'A host for a foetus': Brain dead pregnant woman kept on life support

Lynne Machado, whose daughter, Marlise Munoz, has been brain dead and on life support for more than a month, with family photos in Fort Worth, Texas. Photo: New York Times

Lynne Machado, whose daughter, Marlise Munoz, has been brain dead and on life support for more than a month, with family photos in Fort Worth, Texas. Photo: New York Times

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 in Fort Worth, Texas, and to honour 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.

Munoz was 14 weeks pregnant, the doctor said, and Texas is one of more than two dozen US states that prohibit, with varying degrees of strictness, medical officials from cutting off life support to a pregnant patient.

More than a month later, Munoz remains connected to life-support machines on the third floor of the ICU, where a medical team monitors the heartbeat of the foetus, 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 Munoz’s mother, Lynne Machado, 60. "It’s about a matter of our daughter’s wishes not being honoured by the state of Texas."

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 foetus," 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?"

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 the law.

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.

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

A spokeswoman for the JPS 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, JPS 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."

The restrictive measures were largely adopted in the 1980s, with the spread of laws authorising patients to make advance directives about end-of-life care like living wills and health care proxies, said Katharine Taylor, a lawyer and bioethicist at Drexel University in Philadelphia.

The provisions to protect foetuses, she said, helped ease the qualms of the Roman Catholic Church and others about such directives.

"These laws essentially deny women rights that are given others to direct their health care in advance and determine how they want to die," Taylor said. ‘"The law can make a woman stay alive to gestate the foetus.

"But in Texas, the law and the hospital’s efforts to abide by it have drawn support among opponents of abortion.

"The unborn child should be recognised as a separate person," said Joe Pojman, executive director of Texas Alliance for Life. He added: "I would say that, even if she were brain dead, I would favour keeping treatments going to allow the child to continue to survive, with the hope the child could be delivered alive."

Jeffrey P. Spike, professor of clinical ethics at the University of Texas medical school in Houston, said there were some known examples of foetuses having been kept alive while a terminally ill or brain dead mother was on a respirator. But in every case he knew of, he said, those steps were in line with the family’s wishes.

Marlise Munoz, her husband, Erick Munoz, and their son, Mateo, at 3 weeks old. Photo: Munoz Family/New York Times

Marlise Munoz, her husband, Erick Munoz, and their son, Mateo, at 3 weeks old. Photo: Munoz Family/New York Times

Munoz’s parents and her husband, Erick Munoz, 26, remain in limbo, even as they and other relatives help care for the Munozes’ 15-month-old son, Mateo. Erick Munoz has returned to his job as a firefighter but continues to sit by his wife’s side at the hospital.

She had been due to give birth in mid-May, but the hospital’s plans for the foetus - as well as its health and viability - remain unknown.

Ernest Machado said he had been told by the hospital’s medical team that his daughter might have gone an hour or longer without breathing before her husband woke and discovered her, a situation he believes has seriously impaired the foetus.

"We know there’s a heartbeat, but that’s all we know," he said.

Lynne Machado said the doctors had told her that they would make a decision about what to do with the foetus as it reached 22 to 24 weeks, and that they had discussed whether her daughter could carry the baby to full term to allow for a cesarean-section delivery.

"That’s very frustrating for me, especially when we have no input in the decision-making process," Ernest Machado added. "They’re prolonging our agony."

On Tuesday afternoon, in the rural community about 30 minutes outside downtown Fort Worth where they live, Ernest Machado and his wife took care of Mateo while the boy’s father was at work in Crowley, a nearby town.

As he held Mateo in his arms, Machado recalled touching his daughter’s skin as she lay in the hospital.

"She felt more like a mannequin," Machado said. "That makes it very hard for me to go up and visit. I don’t want to remember her as a rubber figure."

The New York Times