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PostPosted: Thu Jan 09, 2014 7:58 pm 
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Parents: Pregnant daughter should be removed from life support
by Jobin Panicker / WFAA.com
Posted on January 9, 2014 at 7:16 AM
Updated today at 8:04 AM

Since November 26, every heartbeat for Marlise Muñoz has been assisted by machines. Marlise was 14 weeks pregnant when she was found unconscious on her kitchen floor by her husband.

She was taken to John Peter Smith Hospital in Fort Worth, where family members said doctors suspected she suffered a pulmonary embolism, but didn't know with complete certainty.

Marlise has been on life support since that day in November, and it has been a very difficult five weeks for the family.

...more at link
http://www.kens5.com/trending/Parents-P ... 13801.html

The reason the family is so firm on the removal of the ventilator. Both are firefighter/EMT. He said that there were frequent discussions about sustained life on machines, especially in cases they were involved with.

After six weeks of this, he has gone back to work. Honestly, I have no idea how he functioning.

They think she was unconscious for about an hour before she was found. It won't be until Feb. that they can do test to even see if the fetus is viable or was injured during the period without proper blood flow.


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PostPosted: Thu Jan 09, 2014 8:09 pm 
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I can see the rationale in continuing to ventilate the dead woman in that case... to be blunt... just as an incubator for the foetus (baby). So long as the foetus is viable.

At least in the Munoz case people have accepted that the woman is dead. It is a bit weird, macabre even, to keep a dead body hanging around as a human incubator, but there is a noble motive. However, the dead woman is dead.. and nobody is fantasising about her ever springing back into life.

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PostPosted: Thu Jan 09, 2014 9:17 pm 
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I was watching the Munoz story on Jane V.M.'s show tonight. Apparently, the whole family is in agreement for removing the life support. I didn't hear any mention of her having a living will. If one has strong feelings about life support, it's vital to have one. Although I don't know if it would have made a difference in this case because of Texas law.

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PostPosted: Thu Jan 09, 2014 9:49 pm 
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After McMath Case, Battle Over Pregnant Woman Declared Brain Dead May Go To Court
January 7, 2014 10:51 PM


OAKLAND (CBS SF) — While Jahi McMath’s family achieved its goal to move her to a long-term care facility, the case of a Texas hospital refusing to take a pregnant woman declared brain dead off a ventilator may soon be decided in court.
The family of Marlise Munoz is urging a hospital to remove the brain dead adult woman off the ventilator. However, John Peter Smith Hospital in Fort Worth is refusing to do so because the woman was 14 weeks pregnant at the time of her admission, citing a Texas state law that prevents them from stopping “life-sustaining treatment” to pregnant patients.

read more: http://sanfrancisco.cbslocal.com/2014/0 ... -to-court/

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PostPosted: Thu Jan 09, 2014 10:02 pm 
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At Issue in 2 Wrenching Cases: What to Do After the Brain Dies
By BENEDICT CAREY and DENISE GRADYJAN. 9, 2014

In one way, the cases are polar opposites: the parents of Jahi McMath in Oakland, Calif., have fought to keep their daughter connected to a ventilator, while the parents and husband of Marlise Muñoz in Fort Worth, Tex., want desperately to turn the machine off. In another way, the cases are identical: both families have been shocked to learn that a loved one was declared brain-dead — and that hospital officials defied the family’s wishes for treatment.

Their wrenching stories raise questions about how brain death is determined, and who has the right to decide how such patients are treated.

“These cases are quite different from those we’ve known in the past,” like Karen Ann Quinlan, Nancy Cruzan or Terri Schiavo, said Dr. Joseph J. Fins, director of the medical ethics division at NewYork-Presbyterian/Weill Cornell hospital. He explained: “Those patients could all breathe without a ventilator. They were in a vegetative state, not brain-dead, and that distinction makes all the difference.”

Read more: http://www.nytimes.com/2014/01/10/healt ... ef=us&_r=0


Rumpole posted this fascinating article in the Jahi McMath thread, but I wanted to also post it here for those not following both cases.

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PostPosted: Fri Jan 10, 2014 12:56 am 
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I'll continue to post some stories in both threads.

Ethicists criticize treatment of brain-dead patients
Liz Szabo, USA TODAY 10:17 p.m. EST January 9, 2014

Brain death raises ethical issues.

The cases of two young women — a California teen and a pregnant Texas mother — have generated sympathy for their families, but also have left some doctors and bioethicists upset about their treatment.

Many doctors are questioning continued medical procedures on a 13-year-old girl declared brain-dead nearly one month ago, calling interventions to provide nutrition to a dead body unethical.

Many people around the country also have questioned the decision of a Texas hospital to refuse to remove a pregnant woman from a ventilator, although her husband says she is brain dead. Her husband has asked for his wife to be taken off a breathing machine. The hospital, John Peter Smith Hospital in Forth Worth, has not commented publicly on her condition.

...more at link
http://www.usatoday.com/story/news/nati ... s/4394173/

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PostPosted: Fri Jan 10, 2014 12:01 pm 
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The hospital did make a statement of sorts. They said they would not violate Texas law which states that there is nothing to be done with the mother, i.e. unhook ventilator, because of the harm it would cause to the fetus. They have acknowledged that Ms. Munoz has suffered brain death.

There was a case similar overseas that involved a pregnant woman. IIRC, she was further along and at about 32 weeks, the mother/baby's heart rate began to sink so they did a caesarian on the mother and delivered her 3 lb. baby. No names were disclosed. Seems like it was in the Daily Snail.


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PostPosted: Fri Jan 10, 2014 12:54 pm 
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I don't see anything wrong with trying to give the fetus the gift of life. I have no doubt if possible to ask the mother, she would willingly be an incubator for her baby. What's the rush to kill the fetus off? Are there inheritance issues here?


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PostPosted: Fri Jan 10, 2014 3:07 pm 
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The fetus was in it's 14th week when Marlise collapsed at home in November. According to the articles I've read, there seems to be great concern as to the health of the fetus. (I don't know if they have other motives i.e. inheritance, etc.)

From Salon.com: http://www.salon.com/2014/01/08/when_an ... ns_rights/

"Munoz may have been unconscious for up to an hour before her husband, Erick, the father of their 15-month-old son, discovered her – a situation that may have caused untold damage to the fetus. “We know there’s a heartbeat, but that’s all we know,” he says. The fetus is now in its 20th week, and the family claim the hospital doctors have said they will “make a decision about what to do with the fetus as it reached 22 to 24 weeks,” and that they have discussed whether Munoz will be able to carry the baby to full term for a cesarean."

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PostPosted: Fri Jan 10, 2014 5:23 pm 
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Obviously she's in no condition to consent to a cesarean, but what if her husband doesn't consent, either?

Do they get to tell him "Tough, we're cutting her open anyway."?

If she's already dead by virtue of being brain dead, and they can't pass off the cesarean as part of an autopsy, does that violate any laws against desecrating a corpse?

The Salon article doesn't say anything one way or the other about whether the coroner's office down there has issued a death certificate for her or not, so that adds another wrinkle.

And I wonder, what if they'd gotten to her sooner, but attempts to revive her, like CPR, or shocking her with the paddles to get the heart going again, or administering certain drugs, were likely to be extremely dangerous, or even fatal, to the fetus?

Would it be legal down there to increase the danger to her to decrease the danger to it?

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PostPosted: Fri Jan 10, 2014 5:43 pm 
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Yes Unitron... the situation inspires several ethical questions... I guess opinion will be divided on them all. It does also bring the whole abortion debate into play. When is a foetus a human being?

Talking off the top of my head.... if the foetus is "viable" (likely to develop into a live child) then I would err on the side of saving it. At least the "mothers rights to decide on what happens to, and within, her own body" are not in play. IANAL and several laws may apply, but....I think there is precedent for "The State" to have the right to mess about with a dead body... mandatory autopsies, exhumations etc. Bodies are used for research, medical training etc. So... I think the State could "use the body" as an incubator, to keep the foetus alive, if it is in fact designated as an individual in its own right?

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PostPosted: Fri Jan 10, 2014 9:30 pm 
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The Salon article says

"Texas, along with a harrowing 30 other states, has “laws restricting the ability of doctors to end life support for terminally ill pregnant women, regardless of the wishes of the patient or the family.” "

I wonder if the law actually says "terminally ill".

She's beyond terminally ill. She's already reached that terminus. She's dead enough that if not pregnant they could have harvested organs for transplant back when this started.

How long until they back things up enough they can say the brain dead woman "might" be pregnant and force the machines to stay connected for a few weeks "just in case" until it becomes obvious that she's not?

Is every brain dead woman going to have to have an ultrasound done on them before they pull the plug?

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PostPosted: Fri Jan 10, 2014 9:43 pm 
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I know the "ramifications" lead in many bizarre directions, but.....

Sticking to this case, and the current situation....

One could look upon it as the ENTIRE BODY has been "organ harvested" to provide an incubator.

We have an incubator and a foetus (premature baby).

I am not having any problems being on the side of "the unborn child" here... and I avoid the abortion debate normally. :)

This is NOT the first case where a brain dead pregnant woman has been kept on ventilation for the sake of an unborn child... (I can't recall details, but have heard of this before) but such instances are rare. I don't see this case setting any precedents and leading to lots of similar cases.

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PostPosted: Sat Jan 11, 2014 3:56 pm 
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It's not the first time they've kept the mother's body alive for the sake of the fetus, but it's the first time I've heard of that it wasn't done with the consent, if not at the urging, of the husband/father, and I'm pretty sure it was done later in the pregnancy as well.

And I'm curious as to whether the state plans to pick up the medical tab or if they're going to essentially say to the family "We get to force you to buy these medical procedures", which makes the "ObamaCare" debate a bit more interesting and involved.

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PostPosted: Sat Jan 11, 2014 4:14 pm 
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I still don't have a problem :)
(And I am very much anti State interference in people's lives.)

I see in this instance the State acting in the interest of the foetus (baby)... and protection of the lives (and freedoms) of individuals is one of the few legitimate roles of the State. You can not get a much more "vulnerable" individual than an unborn child. "Consent" as to what happens to the mother is not relevant. She is dead. I do agree that what ever is done to the body is no longer a medical matter in regards to her, but it may well be a "medical matter" in regards to the foetus... which I guess must be regarded as a "ward of the State"

Medical costs may well be an issue? But I think not. I begrudge almost every dollar of my taxes that the government spends... but quite happy to pay for this lot. The foetus is not in a possition to sign up for medical insurance.. either private or Obamacare. I guess there could be an argument that a live foetus(baby) is covered by whatever insurance covered the (now dead) mother? Lawyers can argue who pays... later maybe??

(Always provided that tests show that the foetus is "viable" and that there is a least a good chance of "saving a life"

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PostPosted: Tue Jan 14, 2014 4:43 pm 
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Pregnant, brain-dead woman's husband sues hospital

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A lawsuit asks a judge to order a hospital in Fort Worth, Texas, to remove life support for Marlise Munoz, who fell unconscious in November while pregnant.

DALLAS — The husband of a brain-dead, pregnant Texas woman on Tuesday sued the hospital keeping her on life support, saying doctors are doing so against her and her family's wishes.

The lawsuit filed in state district court asks a judge to order John Peter Smith Hospital in Fort Worth to remove life support for Marlise Munoz, a North Texas woman who was 14 weeks pregnant when her husband found her unconscious on Nov. 26. Her family says the exact cause of her condition isn't known, though a pulmonary embolism is a possibility.

The hospital has said a state law prohibits life-saving treatment from being denied to pregnant patients.

Erick Munoz said a doctor told him his wife is considered brain-dead. He says that he and his wife, who are both paramedics, are very familiar with end-of-life issues and that she has made it clear to him that she would not want life support in this kind of situation. Marlise Munoz's parents agree.

Experts familiar with the Texas law say the hospital is incorrectly applying the statute because Munoz would be considered legally and medically dead.

"Marlise Munoz is dead, and she gave clear instructions to her husband and family — Marlise was not to remain on any type of artificial 'life sustaining treatment', ventilators or the like," the lawsuit said. "There is no reason JPS should be allowed to continue treatment on Marlise Munoz's dead body, and this Court should order JPS to immediately discontinue such."

Erick Munoz's lawyers, Heather King and Jessica Hall Janicek, also asked for an expedited answer from the court. No hearing was immediately scheduled.
[...]

In refusing to take Marlise Munoz off life support, the hospital has cited a provision of the Texas Advance Directives Act that reads: "A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient."

Experts interviewed by The Associated Press, including two who helped draft the legislation, said a brain-dead patient's case wouldn't be covered by the law.

...more at link
http://news.msn.com/us/pregnant-brain-d ... s-hospital

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PostPosted: Tue Jan 14, 2014 4:53 pm 
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I am still of the view that while there is a chance that the foetus is viable... then that life is what is at issue.

I agree... the woman is dead... and so the issue become can the State take possession of a corpse, for whatever purpose... and IMO they can. In this case they are using the corpse as a temporary incubator.. sounds a bit ghoulish... but that is what it amounts to. And IF the foetus is viable, then they may well want to use the corpse-incubator for a few months. I think the State (medical community) are bound to do all they can to sustain a human life... using a mechanical incubator would not raise too many complaints I think. Using a corpse is an odd situation.. but then human corpses are used in Medical research and education ... so why not also use a corpse as a part of Medical treatment?

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PostPosted: Wed Jan 15, 2014 12:18 am 
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Court Documents filed 1/14/2014:

Petition for declaratory judgment and application for unopposed expedited relief
https://docs.google.com/viewer?url=http ... hrome=true



Plantiff's motion to compel defendants to remove Marlise Munoz from "life sustaining" measures and application for expedited relief
https://docs.google.com/viewer?url=http ... hrome=true

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PostPosted: Thu Jan 16, 2014 3:27 pm 
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Defining "Brain Dead" with some reference to both recent cases.....


Lights Out: A New Reckoning for Brain Death
Posted by Gary Greenberg
January 15, 2014

“Brain death” was introduced to the world, in 1968, by a committee at Harvard Medical School. “Responsible medical opinion,” the committee reported, “is ready to adopt new criteria for pronouncing death to have occurred in an individual sustaining irreversible coma as a result of permanent brain damage.” People on ventilators in intensive care units, their brains destroyed by trauma or disease, their hearts still going strong, may have been breathing, taking in nourishment, excreting waste, and healing from infection, but, at least in the opinion of doctors, they were dead—“heart-beating cadavers,” as bioethicists came to call them. Thirteen years later, the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research endorsed this opinion, recommending that all states adopt statutes to give doctors the right to pronounce brain-dead people legally deceased. Today, in every state, if your brain, including the brain stem, has been irreversibly and completely destroyed, you are dead.
[....]

Each case is heartbreaking in its own way. In California, a thirteen-year-old girl, Jahi McMath, hemorrhaged after throat surgery performed at Oakland Children’s Hospital on December 9th. Blood loss deprived her brain of oxygen, and she lapsed into a coma. On December 11th, her doctor called the neurologist Robin Shanahan to determine, as the attending physician put it to the court, “whether or not Ms. McMath had sustained an irreversible cessation of all functions of the entire brain.” Shanahan detected no brain activity. On December 12th, McMath was declared dead, and a death certificate was issued.

While the families of the brain-dead usually take doctors at their word, or at least accept that their loved one’s life is over, something went wrong; both the hospital and the family lawyered up. The hospital portrayed the family as ignorant. “There is absolutely no medical possibility that Ms. McMath’s condition is reversible or that she will someday recover from death,” Shanahan told the California Superior Court. Meanwhile, experts consulted by the McMaths’ legal team—who included a “forensic-intelligence analyst,” an Ohio doctor who concluded that the teen-ager was reacting to the presence of her family and thus could not be dead, along with a lawyer known for his opposition to California’s malpractice laws—insisted that Oakland Children’s had misdiagnosed her.
[...]

In the Texas case, the roles of the family and hospital were reversed. Shortly before Thanksgiving, thirty-three-year-old Marlise Machado Muñoz got out of bed to check on her crying child in the middle of the night. Her husband, Erick Muñoz, a paramedic, got up and discovered her on their kitchen floor, unconscious and not breathing. She had been there at least an hour, and neither his attempts nor those of emergency-room personnel could revive her. At John Peter Smith Hospital, in Fort Worth, her heart stopped beating, multiple times. The family, in accordance with her wishes, told the staff not to make further resuscitation attempts, but was informed that the hospital could not comply: she was fourteen weeks pregnant, and Texas law forbids withdrawing or withholding life support from a pregnant woman until the fetus is viable and can be delivered. Later, according to Erick Muñoz, doctors told him his wife was brain-dead, but would be kept on the machines for at least another twelve weeks.
[....]

Our sense that a body is not dead until it is still and cold may be uninformed and unscientific, but so is our sense that the sun moves across the sky from east to west, and most of us live our lives as if this were the case. Of course, you can’t plan a rocket trip to the moon based on that understanding of heavenly movement, and you can’t harvest organs from a body based on our instinctual understanding of death. The concept of brain death has its uses; organ transplants save many lives. But it has its limits, too, as these cases show, chief among them the fact that it is a concept dreamed up by humans in their quest to overcome suffering, one that can have difficulty standing up to the power of love and the implacable mysteries of death.

Gary Greenberg is a practicing psychotherapist and the author of “The Book of Woe: The DSM and the Unmaking of Psychiatry.”

...more at link
http://www.newyorker.com/online/blogs/e ... death.html

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PostPosted: Sat Jan 18, 2014 2:59 am 
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Texas Judge Recuses Herself From Life Support Pregnancy Case
Jan 17.2014
By SYDNEY LUPKIN

A Texas judge has recused herself from hearing a lawsuit against a Fort Worth hospital regarding a woman who is brain dead, pregnant and on life support against her family's wishes.

Judge Melody Wilkinson of Tarrant County District Court recused herself on Thursday but did not give a reason for her recusal. She requested to have another judge assigned to the case.

The family of Marlise Munoz sued John Peter Smith Hospital on Tuesday, in order to have Munoz removed from life support.

...more at link
http://abcnews.go.com/Health/texas-judg ... d=21571700

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