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Why You Should Care about Marlise Muñoz

Lest you think the case of Marlise Muñoz, the pregnant woman who was kept on life support against her family’s wishes, has nothing to do with infertility, think again.  CNN’s opening to their report shines a beam of light on what was really at play here, and it wasn’t the best interests of the mother:

A wrenching court fight — about who is alive, who is dead and how the presence of a fetus changes the equation — came to an end Sunday when a brain-dead, pregnant Texas woman was taken off a ventilator.

I’ve been reading about this court case with horror because any of us could be Marlise Muñoz.  An otherwise healthy woman, 14 weeks pregnant, 33 years old, collapses in her kitchen.  She is declared brain dead, but the hospital keeps her alive for two months for the sake of her unborn child.  As the LA Times reports, “The hospital says it is compelled to do so by the Texas Advance Directives Act, which says in part: ‘A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient’.”

In other words, even brain-dead, a woman in Texas can be forced to continue to gestate a fetus.

Of course, she isn’t alive to protest this treatment of her body.

Reproductive health laws have far-reaching effects: the most visible one being abortion, but the backdoor one being fertility treatments.  Instead of outlawing abortion outright, which would be illegal, tiny steps are taken to bring certain states closer and closer to that edge of outlawing abortion.  Along the way, they make restrictions that impact fertility treatments, impact embryo storage, and paint procedures with a wide brush that doesn’t take into account various situations.

If you don’t stand up to fight for all reproductive rights — even the ones that will personally never affect you since you’ve already decided what you’re willing to do on a personal level — you can’t be upset down the road when freedoms you DO want are taken away.  If you want a say over what happens to your embryos/fetuses and your body (and you want to extend that courtesy of decision making to the bodies of your daughters or sisters or mothers or friends or neighbours), you need to think hard about stories like Marlise Muñoz.  Because while the law didn’t sound that unreasonable on paper, it certainly looked unreasonable in practice.  And the only thing that changed Muñoz’s situation is that her fetus was deemed nonviable.

I said it before: “Legal wranglings are not a pu-pu platter where you can say hands-off my embryos and making decisions for me about their creation and storage but then leave women who want to choose whether or not they carry a child back on the plate.  Either your government’s hands are in your uterus or they’re not.”  I’m taking the whole meal; I will do anything to protect your rights when it comes to your body and the body of your unborn child and not give that decision-making to a state government that doesn’t need to live out the consequences of its laws on the personal level.  There are things I can believe with my heart on a personal level that I don’t need to create laws that impact other people in order to have that belief be true for me.

My heart is heavy for the Muñoz family.  I wish them a lot of comfort as they grieve the loss.

23 comments

1 Heather { 01.27.14 at 8:10 am }

Amen! He fetus has been non-viable since November when this happened, as she was barely out of the first trimester. I am appalled that the state of Texas has decided it is their responsibility to decide her fate with complete disregard to her own wishes and the wishes of her family. If she had a written medical directive would it have mattered? Or would the state of Texas disregard that as well?

At the same time it has given me pause. My husband and I both have wills and advanced medical directives that state we would not want to be kept alive in this condition but mine does not specify regarding pregnancy. Nor had we ever had a conversation about it. Honestly, I just never thought of it. And in pondering it I guess if there was a reasonable chance (not sure how to quantify reasonable though…) that the pregnancy could continue and the baby born premature, but otherwise healthy, I’d want to be kept alive. I wonder if she expressed her wishes to her family with pregnancy in mind. Either way, her husband should have been able to make a decision regarding her and her unborn fetus without the state of Texas having any hand in it whatsoever.

2 Tiara { 01.27.14 at 8:14 am }

Well said, Mel. As always, so very well said.

3 mrs spock { 01.27.14 at 8:42 am }

Most states are similar to Texas in that if you have a living will and are pregnant, the living will is considered invalid until you are no longer pregnant. Every time I have been admitted for a birth, I have been asked if I have a living will. (I am also told each time, “No one ever says yes; I can’t believe you have one!) I am then told that until the baby is out, the living will is invalid. Now, if there was a chance my child could survive intact, especially if near viability, I would want to take that, though I will tell you, after working ICU for years, it is not uncommon for the body to crash after brain death, particularly if the brain stem has been affected by the hypoxic injury. I imagine being able to make it from week 14 to 22 is a rare event.

4 LN { 01.27.14 at 8:42 am }

Sing it, sister.

5 Catwoman73 { 01.27.14 at 9:46 am }

As a current employee of a hospital, working in ICU, I can attest that written directives are often ignored once a patient becomes unable to speak for his/herself. It’s disgusting, and it’s a bit part of the reason why I can’t stand my job. We often prolong life and suffering in completely inappropriate situations. Sadly, this case didn’t surpise me in the least, and just made me shake my head. I sincerely hope that the family is finally able to find peace- I can only imagine how tough this was on them.

6 Heather { 01.27.14 at 10:08 am }

Interesting, Mrs. Spock. When went to the hospital to have my daughter I told them I had a living will, but they never said it was invalid until after she was born. I’ll have to check my state’s laws regarding that.

7 Sharon { 01.27.14 at 10:23 am }

I have been following this story with interest since a TX friend brought it to my attention and agree with what you have written here, Mel. It is a heartbreaking situation where the decisions should have been left in the hands of Ms. Munoz’s family. I can only imagine how their pain has been compounded by having this dragged out for months and by having their private suffering become a national headline.

8 Pepper { 01.27.14 at 10:48 am }

Well said. My heart is heavy for this whole family.

9 a { 01.27.14 at 11:09 am }

Amen.

10 Barb { 01.27.14 at 11:16 am }

Thank you.

11 Victoria { 01.27.14 at 11:52 am }

This is beautifully said and intelligently thought. On highly emotional issues like those around reproductive rights, I think it is so important to remember thatI am not bound to protect people’s rights to choose as I have chosen, but to choose as they choose, and only thne can I expect the samekind of respect and legal validation of my own choices. I also extendtenderness to the family of Marlise Munoz.

12 Turia { 01.27.14 at 1:09 pm }

I have been following this case with horror and have not been able to stop thinking about Margaret Atwood’s The Handmaid’s Tale. If she had been alive, she would have been able to legally get an abortion in Texas, but because she was dead, she had no choice in the matter. And how someone who is dead can be still subject to rules for patients is beyond me. To say nothing of the fact that by all accounts she stopped breathing for a significant amount of time (possibly an hour) before she was resuscitated. Why it took the authorities this long to realize the fetus would have been badly damaged is beyond me.

Terrible situation. Just terrible.

13 Meredith { 01.27.14 at 1:23 pm }

Extremely well said. I’ve been following this case and have been horrified and heartbroken for the family. It’s high time we take reproductive rights off the political agenda. This is, after all, a free country for all. Not just for the priveleged white men who sit in Washington and debate these issues and make these laws with no true perspective on the overall impact.

14 Battynurse { 01.27.14 at 7:39 pm }

I’ve been following this a lot too and it bothered me on so many different levels. When it first started and I read somewhere that they would try to keep her alive until viability and could deliver the baby around 24-28 weeks. Not term. Not that I’d want to see her kept gestating until 37+ weeks but seriously? Just because a fetus is viable at 24 weeks doesn’t mean there will automatically be a good outcome. What if the 24 week infant survived but with severe medical conditions due to being so preterm. Who is responsible for the care of that infant and the medical cost? I know that may sound a lot harsher than I mean it to but having a baby come at 24 weeks because it can’t be avoided is far different than choosing to deliver a baby at that gestation because hey the mom has been dead for 3 months. Sorry that still probably sounds bad. However when offered a choice between a loss at 14 weeks or a live infant at 24 weeks who may need constant care for its entire life, not everyone will make the same choice and I believe that is ok. Other things that bothered me was reading that her husband may be responsible for all the medical expenses even though he wanted life support withdrawn is horrible. Plus the idea that people saw the need on either side of the issue to picket their beliefs at the hospital is just cruel and selfish.

15 deathstar { 01.27.14 at 8:43 pm }

Well said, Mel. Unbelievably sad and tragic that they could have imposed those rules on a dead woman and her family. What’s the point of a living will if it will never be relied upon? Your post made me think of what Hillary Clinton said here. http://www.upworthy.com/dont-ask-hillary-clinton-about-abortion-if-you-cant-handle-her-answer
Wonder what she would think about this situation?

16 Queenie { 01.27.14 at 9:27 pm }

This case breaks my heart, on so many levels. That poor family. What an awful thing to go through. At some point, we have to step back and say “does this make sense?” And that law, as applied here, does not.

17 Laura { 01.27.14 at 9:47 pm }

The baby was the second patient. The hospital had to treat both the mother and the baby. I am grateful knowing that should I have been in an accident at 14 weeks, the hospital would have tried to see if my pregnancy/baby would still be able to survive.

18 Mommy-At-Last { 01.28.14 at 2:04 am }

As always you take my breath away with your ability to make me stop and really question my thought processes and the ultimate conclusion of them. You have really shone a light on a very sensitive and complex issue and do it in a way that is not judgemental and allows for personal thought but makes us question what is legislated and the impact of it. I too would be glad for medicine to do whatever it could to save my baby, but family would also know that and I would trust my family to make the decision for me if I couldn’t. Someone else’s decision and choice mught be different and I would hope their family would know them well enough to make the decision that was right for that person. How can some government of law ‘know’ what is ‘right’ for me.

Thank you for such a fabulous thought provoking post I can see I am going to be mulling this over all day.

19 Justine { 01.28.14 at 7:33 am }

I, like you, worry that this is part of a larger, more insidious movement to legislate and control women’s bodies. I don’t know what the equivalent would be for men, but I suspect that it wouldn’t even be a question. I feel, keenly, that we need to DO something about this. And yet, I don’t know what to do. Voting doesn’t seem to be enough. We are taking steps towards a world that looks, as Turia said, increasingly like something out of _The Handmaid’s Tale_.

20 Katie { 01.28.14 at 12:32 pm }

Very well stated. Thank you for sharing this viewpoint. I often find it difficult to contend with the fact the I consider myself “pro-choice” while battling infertility; knowing that I firmly believe it is up to a women to decide what happens to her own body, even if that means giving up a life that I so desperately am striving for.

21 Katherine A { 01.30.14 at 8:22 am }

What’s particularly unique about the Marlise Munoz case is that there’s a legitimate argument to be made that the Texas law shouldn’t have applied in the first place. Munoz was not on “life sustaining” treatment if she was in fact brain dead. Brain death is legal death. I suspect bioethics and legal people are going to be examining this case closely for years to come.

But leaving aside the technical, yes, the implication that a woman – dead or alive – can be forced to gestate a fetus very much against her known wishes is extremely frightening. This is precisely why I’m pro-choice. There are far too many gray areas to allow black-and-white laws.

One of the things that worries me about the current climate of encroaching, smaller laws on women’s rights regarding abortion is exactly what’s illustrated by this case: a huge amount of confusion among health care providers and institutions over what they can or cannot legally do in such situations. Which in turn leads to invasive legal cases or wrangling before bioethics boards when in reality, the wishes of the people involved were clearly expressed. In many scenarios, such wrangling leads to incredible, avoidable pain for the families/patients involved. In the worst case scenarios, it can result in physical harm or death (thinking, for example, of the Irish case of Savita Halappanavar). Not even to mention the loss of privacy that such a publicized case entails. I feel terrible for Munoz’s family that they’ve had to go through all of this.

Additionally, I think most of these smaller laws regulating women’s bodies are designed to test the boundaries to make way for far more restrictive measures. That’s enormously frightening as well.

22 Kathy { 01.30.14 at 8:53 am }

Mel is correct. It is all connected. Have you read about the bill (HB31) in the Alabama Senate? It is pretty scary too. https://www.aclu.org/blog/reproductive-freedom-womens-rights/alabama-hospitals-pregnant-women-sorry-honey-we-wont-help

23 loribeth { 01.30.14 at 2:20 pm }

I completely agree, Mel. I feel so awful for that poor family & all they have been through. The thought of a woman being kept on life support to try to incubate her baby (which had its own problems, apparently) made me think of “Never Let Me Go.” They knew their ultimate fate, but wasn’t there a passage about how it was rumoured they were kept on life support in a sort of state of living death, long after most people thought theyhad “completed,” while their remaining organs were harvested? :p

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