Texas hospital considers judge's order on pregnant woman

Fort Worth, Texas • Hospital executives in North Texas were conferring Saturday with the district attorney's office to determine their next step following a judge's ruling that they must disconnect life support for a pregnant, brain-dead woman, according to a hospital official.

John Peter Smith Hospital spokeswoman J.R. Labbe said "discussions are ongoing" as administrators weigh the order issued a day earlier by Judge R. H. Wallace Jr. The hospital is owned by Tarrant County and is being represented in the contentious case by the DA's office.

Wallace agreed with a request by Erick Munoz to have life support removed for his wife, Marlise Munoz. She was 14 weeks pregnant with the couple's second child when her husband found her unconscious Nov. 26, possibly due to a blood clot.

The judge's ruling could give Erick Munoz a long-awaited chance to bury his wife and move forward to care for their son and his relatives. It would also mean the fetus would never be born.

Wallace gave the Fort Worth hospital until 5 p.m. CST Monday to remove life support. Labbe declined to elaborate Saturday on what the hospital's next step might be — whether to appeal the judge's order or comply with it. The hospital previously has said it has a legal duty to protect the fetus.

Both the hospital and the family agree that Marlise Munoz meets the criteria to be considered brain-dead — which means she is dead both medically and under Texas law — and that the fetus could not be born alive this early in pregnancy. But while the hospital says it's obligated to protect the fetus, Munoz contends his wife would not have wanted to be kept in this condition. And his attorneys have said medical records show the fetus is "distinctly abnormal."

The case has raised questions about end-of-life care and whether a pregnant woman who is considered legally and medically dead should be kept on life support for the sake of a fetus. It also has gripped attention on both sides of the abortion debate, with anti-abortion groups arguing Munoz's fetus deserves a chance to be born. Several anti-abortion advocates attended Friday's hearing.

Hospital officials have said they were bound by the Texas Advance Directives Act, which prohibits withdrawal of life-sustaining treatment from a pregnant patient. But in his brief ruling, Wallace said that "Mrs. Munoz is dead," meaning that the hospital was misapplying the law. The ruling did not mention the fetus.

The hospital has not pronounced her dead and has continued to treat her over the objections of both Erick Munoz and her parents, who sat together in court Friday.

Larry Thompson, a state's attorney representing the public hospital, told the judge Friday that the hospital recognized the Munoz family's pain and rights, but said it had a greater legal responsibility to protect the fetus.

"There is a life involved, and the life is the unborn child," Thompson said.

As Wallace gave his ruling, Erick Munoz embraced his wife's parents and one of his attorneys. Munoz declined to comment as he left court Friday. But he told The Associated Press earlier this month, in a phone interview sitting in the hospital room, that he and his wife were both paramedics who knew they didn't want to stay on life support this way.

Munoz described in a signed affidavit filed Thursday what it was like to see her now: her glassy, "soulless" eyes; and the smell of her perfume replaced by what he knows to be the smell of death. He said he's tried to hold her hand but can't.

"Her limbs have become so stiff and rigid due to her deteriorating condition that now, when I move her hands, her bones crack, and her legs are nothing more than dead weight," Munoz said.

Jessica Hall Janicek and Heather King, Erick Munoz's attorneys, accused the hospital of conducting a "science experiment" and warned of the dangerous precedent her case could set, raising the specter of special ICUs for brain-dead women carrying babies.

"There is an infant, and a dead person serving as a dysfunctional incubator," King told the judge.

King and Janicek did not say what they would do next, pending a potential appeal by the hospital, and they didn't respond to phone messages left for them Saturday.

The hospital said in a statement that it "appreciates the potential impact of the consequences of the order on all parties involved" and was deciding whether to appeal.

The hospital argued in a court filing Thursday that there was little evidence of what state lawmakers and courts thought of this issue, but recent laws passed by the Republican-controlled Legislature to restrict abortion made it clear that they wanted to preserve a fetus' rights.

The Advance Directives Act "must convey legislative intent to protect the unborn child," the hospital said in its filing. "Otherwise the Legislature would have simply allowed a pregnant patient to decide to let her life, and the life of her unborn child, end."

Not much is known about fetal survival when mothers suffer brain death during pregnancy. German doctors who searched for such cases found 30 of them in nearly 30 years, according to an article published in the journal BMC Medicine in 2010.

Those mothers were further along in pregnancy — 22 weeks on average — when brain death occurred than in the Texas case. Birth results were available for 19 cases. In 12, a viable child was born. Follow-up results were available for six, all of whom developed normally.

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