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

[alliemay]

I am guessing the court gave them till Monday to do this just in case the hospital wanted to appeal, (standard procedure?) Otherwise they would have ordered them to do this over the weekend.

 

[Amster]

The hospital agreeing that the baby is not viable.....unable to live outside the womb....is not agreeing with the lawyers for dad that this baby is "distinctly deformed". Not viable has nothing to do with the list of maladys that the lawyers for the dad claim. I bet we never are told the condition of this baby after he/she is killed. God Bless his/her little soul.

 

[K_Z]

I am guessing the court gave them till Monday to do this just in case the hospital wanted to appeal, (standard procedure?) Otherwise they would have ordered them to do this over the weekend.

Yes. Several of the articles say that the judge said that at the time he gave his decision. I also understand the judgement to mean that the hospital does not "have to" wait until Monday at 5 pm.

As with. Jahi Mc Math's removal from the hospital, it might be best for the hospital to consider the disruption of potential protestors, in their timing. The Munoz family (and the hospital staff) needs and deserves privacy now, not a circus of protestors demonstrating on hospital property.

 

[K_Z]

The hospital agreeing that the baby is not viable.....unable to live outside the womb....is not agreeing with the lawyers for dad that this baby is "distinctly deformed". Not viable has nothing to do with the list of maladys that the lawyers for the dad claim. I bet we never are told the condition of this baby after he/she is killed. God Bless his/her little soul.

I see this much more clearly as a compassionate, hospice type situation, rather than a "killing".

They are allowing the fetus to die, not killing it, IMO. It is "terminally ill" for lack of a better example. They are simply not prolonging the inevitable. I believe this is a compassionate and ethical thing to do.

 

[popsicle]

10. At the time of this hearing, the fetus gestating inside Mrs. Munoz is not
viable.

http://thaddeuspope.com/images/MUNOZ_-_Stipulation_Facts.pdf

All court docs here: http://thaddeuspope.com/braindeathcases.html

 

[faw720]

http://www.star-telegram.com/

Is this the article you were trying to post, not sure.

Yes, thank you!

 

[faw720]

Yes. Several of the articles say that the judge said that at the time he gave his decision. I also understand the judgement to mean that the hospital does not "have to" wait until Monday at 5 pm.

As with. Jahi Mc Math's removal from the hospital, it might be best for the hospital to consider the disruption of potential protestors, in their timing. The Munoz family (and the hospital staff) needs and deserves privacy now, not a circus of protestors demonstrating on hospital property.

I hope I'm wrong but I'm expecting a large protest tomorrow from the extreme pro right to life group. IMO, there is a huge difference in being pro life & extreme pro life.

 

[popsicle]

Legal and Ethical Responsibilities Following Brain Death
The McMath and Muñoz Cases

JAMA. Published online January 24, 2014. doi:10.1001/jama.2014.660

http://jama.jamanetwork.com/article...MA:OnlineFirst01/24/2014#.UuK9wJEwSx9.twitter

 

[KateB]

I hope I'm wrong but I'm expecting a large protest tomorrow from the extreme pro right to life group. IMO, there is a huge difference in being pro life & extreme pro life.

They're in Austin today at this event:

http://www.keyetv.com/news/features...ial-candidates-speak-austin-today-15727.shtml

AUSTIN, Texas (AP) -- Republican gubernatorial candidate Greg Abbott is scheduled to address an anti-abortion rally on the steps on the Texas Capitol.

He was invited by Texas Alliance for Life, which organized Saturday's rally.

 

[Donjeta]

10. At the time of this hearing, the fetus gestating inside Mrs. Munoz is not
viable.

http://thaddeuspope.com/images/MUNOZ_-_Stipulation_Facts.pdf

All court docs here: http://thaddeuspope.com/braindeathcases.html

If that is what the hospital admitted it was a little misleading when [whoever it was] said that the hospital had admitted for the first time that the fetus was not viable. I think it pretty much went without saying that a fetus that age is not viable. Actually it was the whole point of the gestation experiment as they could just have performed a C-section and taken the fetus out had it been viable.

 

[BeginnersLuck]

I see nothing wrong with the way the laws read now. In Jahi's case for instance, it is very rare that a family would chose to continue ventilator support and other extraordinary means, for a deceased person. In the cases that I have seen, families have obtained court orders to do so.

There may be cases that we are unaware of, in which hospitals have allowed families extra time and the brain dead patients have failed from cardiac criteria. I think the cases in which conflicts have presented, are when families have compelled hospitals to provide extraordinary care to brain dead individuals. Without extraordinary care, from what I have read, a brain dead persons heart will cease to function within a few days.

We cannot compel physicians and other health care providers, to perform medically unnecessary procedures. We cannot force health care providers to go against their ethics and provide care to a deceased person.

The law should stand as it is. If a few minority want these extraordinary measures, then they will have to obtain court orders to do so and find physicians and other healthcare providers and facilities willing to cater to these individuals requests.

Even though NJ has the religious exclusion, I think it is important to point out it doesn't mean that extraordinary, medically unnecessary care is provided. Thus cardiac failure will come quickly after brain death. The requests made upon healthcare providers by the family and attorney in Jahi's case, crossed way over the line of ethics. It is their personal choice/belief and unreasonable to force those choices/beliefs on others.

In a case of a pregnant brain dead female, if the fetus is viable outside of the womb, when brain death occurs, there can be an attempt to save the fetus. The longer the BD patient is kept on support, the greater the risks are to the fetus. I think some that hear the word fetus, don't consider the many factors or they think that all measures should be taken regardless of what the outcome may be. That would compel hospitals to maintain support for pregnant women, regardless of the gestational age being one week or 14 weeks as in Mrs. Munoz's situation.

This type of treatment is scientific in nature. The outcomes for fetus's of brain dead mothers at a young gestational age are very poor and there are very few examples to compare to. Fetus's should be delivered ASAP, after brain death has occurred. Figure two in this document illustrates the recommendations for management, care and delivery. The remainder of the document is a good read for better understanding. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002294/

The law was clear to me that Mrs. Munoz was deceased and therefore no longer a patient. As the polls have suggested, it is only a small minority that believe Mrs. Munoz should be kept on support, regardless of the fetal outcome. These again, are choices and beliefs that cannot be forced on the rest of society. They should never have been forced on this family and logical, educated criteria, should be taken into consideration when making these decisions.

 

[Wolfie]

The hospital agreeing that the baby is not viable.....unable to live outside the womb....is not agreeing with the lawyers for dad that this baby is "distinctly deformed". Not viable has nothing to do with the list of maladys that the lawyers for the dad claim. I bet we never are told the condition of this baby after he/she is killed. God Bless his/her little soul.

This pregnancy was not viable from the time the mother died. Without the hormones that regulate things, very few babies born from dead mothers on life support make it, and those that do are usually born within a week or two of the death.

 

[BeginnersLuck]

There was no need for the Judge to address the conditions of the fetus, because there was only one law that applied in this case.

If there were other laws that were applicable, then the judge may have addressed the condition of the fetus.

Considering there is a very minute chance that the fetus had developed normally and was viable outside of the womb weeks from now, I will take the word of the father and his attorneys, that there is evidence in the medical records as to the grave condition of the fetus.

 

[jjenny]

This pregnancy was not viable from the time the mother died. Without the hormones that regulate things, very few babies born from dead mothers on life support make it, and those that do are usually born within a week or two of the death.

That isn't accurate. There are a number of brain-dead women that produced normally developing infants after being on life support for several months. And technology to keep them on life support likely is getting better and better. From what some experts have speculated, it is possible Munoz fetus was abnormal even prior to mother's collapse due to some genetic defect. Some of these women even donated organs after being on life support for months.
For organs to be usable, they must have been in good shape still.

 

[gitana1]

JMO,I think the reason that the hospital "dug in their heels" was that initially one or more of the attending doctors were pro life in the extreme because of either religious or political beliefs. I believe there were also other doctors who thought the situation was hopeless. At that point the case was "bumped upstairs" to the administrator who immediately consulted with a hospital attorney. The hospital attorney interpreted the law incorrectly according to Judge Wallace's ruling. Then there is also the factor that the administrator & attorney possibly allowed their own personal beliefs to determine their course of action.

BTW, I have been listening intently to the local news this morning. I have not heard one word about the District Attorney's office responding to the ruling. Yesterday, they said they would be issuing a statement "later in the day". Apparently, that did NOT happen. Hopefully, the lack of a statement indicates they do not plan to appeal. This case is a political hot potato & they may just be hoping people forget about it when election day gets here.

I think you're right.

She had stopped breathing, but was alive when she arrived at the hospital, according to court documents.

http://www.nytimes.com/2014/01/25/u...life-support-from-pregnant-woman.html?hp&_r=0

She was admitted 11/26 and declared brain dead 11/28. I think it was the lack of oxygen which eventually killed her brain.

I agree that it was probably just a couple docs and 1-2 administrators who set this situation in motion, and kept it going this long.

I think it would be very important to do an multidisciplinary incident evaluation to determine chain of decision making, and implement policies for future situations. If the hospital were completely ethical, they would engage in professional transparency, and release a sanitized version (no names) in one or more professional journals. IMO. There is much to be learned about developing policies and procedures to protect hospitals from liability for rogue docs and administrators. I would think that by doing that, they could potentially mitigate their liability, and begin to show some professional integrity, along with rehabilitating their image.

But I doubt that they will. They have already been told in a legal and very public way that they engaged in horrible decision making. And that's not just the docs, but the administrators who supported the situation for 2 months. This situation will plague this hospital's reputation for years, IMO. And there will be liability insurance headaches for the hospital, as well as inevitable litigation. IMO.

Just no one is a winner here. Devastating all around.

I sincerely hope they comply with the court order and don't fight this with injunctions, etc. That would be a colossal mistake, IMO.

Agreed.

I see nothing wrong with the way the laws read now. In Jahi's case for instance, it is very rare that a family would chose to continue ventilator support and other extraordinary means, for a deceased person. In the cases that I have seen, families have obtained court orders to do so.

There may be cases that we are unaware of, in which hospitals have allowed families extra time and the brain dead patients have failed from cardiac criteria. I think the cases in which conflicts have presented, are when families have compelled hospitals to provide extraordinary care to brain dead individuals. Without extraordinary care, from what I have read, a brain dead persons heart will cease to function within a few days.

We cannot compel physicians and other health care providers, to perform medically unnecessary procedures. We cannot force health care providers to go against their ethics and provide care to a deceased person.

The law should stand as it is. If a few minority want these extraordinary measures, then they will have to obtain court orders to do so and find physicians and other healthcare providers and facilities willing to cater to these individuals requests.

Even though NJ has the religious exclusion, I think it is important to point out it doesn't mean that extraordinary, medically unnecessary care is provided. Thus cardiac failure will come quickly after brain death. The requests made upon healthcare providers by the family and attorney in Jahi's case, crossed way over the line of ethics. It is their personal choice/belief and unreasonable to force those choices/beliefs on others.

In a case of a pregnant brain dead female, if the fetus is viable outside of the womb, when brain death occurs, there can be an attempt to save the fetus. The longer the BD patient is kept on support, the greater the risks are to the fetus. I think some that hear the word fetus, don't consider the many factors or they think that all measures should be taken regardless of what the outcome may be. That would compel hospitals to maintain support for pregnant women, regardless of the gestational age being one week or 14 weeks as in Mrs. Munoz's situation.

This type of treatment is scientific in nature. The outcomes for fetus's of brain dead mothers at a young gestational age are very poor and there are very few examples to compare to. Fetus's should be delivered ASAP, after brain death has occurred. Figure two in this document illustrates the recommendations for management, care and delivery. The remainder of the document is a good read for better understanding. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002294/

The law was clear to me that Mrs. Munoz was deceased and therefore no longer a patient. As the polls have suggested, it is only a small minority that believe Mrs. Munoz should be kept on support, regardless of the fetal outcome. These again, are choices and beliefs that cannot be forced on the rest of society. They should never have been forced on this family and logical, educated criteria, should be taken into consideration when making these decisions.

Brilliant post. However, I can't say its regardless of fetal outcome. If the fetus was viable and without catastrophic injuries, I would feel quite differently about not letting the baby come to term. But I think the famiky probably would too.

There was no need for the Judge to address the conditions of the fetus, because there was only one law that applied in this case.

If there were other laws that were applicable, then the judge may have addressed the condition of the fetus.

Considering there is a very minute chance that the fetus had developed normally and was viable outside of the womb weeks from now, I will take the word of the father and his attorneys, that there is evidence in the medical records as to the grave condition of the fetus.

That's right. Nothing the family's attorneys have said have been proven false. They stated the mother was brain dead. People challenged that. The hospital at the final moment admited that. They stated the fetus was not viable. People challeneged that (although that was based on gestational age and is thus a no-brainer). They say fetus isso deformed that gender cannot be established. I see no reason to doubt their word.

That isn't accurate. There are a number of brain-dead women that produced normally developing infants after being on life support for several months. And technology to keep them on life support likely is getting better and better. From what some experts have speculated, it is possible Munoz fetus was abnormal even prior to mother's collapse due to some genetic defect. Some of these women even donated organs after being on life support for months.
For organs to be usable, they must have been in good shape still.

I don't count 3 as "a number". I mean, it is a number. That number is 3, LOL! But that doesn't count as much. That number came from your research, your post answering my questions as to whether it is possible to bring a baby to term after being in the brain dead body of a mother whose been on life support since the early weeks of pregnancy. Your research showed three such cases and in the same article, a quote from a medical ethicist saying that the number was so low that in such cases it always has to be asked if it is possible, when looking at the ethics of the situation.
Ms. Munoz smells like death. She is decyaing. They have been able to keep her body going for awhile but it doesn't appear to be the optimal host for fetal development.

On another topic, I have seen posts hoping there will be no protests from right to lifers. I hope the family is protecfted from more grief. However, there are people who feel strongly that disconnectinbg life support here is murder to the unborn child. This is America.They have a right to their beliefs and to civilly protest. Thus far, I have seen no evidence, despite asking, that any such protestors have acted cruelly, rudely, or in a threatening manner to this family. They truly belive a little baby is being murdered. Imagine how horrified and saddened they feel right now. I think our world would be a better place if everyone tried to put themselves in the shoes of the other and tried to imagine how they feel and why and not simply brush them off as stupid and wrong.

 

[Wolfie]

That isn't accurate. There are a number of brain-dead women that produced normally developing infants after being on life support for several months. And technology to keep them on life support likely is getting better and better. From what some experts have speculated, it is possible Munoz fetus was abnormal even prior to mother's collapse due to some genetic defect. Some of these women even donated organs after being on life support for months.
For organs to be usable, they must have been in good shape still.

All that I can find in research is that 12 of 30 babies born to brain dead mothers on life support survived. No signs of how "normally developing" they were or any long term complications. That's less than a 50% chance of even making it.

 

[Donjeta]

All that I can find in research is that 12 of 30 babies born to brain dead mothers on life support survived. No signs of how "normally developing" they were or any long term complications. That's less than a 50% chance of even making it.

http://www.biomedcentral.com/content/pdf/1741-7015-8-74.pdf

There is a table of outcomes here and some infants are said to have been normal at age X months, so apparently there is a chance of a good outcome, sometimes.

The reasons for the mother's brain death are mostly direct brain insults and accidents, only one case of a cardiac arrest here so it tells us very little about the outcome in women in whom the brain death was caused by prolonged systemic anoxia that may have damaged other organs and affected the fetus too.

 

[jjenny]

http://www.biomedcentral.com/content/pdf/1741-7015-8-74.pdf

There is a table of outcomes here and some infants are said to have been normal at age X months, so apparently there is a chance of a good outcome, sometimes.

The reasons for the mother's brain death are mostly direct brain insults and accidents, only one case of a cardiac arrest here so it tells us very little about the outcome in women in whom the brain death was caused by prolonged systemic anoxia that may have damaged other organs and affected the fetus too.

And as we study these cases, outcomes are likely to get better. That's how we learn on how to improve treatments.
So I certainly don't agree with Mr. Munoz's laywer said something to the effect that many pregnant women die, and their fetuses die with them. And this is how it should be.
What if we said, well, many people with heart failure die. This is how it should be.
For some reason we try to treat heart disease and don't just accept this is what nature wants. A lot of people would be dead if we just accepted that's what nature wants.

 

[faw720]

Most recent update 1/25, 2:40pm CST


http://www.star-telegram.com/2014/01/25/5512786/hospital-told-to-take-pregnant.html

The Star Telegram is reporting that hospital executives were conferring Saturday (today) with DA to determine their next step.

JMO, that doesn't sound good.

BTW, this link DOES work. After my morning problems with links people probably won't think I'm trustworthy.

 

[scmom]

Looking at Table 1 at the link it seems that none of the fetuses under 15 weeks gestational age at the time of maternal BD survived. Even with the study being so small it seems that the younger the gestational age at the time of maternal BD the less chance of survival for the fetus.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002294/