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

K_Z said:

BBM for focus.

Why in the world would you think that this discussion is at all about racism??

Unless I missed something, both of these cases involve minorities, and both cases involve U.S. citizens. Who cares what color they are??

No one has thrown down the race card. I don't think we need to go there. The laws in THIS case don't discriminate on race-- only on GENDER, (and then, only PREGNANT and female), then which is enough of a problem right there. The situations are complicated enough without bringing race into the conversation. IMO.

I'll say it again. The "pro life" political agenda driving these horrendous laws and policies, IMO, is akin to many parts of the world where women experience tremendous human rights violations, such as under the Taliban. I have spent an extended amount of time in the middle east, and the overwhelming and pervasive need of the cultural and religious leaders in that region to "control" and oppress women comes back to me every single time I contemplate what is going on here with the political pro life agenda. It's gender oppression, cloaked in "religious right" politics. IMO. And it's sickening, and frightening, IMO.

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The law doesn't discriminate based on gender, biology does. Since only woman can be pregnant, obviously, only woman are at issue. If anything, it's men who are discriminated against. This baby is an undivided half the father's. Yet he has zero say over what becomes of it, whether or not Marlise is dead, and has full responsibility regardless of his wishes, also regardless of whether Marlies is dead. Imo, if anyone is discriminated against, it's the father. jmo

K_Z said:

And regarding the fetal cardiac defects that have been reported:



BBM

http://www.ncbi.nlm.nih.gov/pubmed/20712587

http://www.ncbi.nlm.nih.gov/pubmed/12855053

Assuming there has been ongoing difficulties with regulation of MM's body's hemodynamics, it is reasonable to infer that there has been a chronic hypoxic situation for the fetus since at least Nov 26.

Intrauterine hypoxia - Wikipedia, the free encyclopedia

I wanted to add that we have been given information that MM likely suffered a massive pulmonary embolism. My common sense says that they did lots of ventilation/ perfusion studies on her back in Nov 2013.

If she did have a massive PE, then she may still have vast areas of unperfused (dead) lung tissue. You can pump all the oxygen you want into the body, but if areas of lung tissue are not exchanging oxygen and CO2, then the fetus has been a recipient of chronic low oxygen.

http://en.wikipedia.org/wiki/Ventilation/perfusion_ratio

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I'm pretty dense when it comes to these kinds of things. Can you explain in laymen's terms what this means for the baby? Will it be likely to survive to viability? If so, what problems could it have?

She questions the hospital's motives. "If the hospital's true intent was to obtain a judicial determination [about the law], they could have gone into court months ago to seek an opinion. Their failure to do so suggests an intent on their part to delay the process to allow the fetus to reach 24 or 26 weeks to bolster their claim that the fetus has some kinds of rights.

http://www.csmonitor.com/USA/Justic...-pregnant-Texas-woman-takes-complicating-turn

One person comes to mind. Steven Hawking. I wonder what the tests would have shown when he was in utro. Deformed limbs are not that unusual. I have followed the disabled and special Olympics for some time and there are so many athletes that have been born missing part of their limbs. So many with very short leg with little toes on it and short/or no arms with little fingers. These people mostly have the fingers or toes removed or fitted with a prosthesis. Then there are all the ones who were born after mothers took thalidomide those people are living full lives today.

JMO

The tests that are performed to determine brain death do not include a pregnancy test.

There is nothing in the brain death law that states that if a person is pregnant they cannot legally or medically be declared dead.

I will stick with my guns on how I think the law should be interpreted.

Do hospitals do a pregnancy test on all women that are brain dead and if they are a week pregnant, do they continue ventilator support? I don't think so. I never heard of such a thing.


In this particular case, I think the hospital is misapplying the law. Because she is pregnant, THEY have CHOSEN to apply their own criteria and continue ventilator support until the fetus is viable outside of the womb. I see no need to argue any other laws. The hospital was wrong by not discontinuing support when brain death was determined. If the fetus was viable outside of the womb at that time, ethically they could have saved the baby.

Marg from Oz said:

One person comes to mind. Steven Hawking. I wonder what the tests would have shown when he was in utro. Deformed limbs are not that unusual. I have followed the disabled and special Olympics for some time and there are so many athletes that have been born missing part of their limbs. So many with very short leg with little toes on it and short/or no arms with little fingers. These people mostly have the fingers or toes removed or fitted with a prosthesis. Then there are all the ones who were born after mothers took thalidomide those people are living full lives today.

JMO

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I believe that Steven Hawking was diagnosed with ALS when he was a young adult in college and began to display symptoms, so I don't think the two situations are comparable.

I understand your point, but this is not a case of just having a limb deformity. This unborn baby has several issues (brain, heart, etc.) and faces further complications from a likely premature birth. There are a lot more things to consider than the limbs. JMHO.

Marg from Oz said:

One person comes to mind. Steven Hawking. I wonder what the tests would have shown when he was in utro. Deformed limbs are not that unusual. I have followed the disabled and special Olympics for some time and there are so many athletes that have been born missing part of their limbs. So many with very short leg with little toes on it and short/or no arms with little fingers. These people mostly have the fingers or toes removed or fitted with a prosthesis. Then there are all the ones who were born after mothers took thalidomide those people are living full lives today.

JMO

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Steven Hawking was diagnosed with ALS when he was in his twenties. His ultrasound would have been normal and his tests wouldn't show anything abnormal either.
The Munoz fetus apparently has more than just leg abnormalities.
If it actually does have a heart issues it might not be compatible with life depending on how severe it is.

gitana1 said:

I read a quote on a blog from a doctor who stated he could actually breathe on his own. But even if he couldn't, to me there is a difference and the law holds there is. At least it does when determining whether the hospital has a duty to continue life support.

However, it does not see a difference as it applies to medical futility. In that analysis, brain dead or persistent vegetative state doesn't matter. In fact, a person doesn't have to be in a persistent vegetative state even. The law appears to allow hospitals in Texas to choose to pull the plug on people who are terminal, if they are deemed to be "suffering" even against their will, if they give notice to the person and if the person cannot find another facility willing to take them. Scary and the whole thing seems unconstitutional.

How are hospitals allowed to make decisions about life support that are contrary to the wishes of the patient, dead person or in the case of an incapacitated person who did not make their wishes known, contrary to the wishes of his or her family members? It seems quite bizarre to me.

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Brain dead is legally dead.
So there is no point to keep a dead person on life support, is there? There legally is no more life to be supported (unless of course the person is pregnant).

There are reasons why there are not a lot of cases in history to compare to. It tells me that what this hospital has chosen to do is beyond the norm. IMO, someone/s in that hospital made a choice to go against normal protocol and made a decision based on their "beliefs".

This IMO is experimental. They should be reprimanded for what has been done.

(My opinions are based on brain death criteria)

Marg from Oz said:

One person comes to mind. Steven Hawking. I wonder what the tests would have shown when he was in utro.

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Snipped for relevance.

Stephen Hawking was born a normal baby. He developed ALS (amyotrphic lateral sclerosis) at the age of 21. So tests in utero (had they been available back then) would most likely have shown a normal fetus.

Stephen Hawking - Wikipedia, the free encyclopedia

The condition of the Munoz fetus can't be reduced to "just" the treatments needed for each of the (very severe) conditions that have been released to the public. It isn't about "just" putting in a shunt for hydrocephalus, or "just" doing heart surgery, or "just" some orthopedic issues. This is a gravely deformed and profoundly abnormal fetus, from reports. We only know the little bit that has been told to the media thus far, which is very sad, and deeply disturbing, because it is essentially certain that the "treatment" forced upon MM's body was indeed unethical fetal experimentation. The "treatment" produced this abnormal fetus-- that is why it is so disturbing, and angers so many people. The doctors involved know a lot more about the condition of this fetus, and IMO, none of it is hopeful.

Not a single doctor or medical ethicist anywhere in the world was willing to stick their neck out and say that all this fetal experimentation on the Munoz fetus at 14 weeks this was just fine, reasonable, ethical, and full of hope. The potential for a good outcome was just about zero. And because of that, hoardes of misguided and naïve people opined endlessly about how cruel Mr. Munoz is, how he should have his healthy son taken away from him, threatened him with harm, called him a murderer. People imagined this child being born normal, and skipping off to kindergarten in a few years, when the real potential for that was essentially zero.

IMO, people holding out irrational hope for this fetus to have any semblance of being born normal and "just" facing what "regular" micro preemies face, is as misguided, naïve, and uninformed as the Jahi McMath family and supporters who claim that they expect her body to be resurrected.

The Texas "pro life" extremist political movement now has to deal with the fall out and the scrutiny of what they have done. The criticism is not going to be mild, or bland. It will be harsh, brutal, and incendiary. And that is a good thing, IMO.

Hopefully, the harsh and unrelenting criticism of these horribly designed laws will be the positive and enduring legacy of Marlise Munoz and her fetus. I hope the situation makes it to the SCOTUS.

This just in!!!!!!!!!


According to one of the attorneys who drafted the Texas law, they never anticipated anything like the Munoz case & never discussed the law being applied to a brain dead person.

http://www.star-telegram.com/2014/01/23/5509944/texas-law-didnt-anticipate-dead.html

faw720 said:

This just in!!!!!!!!!


According to one of the attorneys who drafted the Texas law, they never anticipated anything like the Munoz case & never discussed the law being applied to a brain dead person.

http://www.star-telegram.com/2014/01/23/5509944/texas-law-didnt-anticipate-dead.html

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They can say whatever they want. I think the intent of the law was obviously to protect the fetus regardless of what condition the mother was in.
There is really very little difference between someone, lets say in a coma, and someone who is brain dead.
Neither person can do anything but lie there. I am not sure why some residual brain activity should make all the difference.

faw720 said:

This just in!!!!!!!!!


According to one of the attorneys who drafted the Texas law, they never anticipated anything like the Munoz case & never discussed the law being applied to a brain dead person.

http://www.star-telegram.com/2014/01/23/5509944/texas-law-didnt-anticipate-dead.html

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Well, I'm sorry but they should have. What exactly did they anticipate if not women in a very bad shape being kept on life support for the fetus? Life support is very seldom needed for someone who is in top form.

"We did not think about it" is no excuse imo. If you're drafting laws that affect people's lives and deaths it's your duty to think about what's going to happen, what kind of cases could come along, how the law is going to be interpreted and how it could be misinterpreted.

Just read that on Thursday, Erick Munoz filed an affidavit supporting amended motion regarding his wife.

http://www.wfaa.com/news/local/tarr...e-of-brain-dead-pregnant-woman-241750531.html

JMO......From everything I've read, the district attorney, who represents the hospital, is going to fight like a tiger to keep life support going. Tragically, I don't think this issue is going to resolved today. It is going to drag on forever. Welcome to Texas, the land of Frankenstein.:tantrum:

Lest someone misinterpret my last sentence, the land of Frankenstein I am referring to is any place that would demand that a dead woman's body to be used as an incubator.

Donjeta said:

Well, I'm sorry but they should have. What exactly did they anticipate if not women in a very bad shape being kept on life support for the fetus? Life support is very seldom needed for someone who is in top form.

"We did not think about it" is no excuse imo. If you're drafting laws that affect people's lives and deaths it's your duty to think about what's going to happen, what kind of cases could come along, how the law is going to be interpreted and how it could be misinterpreted.

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I couldn't agree more!!

http://www.utmb.edu/policies_and_pr.../IHOP - 09.15.09 - Determination of Death.pdf

Documentation: The medical record must reflect the actual time death is pronounced. Time of death is the time the arterial PCO2 reached the target value or when the ancillary test has been officially interpreted.

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According to what has been released so far, the hospital has acknowledged that she is brain dead. The date of death is recorded when brain death is determined.

I'm going to consider that the hospital might argue that she is still considered a patient.

The question I have is once a person is determined to be deceased in a hospital, what are they legally required to do as far as reporting the death. There has to be something that says that within a certain amount of time after declaration of death the body is removed from the facility.

The Law Behind The Texas Life Support Controversy
January 23, 2014 4:00 PM

Controversy has been swirling around a Texas hospital's decision to keep a pregnant woman on life support, saying that state law won't permit removing her. Robert Siegel talks to Tom Mayo, associate professor of law at Southern Methodist University, about the details of the case.

MAYO: Well, I don't think so. The law that they say compels them to continue ICU-level support for Ms. Munoz is the so-called Pregnancy Exclusion Provision in our Advanced Directives Act. And I think the Pregnancy Exclusion Provision doesn't apply because I don't think the act applies to someone who is dead. And this is all assuming now that the husband has it right and that we'll see confirmation of her brain death as a result of the hearing.

SIEGEL: But isn't it the point of that exclusion to protect the fetus, that is it's not in there to protect the pregnant woman, is it, the mother?

MAYO: Well, yes, that's the purpose. But technically, I would say the statute does not compel this. If you're relying on the statute, you're just relying on the wrong thing.

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http://www.npr.org/2014/01/23/26535...texas-life-support-controversy?sc=tw&cc=share

K_Z said:

"Brain-Dead Marlise Munoz’s Fetus Is “Distinctly Abnormal.” Please, Texas, Let This Nightmare End."



http://www.slate.com/blogs/xx_facto...ead_texas_woman_is_said_to_be_distinctly.html

I personally hope this case makes it all the way to the SCOTUS. The whole country needs to be talking about this case, and the overreaching power of the states in private matters. The whole thing is like a warped and twisted U.S. version of the Taliban, IMO. Forcing a brain dead woman to gestate a profoundly damaged, non-viable fetus. SMH. Shameful, unethical, and cruel, IMO.

The politics in Texas really are terrifying to contemplate.

And keep in mind, Texas ranks 42nd in the country in their policies and laws about children. It seems Texas only cares about "children" while the are in the womb. Once born, not so much.

http://forabettertexas.org/images/CPPP13_KC-databook-v27.pdf

http://forabettertexas.org/home.html

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I couldn't agree more! It is completely beyond belief that Texas is so concerned with life in the womb & then cares not one ounce about them once they are born. The laws regarding life in the womb were enacted to appease the extreme religious right. I don't understand how anyone with a religious bone in their body could want a severely malformed baby to be artificially kept alive when the only thing in the baby's future is suffering & pain. It's as if compassion, Christian or otherwise, is totally irrelevant.

IMO, SCOTUS is exactly where this case belongs & hopefully at some point in time it will get there.

There currently a big political push in Texas to require drug testing before a person is eligible to receive welfare. I do NOT advocate supporting a drug addicts habit. However, some, or even many, of these drug addicts have children. Do we really want to deprive these children of food, clothing & shelter just because fate gave them to an undeserving parent? Unfortunately, no child gets to chose his/her parents.

faw720 said:

Just read that on Thursday, Erick Munoz filed an affidavit supporting amended motion regarding his wife.

http://www.wfaa.com/news/local/tarr...e-of-brain-dead-pregnant-woman-241750531.html

JMO......From everything I've read, the district attorney, who represents the hospital, is going to fight like a tiger to keep life support going. Tragically, I don't think this issue is going to resolved today. It is going to drag on forever. Welcome to Texas, the land of Frankenstein.:tantrum:

Lest someone misinterpret my last sentence, the land of Frankenstein I am referring to is any place that would demand that a dead woman's body to be used as an incubator.

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BBM.
Of course the hospital attorney is going to fight like a tiger. I wouldn’t expect any less. The hospital stands to lose millions of dollars in multiple lawsuits, as well as the negative publicity. This case has now become front and center in the discussion as to the “reasonableness” of extremist pro life positions on their onging quest for fetal rights that supercede the rights of “born and living” people. Texas is the cradle of this kind of prolife extremism, IMO.


I agree with posters upthread who opine that this situation likely came about because of the personal agenda of probably just a few extremist physicians and administrators. I feel badly for the staff who have to deal with public perception that this hospital is in the “Frankenstein” business of forcing dead women to gestate and create deformed fetuses.


I actually work at one hospital with 2 OB-GYN’s who are so extremist in their pro life religious views that they refuse to prescribe birth control, and will not do tubal ligations. Needless to say, there are very few places that OB GYN’s with these kind of views would be welcomed into a practice. I haven’t had a chance to ask either of them what they think about this case, but I’ll be interested to see what they say. They are both extremely nice people, but horribly misguided, IMO, and should have chosen different specialties, IMO. Or found a practice big enough to have other docs around to accommodate them and the patients when these 2 are “unwilling” to do something that 99.999% of OB GYN’s will do. The hospital has had numerous ethical complaints. Fortunately, these 2 docs stick to doing GYN and cancer care for the most part, which I’m thankful for, but they do pull call for c-sections. We have had a several instances where patients were pre-approved for tubals during their pregnancies, (which would be done as a post partum tubal after a planned vaginal delivery in the same hospitalization), then ended up having urgent c-sections when these docs were on call. They wouldn’t do the tubals during the c-section (which is standard for pre-approved cases), and wouldn’t call in general surgery to do it. These women were forced to come back to the hospital at another time, incurring the risk and costs of another surgery (a more complicated laparoscopic one, than a very simple post partum tubal), and another anesthetic with risks, time off work, cost, etc. All because of the religious beliefs of the doc who happened to be on call. Massively unethical, IMO.

But until a patient sues the hospital, I doubt anything will change. For the most part, the population of women in child bearing years in this community are very poor, unemployed/ underemployed, and not highly educated, (and many are single moms to several children). IMO, that makes them even more vulnerable and captive to the power abuses of docs with extremist religious views. JMO.

BeginnersLuck said:

http://www.utmb.edu/policies_and_pr.../IHOP - 09.15.09 - Determination of Death.pdf



According to what has been released so far, the hospital has acknowledged that she is brain dead. The date of death is recorded when brain death is determined.

I'm going to consider that the hospital might argue that she is still considered a patient.

The question I have is once a person is determined to be deceased in a hospital, what are they legally required to do as far as reporting the death. There has to be something that says that within a certain amount of time after declaration of death the body is removed from the facility.

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The hospital might have acknowledged it. It doesn't mean she was legally pronounced brain dead. They need to take specific steps to do so.
Lets say only one physician examined her instead of two independent ones. Well, she isn't legally dead then.