Texas hospital removes pregnant woman from ventilator after court order

BMJ 2014; 348 doi: (Published 28 January 2014) Cite this as: BMJ 2014;348:g1194
  1. Michael McCarthy
  1. 1Seattle

A Texas hospital that had refused to remove a brain dead woman from a ventilator despite her family’s wishes because she was pregnant complied with a court order on 26 January and halted life support.

Marlise Muñoz, a 33 year old mother of one, had been found unconscious and without a pulse by her husband, Erick Muñoz, at their home on 26 November. It is thought that she had a pulmonary embolism. At the time she was 14 weeks pregnant.

Her husband, a paramedic, called for an ambulance and began cardiopulmonary resuscitation. Ms Muñoz was taken to John Peter Smith Hospital in Fort Worth, Texas, where she was put on life support.1 2

Although doctors determined that she was brain dead, the hospital refused the family’s request that it withdraw life support. The hospital cited a Texas statute stating that providers can ignore a woman’s advance directive and her surrogates’ requests to halt life sustaining treatment if the woman is pregnant.

Her family said that Ms Muñoz, who was also a paramedic, had said that she would not have wanted such treatment. Her husband said in a television interview, “We were both paramedics, we’ve seen things out in the field, and we both knew we didn’t want to be put on life support.”

The family took the case to the Tarrant County District Court, arguing that the Texas statute applied only to living patients and not the dead. In an order issued Friday 24 January, Judge R H Wallace agreed and gave the hospital until 5 pm Monday to comply with the family’s wishes.

On Sunday the hospital issued a statement announcing that it would take Ms Muñoz off the ventilator. It said, “The past eight weeks have been difficult for the Muñoz family, the caregivers and the entire Tarrant County community, which found itself involved in a sad situation. JPS Health Network has followed what we believed were the demands of a state statute. From the onset, JPS has said its role was not to make nor contest law but to follow it.”

Antiabortion groups had supported the hospital’s initial decision, arguing that the preservation of the life of the fetus was paramount. The antiabortion group Texas Right to Life denounced Wallace’s decision in a statement that read, “Regrettably, no one was representing the interests or wellbeing of the baby, nor did the judge take time to explore the medical information or the diagnosis of brain death on the record. While we grieve for the family, we grieve also that justice seemed absent in the courtroom today.”

The family’s attorneys said that medical records released to them by the hospital last week indicated that the fetus was “distinctly abnormal,” with underdeveloped lower extremities, hydrocephalus, and a possible heart defect.

Abortion rights advocates said that the hospital’s initial decision had reduced Ms Muñoz to a mere incubator. “This terrible tragedy has shown that there are consequences when politicians interfere in the personal medical decisions of families,” said Heather Busby, executive director of NARAL Pro-Choice Texas. She added that laws allowing health providers to ignore the advance directive of pregnant women went against a woman’s legal rights.


Cite this as: BMJ 2014;348:g1194