Fort Worth

Muñoz family sues to remove life support

The family of Marlise Machado Muñoz, the pregnant Haltom City woman being kept alive at John Peter Smith Hospital against her family’s wishes, filed a lawsuit on Tuesday challenging the constitutionality of the state law that prevents them from removing life support.

The family wants the court to issue an order requiring JPS to immediately cease conducting any further medical procedures, remove Marlise Muñoz from any respirators, ventilators or other “life support” and release her body to the family for proper preservation and burial.

Marlise Muñoz, 33, has been hospitalized since just before Thanksgiving after she was stricken by a pulmonary embolism, when she was 14 weeks pregnant. After doctors reportedly told the family that she was considered to be brain dead, the family asked that life support be removed.

JPS doctors, however, would not allow the family to do so, quoting an obscure and some say confusing Texas law that requires pregnant women to be kept on life support until there is a viable fetus, usually at 24 to 26 weeks. On Monday, Marlise Muñoz entered her 21st week of pregnancy.

Erick Muñoz, Marlise’s husband, has said that leaving her on life support violates his wife’s wishes. The couple also has a 14-month-old son.

“Erick Muñoz vehemently opposes any further medical treatment to be undertaken on the deceased body of his wife,” states the lawsuit filed in Tarrant County civil court by attorneys Heather King and Jessica Janicek. “Marlise Muñoz is legally dead, and to further conduct surgical procedures on a deceased body is nothing short of outrageous.”

The county-owned hospital in Fort Worth has said its hands are tied by the 1999 Texas Advance Directives Act and that the courts are the proper venue to provide clarity and direction in the matter. It referred queries about the lawsuit to the Tarrant County District Attorney’s office, which will defend it in court.

Melody McDonald, a spokeswoman for the district attorney, said the office does not comment on pending litigation.

The lawsuit is scheduled to be heard in state District Judge Melody Wilkinson’s court. No hearing date had been set by late Tuesday afternoon and calls to the court coordinator by the Star-Telegram were not returned.

Constitutional issues

Erick Muñoz, a paramedic for the Crowley Fire Department, said he awoke about 2 a.m. on Nov. 26 to find his wife unconscious on the kitchen floor. He immediately began providing cardio pulmonary resuscitation and called 911, the lawsuit states.

After she arrived at JPS, doctors informed Erik Muñoz that Marlise had lost all activity in her brain stem and her husband saw a medical chart indicating in writing that she was “brain dead.” Since the family had not signed releases, JPS has declined to discuss his wife’s medical condition.

Erick said he and his wife — who was a paramedic with Children’s Medical Center of Dallas — had discussed removing life support if either fell into a vegetative state. With the support of her parents, Erick Muñoz asked the doctors to end “life-sustaining” treatment.

JPS doctors refused to do so.

The Muñoz’s attorneys argue that the hospital is misconstruing the Texas Health and Safety Code by failing to read the relevant sections in conjunction with the entirety of the code.

First, they argue that when you apply one section of the code, Marlise Muñoz would be considered already dead because “there is irreversible cessation of the person’s spontaneous respiratory and circulatory functions.” So JPS would not be removing life-sustaining treatment.

“Marlise cannot possibly be a ‘pregnant patient’ — Marlise is dead,” the lawsuit states.

The lawsuit also argues that even if JPS was to argue that the health code applies to Marlise Muñoz, the advance directive act does not extend the prohibition of withholding or withdrawing life-sustaining support to the unborn child.

Finally, the attorneys argue that the section of the health code that says “a person may not withdraw or withhold life-sustaining treatment … from a pregnant patient” violates Marlise Muñoz’s Fourteenth Amendment’s right to privacy with regard to making decisions about their own body and equal protection under the law.

Marlise Muñoz was competent when she made her medical directives known to her husband and parents, even if those decisions “affect at some point of the gestation period,” the lawsuit says.

On its face, the code violates the equal protection clause because it “treats pregnant women … different from everyone else,” and because Marlise Muñoz was pregnant when she died they are treating her differently then they would anyone else in this unfortunate position, the lawsuit states.

“Any claim by John Peter Smith Hospital that it can ignore the requests of Erick and Marlise’s family and continue conducting medical procedures on Marlise’s body is factually and legally groundless.”

Lawsuit reaction

The Muñoz family’s predicament has led to regional and national media exposure, which has encouraged commentary from medical ethics experts as well as right-to-life groups.

Arthur Caplan, director of medical ethics at New York University’s Langone Medical Center, said he has studied the lawsuit, although he is not a consultant in the Munoz case.

Caplan criticized the state’s advance directives law, saying it does not take facts and circumstances into account.

“The law is a bad law. It doesn’t give enough discretion for facts that come up in situations,” Caplan said. “This family seems to be in agreement that this mom would not want to have this baby under these circumstances.

“I think the husband and the family are in a much better position to think about all of the details and nuances regarding the fetus than the Texas Legislature,” he said.

Last week, Texas Right to Life issued a statement saying that there are “two patients who must be considered.” The group said that the term “brain dead” is often misused and that the criteria for determining it will vary among doctors and hospitals.

“Based on the information made public, Mrs. Munoz is not experiencing multi-system organ failure or cell disintegration, and her body is supporting the growth of the child within her — all signs to indicate that her brain, though impaired or quiescent, is still ordering her physiological functions at some level.”

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