Hypothetical: Brain Dead Pregnant Woman

[Flagg]

No longer hypothetical:

Attorneys: Brain-Dead Woman's Fetus 'Abnormal'
DALLAS January 23, 2014 (AP)
By NOMAAN MERCHANT Associated Press

The pregnant, brain-dead Texas woman being kept on life support over her family's protests is carrying a fetus that is "distinctly abnormal," attorneys for the woman's husband said Wednesday.

Marlise Munoz remains hooked up to machines in a Fort Worth hospital, while her husband and the hospital are locked in a court battle about whether to retain life support.

The case has raised questions about end-of-life care and whether a pregnant woman who is considered legally and medically dead should be kept on life support for the sake of a fetus. The case has gotten the attention of groups on either side of the abortion debate, as anti-abortion groups argue Munoz's fetus deserves a chance to be born.

Erick Munoz said his wife, a fellow paramedic, was clear with him before he found her unconscious on Nov. 26: If she ever fell into this kind of condition, pull life support. But John Peter Smith Hospital says it's bound by state law that prohibits the withdrawal of treatment from a pregnant patient, although several experts interviewed by The Associated Press have said the hospital is misapplying the law.

Munoz's attorneys, Heather King and Jessica Hall Janicek, issued a statement Wednesday describing the condition of the fetus, now believed to be at about 22 weeks' gestation. King and Janicek based their statement on medical records they received from the hospital.

"According to the medical records we have been provided, the fetus is distinctly abnormal," the attorneys said. "Even at this early stage, the lower extremities are deformed to the extent that the gender cannot be determined."

The attorneys said the fetus also has fluid building up inside the skull and possibly has a heart problem.

"Quite sadly, this information is not surprising due to the fact that the fetus, after being deprived of oxygen for an indeterminate length of time, is gestating within a dead and deteriorating body, as a horrified family looks on in absolute anguish, distress and sadness," the attorneys said.

Spokeswomen for the hospital and the Tarrant County District Attorney's office, which is representing the hospital in the lawsuit, declined to comment Wednesday.

A hearing in the case is scheduled for Friday. Munoz's lawsuit asks a judge to order the hospital to pull life support and return Marlise Munoz's body to her family.

Several experts have said the Texas Advance Directives Act doesn't apply in this case because Marlise Munoz, having suffered brain death, is legally and medically dead — a key argument in Erick Munoz's lawsuit.

Munoz previously told the AP he wasn't confident about the health of the fetus. His wife was 14 weeks pregnant when he found her unconscious in November, possibly from a blood clot.

I think in this case it's pretty clear the plug needs to be pulled; I find it odd the hospital is the sole holdout.

The hospital is afraid of breaking Sharia err Texas law.

[Simon_Jester]

But what if the older recipient is 45 and the mother of two, while the younger one is 25 and single? What if the older recipient is 40? 35? 30? What if the 45-year-old needs a transplant because of a viral disease that fried their liver, while the 25-year-old needs a liver transplant because of teenage drug abuse?

At some point, you have to have some kind of granularity in the system, to say "we cannot meaningfully judge whether A or B is more deserving, so any decision about whether A or B gets the organ is made on a first-come, first-served basis."

Drug abuse tends to get someone kicked off the transplant criteria...... I mean, Mr Friendly Guy posted that article about the Australian lady seeking a transplant in Singapore for a reason.

Exactly. My basic point

A first come first served basis does raise other ethical issues though. Patients who have lived longer on the waiting list for kidneys may be worse off than patients whose bodies haven't been wrecked by dialysis yet for example. Ignoring quality adjusted life years entirely is in itself problematic.......

I quite agree, it's very complex- my point is simply that there is a limit. The... resolution of the system is limited, we cannot say "transplanting to person A will give us 100 utilons, transplanting to person B will give us 105 utilons, transplant to B" without raising a lot of ethical issues about how we know those numbers so accurately, and how we know we know.

Similar arguments apply to risky transplants, and even not-so-risky transplants. At some point, for tough enough cases, we need a rule to fall back on that does NOT lead to us committing a moral wrong if we make an error in our arithmetic, because in real life we can only calculate so precisely.

[Borgholio]

Judge orders hospital to remove woman from life support.

http://www.cnn.com/2014/01/24/health/pr ... man-texas/

(CNN) -- A Texas judge ordered a hospital on Friday to remove a pregnant and brain-dead woman from respirators and ventilators by 5 p.m. Monday.

The hospital can appeal the decision.

On Friday, John Peter Smith Hospital acknowledged for the first time that Marlise Munoz, who is being kept on a respirator under Texas law, has been brain dead since November 28 and that the "fetus gestating inside Mrs. Munoz is not viable," according to court documents released before a Friday hearing.

The woman's husband has repeatedly made these claims in his efforts to have her removed from the machines so the family can bury her.

Erick Munoz contends doctors told him his wife "had lost all activity in her brain stem" and an accompanying chart stated that she was "brain dead." He has further called her "nothing more than an empty shell" who should be left to rest in peace.

The overarching, complicated issue of whether the pregnant woman should be kept on a ventilator, as prescribed by Texas law, has been the subject of debate.
Emergency court hearing scheduled today

The wrenching story started with a pregnant woman found unconscious on her kitchen floor. In the more than eight weeks since then, lying supine in a hospital bed, the 33-year-old became the focus of an intense, emotional debate about who is alive, who is dead, and how the presence of a fetus possibly changes the equation.

Hospital spokesman J.R. Labbe said last month that doctors are simply trying to obey a Texas law that says "you cannot withhold or withdraw life-sustaining treatment for a pregnant patient."
Attys: Brain-dead mom's fetus abnormal
Ethics and law regarding brain-dead mother
Family wants pregnant woman off ventilator

But to Munoz's husband, Erick, she is not a patient because she is not alive. He and other family members say the hospital should abide by her wishes -- which weren't written down but, they say, relayed verbally to them -- and not have machines keep her organs and blood running.

Mom of pregnant woman on life support: Change the law

In an affidavit filed Thursday in court, Erick Munoz said little to him now is recognizable about Marlise. Her bones crack when her stiff limbs move. Her usual scent has been replaced by the "smell of death." And her once lively eyes have become "soulless."

"Over these past two months, nothing about my wife indicates she is alive," Erick Munoz said. "... What sits in front of me is a deteriorating body."

Husband: 'Obscene mutilation of a deceased body'

It should have been a happy time for Marlise and Erick Munoz, two trained paramedics awaiting the arrival of their second child.

Then everything came crashing down around 2 a.m. on November 26, when she was rushed to the north-central Texas hospital.

Once there, Erick Munoz said, he was told his wife "was for all purposes brain dead." The family also says the fetus may have been deprived of oxygen.

Lawyers: Records back claim that woman is brain dead

In his lawsuit, Munoz claims subsequent measures taken at the hospital -- and, in turn, the state law used to justify them -- amount "to nothing more than the cruel and obscene mutilation of a deceased body against the expressed will of the deceased and her family."

The family's attorneys more recently said that Marlise's fetus "is distinctly abnormal," suffering from hydrocephalus and "deformed to the extent that the gender cannot be determined."

"Quite sadly, this information is not surprising due to the fact that the fetus, after being deprived of oxygen for an indeterminate length of time, is gestating within a dead and deteriorating body, as a horrified family looks on in absolute anguish, distress and sadness," attorneys Jessica Janicek and Heather King said in a statement.

The hospital and the Tarrant County District Attorney's Office, which said it will defend the medical facility, have not offered the same level of detail as members of the Munoz family.

But earlier this month, Labbe did tell CNN that his hospital believed "the courts are the appropriate venue to provide clarity, direction and resolution in this matter."

Strong opinions on both sides of debate

The strong feelings about the next chapter for Marlise Munoz and her unborn child were on display Thursday outside the Fort Worth hospital.

Some held signs reading "God stands for life" and "Praying for Baby Munoz and family," believing that doing whatever is necessary for the unborn child's sake was imperative.

The opposite view was represented by those toting placards with messages like "Let Marlise rest in peace" and "Respect Marlise's wishes."

When life support is really 'death support'

"Her family doesn't want life support for her, and we don't feel its right for the state or the hospital to force this on her," a woman on that side of the debate, Autumn Brackeen, told CNN affiliate WFAA.

Another person who doesn't believe the "life-sustaining measures" are warranted is Tom Mayo, a Southern Methodist University law professor who helped write the law being cited by the hospital.

"She's not a patient anymore," Mayo said, adding that the hospital was misinterpreting the statute. "So I don't see how we can use a provision of the law that talks about treating or not treating a patient in a case where we really don't have a patient."

For all the passions on both sides of the debate, others saw plenty of gray area -- the kind of thing that might not be resolved until the baby is born and, perhaps, develops outside the womb.

"A lot depends, first of all, on how long the patient here was deprived of oxygen, or otherwise compromised," said Dr. Jeffrey Ecker of Massachusetts General Hospital, who works on complicated pregnancies and prenatal diagnosis

"We can certainly use tools like ultrasound and MRI to sometimes see where there has been injury as a result of low blood pressure or low oxygen. But just seeing that things look well isn't the same as saying that things will be well," Ecker said.

[Flagg]

About fucking time. Hope the state has to reimburse her insurance for the cost of keeping her breathing.

[Simon_Jester]

I think we need a fundamental change in our medical vocabulary, because cases like this show that there is something wrong with the term "life support." Because as Dr. Mayo notes, there really is no living patient here to support.

For example, I don't think many fundamentalists would be happy with the idea of keeping the brain-dead in a ventilator if we instead described it as a "Frankenstein machine for making a corpse breathe." But in a case like this, that's pretty much what it's being used as.

[I don't support actually calling ventilators something like that, because it's a spectacularly loaded word to use under normal conditions. But I hope that gets the idea across.]

[Flagg]

I don't get the preoccupation these people have with a beating heart, either. All the "follow your heart" bullshit is a fucking turn of phrase considering that everything that makes you "you" is your brain. And we've known this for a very long time. Describing the woman as a corpse is accurate if harsh.

[PainRack]

I think we need a fundamental change in our medical vocabulary, because cases like this show that there is something wrong with the term "life support." Because as Dr. Mayo notes, there really is no living patient here to support.

For example, I don't think many fundamentalists would be happy with the idea of keeping the brain-dead in a ventilator if we instead described it as a "Frankenstein machine for making a corpse breathe." But in a case like this, that's pretty much what it's being used as.

[I don't support actually calling ventilators something like that, because it's a spectacularly loaded word to use under normal conditions. But I hope that gets the idea across.]

So.... what happens when the equipment is used for patients who need it to stay alive until they mend?

Or for withdrawal of life support, what do you call it when the person is still alive, just not expected to get better and will steadily deteriorate?

[Broomstick]

It is now over for the Munoz family, the machines attached to Marlise's body have been disconnected and her family can now make final arrangements for her mortal remains.

My theory is the hospital backed down on this because they weren't going to get a photogenic, healthy baby to parade before the media and use to boost the "fetal rights" cause.

The husband describing his wife's body was getting positively creepy - almost like rigor mortis was starting to set in.

I'm glad this is over for her family. They've had enough heart-wrenching tragedy.

[PainRack]

Or you know.......... they were actually sincerely afraid of the PR backlash that would happen if they terminated treatment for a pregnant woman.

[Kitsune]

I agree. . . I think it was the hospital just covering their butt (Which I can understand)
If you note, they went through the County Attorney which means they almost certainly asked their opinion.

[Simon_Jester]

I don't get the preoccupation these people have with a beating heart, either. All the "follow your heart" bullshit is a fucking turn of phrase considering that everything that makes you "you" is your brain. And we've known this for a very long time. Describing the woman as a corpse is accurate if harsh.

Everything they think is important to know, they learned in Bible study. The Bible was written by ancient authors who knew very little about anatomy. Like a lot of the ancients, they used 'heartbeat' as an epithet for that 'vital essence' which was to them indefinable. Heck, we still do talk about the heart's activity as being essential to life.

This is the same mindset behind young-Earth creationism, only applied to medicine instead of paleontology. The exact wording of the Bible is important, everything in the Bible reflects divine truth rather than the limited knowledge and understanding of its writers. Therefore, if modern science tries to tell us that human life has more to do with brain activity than heartbeat, and the Bible doesn't use the word 'brain...' obviously the Bible knows what it's talking about and the scientists don't.

So.... what happens when the equipment is used for patients who need it to stay alive until they mend?

Or for withdrawal of life support, what do you call it when the person is still alive, just not expected to get better and will steadily deteriorate?

Which is exactly why I do not recommend using such a loaded word.

My point is simply that it is profoundly misleading to say that this brain-dead woman is "on life support," when it is far more accurate to say that we are using machinery to sustain the metabolism of a dead body.

The fact that the same machines are routinely used to sustain life in patients who are still alive explains why we normally call it "life support," and that's sensible. But when we apply it to what is, for all purposes, a corpse... well, I think it would help educate the ignorant if we were honest and called this a case of "a fetus gestating (and becoming horribly deformed) inside a dead body, which we keep in a semblance of life with machinery." That might put it in perspective for the fundies.

It is now over for the Munoz family, the machines attached to Marlise's body have been disconnected and her family can now make final arrangements for her mortal remains.

My theory is the hospital backed down on this because they weren't going to get a photogenic, healthy baby to parade before the media and use to boost the "fetal rights" cause.

I'm a little unsure whether the hospital wanted to keep Marlise Munoz on the machines, or whether they were just trying to comply with state law and not imply that they might desire to do otherwise. They have to work and cooperate with state inspectors and authorities, some of whom are probably raging fundies, so I can't blame them for staying scrupulously within the confines of the law, if that's what they were doing.

[Broomstick]

Why do you assume the fundies and the hospital operators are separate groups?

I'm sure this was very hard on non-fundie staff who had to take care of the corpse.

[Simon_Jester]

What I mean is, I see no evidence that the responsible decision-maker(s) at the hospital WERE fundie enough to adopt this decision and approve of it, rather than being 'stuck' with it by idiotic laws in Texas. I'm not saying such evidence doesn't exist, only that I don't see it.

[Broomstick]

So all the legal experts, including some that had had a part in drafting the law, saying the law didn't apply in this case had no weight? There was something preventing the hospital from going to a judge and securing a ruling on whether or not the law applied?

Nope, I'm on the other side - I believe this was driven by some one or several at the hospital trying to promote a pro-fetus agenda.

[edaw1982]

I suspect the family would probably want the baby carried to term in this case, because 'They have a piece of her left' or somesuch to that effect. Sure you don't get your daughter back but you get a baby that will carry 'part of' their mother with them so for intents and purposes the mother lives on in some part; which is really what the whole drive to procreate is all about.

True if the mother has 'don't plug me up like a battery' that policy was probably put in place before they got pregnant, and how often do people think to update these things before bad shit happens?

[Oskuro]

If I may go on a bit of a tangent, a case like this I feel is a different can of worms to the usual debate about abortion.

To me, the main issue with abortion is the conflict between the desires/liberties of the mother when facing a pregnancy, and in this case there no longer is a mother in the equation.

To me, this is more like a case of finding an abandoned baby, with the detail of said baby still being attached to what used to be its mother, and as such, the desires/rights of the mother out of the equation, it would be reasonable to help carry the fetus to term, as there is no longer any of the usual conflict with abortions.

Of course this implies that the next of kin (or father) would have no say in the matter, which is something I'd need to ponder about.

Another thing in my mind, is that there's also a lot of baggage regarding the meaning of death. In our culture there's this expectation that mortal remains are still somewhat "sacred", and that the wishes of the dead have this great importance. I do not subscribe to that, but many people do, so even if the mother is technically dead, my guess is there will still be a conflict of interest similar to the one posed in the abortion debate. Same could apply to the "do not keep on life support" clauses, in my opinion, once the person is brain dead, their wishes should never be above the needs of actual living beings, but to most people actual "death" is more of an internal thing (their accepting the other person being dead) rather than a biological state.

I don't know, it's still a can of worms, but a different can of worms, and I'd hate a case like this to be used to make an argument on the abortion debate.


As for the hospital in the news story... I'm of the opinion that it's usually better to assume incompetence rather than malice, and I'd suspect this was another case of a hard to manage organization facing a situation it wasn't prepared to handle.