Court Orders Vent Removed From Brain-Dead Pregnant Woman

A Texas judge has ordered a hospital to remove Marlise Munoz, a brain-dead pregnant woman, from mechanical ventilation. Munoz was being kept ventilated against her husband's, her parents' and her own previously-expressed wishes because the hospital believed it was legally obligated to provide life-support to her fetus under the Texas Advance Directives Act. The Act prohibits removal of "life support" from any pregnant "patient." The court found that the Act did not apply to persons who are legally dead. The court's order is here. The parties' stipulation of facts, including that Munoz is brain dead and that her fetus is not currently viable, is here.  Munoz's husband filed an affidavit with the court, describing his wife as rigid-limbed, smelling of death, and having a soulless look in her eyes. His attorneys had earlier described the fetus as developing abnormally, and today in court accused the hospital of using Marlise Munoz as "a science experiment" and as a "dysfunctional incubator."

The hospital, which has until Monday at 5pm to comply with the order or file an appeal, is considering its options.

Earlier posts on the Munoz matter are here, here and here.

Bioethics Poetry: Peter Everwine Edition

At the Playground, Singing for Psychiatric Outpatients

The bright-faced children have gone home,

trailing the sun to supper.

                   Tonight,

these others have come,

almost sweetly shy, starched

for their monthly party.

Nurse herds them into metal chairs.

I've come to sing, Nurse tells them,

and they fold their hands

--these lately mad who failed behind a door

or slipped under in a jammed street,

whose eyes blossomed like silver

fists in mirrors, in plate-glass windows.

Nurse is waiting for me.

So I sing for them,

                    for the boy

in the front row, groping

the stiff corners of his pockets;

for the ugly one in pink anklets

--her legs have never felt a razor,

though her wrist has; for him

whose fingers are eaten by ants; for her

whose face sags like a torn sack.

They do not like my songs,

but infinitely polite, they turn

their smiles up into the dark

as if a smile should fall softly, 

obliquely, like rain.

"Home on the Range," Nurse calls out,

her sure fingers on the pulse of America.

I start in faltering voice,

half-forgetting those dead words

sung at campfires in the past.

One joins, and then another:

Home, home on the range. . .

Where the deer. . .

And the skies are. . .

The voices crack and lurch, we

are singing--the boy, the ugly one--

singing like crows in the empty

prairie of a children's playground 

where if there are distances that shine 

they shine like the eyes of pain.

Peter Everwine

Friday Frivolity: Nursing Realism Edition

Ventilating the Dead, Continued

Though she is brain-dead, Marlise Munoz is being kept ventilated against her husband's, her parents', and her own previously-expressed wishes. The Texas hospital where she is being kept argues that this course of action may be required by the Texas Advance Directives Act, which makes it illegal to disconnect any "patient" from "life-support"--if that patient is pregnant. Munoz was 14 weeks pregnant when she died; her fetus is now 22 weeks old. A hearing tomorrow should determine whether ventilation of the dead counts as "life support" under the Act, and whether a dead person is a "patient." Meanwhile, her husband's attorneys point out that the fetus suffered from the same lack of oxygen that destroyed Munoz's brain:

"According to the medical records we have been provided, the fetus is distinctly abnormal," the attorneys said. "Even at this early stage, the lower extremities are deformed to the extent that the gender cannot be determined." The attorneys said the fetus also has fluid building up inside the skull and possibly has a heart problem.

"Quite sadly, this information is not surprising due to the fact that the fetus, after being deprived of oxygen for an indeterminate length of time, is gestating within a dead and deteriorating body, as a horrified family looks on in absolute anguish, distress and sadness," the attorneys said.

 Previous posts on Munoz here and here.

 

Attention: Your $1000 Genome Has Arrived

With the unveiling by Illumina of its Hi Seq X combination of machines yesterday, we've now got the technology to sequence a human genome for $1000. The $1000 genome has been an industry goal for some years now, and seemed tantalizingly close last year. But now, it seems, it's arrived. Sequencing at that price level (the current level is $10,000) will, of course, make sequencing much more common. Goodbye, genetic privacy. Hello, debates about data control and access. Everyone better go read the Presidential Commission for the Study of Bioethical Issues's new report on incidental findings. We're going to have quite a few.

India Eradicates Polio

Monday marked India's third year without any new polio cases, so the country will soon be WHO-certified as having eradicated the disease. Meanwhile, in neighboring Pakistan, where the disease is still rampant, Taliban are executing vaccinators as possible spies. This is apparently because the US used a fake vaccination program as cover for its search for Osama bin Laden. Aagh!

Ventilating the Dead: Update

The Fort Worth Star Telegram is reporting that the family of Marlise Munoz, the pregnant brain-dead woman who is being kept ventilated against the wishes of her family, will sue the John Peter Smith hospital to get her removed from the machinery.  The hospital has kept Ms. Munoz on the machinery for weeks, citing the Texas Advance Directives Act, which states that no one can withdraw or withhold "life sustaining treatment" from a pregnant patient. The crucial legal question is whether the statutory restriction can properly be applied to treatment which is not "life-sustaining," because the patient in question is dead. (Family members have said that they've been told Ms. Munoz is brain-dead, but the hospital has made no official statement confirming this.) A hospital spokesman said the hospital was "encouraged" by the lawsuit "because the courts are the appropriate venue to provide clarity, direction and resolution in this matter." That sounds to me as if the hospital's position may be wholly liability-driven, and they're just looking for the safety of a court ruling to justify stopping the mechanical intervention. On the other hand, the hospital's outside council is reportedly one Neal Adams, who led a drive to end abortions at the hospital in 1988 and serves on the advisory board of the Northeast Tarrant Right-to-Life Educational Association, so perhaps more than liability is driving the hospital's position.

Earlier post on this case and on the Jahi McMath case in California here.

Read more here: http://www.star-telegram.com/2014/01/09/5473242/family-of-pregnant-brain-dead.html?rh=1#storylink=cpy

Read more here: http://www.star-telegram.com/2014/01/09/5473242/family-of-pregnant-brain-dead.html?rh=1#storylink=cpy

New Mexico Judge Finds State Constitutional Right to Aid-in-Dying

A judge in the New Mexico Second Judicial District Court (County of Bernalillo) has found that "the liberty, safety and happiness interest of a competent, terminally ill patient to choose aid in dying is a fundamental right under [the Due Process clause of the] New Mexico Constitution." District Judge Nan G. Nash therefore found that the state's criminal law against assisting in suicide is unconstitutional insofar as it is applied to aid-in-dying for competent, terminally-ill patients. The court's order enjoins prosecution of physicians for aiding competent terminally-ill patients in dying. From the opinion:

This Court cannot envision a right more fundamental, more private or more integral to the liberty, safety and happiness of a New Mexican than the right of a competent, terminally ill patient to choose aid in dying. If decisions made in the shadow of one’s imminent death regarding how they and their loved ones will face that death are not fundamental and at the core of these constitutional guarantees, than what decisions are? As recognized by the United States Supreme Court in Cruzan “[t]he choice between life and death is a deeply personal decision of obvious and overwhelming finality.” Cruzan, 497 U.S. at 281.

The opinion in Morris v. New Mexico only affects prosecutions within Bernalillo County; it will not apply to the whole state unless it is affirmed on appeal by the state's Supreme Court.

The court explicitly declined to distinguish aid-in-dying from suicide: "Through the practice of aid in dying a physician deliberately aids the terminally ill patient in taking of his own life, bringing the practice of aid in dying within the definition of assisting suicide contained in [the criminal law]." But the court went on to find a constitutionally-protected right to suicide for competent, terminally-ill patients, and therefore invalidated the criminal law against assisted suicide insofar as it is applied to doctors assisting in the suicides of such patients.

The case was brought by the ACLU of New Mexico and Compassion & Choices on behalf of two physicians and a terminal cancer patient.