[MP-Ryan]

http://www.wfaa.com/news/local/With-pregnant-wife-unresponsive-on-life-support-husband-hopes-to-fulfil-her-wishes-236654371.html

Erick is talking about the moment he saw his wife, Marlise, unconscious on the living room floor at around 2 a.m. Nov. 26. As a paramedic, Erick rushed in to do CPR and later called 911.

Marlise Munoz, who was 14 weeks pregnant at the time, was taken to JPS in Fort Worth. Family members say doctors suspected she suffered a pulmonary embolism, but didn't know with complete certainty.

"You just never think it's going to be you," Erick said.

Marlise has been on life support since that day in November. Erick tells News 8 she has not regained consciousness and is "simply a shell." Tests are done daily on the fetus, and results show a normal heart beat.

Both Marlise and Erick are paramedics in the Tarrant County area, and both have had serious conversations about what to do if the worst happens. Marlise's mother told News 8 that conversation started when Marlise lost her brother tragically four years ago.

"We knew what her wishes were," Erick said. His wife told him she never wanted to be kept alive by machine.

Marlise was taken to the emergency room at JPS in the early morning of Nov. 26. Later in the day, the family was informed by doctors that they would provide any life-saving measures because she was pregnant. The family was told the hospital was taking that measure because of state law in Texas' Health and Safety Code.

"Section 166.049 Pregnant Patients. A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient," the code reads.

Even more, in a health directive form found under the Health and Safety Code, it reads, "I understand under Texas law this directive has no effect if I have been diagnosed as pregnant."

The chances of this child being healthy are infinitesimally small, and, moreover, in any civilized legal jurisdiction, this man would have the legal right to terminate a pregnancy in the course of seeing to the wishes of his dead wife.

Seriously, Texas... I hear your politicians talk about how bad the nanny-state is all the time, but this is the goddamned literal definition of the term.

[The E]

Nononono, you don't understand. It's only a nanny state when it does something we don't like. When it does something good, it's enlightened intervention for the greater good.

This level of hypocrisy is just so ****ed up.

[666maslo666]

Assuming she is already braindead, then dead people dont have rights and their bodies should be used as life support if the need arises. I dont see the harm in it. Her body is used as property because our bodies without working brains are really on that level, and needs of living people should certainly override the past wishes of braindead ones.

Now dont get me wrong, I do think that abortion should be allowed in this case, however my justification is because the baby is still not very developed so its not really wrong to terminate the pregnancy for any reason. In this situation Id choose to abort  over the risk of bringing an unhealthy baby to term, too. So I dont agree with this, however its not that much big of a violation of any rights, IMHO.

[BloodEagle]

Assuming she is already braindead, then dead people dont have rights and their bodies should be used as life support if the need arises. I dont see the harm in it. Her body is used as property because our bodies without working brains are really on that level, and needs of living people should certainly override the past wishes of braindead ones.

Now dont get me wrong, I do think that abortion should be allowed in this case, however my justification is because the baby is still not very developed so its not really wrong to terminate the pregnancy for any reason. In this situation Id choose to abort  over the risk of bringing an unhealthy baby to term, too. So I dont agree with this, however its not that much big of a violation of any rights, IMHO.

Then if the government decided to take all of your properties on death, regardless of your written will and testament, that's not a violation of rights?

[DarkBasilisk]

Also there's the matter that regardless of what you think about the afterlife, following proper final wishes, funeral arrangements, etc, of the deceased has a profound effect on the emotional well-being of those still living that cared about the person. Or rather, not following them tends to be extremely harmful to the grieving process.

[666maslo666]

Then if the government decided to take all of your properties on death, regardless of your written will and testament, that's not a violation of rights?

Well, if it is needed to save a baby..  then surely human live > property

Also: whether she is legit braindead or merely unresponsive could be of importance, its not clear from the article. First of all we need to determine if there are two patients or one..

[Ghostavo]

Then if the government decided to take all of your properties on death, regardless of your written will and testament, that's not a violation of rights?

Well, if it is needed to save a baby..  then surely human live > property

Also: whether she is legit braindead or merely unresponsive could be of importance, its not clear from the article. First of all we need to determine if there are two patients or one..

She was 14 weeks pregnant, Texas's restrictions regarding abortion start at 15 weeks (not forbidding it, just adding restrictions). Does the husband/family have no say on whether the pregnancy should come to term or not?

[BloodEagle]

Then if the government decided to take all of your properties on death, regardless of your written will and testament, that's not a violation of rights?

Well, if it is needed to save a baby..  then surely human live > property

Also: whether she is legit braindead or merely unresponsive could be of importance, its not clear from the article. First of all we need to determine if there are two patients or one..

Your argument was that dead people don't have rights.  A will is a legally binding document.  If dead people don't have rights then the dead person's will cannot count for anything -- including property rights and the transferal thereof.

That being said (and I'd like someone with more knowledge on the subject to check me on this), I'm relatively certain that at three-four months into the pregnancy the 'child' is completely screwed no matter what happens.

[Bobboau]

To be honest this is not a case that gets my normal hairs on end. the person is effectively dead, they are keeping her alive against what was her will when she was alive, but just for a while, she won't stay pregnant forever. She is not in a condition to care one way or another, so I don't honestly care what happens to her. If they want to err on the side of svingg the baby's life, fine. The typical arguments in favor of abortion don't really work here, because the mother has no will of her own. The only input I think that is important from the father is if they want to raise the kid if it somehow survives or not.
This is a weird edge case, I don't think typical rules should necessarily apply, and I don't think decisions made here should have any bearing over more typical circumstances.

[Flipside]

Thing is, there's a very important reason why Organ Donors use an opt-in system. And whilst I am in two minds as to whether it should be opt-in or opt-out, if a preference has been stated about the mortal remains after death, it should be respected.

If this child is only 14 weeks developed at point of death, what are its actual odds of survival? I suppose that's the mitigating factor here, IF there's any real chance of saving the child then I can at least see the States' point even if I don't necessarily agree with it.

[Dragon]

I think that if the mother is only brain-dead, the child could survive. Afterall, pregnancy doesn't require any conscious input from the mother. I'm not a doctor, though. But if the doctors see the point in keeping her on life support, if there's a slightest chance of saving the child, they might have a point there. If they pulled it off, that would really be testament to how advanced modern medicine is.

[Flipside]

What also confuses me is that I presume from a legal standpoint, the child is now being considered a separate organism from the mother, otherwise the mothers' status would be something only Schrodinger could explain. But the legal upper limit for unrestricted abortion in the US is around 20-24 weeks, so the child was at least a month from that date.

I suppose the problem is an impossible one in a way, it's centered around that question of 'when does a fetus become a human?', but legally speaking, this isn't really a baby yet so if it boils down to purely a matter of law, I'd actually say the mothers wishes take precedence.

[666maslo666]

Thing is, there's a very important reason why Organ Donors use an opt-in system. And whilst I am in two minds as to whether it should be opt-in or opt-out, if a preference has been stated about the mortal remains after death, it should be respected.

In Texas it is opt-in, but there are countries where it is opt-out and even the wishes of the family to not donate can be disregarded. And I dont think it is a bad idea at all, if it helps to save lives. So I disagree that there is some important reason for opt-in system.

There were some cases of braindead women succesfully continuing pregnancy on life support:
http://www.cbsnews.com/news/brain-dead-mom-gives-birth-to-twins-while-on-life-support/

She was 14 weeks pregnant, Texas's restrictions regarding abortion start at 15 weeks (not forbidding it, just adding restrictions). Does the husband/family have no say on whether the pregnancy should come to term or not?

I do agree that before the abortion limit abortion should be allowed for any reason, even in this case. I just dont see it as a particularly important issue, since nobody is really harmed if it is not allowed here. So its kinda stupid and inconsistent, but not malicious.

[Flipside]

@666maslo666

True, but there is still that option to opt-out. The mother had stated that she did not wish to be kept alive by machines, so it really boils down to the child and what it is considered as under law. Sadly, the one person who could clear this up beyond doubt is dead.

The irony is, I can see where this is coming from, it's kind of a re-phrasing of the 'Reasonable Doubt' concept, that it is better to save a life and be wrong than take a life and be wrong, but I also think that it is legally risky.

[MP-Ryan]

Regarding the odds of a healthy child developing:  the mother's condition was due to acute anoxia - loss of oxygen.  Fetuses are even more sensitive to loss of oxygen than adults; the chances that this child is developing normally are exceedingly low.  If it isn't brain-dead already, it's likely to have severe medical complications.  And you can bet that the people who are going to have to raise that child (if it survives) and pay those medical bills aren't the ****ing hypocrites that have drafted laws that force the medical profession to refuse to comply with the family's wishes.

Regarding Texas law and abortion:  Texas has made some recent changes to its abortion-related laws that make it one of the most difficult states to obtain a legal abortion in.  That's the culture in which this case is developing.

The dad/husband is a paramedic - he knows exactly what the risks are, and he wanted to terminate life support to the mother (simultaneously ending the pregnancy) when it became clear his wife is functionally dead because of her wishes and the way she died.  That should be respected.  But in Texas, if you're pregnant, the State owns you until you aren't.  Then it could give a **** what happens to you or your child.

The "god-fearing" types posting in that newspaper's comments keep talking about miracle and God's will, which makes me even more irate - without the interference of modern medicine and a legal landscape that claims ownership over physical people, both mother and unborn fetus would have died long since.

This story would be significantly different had the woman died at 36 weeks gestation; but she didn't.  She died at a point in the pregnancy which is well below the viability threshold.

[Dragon]

How can you be so sure that the fetus doesn't have a chance here? If it was as bad as you say, it'd be declared dead by now and the case would be closed. The doctors, I think, know what they're doing. They know all the details, and are probably more competent in those matters than a paramedic due to their specialization. If they're convinced they can save the child, I think they should try. Besides, the mother is not in a vegetative state, she's brain-dead. Thus, she's not really being "kept alive" by the machinery. The child is.

[BloodEagle]

How can you be so sure that the fetus doesn't have a chance here? If it was as bad as you say, it'd be declared dead by now and the case would be closed. The doctors, I think, know what they're doing. They know all the details, and are probably more competent in those matters than a paramedic due to their specialization. If they're convinced they can save the child, I think they should try. Besides, the mother is not in a vegetative state, she's brain-dead. Thus, she's not really being "kept alive" by the machinery. The child is.

The doctors, in this case, are legally hamstrung.  We don't know what they think is right or wrong in any sense.

[Scotty]

I think that what this ultimately comes down to is whether someone's dying wishes are more important than a potentially viable fetus.  Likelihood not withstanding, is it really more important to respect those wishes immediately and therefore absolutely terminate any chance of viability, or is it more important to see whether the fetus could possibly survive?

That's significantly more prickly of an issue than "just" abortion or "just" keeping someone on life support.

I honestly have trouble knowing which side I come down on, though it does occur to me that life support can be immediately terminated once the fetus is born and finally determined whether it will survive, not whether it might survive.  In a scenario where one option kills whatever little hope there is, and the other does not, I find it morally irresponsible to not at least attempt to bring the fetus to the point of birth before removing life support.

[FUBAR-BDHR]

No what everything comes down to is $$$$$.  Every day that person is kept in the hospital is tens if not hundreds of thousands of dollars for that hospital.  Even if it wasn't a state law getting the hospital to remove life support would be damn near impossible as long as there was any chance of survival for the mother or the fetus.  Once on machines it doesn't really matter if you have a living will stating you don't want to be kept alive by them.  What matters is the doctors opinion of if there is any chance of recovery.  Who determines if there is a chance?  The hospitals doctors.  Will they ever say there isn't one without clear evidence of total death?  No they work for the hospital and would be looking for another job real fast.  Since the hospital will have no problem having their doctors say there is a chance the hospital will not remove the patient from support since they are making money. 

Bottom line unless your DOA don't expect that living will to mean jack **** once they put you on machines.

Now you may say this case is totally different because of the involvement of a fetus and that particular law and I somewhat agree except for the money part.  The only thing keeping this woman alive is going to do is run up bills for the father who will not only have lost his wife but have to deal with trying to support his other child after loosing just about everything he has probably to bankruptcy.  If the fetus does go to term and is born there is very little chance it will be healthy so then the father will have to try to support a special needs child with no money. 

[Mongoose]

Bottom line unless your DOA don't expect that living will to mean jack **** once they put you on machines.

At least ideally, this is patently false: there are legal statues in most states that recognize the authority of advanced health care directives, and any hospital which did not respect them would open themselves up to all sorts of legal hell.

The point that seems to be getting lost in this discussion is that the woman did not have any sort of formal DNR order on record at the time of the incident.  (Granted, even if she had, the provision in the state law would have mandated this course of action anyway, but bear with me for a moment.)  More to the point, even if she had discussed an aversion to prolonged life support with her husband in the past, there are no guarantees that she would feel the same way in the case of being pregnant.  I feel pretty sure there are many women out there ordinarily opposed to extraordinary life-sustaining measures who would be very willing to be subjected to them if it meant allowing her child to make it.  I think the intent of the provision, as clumsily as it may have been executed, was to make that provision clear to women up-front if they were to create a formal advance directive.

Regardless, if the medical details about the case are accurate, it unfortunately sounds as though the fetus is almost certainly brain-dead, and that at this point prolonging life support is little more than an extended cruelty to the family.  Their best bet now may be to just hold tight until the fetus is able to be properly tested for brain functions, and then hope for a court order to remove support if the tests come back negative.