January 15, 2014 — The husband of a pregnant woman being kept on life support against her family's wishes has sued the hospital involved and asked a judge to strike down the state law the facility cites in the case, the New York Times reports.
The woman, Marlise Munoz, was 14 weeks pregnant when she was taken to John Peter Smith Hospital in Fort Worth, Texas, after collapsing on Nov. 26, apparently from a blood clot in her lungs (Fernandez, New York Times, 1/15). 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.
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 (Women's Health Policy Report, 1/14).
In court filings, attorneys for Munoz's husband, Erick Munoz, argued that the contested law does not apply to Munoz because she is legally dead and, thus, not considered a "pregnant patient" under the law's parameters. They cited other sections of Texas law that describe death as an "irreversible cessation of all spontaneous brain function."
"Marlise Munoz is legally dead, and to further conduct surgical procedures on a deceased body is nothing short of outrageous," the attorneys wrote (New York Times, 1/15).
The lawyers also argued that if a judge determines that the law applies to Munoz, then it is should be struck down because it is confusing and unconstitutional (Pruet, Reuters, 1/14). Specifically, they said the hospital has violated Munoz's constitutionally protected right to make medical decisions about her body. They also argued that the Texas law is unconstitutional because it treats pregnant women differently than everyone else, in violation of the 14th Amendment's equal protection clause.
The J.P.S. Health Network, the publicly financed county hospital district that operates John Peter Smith Hospital, has maintained that it is following state law. J.P.S. Health Network spokesperson Jill Labbe referred comment to the hospital district's legal representation in the case -- the Tarrant County district attorney's office -- which declined to comment because the case is ongoing (New York Times, 1/15).
Experts Question Applicability of Texas Law
Experts familiar with Texas law, including two who helped draft the statute, said the hospital is incorrectly applying the measure because it is not applicable to a brain dead patient.
Robert Fine, clinical director of the office of clinical ethics and palliative care for Baylor Health Care System, said, "This patient is neither terminally nor irreversibly ill," adding, "Under Texas law, this patient is legally dead."
Likewise, Tom Mayo, a Southern Methodist University law professor, said that while the hospital would not be immune from criminal or civil action for violating the subchapter in question, "most medical decisions" are made without such immunity. He explained, "It simply says that if you were to take life support away, you'd be outside the subchapter" but it "doesn't have an affirmative command in it that you must keep life support going" (Merchant, AP/Contra Costa Times, 1/14).
Past Cases Shed Light on Fetus' Chances
A literature review published in 2010 that examined several cases of pregnant women who were kept on life support after being declared brain dead sheds some light on the fetus' chance of survival in the Munoz case, the Los Angeles Times' "Science Now" reports.
The study examined 19 cases that were reported between 1982 and 2010. The researchers found that six fetuses were born via caesarean section and were developing normally at the time of the study; seven died either in utero or by miscarriage, after a premature birth or from an infection post c-section; and the conditions of the six remaining fetuses were unknown.
According to the study, just one of the four fetuses survived in cases in which the woman was declared brain dead at 13, 14 or 15 weeks of pregnancy. Four of five fetuses that remained in utero for at least 49 days after the woman was declared brain dead -- the fetus' current time in utero in the Munoz case -- survived, although in all of those cases, the pregnancy was further along than Munoz's at the time she was declared brain dead (Kaplan, "Science Now," Los Angeles Times, 1/14).