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

[jjenny]

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

And unlike the Munoz case, in at least some of these cases, family does want pregancy to continue and baby delivered. But there is no protection from the hospital pulling the plug on a pregnant "non-patient" despite wishes of the family. And some TX hospitals fought tooth and nail to remove patients (non-pregnant) from life support despite wishes of the family, even though these patients weren't actually brain dead, they were futile. So, I can easily envision that the hospitals will remove life support from pregnant "non-patient" despite wishes of the family.

 

[BeginnersLuck]

Families can always get a TRO if the hospital and family can't come to an agreement. Show me a case where a hospital pulled the plug on a BD pregnant woman against family wishes.

 

[hambirg]

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.

BBM

There are such cases. I will need some time to dig them up, but there are definitely just such cases.

 

[gitana1]

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.

You are stating an opinion not a fact. Back it up. Cite me the code or the case law in Texas that supports your position. Clearly, babies are born in the US to brain dead mothers. So I simply don't understand why you are making this claim.

But I think I do understand why there's confusion. In this case, the family stated they wanted to stop life support. The hospital replied, "We can't because the law mandates we continue it when the patient is pregnant."


As a result, the family petitioned the court to allow life support to be pulled. Again, the hospital claimed it was required to keep it going due to the law. The court stated that was wrong because the law mandating life saving measures when the patient is pregnant, does not apply when there is no patient. So, the REQUEST that the hospital be compelled to terminate life support was granted. The court did not rule or state or cite to any law holding the hospital must always terminate life support in such cases. It simply held that the basis the hospital gave for continuing it was faulty and thus the family's motion could be granted.

 

[BeginnersLuck]

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

Here is the chart I was referencing. Sorry I wasn't more specific in my post. 24 weeks is viable and this chart recommends waiting until 26 weeks and delivering as soon as possible. So basically a two week period if possible. Of course a little longer may be better and each case would be different depending on the status of the fetus and mother.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002294/figure/F2/

 

[gitana1]

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

Oh my gosh that is NOT what this ruling means! Please guys!

There is NO LAW stating a hospital MUST cease life support when the person is declared brain dead. <modsnip> If that was the case, there would be no organ donation.

 

[hambirg]

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 don't define 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.

I thoroughly disagree with you. And I always respect your opinion. I find you to be thoughtful and consistent.

But this judge said Marlise is dead and the Advance Directive Code does not apply to her. That decision goes both ways. If a family wants to keep a pregnant loved one on life support, the message is clear to hospitals, only if she is past 24 weeks.. . .no matter the families wishes or the condition of the fetus.

IMHO. .. if this goes to appeal, this judge did not explain or support his decision with any precedents. .. .he's going to get his *advertiser censored* handed to him by the appellate. MOO.

ETA. . and rightfully so! Explain your decision and back it up with precedent cases. I can honestly say I've never seen such a hot case decided in this manner, with no explanation and no legal foundation based on precedents. It borders on the bizarre. I would almost agree with people that say this all political. It feels almost like a set up. Judge rules one way with no explanation, knowing full well it will be appealed and reversed.

 

[jjenny]

Oh my gosh that is NOT what this ruling means! Please guys!

There is NO LAW stating a hospital MUST cease life support when the person is declared brain dead. This is just getting silly. If that was the case, there would be no organ donation.

Have you not followed McMath case? Hospital has a right to turn off life support regardless of what family wants. All hospital has to do is to give family some reasonably short amount of time to come to grips, and turn off life support.
I am not sure what that has to do with organ donation, however.

 

[Fairy1]

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

Sorry, but this is not how I interpreted the court's decision at all. The hospital was fighting to keep Marlise on life support, despite her wishes and those of her family.

The law, IMO, was intended to keep pregnant women from voluntarily withholding life-sustaining treatment for themselves, thereby endangering the lives of their unborn children. It was never intended to keep brain-dead women on life support indefinitely. I believe if the pregnancy had been much further along and the fetus more developed and deemed medically viable, we would have seen a much different ruling in this case.

 

[jjenny]

Sorry, but this is not how I interpreted the court's decision at all. The hospital was fighting to keep Marlise on life support, despite her wishes and those of her family.

The law, IMO, was intended to keep pregnant women from voluntarily withholding life-sustaining treatment for themselves, thereby endangering the lives of their unborn children. It was never intended to keep brain-dead women on life support indefinitely. I believe if the pregnancy had been much further along and the fetus more developed and deemed medically viable, we would have seen a much different ruling in this case.

You are suggesting that the law is designed to force a concious woman who knows what she wants into treatment despite her wishes?

 

[Fairy1]

You are suggesting that the law is designed to force a concious woman who knows what she wants into treatment despite her wishes?

I'm not suggesting that, it's the way the legislation is actually written. Not a conscious woman, but a pregnant woman.

 

[gitana1]

I thoroughly disagree with you. And I always respect your opinion. I find you to be thoughtful and consistent.

But this judge said Marlise is dead and the Advance Directive Code does not apply to her. That decision goes both ways. If a family wants to keep a pregnant loved one on life support, the message is clear to hospitals, only if she is past 24 weeks.. . .no matter the families wishes or the condition of the fetus.

IMHO. .. if this goes to appeal, this judge did not explain or support his decision with any precedents. .. .he's going to get his *advertiser censored* handed to him by the appellate. MOO.

ETA. . and rightfully so! Explain your decision and back it up with precedent cases. I can honestly say I've never seen such a hot case decided in this manner, with no explanation and no legal foundation based on precedents. It borders on the bizarre. I would almost agree with people that say this all political. It feels almost like a set up. Judge rules one way with no explanation, knowing full well it will be appealed and reversed.

I don't know what's happening here. The judges decision simply does not mandate that ventilators and other life support measures stop when brain death occurs. And he did cite to the law. It was decided based on legal foundation. The judge absolutely explained his ruling. This is a simple case.
This decision may be appealed but it will not be reversed.

 

[gitana1]

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.

Have you not followed McMath case? Hospital has a right to turn off life support regardless of what family wants. All hospital has to do is to give family some reasonably short amount of time to come to grips, and turn off life support.
I am not sure what that has to do with organ donation, however.

I'm sure you understand that can and must are two very different things. I'm sure you realize you and two others stated that this decisions means the hospital must pull the plug. That is 100% false. Period. <modsnip> Good night, friends.

 

[hambirg]

I don't know what's happening here. The judges decision simply does not mandate that ventilators and other life support measures stop when brain death occurs. And he did cite to the law. It was decided based on legal foundation. The judge absolutely explained his ruling. This is a simple case.
This decision may be appealed but it will not be reversed.

We will have to just agree to disagree. Of course he didn't mandate it, but there is no legal backing for hospitals to continue it anymore. They will read this decision as a mandate.

Can you point me to the precedents he cited? I admit I may have missed that.

 

[jjenny]

I'm sure you understand that can and must are two very different things. I'm sure you realize you and two others stated that this decisions means the hospital must pull the plug. That is 100% false. Period. Perhaps it's late and people are tired. Good night, friends.

Actually, no. I never stated the hospital must pull the plug. But it can, and it doesn't matter what family wants. Condition of the fetus does not matter either.
There is nothing in the law to prevent the hospital from pulling a plug, even if family wants pregnancy to continue, fetus is normally developing and is close to viability.

 

[SophieRose]

BBM

There are such cases. I will need some time to dig them up, but there are definitely just such cases.

I haven't seen any such cases and I've done a lot of googling. If there were such cases, the family could involve the right to life movement and have an attorney in no time. And lots of publicity for the cause and against the hospital.

And if it occurred in the last 15 years, it would be all over the internet. There were two cases (one in 1999 TX and one in 1986 GA) where the unwed birth fathers wanted life support for the fetus and the family did not, the judges ruled to continue life support. Both died before birth.

 

[BeginnersLuck]

I haven't seen any such cases and I've done a lot of googling. If there were such cases, the family could involve the right to life movement and have an attorney in no time. And lots of publicity for the cause and against the hospital.

And if it occurred in the last 15 years, it would be all over the internet. There were two cases (one in 1999 TX and one in 1986 GA) where the unwed birth fathers wanted life support for the fetus and the family did not, the judges ruled to continue life support. Both died before birth.

Thank you for doing the research to see what's out there on this issue. Brain death is considered death in all states and it is not a families decision on when to remove ventilator support. The only exception is a religious exclusion in NJ and I haven't seen any cases where there have been conflicts there.

Considering it's the law in all 50 states, if this were some kind of issue with BD pregnant mothers, then I think there would be evidence of it.

 

[jjenny]

I haven't seen any such cases and I've done a lot of googling. If there were such cases, the family could involve the right to life movement and have an attorney in no time. And lots of publicity for the cause and against the hospital.

And if it occurred in the last 15 years, it would be all over the internet. There were two cases (one in 1999 TX and one in 1986 GA) where the unwed birth fathers wanted life support for the fetus and the family did not, the judges ruled to continue life support. Both died before birth.

Doesn't mean it can't happen in the future. TX hospital, around 10 years ago, went to court to remove a baby from life support that wasn't even brain dead (Sun Hudson).
As it is now, hospital can turn off life support from pregnant woman without permission from the family. Family might not have enough time to stop that, since hospital only has to give some reasonably short amount of time before turning off life support.

 

[Elley Mae]

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

The judge, R. H. Wallace Jr. of 96th District Court in Tarrant County, ruled that Ms. Muñoz, 33, who has been on life support at John Peter Smith Hospital since November and is now 22 weeks pregnant, was legally dead, agreeing with the family&#8217;s lawyers that the hospital had erred in its decision to keep her on life support. The hospital had said the Texas law addressing life support for pregnant women prevented it from granting the family&#8217;s wish, but the judge said the law did not apply to Ms. Muñoz because she is dead.

bbm

 

[BeginnersLuck]

Doesn't mean it can't happen in the future. TX hospital, around 10 years ago, went to court to remove a baby from life support that wasn't even brain dead (Sun Hudson).
As it is now, hospital can turn off life support from pregnant woman without permission from the family. Family might not have enough time to stop that, since hospital only has to give some reasonably short amount of time before turning off life support.

Here is more info on Sun Hudson and his mother

Sun Hudson case - Wikipedia, the free encyclopedia

Sun had the same condition as the baby in the top photo on this page. Warning it may be graphic to some.

http://pediatrics.georgetown.edu/residents/visualdiagnosis/week31/