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

[hambirg]

I agree with you. The law says they should terminate life support. I don't think it means they must terminate life support.
But end result will obviously be the same.
Without considering wishes of the family and condition of the fetus, hospitals should terminate life support for brain dead pregnant women if fetus is not yet viable.

I agree, but the only way a family is going to be able to get an injunction if the hospital says the law says we must terminate life support is through a court order. By that time, it will likely be too late for the fetus.

 

[faw720]

WFAA News 8 just reported the family needs time to say goodbye. Marlise won't be taken off of life support today.


Sent from my iPhone using Tapatalk

Not sure I understand. I read the article & it says that the family spent today saying their final goodbyes. Does that mean they know the hospital isn't going to appeal the case????? This entire situation is so crazy I don't know what to think.

 

[gitana1]

Which family member gets to decide? They don't always agree.

Under the law that is very clear: Next of kin unless the person had an Advanced Care Directive that is not vague.
That's why Terry Schiavo's husband got to decide despite the parents' wishes.

Well, The Judge went with the definition of deceased and viable, even though that section of then law does not apply to Marlise because she didn't have a written Advance Medical Directive. Someone is going to have to explain that to me further. How that section can apply in this case when it doesn't apply, idk.

For those thinking this was a win as to the choice of parents and loved ones. It's not. The judge specifically stated that there were no constitutional issues here. So now if a pregnant woman in the state of Texas suffers brain death at 23 weeks and 6 days, even if the fetus is perfectly healthy and normal, even if her husband or the father and her family are begging to keep her on life support just a little bit longer so the baby can be born, the answer will be no. The hospital MUST terminate life support at any time before 24 weeks (legal definition of viable.)

Snipped for space.

Neither the law nor the ruling here mandate that the hospital pull the plug on a pregnant brain dead person at all. That's absolutely not true.

Right. My understanding is that the Court looked to the UDDA to define patient based on the language of the AMDA referring to a patient as someone who is receiving life-sustaining treatment (paraphrasing that last bit), i.e., you can't receive life-sustaining treatment (be a patient under the AMDA) if you're dead under the UDD.
jmo

I did not see that anywhere in the code.

Here is the entire code. http://www.statutes.legis.state.tx.us/Docs/HS/htm/HS.166.htm

Please note this section that applies here. . .

SUBCHAPTER D. MEDICAL POWER OF ATTORNEY

Sec. 166.151. DEFINITIONS. In this subchapter:
(1) "Adult" means a person 18 years of age or older or a person under 18 years of age who has had the disabilities of minority removed.
(2) "Agent" means an adult to whom authority to make health care decisions is delegated under a medical power of attorney.
(3) "Health care provider" means an individual or facility licensed, certified, or otherwise authorized to administer health care, for profit or otherwise, in the ordinary course of business or professional practice and includes a physician.
(4) "Principal" means an adult who has executed a medical power of attorney.
(5) "Residential care provider" means an individual or facility licensed, certified,. . .

(1) according to the agent's knowledge of the principal's wishes, including the principal's religious and moral beliefs; or
(2) if the agent does not know the principal's wishes, according to the agent's assessment of the principal's best interests.
(f) Notwithstanding any other provision of this subchapter, an agent may not consent to:
(1) voluntary inpatient mental health services;
(2) convulsive treatment;
(3) psychosurgery;
(4) abortion; or
(5) neglect of the principal through the omission of care primarily intended to provide for the comfort of the principal.

ETA. .sorry. . I meant "principal" and not "primary." No where does it address "patient."

This section just does not apply in this case at all. The only law that was even discussed was two code sections. 166.049 which states you can't pull the plug from a pregnant patient and 671.001 which defines "dead".

This was a straight forward decision and more should not be read into it. 166.049 does not apply because Ms. Munoz is dead. That's it. It does not have anything to do with fetal viability, the patients wishes, the family's wishes or requiring a hosptial to withdraw life support from a brain dead person who is pregnant.

 

[BeginnersLuck]

Here is the entire code. http://www.statutes.legis.state.tx.us/Docs/HS/htm/HS.166.htm

Please note this section that applies here. . .

SUBCHAPTER D. MEDICAL POWER OF ATTORNEY

Sec. 166.151. DEFINITIONS. In this subchapter:
(1) "Adult" means a person 18 years of age or older or a person under 18 years of age who has had the disabilities of minority removed.
(2) "Agent" means an adult to whom authority to make health care decisions is delegated under a medical power of attorney.
(3) "Health care provider" means an individual or facility licensed, certified, or otherwise authorized to administer health care, for profit or otherwise, in the ordinary course of business or professional practice and includes a physician.
(4) "Principal" means an adult who has executed a medical power of attorney.
(5) "Residential care provider" means an individual or facility licensed, certified,. . .

(1) according to the agent's knowledge of the principal's wishes, including the principal's religious and moral beliefs; or
(2) if the agent does not know the principal's wishes, according to the agent's assessment of the principal's best interests.
(f) Notwithstanding any other provision of this subchapter, an agent may not consent to:
(1) voluntary inpatient mental health services;
(2) convulsive treatment;
(3) psychosurgery;
(4) abortion; or
(5) neglect of the principal through the omission of care primarily intended to provide for the comfort of the principal.

ETA. .sorry. . I meant "principal" and not "primary." No where does it address "patient."

I apologize. I feel lost and confused and I really want to understand why this section applies in this case. Maybe you can dumb it down for me.

When a person is determined by the tests to be brain dead, it is recorded in the medical record. The typical procedures then, is the family is notified and given approximately 2 days to gather and say their goodbyes before the vent is removed. The amount of time the hospital gives the family prior to removal of the vent varies. The hospital after that time period then withdraws support allowing the heart to cease functioning. Advance directives don't apply in brain death. The family is not asked if vent support can be removed in a deceased person.

The judge said that 166.049 does not apply because when applying the standards in 671.001 Mrs. Munoz is dead.

I would think that applying the standards in 671.001 would also mean that166.151 does not apply as she is deceased.

lease: Help me to understand why section 166.151 applies. Is it because you think it should apply and if so why? Thank you....

eta: Thanks Gitana. We posted at the same time.

 

[popsicle]

Hospital: No Decision on Order to End Life Support
FORT WORTH, Texas January 25, 2014 (AP)

Executives from a Texas hospital conferred with the county district attorney's office Saturday to determine their next step, after a judge ordered the hospital to remove a pregnant, brain-dead woman from life support.

Officials from John Peter Smith Hospital and the Tarrant County district attorney's office, which is representing the county-owned hospital, met to discuss Judge R. H. Wallace Jr.'s order regarding Marlise Munoz, hospital spokeswoman J.R. Labbe said. She declined to say whether a possible appeal was being discussed, but said an announcement wouldn't come Saturday.

http://abcnews.go.com/US/wireStory/hospital-told-pregnant-woman-off-support-21728372

 

[jjenny]

Under the law that is very clear: Next of kin unless the person had an Advanced Care Directive that is not vague.
That's why Terry Schiavo's husband got to decide despite the parents' wishes.



Snipped for space.

Neither the law nor the ruling here mandate that the hospital pull the plug on a pregnant brain dead person at all. That's absolutely not true.



I did not see that anywhere in the code.



This section just does not apply in this case at all. The only law that was even discussed was two code sections. 166.049 which states you can't pull the plug from a pregnant patient and 671.001 which defines "dead".

This was a straight forward decision and more should not be read into it. 166.049 does not apply because Ms. Munoz is dead. That's it. It does not have anything to do with fetal viability, the patients wishes, the family's wishes or requiring a hosptial to withdraw life support from a brain dead person who is pregnant.

If person is declared brain dead, hospital pulls the plug. That's what the law is. Family is given some short period of time to come to grips and then the hospital pulls the plug. Since it apparently doesn't matter whether this brain dead person is pregnant, hospital will pull the plug regardless of family's wishes or state of the fetus. Since brain dead person isn't considered a patient, the fetus doesn't have any protection under the current laws. The wishes of the woman don't have any value under the law, if she wanted to remain on life support so the fetus can become viable. The wishes of the father do not matter either. Fetus being normally devoloping makes no difference. Basically brain dead is legally dead regardless of pregnancy and hospital gets to pull the plug.

 

[Wolfie]

If person is declared brain dead, hospital pulls the plug. That's what the law is. Family is given some short period of time to come to grips and then the hospital pulls the plug. Since it apparently doesn't matter whether this brain dead person is pregnant, hospital will pull the plug regardless of family's wishes or state of the fetus. Since brain dead person isn't considered a patient, the fetus doesn't have any protection under the current laws. The wishes of the woman don't have any value under the law, if she wanted to remain on life support so the fetus can become viable. The wishes of the father do not matter either. Fetus being normally devoloping makes no difference. Basically brain dead is legally dead regardless of pregnancy and hospital gets to pull the plug.

Your response to this doesn't make sense. This was a case where the family wanted the life support pulled. It says nothing about cases where the family asks to have life support kept.

 

[faw720]

Hospital: No Decision on Order to End Life Support
FORT WORTH, Texas January 25, 2014 (AP)



http://abcnews.go.com/US/wireStory/hospital-told-pregnant-woman-off-support-21728372

JMO, Best story & comments I've seen.

 

[hambirg]

I disagree.

The section argued here. . .

Sec. 166.049. PREGNANT PATIENTS. A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient.

Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989. Renumbered from Sec. 672.019 and amended by Acts 1999, 76th Leg., ch. 450, Sec. 1.03, eff. Sept. 1, 1999.

This section falls directly under . . .

SUBCHAPTER B. DIRECTIVE TO PHYSICIANS

It states. . .

Sec. 166.031. DEFINITIONS. In this subchapter:
(1) "Directive" means an instruction made under Section 166.032, 166.034, or 166.035 to administer, withhold, or withdraw life-sustaining treatment in the event of a terminal or irreversible condition.

respectively. . .

Sec. 166.032. WRITTEN DIRECTIVE BY COMPETENT ADULT; NOTICE TO PHYSICIAN. (a) A competent adult may at any time execute a written directive.

Sec. 166.034. ISSUANCE OF NONWRITTEN DIRECTIVE BY COMPETENT ADULT QUALIFIED PATIENT. (a) A competent qualified patient who is an adult may issue a directive by a nonwritten means of communication.
(b) A declarant must issue the nonwritten directive in the presence of the attending physician and two witnesses who qualify under Section 166.003, at least one of whom must be a witness who qualifies under Section 166.003(2).
(c) The physician shall make the fact of the existence of the directive a part of the declarant's medical record, and the names of the witnesses shall be entered in the medical record.

Sec. 166.035. EXECUTION OF DIRECTIVE ON BEHALF OF PATIENT YOUNGER THAN 18 YEARS OF AGE. The following persons may execute a directive on behalf of a qualified patient who is younger than 18 years of age:. . .

I don't believe any of those things were done in this case. The section simply does not apply. What does apply is the section that deals with medical power of attorney. If this case is appealed. It will be overturned by the appellate court.

 

[hambirg]

I apologize. I feel lost and confused and I really want to understand why this section applies in this case. Maybe you can dumb it down for me.

When a person is determined by the tests to be brain dead, it is recorded in the medical record. The typical procedures then, is the family is notified and given approximately 2 days to gather and say their goodbyes before the vent is removed. The amount of time the hospital gives the family prior to removal of the vent varies. The hospital after that time period then withdraws support allowing the heart to cease functioning. Advance directives don't apply in brain death. The family is not asked if vent support can be removed in a deceased person.

The judge said that 166.049 does not apply because when applying the standards in 671.001 Mrs. Munoz is dead.

I would think that applying the standards in 671.001 would also mean that166.151 does not apply as she is deceased.

lease: Help me to understand why section 166.151 applies. Is it because you think it should apply and if so why? Thank you....

eta: Thanks Gitana. We posted at the same time.

I'm confused too.

I didn't see statute 671.007 brought up anywhere in the paperwork. Maybe I missed something.

Even so, I still think that's wrong. So a pregnant woman declared dead at 39 weeks, with a healthy fetus must be turned over to the family and the hospital can not take the baby C-section if the family refuses? Uh. . that's gross. . .MOO.

 

[hambirg]

Your response to this doesn't make sense. This was a case where the family wanted the life support pulled. It says nothing about cases where the family asks to have life support kept.

But the state NEVER considered their wishes at all. jjenny's interpretation is dead on. It doesn't matter the condition of the fetus or the family's wishes. If the pregnant woman isn't at or past 24 weeks life support must stop. That was the decision of the judge.

 

[BeginnersLuck]

I'm confused too.

I didn't see statute 671.007 brought up anywhere in the paperwork. Maybe I missed something.

Even so, I still think that's wrong. So a pregnant woman declared dead at 39 weeks, with a healthy fetus must be turned over to the family and the hospital can not take the baby C-section if the family refuses? Uh. . that's gross. . .MOO.

I honestly don't see that as being an issue. I think that a hospital would do an emergency C-section in a instance where the fetus is viable. This is something that would probably go to an ethics committee if there was a disagreement between the family and physicians.

When I researched brain death in another thread, I found that there are approximately 53,000 cases yearly.

There has to be reason why there are some cases to study. Most likely because the family made a choice to continue the support for the fetus. There also has to be a reason why we haven't heard of other cases where the hospital wanted to remove support against the wishes of the family on pregnant BD females.

After all the research I did, I would not recommend trying to sustain support for a fetus that isn't close to being viable outside of the womb. Of course if the family wanted to I would be in favor of that. The odds are very grim though. I would hope on cases of fetuses that are viable outside of the womb they would attempt a successful delivery ASAP, before vent support is removed.

 

[jjenny]

I honestly don't see that as being an issue. I think that a hospital would do an emergency C-section in a instance where the fetus is viable. This is something that would probably go to an ethics committee if there was a disagreement between the family and physicians.

When I researched brain death in another thread, I found that there are approximately 53,000 cases yearly.

There has to be reason why there are some cases to study. Most likely because the family made a choice to continue the support for the fetus. There also has to be a reason why we haven't heard of other cases where the hospital wanted to remove support against the wishes of the family on pregnant BD females.

After all the research I did, I would not recommend trying to sustain support for a fetus that isn't close to being viable outside of the womb. Of course if the family wanted to I would be in favor of that. The odds are very grim though. I would hope on cases of fetuses that are viable outside of the womb they would attempt a successful delivery ASAP, before vent support is removed.

Where are these studies? The studies I have read don't jive with that claim.
And it is not recommended for the fetus to be taken out as soon as it becomes viable. Prematurity can cause a lot of issues even if fetus was developing normally.

"A prolongation of the pregnancy should continue until at least 26 weeks of gestation with a possible second application of glucocorticoids. If maternal and fetal status remain stable, further prolongation of the pregnancy until at least 28 weeks of gestation should be attempted. According to the reported literature, after 32 weeks of gestation and under glucocorticoid-induced fetal lung maturity, no further prolongation of a pregnancy seems necessary."
http://www.biomedcentral.com/1741-7015/8/74

 

[gitana1]

If person is declared brain dead, hospital pulls the plug. That's what the law is. Family is given some short period of time to come to grips and then the hospital pulls the plug. Since it apparently doesn't matter whether this brain dead person is pregnant, hospital will pull the plug regardless of family's wishes or state of the fetus. Since brain dead person isn't considered a patient, the fetus doesn't have any protection under the current laws. The wishes of the woman don't have any value under the law, if she wanted to remain on life support so the fetus can become viable. The wishes of the father do not matter either. Fetus being normally devoloping makes no difference. Basically brain dead is legally dead regardless of pregnancy and hospital gets to pull the plug.

Please cite the specific code that states the hospital must pull the plug regardless of the family's wishes, on a brain dead patient, who is pregnant. I hsve reviewed it and that is not the law in Texas as far as I can tell. If that was the case, there would not have been any debate here at all.

Show me.

I disagree.

The section argued here. . .



This section falls directly under . . .



It states. . .


I don't believe any of those things were done in this case. The section simply does not apply. What does apply is the section that deals with medical power of attorney. If this case is appealed. It will be overturned by the appellate court.

Medical power of attorney does not apply and neither do the subsections you cited. Because those subsections don't define dead, brain death, patient or life sustaining measures.

I'm confused too.

I didn't see statute 671.007 brought up anywhere in the paperwork. Maybe I missed something.

Even so, I still think that's wrong. So a pregnant woman declared dead at 39 weeks, with a healthy fetus must be turned over to the family and the hospital can not take the baby C-section if the family refuses? Uh. . that's gross. . .MOO.

It's 671.001. Sorry if I gave you the wrong one. Here is the decision:http://thaddeuspope.com/images/MUNOZ_202053415-Judges-Order-on-Munoz-Matter.pdf

And I think if the situation you described occurred, a hospital may have grounds to petition the court to maintain life support until birth. Then, different issues would be relevant, like viability. But that's not the case here and we do not know what the court would decide in such a case.

But the state NEVER considered their wishes at all. jjenny's interpretation is dead on. It doesn't matter the condition of the fetus or the family's wishes. If the pregnant woman isn't at or past 24 weeks life support must stop. That was the decision of the judge.

No. That was absolutely NOT the decision of the judge. The judge simply stated that because the mother is dead, the code section MANDATING life sustaining measures does not apply. That's a massively huge difference from what you and jjenny are saying.

 

[jjenny]

Please cite the specific code that states the hospital must pull the plug regardless of the family's wishes, on a brain dead patient, who is pregnant. I hsve reviewed it and that is not the law in Texas as far as I can tell. If that was the case, there would not have been any debate here at all.

Show me.



Medical power of attorney does not apply and neither do the subsections you cited. Because those subsections donnitvdegibe dead, brain death, patient or life sustaining measures.



It's 671.001. Sorry if I gave you the wrong one. Here is the decision:http://thaddeuspope.com/images/MUNOZ_202053415-Judges-Order-on-Munoz-Matter.pdf

And I think if the situation you described occurred, a hospital may have grounds to petition the court to maintain life support until birth. Then, different issues would be relevant, like viability. But that's not the case here and we do not know what the court would decide in such a case.



No. That was absolutely NOT the decision of the judge. The judge simply stated that because the mother is dead, the code section MANDATING life sustaining measures does not apply. That's a massively huge difference from what you and jjenny are saying.

No it's not. If the code mandating life sustaining measures does not apply, then there is no protection for the fetus. Brain dead pregnant woman will be treated the same way as non-pregnant brain dead person. Hospitals pull plugs on non-pregnant brain dead persons, they don't keep them on life support. If brain dead pregnant woman is not a patient, and fetus isn't a patient, hospital will simply pull the plug.
As for the laws regarding hospital pulling the plug, haven't you followed McMath case? Hospital can pull the plug without permission from the family.
In fact it was going to, but the family managed to get a lawyer because they were given more time than normal before the plug was pulled.
How is the same thing not going to happen with a brain dead but pregnant person?
What is to stop the hospital from pulling the plug? They don't have to consider what family wants, or what the brain dead person would have wanted.

 

[Fairy1]

No it's not. If the code mandating life sustaining measures does not apply, then there is no protection for the fetus. Brain dead pregnant woman will be treated the same way as non-pregnant brain dead person. Hospitals pull plugs on non-pregnant brain dead persons, they don't keep them on life support. If brain dead pregnant woman is not a patient, and fetus isn't a patient, hospital will simply pull the plug.
As for the laws regarding hospital pulling the plug, haven't you followed McMath case? Hospital can pull the plug without permission from the family.
In fact it was going to, but the family managed to get a lawyer because they were given more time than normal before the plug was pulled.
How is the same thing not going to happen with a brain dead but pregnant person?
What is to stop the hospital from pulling the plug? They don't have to consider what family wants, or what the brain dead person would have wanted.

Two different states and two completely different cases.

My Mom was on life support for 10 days before the hospital allowed us to take her off - as per her own wishes. She was 66 years old and the hospital fought us tooth and nail to keep her on life support. They drug their feet on running the tests that would confirm that she was brain dead, though we all knew she was.

Why? $$$

 

[jjenny]

Two different states and two completely different cases.

My Mom was on life support for 10 days before the hospital allowed us to take her off - as per her own wishes. She was 66 years old and the hospital fought us tooth and nail to keep her on life support. They drug their feet on running the tests that would confirm that she was brain dead, though we all knew she was.

Why? $$$

TX and CA both consider brain death to be equal to legal death. The same law in both states regarding keeping brain dead persons on life support-hospital doesn't have to ask family's permission to turn life support off. In fact the patient doesn't even have to be brain dead in TX for hospital to pull the plug. Google baby Sun Hudson.

 

[Fairy1]

TX and CA both consider brain death to be equal to legal death. The same law in both states regarding keeping brain dead persons on life support-hospital doesn't have to ask family's permission to turn life support off. In fact the patient doesn't even have to be brain dead in TX for hospital to pull the plug. Google baby Sun Hudson.

I understand. However, Malise was pregnant and Jahi wasn't. The laws in each case were applied differently.

 

[SophieRose]

Here's a Texas case from 2007. Infant delivered five weeks after mother declared brain-dead. Organs donated. I think the baby's father died in 2010.

http://today.uchc.edu/headlines/2007/may07/womanlived.html

A Dallas high school teacher kept on life support for a month so she could give birth died on Mother's Day, two days after her daughter was born.

Stacy Rojas suffered an aneurysm over Easter weekend. She was brain dead but kept alive at Baylor University Medical Center at Dallas so her baby could grow closer to full term.

Zoe Sofia Rojas was born Friday, Ms. Rojas' husband, Marcus, said Tuesday. He'll appear on ABC's Good Morning America this morning.

Ms. Rojas was a little more than 29 weeks' pregnant when Zoe was delivered by Caesarean section. Doctors decided to deliver the baby more than two months early because Ms. Rojas developed pneumonia, Mr. Rojas said. The baby weighed 3 pounds, 3 ounces.

Another article two years later when lawsuit over mother's death was settled. Interesting, no legal requirement for medical malpractice insurance in Texas.

http://www.wfaa.com/news/local/64587007.html
But soon, a blood vessel in Mrs. Rojas' brain ruptured, rendering her brain-dead

"I can just remember sitting with the neonatal intensive care doctors and they're trying to talk you out of going through the life support with Stacy to bring her to term," Rojas said. "I'm glad we did it because they were all wrong."

 

[Karmady]

Two different states and two completely different cases.

My Mom was on life support for 10 days before the hospital allowed us to take her off - as per her own wishes. She was 66 years old and the hospital fought us tooth and nail to keep her on life support. They drug their feet on running the tests that would confirm that she was brain dead, though we all knew she was.

Why? $$$

As jjenny said, the law governing who is "dead" is exactly the same among all of the states. There are "accomodations" in NJ/NY, but the person is still considered legally dead. So, the only issue here is what happens if you're dead and pregnant v. dead and not pregnant. The Tx court ruled on Friday, that if you're dead and pregnant, the law requiring the hospital to try and keep your baby alive doesn't apply to you because you're dead. So...now if a family would like to have a fetus gestate in a brain dead mom, they won't have that choice. Actually, they never did based on the "patient" language of the law. But now it's clear. If you're pregnant and brain dead, the law allows the hospital to take you off life support even if you're pregnant and regardless of what you said you wanted or didn't and regardless of whether the baby is "perfect" and regardless of how close to term it is. So now it's up to the hospitals. jmo