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Advance Health Care Directives: Marlise Munoz Story

On Behalf of | Feb 20, 2014 | Advance Health Care Directive

Advance Health Care Directives likely would have helped poor Marlise Munoz.

Brain Death and Pregnancy – the Marlise Munoz Story

Thirty-three year old Texan, Marlise Munoz, who was kept alive by a ventilator for over a month in John Peter Smith Hospital, was taken off of life support on January 26, 2014. In November, she collapsed at home as the result of what doctors believe to be a pulmonary embolism. While Marlise’s husband, Erick, administered CPR until emergency responders arrived, Marlise tragically, suffered brain death. Marlise, who is an EMT herself, reportedly told her family that she would never want to be kept alive by a ventilator. It would seem that her wishes are clear, despite the fact that she never executed a living will or other advance directive. However, doctors refused to take Marlise off of the ventilator. Why? Marlise was pregnant and, according to the hospital’s interpretation of Texas’ law on advance directives, a pregnant woman cannot taken off of life support.

Unfortunately, Marlise became one of extraordinarily few individuals to suffer the unique situation of being brain dead and pregnant. Like the case of Jahi McMath discussed in a previous blog, there was no question that Marlise’s brain was no longer functioning. In accordance with the definition set forth in the Uniform Determination of Death Act, Marlise had suffered “irreversible cessation of all functions of the entire brain, including the brain stem” and, as such, is dead. The debate in Marlise’s case, unlike the debate in Jahi’s case, was not whether she is alive or dead. The debate was this: Even if Marlise is legally dead, can she be kept alive because she is pregnant?

The statute relied on by the hospital to keep Marlise on a ventilator is a provision of the Texas Advance Directives Act, which states the following:

“Section 166.049. PREGNANT PATIENTS. A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient.”

The hospital argued that this provision prevents them from withdrawing or withholding life sustaining treatment (i.e.: a ventilator) from an individual who is pregnant.

On the other side of the coin, according to an article published by ABC news and the Associated Press (, two drafters of the statute said the law is not applicable in these circumstances. Their explanation of the law is that Marlise was not in an end-stage medical condition. Marlise, they argue, was not terminally ill or irreversibly ill or even ill at all. She is dead, they say, and thus her case does not fall within the confines of the Texas Advance Directives Act.

This case was highly emotional and has sparked strong rhetoric on both sides of the political aisle. Pro-life and pro-choice groups alike voiced their strong opinions on the case, the former lobbied to keep Marlise alive through mechanical means to protect her baby’s life, the latter fought to have Marlise’s wishes respected and allow her to die naturally.

Marlise’s life hung in limbo while two sides debated how to interpret a deceptively simple law. The law gives us no clear answer as to who is right. There are two completely valid, supported and compelling arguments. On the one hand, Marlise Munoz’s wishes were clear and they should be respected. On the other hand, Marlise’s unborn child is reportedly healthy and growing inside her. What should the hospital do?

Admittedly, this blog post seems to ask more questions than it answers. Marlise’s case provides important insight to the fact that the law is always subject to interpretation, and that circumstances arise that no one could possibly foresee. Is there anything Marlise could have done to prevent this situation? Certainly, hindsight is 20/20. Marlise could have prepared an advance directive that clearly specified her wishes in the very rare circumstance she became brain dead while pregnant. It is unlikely that thought even crossed her mind. Marlise’s case teaches us that we can never hope to plan for every possible situation, but nonetheless it is absolutely critical that we do plan ahead. Imagine how trying this would be if Marlise hadn’t expressed her wishes to her family!

Advance health care directives are an incredible tool. While, as we have seen, they can’t account for everything, they certainly provide for most situations. They allow you to make the tough decisions for your family, which makes an incredibly heart wrenching situation just a little easier for them to bear. If you have questions about living wills or advanced health care directives, contact the estate planning attorneys at McMorrow Law, LLC at 724-940-0100.