In Texas, a law threatens bodily autonomy

On Sunday Jan. 26, Marlise Munoz, a Texas woman who was pregnant and subsequently pronounced brain dead, was taken off life support. After weeks of controversy surrounding both her rights as well as ethics surrounding the circumstances, a judge correctly ruled that the hospital was indeed misapplying state law.According to Texas law, “A person may not withdraw or withhold life-sustaining treatment . . . from a pregnant patient.” While several states have this law in place, it is unsurprising considering Texas’ poor track record in reproductive health. The National Abortion Rights Action League gave Texas a grade of F in its 2014 reproductive rights report card, with the United States receiving an embarrassing D overall. For context, Munoz was 33 years old when her husband found her unconscious. Both she and her husband were paramedics, and her family was aware of her wish to cease life-sustaining treatment in the case of brain death. Indeed, Munoz has been medically and legally brain dead since Nov. 28, two days after she experienced what may have been a blood clot. According to her wishes as well as her family’s wishes, life-sustaining treatment should have been ceased immediately. Due to Texas’ law prohibiting the withdrawal of life-sustaining treatment, however, a living will as opposed to verbal wishes would not have overridden this. Munoz was already 14 weeks pregnant when she was pronounced brain dead. Between a lack of oxygen and life-sustaining treatment, it was initially unknown how much damage was done to the fetus. By the time her fetus was believed to be at 22 weeks, the fetus was pronounced “distinctly abnormal” and unviable outside of the womb. Arthur Caplan, director of the Division of Medical Ethics at New York University Langone Medical Center, makes an important distinction surrounding the semantics of “life support.” Certainly, according to Caplan, no one wants to end what is known as “life support,” when it is actually quite the contrary. This misconception is likely due to a common belief that brain death accompanied by a beating heart – from “life support” – indicates a hope of recovery. Brain death requires an element of irreversibility, according to federal and Texas state law. Much of the controversy involves the question of whether or not a miracle is possible, but with the legal and medical requirement of irreversibility, that is unfortunately not the case. Remaining cognizant of Munoz’s irreversible brain death, the unviable fetus and the total disregard of Munoz’s wishes as well as those of her family, it is important to consider what “life” was truly being sustained. Certainly, the judge agreed that the hospital was misinterpreting the state law. I agree with Caplan that this law – or the misreading of this law – imposes the state’s ideas surrounding personhood above her own informed and autonomous choice for her body. Since Munoz is irreversibly dead, it is not her life that was being supported. Rather, her fetus was being barely sustained at the expense of her grieving family. Though her body was being “sustained” for her fetus, I believe that it does not matter whether or not the fetus would have been viable outside of the womb. This supports the argument against life-sustaining treatment, but I do not think that is the most important aspect of this debate. Above all, Munoz’s wishes and her family’s wishes ought to be honored before her fetus, for which her body was only being “sustained” as a host at the expense of her bodily autonomy.