In a time when healthcare policy — and medical ethics that go hand-in-hand with it — is in constant flux, the line between legality and morality is frequently obscured.
These hues of gray shroud the tragic case of Marlise Muñoz, the 33-year-old Haltom City woman who collapsed in her home last November and remains on life support at John Peter Smith Hospital. Sadly, the case has become a dual tragedy for the Muñoz family because of a 1999 Texas law.
The law, somewhat ironically, was designed to give patients and their families broader powers when making painful end-of-life decisions — and it has in many circumstances, notwithstanding an exception that prohibits the removal of life support when a patient is pregnant.
Marlise’s body will not function without the assistance of machines that JPS says it must leave on until her baby can be delivered. This is despite the fact that Marlise’s parents and husband, Erick, say that maintaining Marlise through artificial means contradicts her expressed wishes, as well as their own.
According to the Pew Research Center, two-thirds of U.S. adults say there are sometimes circumstances in which patients should be allowed to die. But the ethics of Marlise’s circumstances are much murkier, given that her life is not the only one in the balance.
State law is unequivocal in addressing an end-of-life situation involving a pregnant woman. JPS’s application of the law, while difficult for the Muñoz family, is absolutely correct in this case.
However, this tragedy raises questions about the primacy of a family’s wishes in end-of-life decisions.
Generally, the state should have a role that is both narrow and limited and largely deferential to family and doctors. But what happens in cases that involve a second life?
Arguably, the Texas law is sufficiently narrow because it regulates not the life of the mother but that of her unborn child. Absent a mother’s ability to decide whether or not to terminate her pregnancy, the state is right to err on the side of protecting the little heart that still beats inside her.
While Marlise’s life may be over, her baby’s life may not be, and the state has a legitimate interest in protecting it.
Unfortunately, this leaves the Muñoz family in difficult circumstances, unable to honor the wishes of their loved one.
Two Southlake attorneys said Thursday they are preparing legal action on behalf of the family and will file it “soon.” Although the outcome of any litigation is far from certain, Erick Muñoz has said he hopes that in sharing his family’s story he might trigger changes to the law.
In the wake of this tragedy, effecting such a change might be the most meaningful legacy that Marlise leaves behind. Unless what she leaves behind is something far more profound, like a new life.