What Texas should learn from Marlise Munoz

At 11:29 a.m. Sunday, officials at John Peter Smith Hospital in Fort Worth discontinued the life support of Marlise Munoz, a brain-dead, pregnant Texas woman who had been kept breathing for two months against the wishes of her family but, according to the hospital, in compliance with the laws of the state of Texas, which prevent a hospital from withdrawing or withholding “life-sustaining treatment … from a pregnant patient.” 

It took a court order from district Judge R.H. Wallace Jr. to convince the hospital to fulfill Munoz and her husband’s wishes. Now, Munoz’s family, according to a statement from their lawyers, will “proceed with the somber task of laying Marlise Munoz’s body to rest, and grieving over the great loss that has been suffered.” 

In the body of Marlise Munoz, Texans have a poignant and cruel example of the clash between the ideals of a law — in this case, to protect a human life at all costs — and their practical application. Disturbingly, the behavior of the county-owned John Peter Smith Hospital and the reaction of anti-abortion politicians and lobbyists show just how far some Texans are willing to go to subvert a woman’s control over her own body. 

When Erick Munoz found his wife unconscious on the floor of their house, struck by an apparent blood clot, he, himself a paramedic, knew how to act. Marlise Munoz was quickly taken to the hospital, where she was placed on life support. 

Erick Munoz told the court that doctors told him his wife “was for all purposes brain-dead” and that she had “lost all activity in her brain stem.” In all 50 states, being declared brain-dead is tantamount to being declared dead. 

The fetus that the technically-dead Marlise Munoz was carrying had been harmed by the mother’s fall. According to Munoz’s attorneys, the fetus was described by doctors as “distinctly abnormal” and had a severely deformed lower torso. 

Knowing all this, the hospital still refused to take Marlise off life support, citing the Texas Advance Directives Act. 

That act states the wish of a woman to be taken off life support is invalidated if that woman has been “diagnosed as pregnant.” 

Never mind that this law invalidates advance directives in a gender-biased way and fails to specify what trimester of pregnancy a woman must be in to fall under the statute. (Under the present law, a woman at any point in her pregnancy, no matter how young the fetus, would be kept on life support until the 23-week point of viability.) This anti-abortion law, as well as the hospital’s interpretation of it, was supported by local lawmakers.  

“My deepest sympathy goes out to the family enduring this tragedy. My heart goes out to them. But the law’s clear that you can’t withdraw life support,” state Rep. Stephanie Klick, R-Fort Worth, who represents Erick Munoz in Austin, told the Fort Worth Star-Telegram

The law, in reality, is anything but clear. There is controversy in the medical ethics community over the criteria for “brain death.” The law itself does not make clear whether the pregnancy clause is applicable to a woman who is dead, even if her fetus remains alive. 

“There is controversy about the definition of brain death,” Bill Winslade, a professor of medical ethics at the University of Texas medical branch Galveston, told the Texan. “But brain death in Texas is based on the current medical criteria. It was clear Munoz was brain-dead because her body was decomposing … the [county] clerk was very clear that whatever criteria of brain death was being used, [Munoz] met them.” 

Ultimately, it was these criteria that allowed Wallace to rule that “life sustaining measures” could not be performed on a patient who was dead. On Sunday, both Marlise Munoz and her unborn child were finally allowed to die. 

Munoz’s difficulties, yes, were born out of an extremely rare and unfortunate set of circumstances, one that most women wouldn’t ever have to contemplate. But the law that put Munoz and her family in the midst of that two-month-long tragedy could affect any woman in Texas. 

It shouldn’t take extraordinary circumstances like Munoz’s for anti-abortion lawmakers to recognize that ambiguous, ill-defined laws that interfere with sound medical practice shouldn’t be on the books. Hopefully, it will take only one tragedy to convince them.