Ethicist: Texas end-of-life debate must consider unborn child

Washington D.C., Jan 10, 2014 / 12:07 pm

Debate over requiring life support for a reportedly brain-dead pregnant woman should remember both the imperative not to provide excessive care and the personhood of the unborn child, a bioethicist says.

Controversy is growing over the fate of Marlise Munoz, a 33-year-old pregnant Texas woman who is being kept on life-support despite being reportedly brain-dead. Her family maintains she does not want to be on life-support in such a situation, but Texas law bars removing life-sustaining treatment for a pregnant patient until the child can be delivered.

Marie Hilliard, director of bioethics and public policy at the National Catholic Bioethics Center, told CNA Jan. 9 that we "want to give an identity to that human being, who isn't just a fetus but a grandchild."

"This might be all that a family has left of the person who has been declared brain-dead."

Ethical treatment of the unborn baby could require the life-sustaining treatment for the mother, so long as this medical treatment is not "disproportionate," "futile," or causing harm to the baby, Hilliard said, acknowledging that the pregnant woman's family is suffering "the great grief that accompanies the death or the dying of a loved one."

Munoz collapsed in November from an apparent blood clot while 14 weeks pregnant. Her doctors at John Peter Smith Hospital, a publicly funded facility in Fort Worth, are following Texas law requiring "life-sustaining treatment" for a pregnant patient until the baby can be delivered, the New York Times reports.

Munoz' parents said the hospital clearly said their daughter was brain-dead, though hospital officials have not publicly commented on her condition because they lack the family's permission.

The woman's husband and her parents said that Munoz, a paramedic and mother to a 15-month-old child in addition to her fetus, had clearly stated her desire not to be kept on life support in such an event, and that the hospital and state law are not respecting her wishes.

According to the family, physicians have said they will decide what to do with the unborn baby, now 20 weeks old, when it reaches 22 to 24 weeks into the pregnancy.

Munoz' father, Ernest Machado, told the New York Times the doctors' action was "very frustrating" and is "prolonging our agony."

"All she is is a host for a fetus," he said of his daughter.

The woman's family is planning to sue the hospital, the Fort Worth Star-Telegram reports.

Over 30 states have laws requiring life support for pregnant women, though there is debate over whether the Texas law applies to Munoz, as brain-dead persons are considered legally dead.

Hilliard, a registered nurse with a master's degree in maternal-child health nursing, noted that the woman's pregnancy complicates the degree to which a patient's wishes can be followed.

"Her wishes are about her own body. Now we have another human being involved."

Hilliard said Catholic ethics recognize total brain death as death, but she noted that it is uncertain whether Munoz is fully brain-dead, given the hospital's silence on the question.

If Munoz is in fact brain-dead, "we are now dealing with one human being who is alive, and that is the unborn child."

Ethical treatment, she explained, is "always case-specific." In this case, treatment decisions must consider whether keeping alive the body of the mother as a means of life-support is proportionate and ordinary care, which is morally required, or is "extraordinary" or "futile" care.

This moral judgment should include whether the impact of providing treatment will be excessive on the family or on the community as a whole. It should also weigh the "serious concerns about the baby's ability to live." The unborn child's health may have been compromised by oxygen deprivation.

However, if the care can be provided "proportionately" and without "undue burden" to the unborn child, the family, and the community, then it is morally required.

Hilliard warned against overuse of the word "fetus" to describe the unborn child. Although this is a "technically accurate" description, in practice it "denies the humanity of the unborn child."

She also defended the law requiring life-sustaining treatment for pregnant women, saying such laws "protect the identity and the rights of the unborn child."

Arguments that the law denies self-determination to women ignore "that there are already two human beings present."

Hilliard added that the community should help Munoz' family deal with their grieving, and with the awareness of the unborn child.