TX - pregnant wife unresponsive on life support, husband hopes to fulfill her wishes

New Posts

NevadaMom said:
BBM... The problem is the Texas state law that says the non-viable fetus trumped the prior declared choices of the mother as well as the wishes of both her husband and her parents.

Honestly I think making her loved ones suffer through watching her on a vent week after week knowing she's dead was bad enough. Now to get word that the fetus has multiple abnormalities to the point where gender cannot be identified... it's disgusting. The level of pain they are enduring because the state of Texas wants to have supreme power over all the uteruses is beyond despicable.

I'm glad my pregnancy when I lived in DFW was not problematic. I could not imagine my family going through this horror.

IMO. :moo:
Click to expand...

Many states have similar laws. My own, California has something similar for "viable" fetuses. When we did our will, I learned that a woman cannot choose no life saving measures in certain circumstances like a vegetative state or even brain death, if she is pregnant. Here's the law on that: http://www.google.com/url?sa=t&rct=...RSd3eT8YWdkNa_H7bA&bvm=bv.59568121,bs.1,d.cGU

However, under California law, unlike Texas, the family of the brain dead person has to want to keep the body going until the baby comes to term.

To me, that's more as it should be. These kinds of decisions are personal ones and should be up to the patient or his or her family if the patient lack the capacity to decide and has not (or is not allowed) to make his or her wishes known.

I hope Texas is not saddling this man with the medical bills. And what about the baby? If he or she is born with significant issues, is the state going to help with care for the baby? Because if his wishes and his wife's wishes were followed, the baby would not have been born under such circumstances.

I don't mean to sound harsh. I understand it is a sensitive issue. But to me, the law should not force us to accept the scientific artificial extension of life or life support if we do not choose it.

I think it would be much different if she had been declared in a vegetative state or even brain dead close to birth. Then it would make sense to keep her going long enough to allow the baby to be born, even against the father's wishes. But the fetus in this case was not even viable when the mother was declared brain dead, to my knowledge.
 
ohiogirl said:
I will have to disagree. I don't think the law is clear at all. jmo
Click to expand...

It looks like you are right. There are competing laws. One states that a person declared brain dead is legally dead (and thus I presume no life sustaining measures can be continued, like in the California case) and the other states advanced directives have no effect if the patient is pregnant. http://www.dallasnews.com/news/metr...ant-fort-worth-woman-kept-on-life-support.ece

http://www.economist.com/news/unite...ce-and-pro-life-alike-brain-dead-and-pregnant

But is a dead person a "patient". It appears she is brain dead, according to lawyers who have reviewed her file.

Also, what does the law state about fetus viability? Does that factor in? And although the law states that advanced directives will not be followed in the case of a pregnant person, does it state also that life support MUST be utilized in the case of such a person? Isn't there an ethics board who looks at such cases and decides based on the facts?

I think this is an area that will have to be cleared up so that hospitals like this one can have clear-cut plans in place for cases like this.

In the meantime, I asked if the state should cover the medical bills. However, it is the hospital making this decision in their interpretation of the law. So, it should cover the costs.
 
http://www.babycenter.com/fetal-development-images-14-weeks

I'm wondering what kind of deformity they are talking about. Marlise was 14 weeks pregnant when she got the embolism, wasn't she? Fetuses get their basic shape in the first trimester. If everything was developing fine until 14 weeks I would have expected growth retardation, problems with the maturation of the organs and abnormal brain development more than gross structural deformities in the shape of the limbs.
 
Just hypothesizing .....

Deformities in the lower limbs after 14 weeks could be caused by amniotic band syndrome. Amniotic band syndrome may occur when the placenta and amnion (portions thereof) begin to deteriorate, creating fibrous bands within the amniotic sack, entrapping limbs, digits, etc, leading to growth restriction and deformation.
 
gitana1 said:
It looks like you are right. There are competing laws. One states that a person declared brain dead is legally dead (and thus I presume no life sustaining measures can be continued, like in the California case) and the other states an advanced directives have no effect if the patient is pregnant. http://www.dallasnews.com/news/metr...ant-fort-worth-woman-kept-on-life-support.ece

http://www.economist.com/news/unite...ce-and-pro-life-alike-brain-dead-and-pregnant

But is a dead person a "patient". It appears she is brain dead, according to lawyers who have reviewed her file.

Also, what does the law state about fetus viability? Does that factor in? And although the law states that advanced directives will not be followed in the case of a pregnant person, does it state also that life support MUST be utilized in the case of such a person? Isn't their an ethics board who looks at such cases and decides based on the facts?

I think this is an area that will have to be cleared up so that hospitals like this one can have clear-cut plans in place for cases like this.

In the meantime, I asked if the state should cover the medical bills. However, it is the hospital making this decision in their interpretation of the law. So, it should cover the costs.
Click to expand...

If I understand correctly, the Munoz attorneys are going to argue that a dead person cannot also be considered a patient.

I do not think an ethics committee, if one even exists here in Texas, would be allowed to give an opinion. As I've always maintained, this is purely a political situation & to the devil with ethics. The law regarding a pregnant person was passed simply to garner votes in an extremely pro life state.

I also believe that after this fiasco of a case, the laws will be refined to be extremely specific to any given situation. However, I don't believe more specific laws would favor a woman or her family's wishes in any way. The bottom line is: "If you are a pregnant woman, you are gonna dang well have a baby!"

In addition, there is no way the state would ever accept financial responsibility. Texas has one of the toughest stances against welfare of just about any state in the union.

All the above is JMO.
 
http://www.braindeath.org/law/texas.htm

TITLE 8. DEATH AND DISPOSITION OF THE BODY

SUBTITLE A. DEATH CHAPTER 671.

DETERMINATION OF DEATH AND AUTOPSY REPORTS SUBCHAPTER A.

DETERMINATION OF DEATH § 671.001.

Standard Used in Determining Death (a) A person is dead when, according to ordinary standards of medical practice, there is irreversible cessation of the person's spontaneous respiratory and circulatory functions. (b) If artificial means of support preclude a determination that a person's spontaneous respiratory and circulatory functions have ceased, the person is dead when, in the announced opinion of a physician, according to ordinary standards of medical practice, there is irreversible cessation of all spontaneous brain function. Death occurs when the relevant functions cease. (c) Death must be pronounced before artificial means of supporting a person's respiratory and circulatory functions are terminated. (d) A registered nurse or physician assistant may determine and pronounce a person dead in situations other than those described by Subsection (b) if permitted by written policies of a licensed health care facility, institution, or entity providing services to that person. Those policies must include physician assistants who are credentialed or otherwise permitted to practice at the facility, institution, or entity. If the facility, institution, or entity has an organized nursing staff and an organized medical staff or medical consultant, the nursing staff and medical staff or consultant shall jointly develop and approve those policies. The board shall adopt rules to govern policies for facilities, institutions, or entities that do not have organized nursing staffs and organized medical staffs or medical consultants. Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989. Amended by Acts 1991, 72nd Leg., ch. 201, § 1, eff. Sept. 1, 1991. Amended by Acts 1995, 74th Leg., ch. 965, § 8, eff. June 16, 1995.

§ 671.002. Limitation of Liability (a) A physician who determines death in accordance with Section 671.001(b) or a registered nurse or physician assistant who determines death in accordance with Section 671.001(d) is not liable for civil damages or subject to criminal prosecution for the physician's, registered nurse's, or physician assistant's actions or the actions of others based on the determination of death. (b) A person who acts in good faith in reliance on a physician's, registered nurse's, or physician assistant's determination of death is not liable for civil damages or subject to criminal prosecution for the person's actions. Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989. Amended by Acts 1991, 72nd Leg., ch. 201, § 2, eff. Sept. 1, 1991. Amended by Acts 1995, 74th Leg., ch. 965, § 9, eff. June 16, 1995.

Copyright 2000 by the State of Texas
Click to expand...

BBM. Does this bit mean what I took it to mean? That if they haven't declared her officially dead yet it would be illegal in Texas to remove life support even if she was not pregnant?

I'm sure I must have misunderstood something...
 
Donjeta said:
http://www.braindeath.org/law/texas.htm



BBM. Does this bit mean what I took it to mean? That if they haven't declared her officially dead yet it would be illegal in Texas to remove life support even if she was not pregnant?

I'm sure I must have misunderstood something...
Click to expand...

Your interpreting that correctly. The tests to determine brain death have to be performed before they declare her brain dead. Once brain death is declared support can be discontinued.

This just applies to brain death.

There are other guidelines for different situations.

eta: the hospital does not need concent from family for removal of life support after the declaration of brain death. Where if life support is removed from a person say, in a coma it would require an advanced directive or consent of family. I think that's why the statute reads the way it does.
 
Just revolting - medically and ethically.

This woman is dead. Her fetus is being forcefully gestated inside of a corpse and sustained by extremely invasive, artificial means ( ECMO perhaps ? ).

The initial insult included several minutes of oxygen deprivation, damaging the placenta and compromising future growth. So this fetus is suffering from (most likely) intra-uterine growth retardation, hypoxic/anoxic brain injury, possible amniotic band syndrome, and who knows what as far as side effects from multiple medications.

That poor woman and get family. Abuse of a corpse and willful infliction of harm on the unborn. Disgusting.
 
BeginnersLuck said:
What would medical power of attorney have to do with anything, when Texas law accepts brain death criteria. It all boils down to the brain death law. If she is deceased then the vent is removed. She is not on life support if she is deceased, she is on death support. The law should end there. That should trump anything else. If she were in a coma it would be a totally different story.
Click to expand...

BBM

And that is a legal argument to be tried. But I think it fails. A deceased person does not have more rights than a living one, and the argument has been made, a potential one.

ETA. . just for example. . .a mother, even with a written legal directive, dies in her 8th month of pregnancy, her written directive can be overridden by the obvious fact that she intended for the child to be born. . . as well as the legal precedent that the state has a more compelling interest in a potential life than in a dead person. That is a legal argument that has already been decided, as well, it is addressed in the Texas Advance Directive Code. A person does not magically gain more rights when they die.

Frankly the argument is moot. If the argument is that she is dead, well, dead people also do not have rights of personhood, which would include the right to a assign power of medical attorney. So which is it? If she's dead Mr Munoz has no decision making rights, as he is no longer her agent under the definition of medical power of attorney.

I've said this before, there are MANY legal issues here. IMHO arguing whether she is dead or not is probably one of the worst ways to go about it. The State actually has MORE authority over dead bodies than they do living persons.

MOO. . .the attorney's for Mr. Munoz are going after the wrong issue. When this case first came to light it seemed that they were going to be arguing that this case was based on the 14th Amendment. I can only assume that they figured out they would lose on that basis. A man does not have the right to terminate a woman's pregnancy, no matter the circumstances. So now they have moved on to this "she is dead" issue. Again, the State has even MORE authority over dead bodies than they do living persons. What they should be arguing is that the fetus is futile. THAT is a legal gray issue, and a judge can determine that if there is no hope, regardless of what the physicians do, that it would be in the best interest of the fetus (which is the State's only interest at this point) to no longer prolong it's inevitable death. Of course, that also depends solely on the medical evidence that this fetus is, in fact, futile.

And just in case anyone's wondering, I do NOT want the Constitutional basis of a woman's right to terminate her pregnancy to change. I in NO way want to start claiming that other people have the right to determine what a pregnant woman decides, within the confines of the law.

I also do NOT want to start arguing that States have no interest in life. I don't want to argue that they have NO rights over parents with regards to life and potential life. If we argue that, than States can no longer remove abused children from abusive parents. Period. The law has to apply to everyone equally.

With this case specifically, I see it as Marlise did not choose to change her directive once she became pregnant and that is interpreted as she did NOT choose to express in writing that she still wanted to be kept off life support. If she did, than she has to express that given the change in circumstances. If you write a will when you only have one child, upon the birth of subsequent children, you have to change it if you want it changed.

While I can sympathize with Mr Munoz and her family, I don't find their case exceptional. Lots of parents and fathers find themselves in unfortunate situations. It's just the way life is. I understand the burden that may be placed on him, but it is NO different than any other father's. Sometimes mothers leave the hospital and get hit by a bus. Not all babies are born healthy. It has nothing to do with "rights" but has everything to do with life. I suspect that this case has MUCH more to do with Mr Munoz's "wishes" than Marlise's.

Given all that, I do not want to see this child suffer unduly if it has no chance of survival. But I want that "no chance of survival" to be proven. Life and death is a serious matter. The evidence must be compelling.


MOOOOO!!!!!!!!!!!!
 
Donjeta said:
http://www.braindeath.org/law/texas.htm



BBM. Does this bit mean what I took it to mean? That if they haven't declared her officially dead yet it would be illegal in Texas to remove life support even if she was not pregnant?

I'm sure I must have misunderstood something...
Click to expand...

Hospital has to follow specific steps to declare someone brain dead. Just as in McMath case, she would have to be examined by two independent physicians, specific tests need to be carried out, such as apnea test. Only then hospital can declare her brain dead. If this hospital didn't follow all these steps, even if she is brain dead, if she hasn't been declared, then she isn't yet legally dead.
Therefore, still a patient.
Hospital can't just removed someone from life support unless all the steps were followed. If the steps were followed, and person declared brain dead, only then hospital is allowed to remove life support (without permission from the family).
 
Are they even able to perform the apnea test with the fetus in her who is already compromised by previous oxygen deprivation? Sounds risky to me.
 
LaborDayRN said:
In general, a person with no training in radiology would look at this type of ultrasound (for medical evaluation) and not be able to discern a great deal. The information may have actually been provided in a verbal or written form.
The ultrasound itself was more than likely preformed by a perinatologist (maternal fetal medicine specialist who. They specialize in high risk pregnancies). MOO
Click to expand...

I also believe that lawyers had an MD to inspect the ultrasound and interpret it for them.
 
Elainera said:
Are they even able to perform the apnea test with the fetus in her who is already compromised by previous oxygen deprivation? Sounds risky to me.
Click to expand...

Probably not if they want to preserve the fetus. The other case I posted, they didn't do apnea test while brain dead woman was still pregnant. They waited until fetus was delivered and then did it, and declared her dead.
 
craftybatchy said:
Just hypothesizing .....

Deformities in the lower limbs after 14 weeks could be caused by amniotic band syndrome. Amniotic band syndrome may occur when the placenta and amnion (portions thereof) begin to deteriorate, creating fibrous bands within the amniotic sack, entrapping limbs, digits, etc, leading to growth restriction and deformation.
Click to expand...

I think that is a very good possibility.
 
craftybatchy said:
Just revolting - medically and ethically.

This woman is dead. Her fetus is being forcefully gestated inside of a corpse and sustained by extremely invasive, artificial means ( ECMO perhaps ? ).

The initial insult included several minutes of oxygen deprivation, damaging the placenta and compromising future growth. So this fetus is suffering from (most likely) intra-uterine growth retardation, hypoxic/anoxic brain injury, possible amniotic band syndrome, and who knows what as far as side effects from multiple medications.

That poor woman and get family. Abuse of a corpse and willful infliction of harm on the unborn. Disgusting.
Click to expand...

I agree 100%
 
hambirg said:
BBM

And that is a legal argument to be tried. But I think it fails. A deceased person does not have more rights than a living one, and the argument has been made, a potential one.

ETA. . just for example. . .a mother, even with a written legal directive, dies in her 8th month of pregnancy, her written directive can be overridden by the obvious fact that she intended for the child to be born. . . as well as the legal precedent that the state has a more compelling interest in a potential life than in a dead person. That is a legal argument that has already been decided, as well, it is addressed in the Texas Advance Directive Code. A person does not magically gain more rights when they die.

Frankly the argument is moot. If the argument is that she is dead, well, dead people also do not have rights of personhood, which would include the right to a assign power of medical attorney. So which is it? If she's dead Mr Munoz has no decision making rights, as he is no longer her agent under the definition of medical power of attorney.

I've said this before, there are MANY legal issues here. IMHO arguing whether she is dead or not is probably one of the worst ways to go about it. The State actually has MORE authority over dead bodies than they do living persons.

MOO. . .the attorney's for Mr. Munoz are going after the wrong issue. When this case first came to light it seemed that they were going to be arguing that this case was based on the 14th Amendment. I can only assume that they figured out they would lose on that basis. A man does not have the right to terminate a woman's pregnancy, no matter the circumstances. So now they have moved on to this "she is dead" issue. Again, the State has even MORE authority over dead bodies than they do living persons. What they should be arguing is that the fetus is futile. THAT is a legal gray issue, and a judge can determine that if there is no hope, regardless of what the physicians do, that it would be in the best interest of the fetus (which is the State's only interest at this point) to no longer prolong it's inevitable death. Of course, that also depends solely on the medical evidence that this fetus is, in fact, futile.

And just in case anyone's wondering, I do NOT want the Constitutional basis of a woman's right to terminate her pregnancy to change. I in NO way want to start claiming that other people have the right to determine what a pregnant woman decides, within the confines of the law.

I also do NOT want to start arguing that States have no interest in life. I don't want to argue that they have NO rights over parents with regards to life and potential life. If we argue that, than States can no longer remove abused children from abusive parents. Period. The law has to apply to everyone equally.

With this case specifically, I see it as Marlise did not choose to change her directive once she became pregnant and that is interpreted as she did NOT choose to express in writing that she still wanted to be kept off life support. If she did, than she has to express that given the change in circumstances. If you write a will when you only have one child, upon the birth of subsequent children, you have to change it if you want it changed.

While I can sympathize with Mr Munoz and her family, I don't find their case exceptional. Lots of parents and fathers find themselves in unfortunate situations. It's just the way life is. I understand the burden that may be placed on him, but it is NO different than any other father's. Sometimes mothers leave the hospital and get hit by a bus. Not all babies are born healthy. It has nothing to do with "rights" but has everything to do with life. I suspect that this case has MUCH more to do with Mr Munoz's "wishes" than Marlise's.

Given all that, I do not want to see this child suffer unduly if it has no chance of survival. But I want that "no chance of survival" to be proven. Life and death is a serious matter. The evidence must be compelling.


MOOOOO!!!!!!!!!!!!
Click to expand...

Hambirg, can you please cite me to the support for the futility argument. Statute, case law, whatever. I haven't seen what this this aspect is based on and would like to take a look. TIA :seeya:
 
Karmady said:
Hambirg, can you please cite me to the support for the futility argument. Statute, case law, whatever. I haven't seen what this this aspect is based on and would like to take a look. TIA :seeya:
Click to expand...
I am not Hambirg, but here is the case of baby Sun Hudson. I don't think this argument could work for Munoz baby. Despite multiple issues, I haven't seen anything to suggest the fetus is futile. Even if legs have to be amputated (for example) that doesn't mean futility. One can live without legs.
Hydrocephalus can be treated by surgery. Heart conditions (at least some) can be treated by surgery. It appears to be very abnormal but not exactly futile.

"Texas Children's contended that continuing care for Sun was medically inappropriate, prolonged suffering and violated physician ethics. Hudson argued her son just needed more time to grow and be weaned from the ventilator."

http://www.chron.com/news/houston-t...h-fatal-defect-dies-after-removal-1498268.php
 
BeginnersLuck said:
BBM: Are you talking about the same statute or is this something else? If it's the same statute IMO, it's not applicable if she is deceased.

Section 166.049:
Pregnant Patients
A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient.

They are not providing her with life-sustaining treatment if she is legally dead. It would apply if she was in a coma.

The only law that should apply in the case is the brain death law. The pregnant patient law should not apply if she is deceased.

Is there another statute that they are questioning? If you can direct me to it, I would much appreciate it. I am coming in late in the discussion.
Click to expand...


I'm late to reply as I was off grocery shopping all day, so this was likely commented on already, and if it was... Sorry. :blushing:

If in fact they have not officially pronounced her as being brain dead, and not performed the apnea portion of the brain death test, they (the state and hospital) may well have skirted the whole "she's deceased" thing. That's an unknown at this point though, but totally plausible as others have pointed out as 10 minutes of no vent for the apnea test would only further harm the fetus. IMO If that is the case it's deplorable and flies in the face of medical ethics.
 
NevadaMom said:
I'm late to reply as I was off grocery shopping all day, so this was likely commented on already, and if it was... Sorry. :blushing:

If in fact they have not officially pronounced her as being brain dead, and not performed the apnea portion of the brain death test, they (the state and hospital) may well have skirted the whole "she's deceased" thing. That's an unknown at this point though, but totally plausible as others have pointed out as 10 minutes of no vent for the apnea test would only further harm the fetus. IMO If that is the case it's deplorable and flies in the face of medical ethics.
Click to expand...

Well I don't think it's medically unethical if their goal is to preserve the fetus. Obviously if you are trying to preserve if you are not going to do anything that can harm it. They ceartinly appear to be dead set on preserving it despite it's abnormal condition.
 
If this case isn't the perfect example for why the government should stay out of women's wombs, I don't know what is.
 
You must log in or register to reply here.

DNASolves

Who is Escambia County John Doe (1989)?

Members online

... and 162 more.
Total: 3,065 (members: 163, guests: 2,902)

Online statistics

Members online
163
Guests online
2,902
Total visitors
3,065
Totals may include hidden visitors.

Forum statistics

Threads
595,454
Messages
18,024,866
Members
229,652
Latest member
xobehtedistuO
Back
Top