NYT: Complex Debates Intersect in Dispute Over Life Support for Pregnant Texas Woman

January 8, 2014 — A case of a pregnant Texas woman being kept on life support against her and her family's wishes is sparking debate about the intersection of medical, legal and ethical issues involving abortion and end-of-life care, the New York Times reports.

Marlise Munoz was 14 weeks pregnant when she was taken to John Peter Smith Hospital in Fort Worth, Texas, after collapsing, apparently from a blood clot in her lungs. According to Munoz's parents, officials at the hospital told the family that Munoz is brain dead. The Munoz family prepared to ask that the hospital remove life support, per her end-of-life wishes, but hospital officials said they would not comply because of a state law that prohibits withdrawing or withholding "life-sustaining treatment" from a pregnant patient.

Munoz has remained on life-support for more than a month, and the fetus is now in the 20th week of development, the Times reports. According to Munoz's mother, hospital officials said they will make a decision regarding delivery at 22 to 24 weeks, although they have not commented on the fetus' health or viability.

Munoz's relatives have said they want to see the law overturned but have not taken any legal action against the hospital, the Times reports.

Legal Background

Katherine Taylor, a lawyer and bioethicist at Drexel University, said laws governing how doctors can treat terminally ill pregnant women originated in the 1980s, largely as a response to concerns from the Catholic Church and others about the spread of laws allowing patients to make advance directives about end-of-life care.

According to a 2012 report from the Center for Women Policy Studies, 31 states restrict the ability of doctors to end life support for terminally ill pregnant women, and 12 states -- including Texas -- enforce the restriction at all stages of pregnancy.

Key Issues

Medical experts have suggested that the hospital might be misinterpreting the state law in the Munoz case because it is unclear whether the statute applies to patients who are brain dead or only to those who are in a coma or vegetative state.

A person who is brain dead -- meaning there is no neurological activity -- is considered legally dead, according to the Times. Munoz's parents have said the hospital has declared Munoz brain dead, but hospital officials have not spoken publicly about the issue.

Legal and ethical experts noted that the condition can be readily determined and questioned why there are conflicting accounts of Munoz's state.

Arthur Caplan, director of medical ethics at NYU Langone Medical Center, said, "The Texas Legislature can't require doctors to do the impossible and try to treat someone who's dead." He added, "I don't think they intended this statute the way the hospital is interpreting it."

Other observers have said that Munoz has a legal right to abortion regardless because the fetus is not yet viable outside the womb. "These laws essentially deny women rights that are given others to direct their health care in advance and determine how they want to die," Taylor said, adding, "The law can make a woman stay alive to gestate the fetus" (Fernandez/Eckholm, New York Times, 1/7).