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

[jjenny]

Again these are quotes from the family, which again the say they don't know the baby's condition, that's not nearly the same as a hospital releasing they don't know the condition of the baby.

I could liken it another high profile case (Jahi mcMath) and the media report that her family states she's not brain dead. That's what they want to tell the public.

I think in the Munoz case there is no way they CANNOT know the baby's growth, organ, blood flow, abnormalities. The only unknown would be in relation to the baby's brain. But they want to tell the public they don't know baby's condition at all..

Hospital can not release any information because of privacy laws. Father of the fetus could give them permission but he hasn't.

 

[ceecee30]

I think the hospital has been waiting until the fetus is big enough to do these tests.



"What might doctors know and haven’t told the public?



The fetal heartbeat can be monitored. Tests of the amniotic fluid and fetal blood can identify genetic issues. Sonograms can determine organ development and watch arm and leg movements for signs of abnormality. Whether the fetus is growing can be monitored.



http://www.dallasnews.com/news/metr...gnant-woman-on-life-support-is-brain-dead.ece

This description is of a morphology scan, standard pregnancy scan.

The MRI is not, the MRI would be for the brain activity and to see if the brain is working as it should.

 

[Linda7NJ]

I would think the real concern is brain damage. I'm not away of any test in utero that measures o2 deprivation


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[ceecee30]

Hospital can not release any information because of privacy laws. Father of the fetus could give them permission but he hasn't.

I understand about privacy laws, i was making a point that all we are reading is the fathers interpretation of the hospitals testing etc. not the hospitals.

 

[ceecee30]

I would think the real concern is brain damage. I'm not away of any test in utero that measures o2 deprivation


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Exactly, there's nothing to say the fetus has developed abnormally due to the oxygen depravation.

 

[ceecee30]

Nobody wants to remove a baby from womb at 24 weeks if it does not have to come out.

No they don't, yet world wide 15 million babies are born early each year, and without medical intervention these beautiful babies (and sometimes mothers) would have died.

Seeing as mr Munoz wants to turn his wife's life support off he won't let the baby get to full term inside the womb anyway

#borntoosoon#borntoosick#borntooearly

 

[jjenny]

No they don't, yet world wide 15 million babies are born early each year, and without medical intervention these beautiful babies (and sometimes mothers) would have died.

Seeing as mr Munoz wants to turn his wife's life support off he won't let the baby get to full term inside the womb anyway

#borntoosoon#borntoosick#borntooearly

Right now he doesn't have any say in the matter unless the court allows him to turn off life support.

 

[ceecee30]

Right now he doesn't have any say in the matter unless the court allows him to turn off life support.

And why would he want to turn it off if he doesn't even know if the baby is ok?

I just don't understand it personally.

If the court agrees with mr Munoz then that life support will be switched off, If this were me I personally couldn't live with the thought that I could have saved my baby but chose not to even try.

 

[K_Z]

Some references and discussion of the type of monitoring and testing that is likely being conducted with MM's fetus. One significant observation I have is that no one is hinting at, or overtly saying that the condition of the fetus is "good" or "reassuring". My opinion is that a ton of information is known already about the condition of this fetus. Both the hospital, and the father, have a vested interest in suppressing any information that is not completely positive and "normal"-- for many layers of reason, some obvious, some less obvious.

My overwhelming sense is that the fetus is not demonstrating reassuring signs WRT movement, and heart rate variability (neuro status and myelination), and is very likely growth retarded, due to the condition of the mother's body and her nutritional status (she is in a massively catabolic state, even with TPN or enteral feeds). I guess we will know more in time.

Some references for monitoring and interpretation of the fetus at this stage of gestation.

Fetal heart rate monitoring and interpretation in a fetus 20-24 weeks gestation.

http://www.ncbi.nlm.nih.gov/pubmed/23991757

Conclusion: The 20-24-week fetus demonstrates FHR patterns with more accelerations and decelerations, as well as higher baseline variability than was anticipated.

The association between fetal heart rate patterns and fetal movements in pregnancies between 20 and 30 weeks' gestation.

http://www.ncbi.nlm.nih.gov/pubmed/7081342

In summary, in normal pregnancy, FHR decelerations are common between 20 and 30 weeks' gestation. With advancing gestation, FHR decelerations are less commonly seen, and the frequency of acceleration and acceleration/deceleration patterns increases. The association between FHR and FM becomes stronger with advancing gestational age between 20 and 30 weeks. These findings suggest that the criteria for evaluating the health of the fetus before 30 weeks may be different from the criteria used later in pregnancy. Consequently, in the evaluation of low-birth weight fetuses between 20 and 30 weeks' gestation, new criteria for normal and abnormal nonstress monitoring tests must be developed.

Comparison of late-second-trimester nonstress test characteristics between small for gestational age and appropriate for gestational age infants.

http://www.ncbi.nlm.nih.gov/pubmed/10576176

CONCLUSION:
Periodic or episodic decelerations and increased FHR variability during late second-trimester EFM were associated with an increased risk of SGA birth weight.

Abnormal antepartum fetal heart rate patterns and subsequent handicap.

http://www.ncbi.nlm.nih.gov/pubmed/3046795

In this paper data on abnormal antepartum FHR patterns are related to the state of fetal oxygenation, fetal brain abnormalities and to neurological outcome. It is concluded that in IUGR fetuses changes in heart rate (and movement) patterns are late signs of impairment. Antepartum heart rate decelerations are usually the first of the abnormalities detected and are associated with fetal hypoxaemia. A fixed or flat FHR pattern might be indicative of congenital malformations of the brain or of prenatally acquired encephalopathy. Several studies have shown that antepartum FHR abnormalities (usually late decelerations) are associated with an increased risk of subsequent handicap. This risk is related to the degree of FHR abnormality, and especially applies to infants born preterm and/or growth-retarded.

Surveillance of growth-retarded fetuses with computerized fetal heart rate monitoring combined with Doppler velocimetry of the umbilical and uterine arteries.

http://www.ncbi.nlm.nih.gov/pubmed/8656410

CONCLUSION:
Fetal surveillance with Doppler and computerized FHR monitoring allows better understanding of the management of fetuses that are small for gestational age.

Doppler application in the delivery timing of the preterm growth-restricted fetus: another step in the right direction.

http://www.ncbi.nlm.nih.gov/pubmed/14770388

In conclusion, UA Doppler is a placental function test that provides important diagnostic and prognostic information in preterm IUGR. DV Doppler effectively identifies those preterm IUGR fetuses that are at high risk for adverse outcome (particularly stillbirth) at least 1 week before delivery, independent of the UA waveform. Relationships between perinatal outcome, arterial and venous Doppler status and gestational age require ongoing observational research effort. Randomized management trials are necessary to verify that delivery timing based on venous Doppler will impact on outcome in preterm IUGR.

 

[jjenny]

Even if condition of the fetus was "good" or "reassuring," the hospital can not say anything because of privacy laws.
Family can reveal whatever they know, but, they claim they only know that fetus has a normal heartbeat.
Family could give hospital permission to talk, but they haven't.
So I really have no clue what that means in connection to health of this fetus.
Hospital provided the family with official health records on the mother (I presume as part of discovery over the lawsuit). Surely hospital would have to give the family health records they have on the fetus?
Father wants life support turned off. I don't see any reason for him to suppress anything showing fetus isn't normally developing. He openy talked about his concerns about development of the fetus. If there were any records showing abnormal development, why in the world would he not reveal it?

 

[DeeMarie]

Marlise Muñoz living will must be honored or else we are all one step away from becoming wards of the state.

Texas has disregarded Mrs. Muñoz end of life wishes.

Texas has also disregarded legal rights of marriage because they have ignored Mr. Muñoz’s wishes for his wife.

Texas is deciding what medical treatment Mrs. Muñoz should or should not get.

What else will be forced by the state for medical decisions in the future?


Here are some scenarios for kickers:

>Your 98 year old terminally ill mother has a ‘do not resuscitate’ wish stated in her living will? –Ah the state knows what is best and resuscitation will be performed.

>Your wife is going through a life threatening pregnancy? A law is in place that only allows specific medical procedures that could risk both lives because the state has
decided this.

>You want to care for your ill child/family member at home? – The state thinks that your care this is not the right medical treatment for your loved one, so they are forced
into a hospital or institution.


We must remove the emotion of the pregnancy and discuss the long term effects of what is being done to Mrs. Muñoz by the state of Texas.

It’s the abuse of state power on its citizens and it is terrifying to say the least.

 

[hambirg]

Marlise Muñoz living will must be honored or else we are all one step away from becoming wards of the state.
She did not have a living will. If she did I might agree with you.
Texas has disregarded Mrs. Muñoz end of life wishes. At this point we don't know what they were under these conditions.

Texas has also disregarded legal rights of marriage because they have ignored Mr. Muñoz’s wishes for his wife. Regardless of marriage, no man or husband has the right to terminate a woman's pregnancy.

Texas is deciding what medical treatment Mrs. Muñoz should or should not get. The state does have that right, under the law. If Marlise was alive and she decided she wanted an abortion at 8 months, she could not get one. The state can also choose not to insert a feeding tube into a brain dead patient. The state can commit a mentally ill person to a mental health facility, the state can quarantine someone with a contagious disease . .etc. . .etc. . .etc.

What else will be forced by the state for medical decisions in the future? I don't believe the state is forcing anything. Marlise could have chosen to have an abortion while she was alive. She didn't. There might be an issue IF Marlise had left a written medical directive, but she didn't.


Here are some scenarios for kickers:

>Your 98 year old terminally ill mother has a ‘do not resuscitate’ wish stated in her living will? –Ah the state knows what is best and resuscitation will be performed. The state will follow a written DNR, there is no legal grounds not to in the case of a terminally ill 98 yr old.

>Your wife is going through a life threatening pregnancy? A law is in place that only allows specific medical procedures that could risk both lives because the state has
decided this. The Supreme Court was quite clear on choices of the health of the mother. It would be unconstitutional to deny anyone life saving medical treatment. Marlise's health is not even a question here.

>You want to care for your ill child/family member at home? – The state thinks that your care this is not the right medical treatment for your loved one, so they are forced
into a hospital or institution. Depending on the situation this is already true. There are many laws as to who and where medical treatments can be given. You're hair dresser, Barb, can't give you an abortion in the back of her beauty salon (thank gawd!). Your Uncle Bob can't perform appendectomies in his basement for some side money to subsidize his plumbing business. And you may or may not be able to give your child certain medical treatments in your home.


We must remove the emotion of the pregnancy and discuss the long term effects of what is being done to Mrs. Muñoz by the state of Texas. Exactly. Laws and constitutionality need to be considered outside of emotions. Once precedents are set, they are rarely reversed.

Let's take the case of Melissa Sowders', also in the state of Texas. She was still legally married to her husband, and two months pregnant with her bf's baby. Her soon-to-be ex killed her and her unborn child. BUT let's say instead of hiding her body in a river, he just ran screaming from his apartment. And let's say Melissa was found by someone and was rushed to the hospital in an attempt to save her life. Despite everything the medical professionals did, she was declared brain dead, but the baby had a heart beat. Now not unlike Marlise, Melissa also did not leave a written medical directive. Sooo. . .her husband, yeah, the one who just killed her, has legal power of attorney. And being her husband, he is also the assumed father under the law. What you are saying is that it would be HIS choice to suspend life support and terminate her pregnancy?

It’s the abuse of state power on its citizens and it is terrifying to say the least.

My words in purple.

 

[ceecee30]

My words in purple.

Thank you, I wanted to write something similar but couldn't put it as eloquently as you

 

[faw720]

Could the hospital not be telling them what they know? Maybe they heard the baby's heartbeat. Maybe they didn't tell them the findings of the ultrasound? Is the hospital allowed to hold back info on the baby?

I've wondered the same thing.

 

[faw720]

I honestly wonder if they would hold information that they feel would validate Mr. Munoz's fears of fetal brain damage. I really don't like to think poorly of medical professionals in such a manner, but if they are being forced by the state then their hands may well be tied. If he knew shortly after his wife was declared brain dead that the fetus had been impacted as well it might have changed his persistence to end the waiting game. I doubt the powers that be in the state of Texas want such a things to be known that might make them look bad either - and knowingly forcing a brain damaged fetus to come to viability only to be born and suffer will not sit will with a LOT of people.

IMO. :moo:

IMO, the medical professionals are in much the same situation as the Munoz family. Helpless!! The state of Texas has hijacked this pregnancy & they are the only decision makers unless a judge decides otherwise.

 

[Elainera]

I think the hospital has been waiting until the fetus is big enough to do these tests.

"What might doctors know and haven’t told the public?

The fetal heartbeat can be monitored. Tests of the amniotic fluid and fetal blood can identify genetic issues. Sonograms can determine organ development and watch arm and leg movements for signs of abnormality. Whether the fetus is growing can be monitored. An MRI might see evidence of strokes or other abnormalities in the developing brain. But that test can’t really be done effectively before 20 weeks, said Dr. Vincenzo Berghella, president-elect of the national Society for Maternal-Fetal Medicine."

http://www.dallasnews.com/news/metr...gnant-woman-on-life-support-is-brain-dead.ece

The fetus is now older than 20 weeks, right? So an MRI could now be done?

 

[jjenny]

The fetus is now older than 20 weeks, right? So an MRI could now be done?

Yes, fetus is at 22 weeks.
So MRI can be done.

 

[Elley Mae]

"If the hospital's plan currently is to maintain this body on life-support machinery until the fetus becomes viable and then do a C-section, I'd ask the hospital lawyers to think about who's going to provide consent for that C-section. Because it would be unethical to do a procedure like that without informed consent of some kind," he says.

The Tarrant County District Attorney's Office is representing the hospital. No individual defendants were named in the complaint.

http://www.usnews.com/news/articles/2014/01/15/texas-husband-sues-hospital-over-brain-dead-wife

 

[jjenny]

"If the hospital's plan currently is to maintain this body on life-support machinery until the fetus becomes viable and then do a C-section, I'd ask the hospital lawyers to think about who's going to provide consent for that C-section. Because it would be unethical to do a procedure like that without informed consent of some kind," he says.

The Tarrant County District Attorney's Office is representing the hospital. No individual defendants were named in the complaint.

http://www.usnews.com/news/articles/2014/01/15/texas-husband-sues-hospital-over-brain-dead-wife

Wow. So it's unethical to remove the fetus without consent? But it's not unethical to let it die even if its viable, by intentionally leaving it inside? Wouldn't that be murder? If somebody killed a pregnant woman, that somebody could be charged with double murder. And mother could no longer go out and get an abortion. Fetus is at 22 weeks. TX now set an abortion limit at 20 weeks. Not that she ever wanted to.

 

[alliemay]

Prayers for everyone involved, I have hopes though that the baby will survive and be normal with all odds against it.