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

[gitana1]

BBM

And that is a legal argument to be tried. But I think it fails. A deceased person does not have more rights than a living one, and the argument has been made, a potential one.

ETA. . just for example. . .a mother, even with a written legal directive, dies in her 8th month of pregnancy, her written directive can be overridden by the obvious fact that she intended for the child to be born. . . as well as the legal precedent that the state has a more compelling interest in a potential life than in a dead person. That is a legal argument that has already been decided, as well, it is addressed in the Texas Advance Directive Code. A person does not magically gain more rights when they die.

Frankly the argument is moot. If the argument is that she is dead, well, dead people also do not have rights of personhood, which would include the right to a assign power of medical attorney. So which is it? If she's dead Mr Munoz has no decision making rights, as he is no longer her agent under the definition of medical power of attorney.

I've said this before, there are MANY legal issues here. IMHO arguing whether she is dead or not is probably one of the worst ways to go about it. The State actually has MORE authority over dead bodies than they do living persons.

MOO. . .the attorney's for Mr. Munoz are going after the wrong issue. When this case first came to light it seemed that they were going to be arguing that this case was based on the 14th Amendment. I can only assume that they figured out they would lose on that basis. A man does not have the right to terminate a woman's pregnancy, no matter the circumstances. So now they have moved on to this "she is dead" issue. Again, the State has even MORE authority over dead bodies than they do living persons. What they should be arguing is that the fetus is futile. THAT is a legal gray issue, and a judge can determine that if there is no hope, regardless of what the physicians do, that it would be in the best interest of the fetus (which is the State's only interest at this point) to no longer prolong it's inevitable death. Of course, that also depends solely on the medical evidence that this fetus is, in fact, futile.

And just in case anyone's wondering, I do NOT want the Constitutional basis of a woman's right to terminate her pregnancy to change. I in NO way want to start claiming that other people have the right to determine what a pregnant woman decides, within the confines of the law.

I also do NOT want to start arguing that States have no interest in life. I don't want to argue that they have NO rights over parents with regards to life and potential life. If we argue that, than States can no longer remove abused children from abusive parents. Period. The law has to apply to everyone equally.

With this case specifically, I see it as Marlise did not choose to change her directive once she became pregnant and that is interpreted as she did NOT choose to express in writing that she still wanted to be kept off life support. If she did, than she has to express that given the change in circumstances. If you write a will when you only have one child, upon the birth of subsequent children, you have to change it if you want it changed.

While I can sympathize with Mr Munoz and her family, I don't find their case exceptional. Lots of parents and fathers find themselves in unfortunate situations. It's just the way life is. I understand the burden that may be placed on him, but it is NO different than any other father's. Sometimes mothers leave the hospital and get hit by a bus. Not all babies are born healthy. It has nothing to do with "rights" but has everything to do with life. I suspect that this case has MUCH more to do with Mr Munoz's "wishes" than Marlise's.

Given all that, I do not want to see this child suffer unduly if it has no chance of survival. But I want that "no chance of survival" to be proven. Life and death is a serious matter. The evidence must be compelling.


MOOOOO!!!!!!!!!!!!

Super intelligent analysis Hambirg. I'm impressed. I won't say I 100% agree with you yet but you're making some excellent, logical points.

 

[gitana1]

I'm late to reply as I was off grocery shopping all day, so this was likely commented on already, and if it was... Sorry. :blushing:

If in fact they have not officially pronounced her as being brain dead, and not performed the apnea portion of the brain death test, they (the state and hospital) may well have skirted the whole "she's deceased" thing. That's an unknown at this point though, but totally plausible as others have pointed out as 10 minutes of no vent for the apnea test would only further harm the fetus. IMO If that is the case it's deplorable and flies in the face of medical ethics.

It appears from all reports that they have declared her brain dead.

 

[jjenny]

It appears from all reports that they have declared her brain dead.

Hospital never said they declared her brain dead.
She might actually be brain dead, but if hospital hasn't officially declared her to be brain dead, then she is not legally dead.

 

[Softail]

Honestly,,, I don't care about the law... This family is grieving.
Let Them... Shut the F up state of texas.. let this woman go...

So Sad: :cry:

 

[txsvicki]

Bush passed a law here in Texas that doctors can decide when to end life support. If the baby survives and is born to never develop or be able to eat, will they then start suggesting no nutrition?

 

[K_Z]

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

So Marlise remains hooked up because the hospital is misreading Texas law. NYU bioethicist Arthur Caplan laid this out last week, explaining why the hospital is misinterpreting the law (and also why that law must be unconstitutional). “The fact that the fetus apparently has significant abnormalities shows just how awful, misguided and cruel the Texas law is,” he emailed me Thursday morning. “The uncertainties about the pregnancy—damaged fetus, almost no cases of trying to bring a 14-week-old to term in this circumstance, what he the dad is able to cope with, his dead wife’s wishes about wanting to have a child if she cannot parent, the massive costs involved and the impact of a tragic outcome on his other child—they point clearly in the direction of who should be making the decisions and who should have been making them all along. Not the hospital, not the legislature, not pro-life or pro-choicers—the husband.”

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

 

[gitana1]

Hospital never said they declared her brain dead.
She might actually be brain dead, but if hospital hasn't officially declared her to be brain dead, then she is not legally dead.

How do you know what the hospital has declared? Just because they haven't publicly stated that she's brain dead doesn't mean they haven't declared her to be brain dead:

The pregnant, brain-dead Texas woman being kept on life support over her family's protests is carrying a fetus that is "distinctly abnormal," attorneys for the woman's husband said Wednesday.
Several experts have said the Texas Advance Directives Act doesn't apply in this case because Marlise Munoz, having suffered brain death, is legally and medically dead — a key argument in Erick Munoz's lawsuit. http://abcnews.go.com/US/wireStory/attorneys-brain-dead-womans-fetus-abnormal-21630077

Erick Munoz's wife, Marlise, has been declared brain-dead, but a Texas hospital is keeping her body on life-support machines for the sake of her fetus.
The 33-year-old woman was taken to John Peter Smith Hospital in Fort Worth, “where doctors informed Erick that Marlise had lost all activity in her brain stem, and was for all purposes brain dead,” according to a civil court petition filed Tuesday in Tarrant County.
Erick Munoz, Marlise’s parents and several medical and legal experts agree that the state law doesn’t apply on the grounds that Marlise is not a “patient” because she is dead. As the tragic case of 13-year-old Oakland girl Jahi McMath brought to light, brain death – defined as the “irreversible cessation of all functions of the entire brain, including the brain stem” – qualifies as a legal death.

http://www.latimes.com/science/scie...-munoz-20140114,0,1320584.story#ixzz2rHDwsXId​

The legal team representing the family of Marlise Munoz confirmed Friday that the Texas woman has been clinically brain dead since she collapsed in her home while 14 weeks pregnant.
“We have recently received Marlise Munoz’s medical records, and can now confirm that Mrs. Munoz is clinically brain dead, and therefore deceased under Texas law,” attorneys Jessica Janicek and Heather King said in an e-mail statement to CNN. http://www.salon.com/2014/01/17/law..._family_confirm_she_is_clinically_brain_dead/

"Marlise Muñoz was declared legally dead, and to keep carrying out surgical procedures on her body is nothing less than outrageous," reads the legal document presented by the family to the hospital, quoted by the BBC. http://www.latinospost.com/articles...spital-for-keeping-her-artificially-alive.htm

Also all you need for legal death under Texas law is for a doctor to declare that: "according to ordinary standards of medical practice, there is irreversible cessation of the person's spontaneous respiratory and circulatory functions [or, if artificial means of support preclude a determination that a person's spontaneous respiratory and circulatory functions have ceased] the person is dead [because] according to ordinary standards of medical practice, there is irreversible cessation of all spontaneous brain function." http://www.braindeath.org/law/texas.htm

I does not appear that the hospital has to actually declare her dead for her to be legally dead. Instead, a doctor employed by them needs to state that "according to ordinary standards of medical practice, there is irreversible cessation of the person's spontaneous respiratory and circulatory functions [or, if artificial means of support preclude a determination that a person's spontaneous respiratory and circulatory functions have ceased] the person is dead [because] according to ordinary standards of medical practice, there is irreversible cessation of all spontaneous brain function."

I think this can happen in a medical report and I think that's what has happened here.

 

[jjenny]

In it's response, hospital said that they are denying the allegations in the lawsuit. I presume they are denying they pronounced her brain (legally) dead.

 

[gitana1]

Honestly,,, I don't care about the law... This family is grieving.
Let Them... Shut the F up state of texas.. let this woman go...

So Sad: :cry:

Amen. I agree.

In it's response, hospital said that they are denying the allegations in the lawsuit. I presume they are denying they pronounced her brain (legally) dead.

"Denying the allegations" is a standard response to a lawsuit. It does not mean that the allegations are false or that all facts stated are controverted. At some stage of the litigation, the parties will have to determine which facts are controverted and which are not.

It appears clear to me there is a basis for the attorneys for the husband/father to state that the woman is legally dead.

 

[gitana1]

Well I don't think it's medically unethical if their goal is to preserve the fetus. Obviously if you are trying to preserve if you are not going to do anything that can harm it. They ceartinly appear to be dead set on preserving it despite it's abnormal condition.

That's the argument. Some feel it is ethical and some do not and that's what ethics boards are for. I think the answer depends on one's beliefs. It's not so black and white.

Now we have to see whether legally, it is black or white and whether, if not, a decision will be made to make it so.

 

[hambirg]

Hambirg, can you please cite me to the support for the futility argument. Statute, case law, whatever. I haven't seen what this this aspect is based on and would like to take a look. TIA :seeya:

http://www.thaddeuspope.com/futilitycases.html

Woohooo! The very first cases listed are that of Jahi McMath. :heavysarcasm: The parents', and hence the agents of power of attorney, rights are absolute and supersede any legitimate State interests, so say many posters here. It's kinda weird that no one is arguing that point of view in Jahi's thread, but it is a major issue here. Why is that? Is it racism or are people just thinking that the laws don't have to apply to everyone equally. . .which in essence is racism? Maybe it's just political bias. Hmmm. . .

I haven't read through them all. I just know of the ones considered major decisions. Good luck!

 

[hambirg]

Honestly,,, I don't care about the law... This family is grieving.
Let Them... Shut the F up state of texas.. let this woman go...

So Sad: :cry:

So now we don't care about the law?!!! But yet the argument about some people being "emotional" is being thrown around? The law is not emotional. . .but statements like "I don't care about the law" are. Remember that sentiment the next time some douchebag rapes or kills someone. "I don't care about the law."

Sorry! :banghead::banghead::banghead:

If you don't care or know about your own rights under the law, than I guess that it is just better to allow some people to continue under some delusional, blissful state of ignorance. Duly noted.

 

[K_Z]

Absolutely excellent analysis of law and ethics. I recommend the entire article.

Excluding Pregnant Women from the Right to Terminate Life Support

Though I am not unmoved by the plea for the fetus’s life over a dead woman’s wishes, there is an argument—in my view, a strong argument—that the right of anyone, pregnant or not, to terminate life support is even more fundamental than the right to abortion. The right to terminate or refuse life support is a variant on the right to refuse medical treatment. In Washington v. Glucksberg, the Supreme Court held that there is no constitutional right to physician assistance in dying. But in drawing this conclusion, the Court distinguished between removing a feeding tube or a respirator, on one hand, and taking a life-ending medicine, on the other, and a majority of the Court has indicated its view that the former would be constitutionally protected.

This right against a governmental battery (defined in the law as an unconsented touching) belongs to everyone, male and female, and it means that no matter how beneficial a treatment might be for the individual to be treated, she still has the right to refuse it. It follows a fortiori that the government may not compel one person to receive unwanted medical treatment in order to promote someone else’s interests. Otherwise, the government could compel the donation of blood, bone marrow, and kidneys, to save others’ lives. Yet medical treatment virtually always requires consent.

When a woman decides to terminate life support, she therefore chooses to withhold her consent to the imposition of mandatory medical treatment. That she is pregnant does not convert her choice into an abortion, since her objective is not to kill the fetus, but, rather, to stop existing on life support. In the language of Catholic doctrine, the pregnant woman’s decision to forgo life-saving medical treatment is a case of double effect: the fetus’s death is a collateral, rather than an inherent, consequence of her decision to reject life support. Similarly, if a pregnant woman with cancer decides to undergo chemotherapy to lengthen her own life, but the chemotherapy foreseeably results in the death of her fetus, the chemotherapy does not thereby become the ethical equivalent of an abortion.

http://verdict.justia.com/2014/01/2...t-terminate-life-support#sthash.6uYziBus.dpuf

 

[K_Z]

http://www.thaddeuspope.com/futilitycases.html

Woohooo! The very first cases listed are that of Jahi McMath. :heavysarcasm: The parents', and hence the power of attorneys', rights are absolute and supersede any legitimate State interests, so say many posters here. It's kinda weird that no one is arguing that point of view in Jahi's thread, but it is a major issue here. Why is that? Is it racism or are people just thinking that the laws don't have to apply to everyone equally. . .which in essence is racism? Hmmm. . .

I haven't read through them all. I just know of the ones considered major decisions. Good luck!

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.

 

[gitana1]

http://www.thaddeuspope.com/futilitycases.html

Woohooo! The very first cases listed are that of Jahi McMath. :heavysarcasm:

I haven't read through them all. I just know of the ones considered major decisions. Good luck!

The only cases that are relevant are Texas cases. The first two are from 2005. One is the Sun Hudson case and it looks like it decided nothing as the appeal was won only on the issue of the judge's recusal. The trial court again denied the injunction and the mother failed to appeal that second decision, so life support ceased: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCcQFjAA&url=http%3A%2F%2Fwww.childrensmercy.org%2Fcontent%2FuploadedFiles%2FRIGHT%2520TO%2520DIE.pdf&ei=surhUsvlK9GhogSm5ICwBg&usg=AFQjCNG8RNRi8su4KwbepFocsKA0JQ0Ekg&sig2=i96kRzoN7I0nLS79hZLTtA&bvm=bv.59930103,d.cGU

It appears, however, that the medical futility cases have to do with the hospital's right to discontinue life saving measure, not their duty to discontinue such measures. I think it comes down to what their ethics board determines and while the medical futility statute may provide some peripheral support for taking Munoz off life support, I can't say that's the central argument.

But I like the way you think, Hambirg. Super sharp.

So now we don't care about the law?!!! But yet the argument about some people being "emotional" is being thrown around? The law is not emotional. . .but statements like "I don't care about the law" are. Remember that sentiment the next time some douchebag rapes or kills someone. "I don't care about the law."

Sorry! :banghead::banghead::banghead:

If you don't care or know about your own rights under the law, than I guess that it is just better to allow some people to continue under some delusional, blissful state of ignorance. Duly noted.

Well, perhaps that's a bit of an exaggeration. I think the point is that the law in these cases needs to be about human suffering and the right thing to do.

And I cannot say that the law is unemotional. People say "You cannot legislate morality." That's false. We can and we do, every day. Compassion, suffering, emotion plays a big part in the laws we allow to be enacted. For example, there are different categories of crimes and often different penalties depending on the pain and anguish caused or the lack of emotion, the carelessness or depravity of a defendant.

There are two laws (two subsections of an act) at play here in Texas that have a lot to do with emotion - the part of the Advanced Directives Act that states a person may choose when life saving measures should be stopped and also that a hospital may decide when to pull the plug, which has to do with what people want and whether a patient is suffering, and then the part of the act that states one cannot stop life saving measures from a pregnant patient. Both have to do with belief which is based on emotion.

So I think emotion has a lot to do with the law.

Reading more about this case, I think it will ultimately come down to whether or not the hospital found Ms. Munoz to be clinically dead and whether or not a dead person is a patient:

The Texas Advance Directives Act, Section 166.049, provides that "a person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient." The Texas law, like similar laws in other states, is almost always applied when the woman is incapacitated and terminally or irreversibly ill.
It does not, however, on any reading, apply to a pregnant patient who has died.
The Texas Advance Directives Act defines "life-sustaining treatment" as that which "sustains the life of a patient and without which the patient will die." Because Munoz has died, cardiopulmonary or any other form of support is not, and cannot be, "life-sustaining." The law requires only that a living pregnant woman be kept alive.
Given the clarity of this statutory language, it is hardly surprising courts have determined it inapplicable after a determination of death. For example, in a similar case in Houston, a Texas court ordered a hospital to continue treatment for a comatose Tammy Martin, who was then 15 weeks pregnant. But the court reversed the order, a few weeks later, once Martin had been declared dead.

http://www.latimes.com/opinion/comm...upport-20140116,0,3476520.story#ixzz2rHvDb5k6​

Whether they are, in fact, following the law is furiously disputed. Her family maintains that she is brain-dead. The hospital has not released her medical records, but several lawyers have reviewed them and confirmed the family’s account. Some legal experts argue that this particular bit of state law should never have been invoked, because the woman is not a patient: she is dead. Erick Munoz shares that view. On January 14th he filed a civil suit asking the county to order the hospital to stop its “life-sustaining” treatment, which is, as the suit puts it, “mutilating, disturbing and damaging Marlise’s deceased body”.http://www.economist.com/news/unite...ce-and-pro-life-alike-brain-dead-and-pregnant

By the way, the irony of how the two, in this case competing, sections of the act have been applied is not lost on me. In the Sun Hudson case and the Spiro Nikolouzos cases, hospitals fought to be able to determine that people, actual, live, living, born human beings, should have life support taken from them. Yet here, the hospital is fighting for the right to continue life support on a woman who is apparently quite dead, in order to allow a baby who is not born, and who apparently has serious medical issues and is not yet "viable", to have a chance at life.

Strange difference to me. Is the life of a fetus more important than that of a person who has been born? Is this about politics? About views becoming so polarized that logic is lost? Hmmm.

 

[K_Z]

Just revolting - medically and ethically.

This woman is dead. Her fetus is being forcefully gestated inside of a corpse and sustained by extremely invasive, artificial means ( ECMO perhaps ? ).

The initial insult included several minutes of oxygen deprivation, damaging the placenta and compromising future growth. So this fetus is suffering from (most likely) intra-uterine growth retardation, hypoxic/anoxic brain injury, possible amniotic band syndrome, and who knows what as far as side effects from multiple medications.

That poor woman and get family. Abuse of a corpse and willful infliction of harm on the unborn. Disgusting.

Just a bit of clarification in the BBM.

ECMO is extracorporeal membrane oxygenation. It isn't possible to do ECMO on a fetus of any gestational age. ECMO is for the living who are already born.

I feel pretty confident MM's body is on a normal "garden variety" ventilator. ECMO is similar to a heart/ lung bypass machine.

Extracorporeal membrane oxygenation - Wikipedia, the free encyclopedia

We haven't heard if MM's body is receiving other extraordinary support means, such as hemofiltration. But it's not outside the realm of possibility, since we are 8 weeks out from brain death, and presumably they are treating her body aggressively to create some semblance of adequate physiology. Her body would be expected to have the same issues as any brain dead patient, with diabetes insipidis, difficulty with blood pressure regulation, difficulty with temperature regulation, skin breakdown, dehydration from the DI, constant issues with obstruction with secretions and atelectasis in the lungs, etc.

Hemofiltration - Wikipedia, the free encyclopedia

 

[jjenny]

The only cases that are relevant are Texas cases. The first two are from 2005. One is the Sun Hudson case and it looks like it decided nothing as the appeal was won only on the issue of the judge's recusal. The trial court again denied the injunction and the mother failed to appeal that second decision, so life support ceased: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCcQFjAA&url=http%3A%2F%2Fwww.childrensmercy.org%2Fcontent%2FuploadedFiles%2FRIGHT%2520TO%2520DIE.pdf&ei=surhUsvlK9GhogSm5ICwBg&usg=AFQjCNG8RNRi8su4KwbepFocsKA0JQ0Ekg&sig2=i96kRzoN7I0nLS79hZLTtA&bvm=bv.59930103,d.cGU

It appears, however, that the medical futility cases have to do with the hospital's right to discontinue life saving measure, not their duty to discontinue such measures. I think it comes down to what their ethics board determines and while the medical futility statute may provide some peripheral support for taking Munoz off life support, I can't say that's the central argument.

But I like the way you think, Hambirg. Super sharp.



Well, perhaps that's a bit of an exaggeration. I think the point is that the law in these cases needs to be about human suffering and the right thing to do.

And I cannot say that the law is unemotional. People say "You cannot legislate morality." That's false. We can and we do, every day. Compassion, suffering, emotion plays a big part in the laws we allow to be enacted. For example, there are different categories of crimes and often different penalties depending on the pain and anguish caused or the lack of emotion, the carelessness or depravity of a defendant.

There are two laws (two subsections of an act) at play here in Texas that have a lot to do with emotion - the part of the Advanced Directives Act that states a person may choose when life saving measures should be stopped and also that a hospital may decide when to pull the plug, which has to do with what people want and whether a patient is suffering, and then the part of the act that states one cannot stop life saving measures from a pregnant patient. Both have to do with belief which is based on emotion.

So I think emotion has a lot to do with the law.

Reading more about this case, I think it will ultimately come down to whether or not the hospital found Ms. Munoz to be clinically dead and whether or not a dead person is a patient: By the way, the irony of how the two, in this case competing, sections of the act have been applied is not lost on me. In the Sun Hudson case and the Spiro Nikolouzos cases, hospitals fought to be able to determine that people, actual, live, living, born human beings, should have life support taken from them. Yet here, the hospital is fighting for the right to continue life support on a woman who is apparently quite dead, in order to allow a baby who is not born, and who apparently has serious medical issues and is not yet "viable", to have a chance at life.

Strange difference to me. Is the life of a fetus more important than that of a person who has been born? Is this about politics? About views becoming so polarized that logic is lost? Hmmm.

Spiro Nikolouzos didn't meet criteria for brain death, but he could not eat on his own or breathe on his own. He couldn't communicate. I just don't see any real difference in his condition and that of someone who is brain dead. It's not like he could do something brain dead people can not do. So he had some sort of brain activity still present, but it didn't seem to translate into anything else.
I am not sure why that would make so much difference into whether someone should be considered a live human being as opposed to being legally dead.

 

[K_Z]

http://www.babycenter.com/fetal-development-images-14-weeks

I'm wondering what kind of deformity they are talking about. Marlise was 14 weeks pregnant when she got the embolism, wasn't she? Fetuses get their basic shape in the first trimester. If everything was developing fine until 14 weeks I would have expected growth retardation, problems with the maturation of the organs and abnormal brain development more than gross structural deformities in the shape of the limbs.

Just hypothesizing .....

Deformities in the lower limbs after 14 weeks could be caused by amniotic band syndrome. Amniotic band syndrome may occur when the placenta and amnion (portions thereof) begin to deteriorate, creating fibrous bands within the amniotic sack, entrapping limbs, digits, etc, leading to growth restriction and deformation.

Amniotic band syndrome is an interesting thought. But we know that MM sustained a very severe and prolonged hypotensive/ hypoxic/ anoxic/ cardiac arrest situation, and thereby can infer that uteroplacental perfusion pressure was severely compromised during and after that episode. Systolic blood pressure is exquisitely important in sustaining adequate uteroplacental perfusion pressure for the fetus. The fetus cannot store oxygen, nor can the fetus autoregulate its hemodynamics (blood pressure). It is dependent on mom's blood pressure (systolic, NOT mean arterial pressure).

I have been pondering if it is possible that anterior spinal artery syndrome in a fetus of early 2nd trimester status is what occurred to produce the lower extremity deformities. Anterior spinal artery syndrome causes an infarction of the lower spinal cord, and is associated with profound hypotension and hypoxia (low blood pressure and low oxygen). (It is a rare complication of surgery-- the patient awakens paralyzed, with a spinal cord infarct.) If the fetus infarcted the lower spinal cord, then all development below the level of infarct would be grossly impaired.

A few references:

Anterior spinal artery syndrome - Wikipedia, the free encyclopedia

http://www.ncbi.nlm.nih.gov/pubmed/3644305

http://www.medscape.com/medline/abstract/3644305

I just want to add that this is just a theory I'm pondering-- I have no idea if this is what happened. Kind of an educated guess. But it might explain the CNS insult as well-- the hydrocephalus, and the inability to distinguish gender.

 

[gitana1]

Spiro Nikolouzos didn't meet criteria for brain death, but he could not eat on his own or breathe on his own. He couldn't communicate. I just don't see any difference in his condition and that of someone who is brain dead. It's not like he could do something brain dead people can not do. So he had some sort of brain activity still present, but it didn't seem to translate into anything else.
I am not sure why that makes all the difference.

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.

 

[K_Z]

And regarding the fetal cardiac defects that have been reported:

Although "normal" hypoxia (lower oxygen tension in the fetus as compared with the adult) is essential in heart formation, further abnormal hypoxia in utero adversely affects cardiogenesis. Prenatal hypoxia alters myocardial structure and causes a decline in cardiac performance. Not only are the effects of hypoxia apparent during the perinatal period, but prolonged hypoxia in utero also causes fetal programming of abnormality in the heart's development.

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