Pregnant, and Forced to Stay on Life Support

Written By Unknown on Rabu, 08 Januari 2014 | 13.57

Rex C. Curry for The New York Times

Lynne Machado is the mother of Marlise Munoz, who is on life support in a Fort Worth hospital.

FORT WORTH — The diagnosis was crushing and irrevocable. At 33, Marlise Munoz was brain-dead after collapsing on her kitchen floor in November from what appeared to be a blood clot in her lungs.

But as her parents and her husband prepared to say their final goodbyes in the intensive care unit at John Peter Smith Hospital here and to honor her wish not to be left on life support, they were stunned when a doctor told them the hospital was not going to comply with their instructions. Mrs. Munoz was 14 weeks pregnant, the doctor said, and Texas is one of more than two dozen states that prohibit, with varying degrees of strictness, medical officials from cutting off life support to a pregnant patient.

More than a month later, Mrs. Munoz remains connected to life-support machines on the third floor of the I.C.U., where a medical team monitors the heartbeat of the fetus, now in its 20th week of development. Her case has become a strange collision of law, medicine, the ethics of end-of-life care and the issues swirling around abortion — when life begins and how it should be valued.

"It's not a matter of pro-choice and pro-life," said Mrs. Munoz's mother, Lynne Machado, 60. "It's about a matter of our daughter's wishes not being honored by the state of Texas."

Mrs. Munoz's father, Ernest Machado, 60, a former police officer and an Air Force veteran, put it even more bluntly. "All she is is a host for a fetus," he said on Tuesday. "I get angry with the state. What business did they have delving into these areas? Why are they practicing medicine up in Austin?"

Mrs. Munoz's parents said they wanted to see the law overturned, but they have not sought any legal action against the hospital, though they have not ruled it out either.

The hospital maintains that it is following the law, although several experts in medical ethics said they believed the hospital was misinterpreting it. A crucial issue is whether the law applies to pregnant patients who are brain-dead as opposed to those in a coma or a vegetative state. The law, first passed by the Texas Legislature in 1989 and amended in 1999, states that a person may not withdraw or withhold "life-sustaining treatment" from a pregnant patient.

Mr. and Mrs. Machado said the hospital had made it clear to them that their daughter was brain-dead, but hospital officials have declined to comment on Mrs. Munoz's care and condition, creating uncertainty over whether the hospital has formally declared her brain-dead.

A spokeswoman for the J.P.S. Health Network, the publicly financed hospital district in Tarrant County that runs the 537-bed John Peter Smith Hospital, defended the hospital's actions. "In all cases, J.P.S. will follow the law as it applies to health care in the state of Texas," the spokeswoman, Jill Labbe, said. "Every day, we have patients and families who must make difficult decisions. Our position remains the same. We follow the law."

Ms. Labbe said that neither she nor the doctors could answer questions about Mrs. Munoz's condition because her husband had not signed the paperwork allowing them to speak to the news media about his wife's care.

At least 31 states have adopted laws restricting the ability of doctors to end life support for terminally ill pregnant women, regardless of the wishes of the patient or the family, according to a 2012 report from the Center for Women Policy Studies in Washington. Texas is among 12 of those states with the most restrictive such laws, which require that life-support measures continue no matter how far along the pregnancy is.

Legal and ethical experts, meanwhile, said they were puzzled by the conflicting accounts of her condition. Brain death, an absence of neurological activity, can be readily determined, they said. It is legally death, even if other bodily functions can be maintained.

"If she is dead, I don't see how she can be a patient, and I don't see how we can be talking about treatment options for her," said Thomas W. Mayo, an expert on health care law and bioethics at the Southern Methodist University law school in Dallas.

Manny Fernandez reported from Fort Worth and Erik Eckholm from New York.


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