"Brain Dead" & Pregnant:
Why the Marlise Muñoz Case Should Be Important to Us
Last month, the nation witnessed another very emotionally charged and difficult medical ethics debate. The publicly litigated debate concerned whether or not life-sustaining treatment should be discontinued for a young woman named Marlise Muñoz. Mrs. Muñoz was 33 years old when she was declared “brain dead,” after suffering a blood clot in
November of 2012.
The tragedy of the situation was compounded by the reality that Mrs. Muñoz was 14 weeks pregnant at the time of her devastating pulmonary embolism. The circumstances of this case elicit great sorrow and illuminate a heart-wrenching situation. However, I believe there are three ethical concerns demanding our attention.
My first concern in this case is the absence of any written report from Mrs. Muñoz wishing to end the life of her child in a situation in which she was certifiably brain dead. While written desires so specific are rare, they are especially important in medical cases like this. According to Texas law, life-sustaining treatment cannot be withdrawn from a pregnant patient, which is why Erick Muñoz , Mrs. Muñoz’s husband, petitioned the courts to take Mrs. Muñoz off of life support.
The case, therefore, highlights the complexities of surrogate wills and agents, especially when they involve multiple people (e.g. mother AND child). Of course, we respect and want to protect a surrogate’s ability to advocate for and to make reasonable and ethical judgements about an unconscious patient’s care and treatment. In this case, was there clear and convincing evidence that Ms. Muñoz’s desire was truly being presented? Ultimately, the decision to end her life, and her child's life, was left in the hands of her family.
My second concern focuses on another situation wherein a judge has determined whether or not an individual should live. Judge R.H. Wallace Jr. ruled on January 24th, that the mother was dead, and her unborn daughter was abnormal and not viable. Because of these circumstances the Judge gave the family what they asked for. John Peter Smith Hospital in Fort Worth Texas was ordered to end life-sustaining care.
Again, was this really the wish of Mrs. Muñoz? It concerns us that no one advocated for the rights of the unborn child. I use the term “rights” intentionally because we unfortunately still live in a post-Roe society that only affords rights to “wanted children.”
Shouldn’t we conclude from the facts that Mrs. Muñoz, who was 23 weeks pregnant at the time of her death, surely wanted her child to have the opportunity to be born and to live? The intent of the people of Texas was to protect a child growing in the womb of her unconscious mother until she could be viably delivered. The decision of Judge Wallace did not respect this intent.
My final concern examines the question of whether or not discrimination with respect to disabilities was a factor in the Judge and families decision. Lawyers for the family said they were provided with medical records that indicated that the fetus was “distinctly abnormal,” and suffered from hydrocephalus — an accumulation of fluid in the cavities of the brain — as well as from a possible heart problem.
It seems clear that the unborn “wanted” child eventually became “unwanted” because it could've been born with a severe disability or may not have been able to live outside of the womb. However, most medical professionals know that prenatal screenings do not always return perfectly accurate results. Even with the likelihood of an immediate natural death, shouldn’t the Muñoz baby in this situation been given the opportunity to live?
While we know that this was a very difficult situation for the Muñoz family, we also know that there were two patients in this story; and, unfortunately, only one patient was taken into consideration.