Tag: Medical Ethics

The Exercise of Vital Powers

Marlise Munoz was taken off life support and allowed to die yesterday.

A public battle over the fate of a brain-dead, pregnant Texas woman and her fetus ended quietly and privately as she was taken off life support and her family began preparing for her burial.

John Peter Smith Hospital in Fort Worth complied Sunday with a judge’s order to pull any life-sustaining treatment from Marlise Munoz, who was declared brain-dead in November, but kept on machines for the sake of her fetus.

Munoz was removed from the machines shortly afterward and allowed to die. The fetus, which was at 23 weeks’ gestation, was not delivered.

The hospital’s decision brought an apparent end to a case that inspired debates about abortion and end-of-life decisions, as well as whether a pregnant woman who is considered legally and medically dead should be kept on life support for the sake of a fetus, per Texas law. Anti-abortion activists attended Friday’s court hearing and spoke out in favor of trying to deliver the fetus.

While I think the court made the correct decision — indeed, it’s not clear if the hospital applied the law correctly or used it as a shield against liability — I do want to unpack this debate a bit.

There were two questions tied together in the Munoz case: a moral one and a legal one. The legal question, which I’ll get to in a moment, was whether the Munoz family should be forced to keep Marlise on life support until her baby could be delivered. The moral question was whether she should be kept functioning until her baby could be delivered, regardless of the law. To my mind, the latter question was dismissed far too easily.

In this specific case, the question was largely moot; the medical records indicate that the fetus was suffering from severe deformities and would not have survived (fetuses do not gestate well inside of dead people). But the larger issue remains and will come back again in the future. We’ve long accepted that the right of the mother to live is more important than the right of the fetus to live in rare cases of life-saving abortion. But is there a point where the right of the fetus to live would be more important than the right of the mother to die? Can a person who is legally dead even be said to have rights? Had Munoz been, say, 34 weeks pregnant, the issue would have been a straight forward premature delivery of the fetus. But what happens when you have a case where the brain death of the mother occurs before viability? Do we turn the woman into nothing but a zombie incubator for a fetus? Or do we compound one tragedy with a second? Supposing the fetus is brought to term or prematurely delivered and has a lifetime of health issues. Who is responsible for taking care of him?

Much of the debate simply assumed that pulling the plug was the morally right thing to do. But what if Munoz’s had expressed that she would have wanted to be kept alive? This case came up with a friend who is pregnant and said that she would want to stay on life support until her fetus could be delivered. As medical technology improves and the window of viability continues to move backward, this issue will come up again and in other contexts. No matter what happened in this particular case, we can’t wish the moral issue away. Nor can we pretend that everyone is going to see the moral case the same way.

I think people are far too eager to throw the Munoz case into the abortion rubric. The debate gets a lot easier when you can just bash Republicans (even though the Republicans have been mostly silent on this and the law that was used to keep Munoz alive was not really intended for that purpose). Much of the rhetoric I’m reading is borrowed from past abortion debates. But I suspect the debate would have changed had the Munoz family made a different decision. If they had decided on their own to prolong her death long enough for the fetus to be delivered, would some of those supporting them now have turned on them for turning Marlise into a little more than a womb?

In the end, the moral and legal issues have to come down to the wishes of the family whatever those wishes are. Moral, medical and bioethical issues like this one are far too complex, emotional and personal for the state or anyone else to come stomping in. I feel the same way about the Jahi McMath case — where a family has made the opposite decision to keep alive a brain-dead 13-year-old girl. In both cases, I have moral qualms about the decision that has been made. But in both cases, I believe the deciding factor should be either the pre-expressed wishes of the patient or the wishes of the family. That’s the only way to handle this without drowning in moral and legal quicksand. It’s the only way to handle this without politicians and pundits speculating about medical and moral issues they aren’t remotely qualified to decide.

That should have been the course followed in this case two months ago. And I hope it will be going forward so that the next family is spared this kind of drawn-out pain. Or vilification for whatever decision they make.