medical facts are that face the fetus. The mom, presuming she's dead, underwent a terrible loss of oxygen to her body that killed her when she had this clot in her lung when she was 14 weeks pregnant. That means that fetus went without oxygen for a very long time, and that spells trouble for a developing fetus early on.

There's a pretty good chance that that fetus is going to be born with severe, horrible disabilities. Now right-to-lifers may say, well, that's just the way it is. My view is when you face that kind of a choice with a premature infant who underwent lack of oxygen for a long, long time at a critical period in development, the family has to make the decision about what they want to do.

YOUNG: In fact the family says the paramedics told them that the fetus was denied oxygen for up to an hour. And this morning the mother also told us that she's considering legal action. On what grounds? I mean, how could she approach that if Texas law - well again, I guess you said the phrase life support would be the one in question.

CAPLAN: I think the law is unconstitutional, and I mean by that your liberty, to make a choice, should not be abrogated if you are one day pregnant. The way that law reads, remember it says pregnant. It means embryo all the way up to almost ready to deliver. I don't think women in Texas or anywhere should be compelled to have to go as long as nine months on machines when they're dead because they were, let's say, one day pregnant.

I think the legislature also has written it too broadly. Premature fetus, unviable fetus, you've got to take those factors into account. I think they'll win if they challenge that law.

YOUNG: Well, and we should say that there might be families that would agree to this process. Jeffrey Spike, he's professor of clinical ethics at the University of Texas, says there have been cases of brain-dead mothers being kept alive on respirators to pump oxygen to a fetus because that's what the family wants.

CAPLAN: Absolutely, and I've had one here at NYU. But that woman unfortunately was in a bad car accident, but she was eight and a half months pregnant. She was on machines a little bit, a day or two, and then a C-section was done. That's a delivery from a woman who's pregnant and had died.

YOUNG: Well, Professor Spike says this is the first case he's heard of of a family being forced to do this.

CAPLAN: It's certainly the first one I'm aware of. I do know instances where people have said please continue, and that's great. My point is the law in Texas or in these other states is way too broad. You have to give discretion because these situations are different. Somebody dead at 14 weeks, or somebody dead, for that matter, at two days of pregnancy, is not the same as someone who dies sadly at eight and a half months.

And to try and legislate that impose a view about what's the right thing to do when difference of opinion is absolutely there, and we're seeing it in the Texas, I think is just unethical, unconstitutional, wrong.

YOUNG: We'll see how this continues. Art Caplan, director of medical ethics at New York University Langone Medical Center, thanks so much.

CAPLAN: Hey, thanks for having me. Transcript provided by NPR, Copyright NPR.

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