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Old 12-24-2013, 10:38 AM   Topic Starter
dirk digler dirk digler is offline
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Moral Dilemma: Wife is brain dead but pregnant

Interesting story and I am not sure what the right answer is though I tend to side with the wishes of the person over the state. I don't know...

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http://www.cnn.com/2013/12/23/health...html?hpt=hp_t2

Erick Munoz wants to see his wife's wish fulfilled this holiday season, but it's one that carries ethical and legal challenges: To be taken off of life support. Marlise Munoz, 33, is in serious condition in the intensive care unit at John Peter Smith Hospital in Fort Worth, Texas, hospital officials said.

She is unconscious and on a ventilator, her husband told CNN affiliate WFAA, but she wouldn't have wanted her life sustained by a machine.
"We talked about it. We're both paramedics," he told WFAA. "We've seen things out in the field. We both knew that we both didn't want to be on life support."

Complicating an already difficult situation is that Munoz is also pregnant, about 18 weeks along, WFAA reported. Texas state law prohibits withdrawing or withholding life-sustaining treatment from a pregnant patient, regardless of her wishes.

Patients can indicate their future wishes about medical treatment, in the event that they are unable to communicate them, through forms called advance directives. But in Texas, under the Health and Safety Code, such a form includes the provision "I understand that under Texas law this Directive has no effect if I have been diagnosed as pregnant."

Erick Munoz told WFAA doctors said his wife may have suffered a pulmonary embolism, which happens when blood clots travel to the lungs from elsewhere in the body. They do not know how long the baby went without nutrients and oxygen.

The hospital would not release specific details about Marlise Munoz's condition, but officials said the hospital would follow Texas law regarding care during pregnancy.

"We have a responsibility as a good corporate citizen here in Tarrant County to also provide the highest quality care we can for all of our patients," said J.R. Labbe, vice president of communications and community affairs for JPS Health Network, in a statement.

"But at all times, we will follow the law as it is applicable to health care in the state of Texas. And state law here says you cannot withhold or withdraw life sustaining treatment for a pregnant patient. It's that clear."

The husband and wife, both paramedics in the Tarrant County area, have a 14-month-old son named Mateo.

Erick Munoz and Marlise Munoz's mother did not immediately respond to requests for comment from CNN.

Erick Munoz found his wife unconscious on November 26, around 2 a.m. He performed CPR on her and then called 911, WFAA reported.

Since that day, the pregnant woman has been on life support, her husband said. Tests have shown that the fetus has a normal heart beat, he said. At 24 weeks, doctors may know more about when the fetus can be taken out, Munoz's family told WFAA. Doctors have also discussed the possibility of taking the fetus to full term.

He told WFAA that his wife had said she would not want to be kept alive by machine, and said he has reached "the point where you wish that your wife's body would stop."

Munoz wears his wife's pink and blue bracelets on his wrist, WFAA reported. Her wedding ring is on his pinkie.

When Munoz walks in the door, he said his son Mateo is waiting for his mother to show up.

"You can see it in his eyes," Munoz said.
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Old 12-24-2013, 10:41 AM   #2
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I can't imagine casting aside my unborn child just so I don't delay my wife's wishes in this situation.
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Old 12-24-2013, 10:47 AM   #3
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Quote:
Originally Posted by jspchief View Post
I can't imagine casting aside my unborn child just so I don't delay my wife's wishes in this situation.
Totally understand but the problem is they don't know the health of the baby\fetus.
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Old 12-25-2013, 09:43 AM   #4
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Quote:
Originally Posted by dirk digler View Post
baby\fetus.
You are correct that fetus in latin means child.
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Old 12-25-2013, 09:52 AM   #5
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Originally Posted by Cochise View Post
If the wife is already 'gone', then what's the issue really? Sure, she may have given general consent, but if you asked a mother if she would mind her body being kept alive by machines to give the baby a better chance, wouldn't all mothers say yes?

I bet you could make a legal argument that her AND agreement applied only to her own life, and that she neither could have foreseen this circumstance nor could it be presumed that she would want the baby to go with her.

It seems a bit... Off, that the husband would want to shut them both off, doesn't it? Does anyone else find that to be rather unseemly...?
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Originally Posted by HonestChieffan View Post
Unseemly as well as something terribly convenient. If you have no moral compass then choosing the easy way is not an issue. There is no consideration for the baby and giving it up for adoption if the father, or more accurate if he really would kill the baby, sperm donor?
Yep !! You guys both nailed it.
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Old 12-25-2013, 09:55 AM   #6
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Oh btw, no moral dilemma for me. Use the technology God has blessed man with to preserve life until the baby is safe to take from the womb. The mother is already with Jesus. What's the moral issue ??
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Old 12-27-2013, 04:00 PM   #7
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Quote:
Originally Posted by dirk digler View Post
Totally understand but the problem is they don't know the health of the baby\fetus.
As far as I'm concerned, on all questions, you err on the side of life. I don't even comprehend how this is a question. It doesn't compute to me that anyone could find a virtuous path from "we don't know if the health of the baby" to "we should just let it die - it's the right thing to do."
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Old 12-28-2013, 11:22 PM   #8
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Originally Posted by Taco John View Post
As far as I'm concerned, on all questions, you err on the side of life. I don't even comprehend how this is a question. It doesn't compute to me that anyone could find a virtuous path from "we don't know if the health of the baby" to "we should just let it die - it's the right thing to do."
Like I said to shrink, not everyone believes like you do. I would probably wait it out since it is only a short amount of time to find out if the baby is healthy but if my wife was 2-3 weeks pregnant, I might choose different
Quote:
When 'life support' is really 'death support'


Two young females, both brain dead without warning, remain on ventilators while their devastated families challenge the judgments of their hospitals. In one situation, the family believes a miracle is possible, and wants to prolong the patient's biological functioning. In the other case, the family wants to disconnect the patient to honor her wishes. But both families are facing obstacles.

The way we talk about neurological death has created a misperception, ethicists say: that "brain death" is somehow not as final as cardiac death, even though, by definition, it is.

The term "life support" exacerbates the problem, too, because those who are brain dead do not have a life to sustain, said Arthur Caplan, director of the Division of Medical Ethics at NYU Langone Medical Center. This seems to be a fundamental problem in both cases that have entered the national spotlight, he said.

"I think these cases have been botched, horribly," he said. "They're giving the impression that dead people can come back to life."

Brain dead, but kept alive

Here's a quick overview of the two situations:

Doctors in Oakland, California, declared Jahi McMath, 13, to be brain dead on December 12, three days after she underwent surgery to remove her tonsils, adenoids and extra sinus tissue, which doctors thought were causing sleep apnea.

She suffered complications from the procedure, which experts have told CNN is commonly done, but not routine.

A judge concluded Tuesday that Jahi is brain dead, but ruled that Jahi will remain on life support at least until December 30. The family of the teen is seeking to move her to another facility for treatment, the girl's uncle, Omari Sealy, told reporters Thursday.

Moving her would require the insertion of tracheostomy and gastrostomy tubes, family attorney Christopher Dolan said.

However, hospital Chief of Pediatrics David Durand said the judge didn't authorize a transfer to another facility.

"Children's Hospital Oakland does not believe that performing surgical procedures on the body of a deceased person is an appropriate medical practice. Children's Hospital Oakland continues to extend its wishes for peace and closure to Jahi McMath's family," Durand said.

But Jahi's mother, Nailah Winkfield, said on Friday, "I would probably need for my child's heart to stop to show me that she was dead. Her heart is still beating, so there's still life there."

In Texas, a hospital and family of a brain dead patient also clash over continuing life support, but the situation is further complicated because the woman is pregnant.

Marlise Munoz, 33, has been unresponsive since November 26, when her husband, Erick Munoz, discovered her on the kitchen floor at their home, said her mother, Lynne Machado. The family says she is being kept alive on a ventilator at John Peter Smith Hospital in Fort Worth, Texas.

Her family says she would not want her life prolonged by a machine, but Texas state law says "life-sustaining treatment" cannot be withheld from a pregnant patient, regardless of her wishes or the age of the fetus.

"At all times, we will follow the law as it is applicable to health care in the state of Texas," said J.R. Labbe, vice president of communications and community affairs for JPS Health Network, which oversees the hospital.

Life and death

These cases may make you think of Terri Schiavo, a brain-damaged woman who died in 2005 after living on a feeding tube for more than a decade. Schiavo was the subject of a lengthy legal battle between her parents and her husband, Michael Schiavo, who maintained she wouldn't have wanted to live in a "persistent vegetative state."

But "persistent vegatative state" means the brain still has some activity, even though the patient is in a deep state of unconsciousness. "Coma" is another word for this, according to the National Institutes of Health.

Both these situations are distinct from brain death -- according to the Uniform Determination of Death Act, an individual is dead when he or she "has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem."

"It seems like there seems to continue to be confusion about what it means to die using neurologic criteria," said Cynda Hylton Rushton, professor of clinical ethics at Johns Hopkins University.

Rushton suggests, in fact, that this phrase "die using neurological criteria" be used instead of "brain death," to emphasize what it means.

Terms such as "mechanical support" or "artificial machine support" could be used to refer to sustaining the functioning of a brain dead person, Caplan said.

"No one wants to take away 'life support,' " Caplan said.

Unpacking the issues

In Caplan's view, it doesn't do any families any good if hospitals ask them about mechanically continuing biological function in a brain dead patient.

He says doctors should be more transparent about the finality of brain death.

"It just creates the possibility of a terrible scenario like the one that's unfolded (in Jahi's case), where the parents don't really understand and then start to resist any removal of machines because they just want to hope that the worst possible thing did not happen," he said. "I don't think it's kind to not be clear when death happens."

In the Texas case, Caplan noted, where it's the family against a law, if Munoz is indeed brain dead, she is not, by definition, receiving "life-sustaining treatment."

It seems to Caplan that the law's intention was not to continue treating the dead.

"That the heart can continue breathing in a body like this is unnerving to people," said Kenneth Goodman, director of the Bioethics Program at the University of Miami.

One might argue that the fetus is alive, and is the one on "life support." But that opens up a lot of other issues: Will the fetus be viable? Was it damaged by the mother's lack of oxygen when she lost consciousness? Right now it is 18 weeks old; Machado said doctors will know more about its health at 22 to 24 weeks.

The Texas law in this case "imposes the view of the state on the adult pregnant woman, as to whether or not the fetus counts as a human being," Peter Singer, professor of bioethics at Princeton University, said.

Starting new dialogues

The misunderstanding surrounding cases such as Jahi's and Munoz's signals a need for a national conversation about brain death and levels of brain functioning, Caplan said.

Although there are scientific criteria for "brain death," the concept contains a moral judgment, Singer said. When viewed in connection to organ transplantation, there seems to be a value assessment that, for instance, the organs of a brain-dead person should be used to save someone else's life.

Organ transplantation and the idea of brain death have different origins, researchers argue in a 2007 paper in the Journal of Medical Ethics, but they became linked in 1963, when the first kidney transplant with a brain dead donor was performed.

Had these procedures with brain dead patients not emerged until more recent decades, in a cultural climate rife with right-to-life debates, perhaps there would have been more public discussion and controversy about the definition of "brain death," Singer said.

The public might have taken a closer look at what matters: Is it the "person," which exists by virtue of a functioning brain, or the organism?
"If you think that somehow what is precious, or what has a right to life, is simply an organism, then I suppose you might say, 'Well, this is not dead,'" he said. "This organism is still able to function. It needs medical support, but of course there's a lot of people who need medical support."

Jahi's family has said they are hoping for a miracle. Such cases also bring up the question of what is society's responsibility to accommodate requests based on faith, Rushton said.

"We really need to engage in a new dialogue that takes us out of the debate of faith into science, into a conversation about what are the limits of our human knowledge and technology, and how do we accept the fact that all of us will eventually die?" Rushton said. "These are the kinds of situations where there are no easy answers."

Medicine can't cure everything, but we act as though death is optional, she said.

We may have technology called "life support," but even that can't last forever.
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Old 12-24-2013, 10:48 AM   #9
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Old 12-24-2013, 11:00 AM   #10
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Nightmare scenario
This.
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Old 12-24-2013, 10:50 AM   #11
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It might not be the prettiest line we've ever drawn in the sand but we still do allow abortions up to 20wks. It might not be as hard a dilemma for the dad.
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Old 12-24-2013, 10:57 AM   #12
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It might not be the prettiest line we've ever drawn in the sand but we still do allow abortions up to 20wks. It might not be as hard a dilemma for the dad.
I am curious how long they would have to wait in order to deliver the baby? I am thinking several months at least. If I was the husband and felt so strongly about respecting her wishes I would move her to a different state.
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Old 12-24-2013, 11:08 AM   #13
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Originally Posted by dirk digler View Post
I am curious how long they would have to wait in order to deliver the baby? I am thinking several months at least. If I was the husband and felt so strongly about respecting her wishes I would move her to a different state.
They are pretty amazing with how early they can deliver babies these days but the developmental risks are just so huge. Think they really like making it to 6 months which isn't too far away for her. And if they're going 2 months would 2 more on top of that be too unreasonable to ask?

All around sad and it appears I should have yet another qualifying conversation with my family.
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Old 12-24-2013, 11:23 AM   #14
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And if they're going 2 months would 2 more on top of that be too unreasonable to wait
thats your opinion. The family has a different opinion. But, your and the families don't matter. Only the governments opinion matters. This is a very slippery road.
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Old 12-24-2013, 11:36 AM   #15
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thats your opinion. The family has a different opinion. But, your and the families don't matter. Only the governments opinion matters. This is a very slippery road.
I agree with all that except I don't think it's my opinion As much as I was just talking out loud. I think I would want whatever my husband needed at that point. Not that it would necessarily matter.
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