In Lawsuit Over Pregnant Woman’s Right To End Life, Clarity Comes In Short Supply

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Erick Munoz has asked a district judge to review the grounds on which John Peter Smith Hospital is keeping his pregnant and brain-dead wife on life-support against her family's wishes. Texas Capitol Image via Shutterstock

Erick Munoz, the husband of the brain-dead, pregnant Texas woman currently kept on life-support against her family’s wishes, has asked a judge to review the little-known statute that hospital officials say precludes their doctors and staff from honoring his wife’s Do-Not-Resuscitate order.

The complaint, which was filed Tuesday in state district court, charges that John Peter Smith Hospital in Fort Worth, Tex., has no legal right to uphold life-support for Marlise Munoz, a 33-year-old North Texas woman who suffered irreparable brain damage after she was incapacitated by what doctors believe was a blood clot on Nov. 26 last year. It further states that Marlise, who was a paramedic in life, left straight-forward instructions regarding end-of-life issues in the form of a Do-Not-Resuscitate order — a written order that basically tells physicians, doctors, and first responders that this patient doesn’t want anything to do with cardiopulmonary resuscitation (CPR).

“She gave clear instructions to her husband and family — Marlise was not to remain on any type of artificial 'life sustaining treatment', ventilators or the like," the lawsuit says. "There is no reason JPS should be allowed to continue treatment on Marlise Munoz's dead body, and this Court should order JPS to immediately discontinue such."

Right to Life, Right to Death

Here, however, is where things start to get a little murky. From a legal as well as an ethical standpoint, Marlise is not just any patient, as she was 14 weeks pregnant at the time of her hospitalization. In a state where lawmakers recently enacted what some have called the most prohibitive abortion restrictions in the nation, this is a problem.

Hospital officials claim that, under Texas end-of-life guidelines, the Do-Not-Resuscitate order on file is no good, as it is overridden by a state statute whereby pregnant patients cannot be denied life-support. In the eyes of the law, they say, Marlise is not a vegetative patient subject to her family’s wishes, but a mother-to-be protected by the Texas Advance Directives Act. "This is not a difficult decision for us,” hospital spokesperson J.R. Labbe told the Associated Press. “We are following the law."

Counsel for Munoz as well as a number of legal experts retort that, in the eyes of the law, Marlise is actually neither a pregnant woman nor a vegetative patient, but a dead body. They argue that, if the present quandary is to be reduced to a two-dimensional law school question, it follows that Marlise must assume the role she would have in a court of law: a legally dead entity. As such, she is not protected under the Texas Advance Directives Act, as the statute — like most other statutes — only applies for the living.

"This patient is neither terminally nor irreversibly ill," Dr. Robert Fine, clinical director of the office of clinical ethics and palliative care for Baylor Health Care System, told reporters last week. "Under Texas law, this patient is legally dead."

In addition, husband Erick Munoz and other critics of the hospital’s stance point to the questionable viability of the unborn fetus that is now entering its 20th week of gestation. Although doctors say they are monitoring the unborn child’s development, Erick, who is also a paramedic, is afraid his wife’s injuries may not be limited to her own body. "You know what kind of damage my wife sustained, and what kind of possible damage the baby inside her sustained," he told reporters.

An Easier Way Out

As we cede these ethical and legal issues to the state judiciary, two things seem clear. First, given the relatively staunch position of both parties, the lawsuit at hand may be the easiest way out of a situation that could otherwise get very messy very quickly. After all, both sides are trying to protect what they value over most things: the hospital is fighting for its patient care policy, and Erick is fighting for the mother of his child. A drawn-out dispute would be in no one’s interest.

Second, while the present suit may be the most sensible option, it risks pitting against each other two parties that really don’t want any trouble at all. There is a case to be made that the hospital, in refusing to pull Marlise’s life support, is not advancing an uncompromising pro-life agenda, but simply hedging itself against third-party litigants. Tom Mayo, a professor of law at Southern Methodist University, told reporters in early January that if the hospital was to honor Marlise’s Do-Not-Resuscitate order, it would itself run the risk of civil and even criminal liability under the Texas Advance Directives Act.

And if such liability would be established, the hospital could face litigation from anti-abortion activists and pro-life groups — foes with longer arms and deeper pockets than a 26-year-old single father who just wants to bury his wife, return to his 15-month-old son, and resume his life as a paramedic in North Texas.

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