Medic fights Texas life support law keeping pregnant wife alive

His wife, also a medic, said she didn't want life support before falling into a vegetative state, but a law requires an expectant mother be kept alive until her fetus is delivered

Fort Worth Star-Telegram

HALTOM CITY, Texas — Since Nov. 26, Erick Muñoz has been sorely tested.

The burly firefighter-paramedic's busy existence of work and family changed forever when he discovered his wife inert on the kitchen floor in the middle of the night.

Marlise Machado Muñoz, 33, herself a paramedic then 14 weeks pregnant, had collapsed and fallen into a vegetative state. Each had been exposed to such situations in their profession, and each opposed life-sustaining efforts if either was declared brain dead. She had further discussed this view with her father, Erick Muñoz said.

Her heart stopped several times and she was resuscitated. But when her husband learned she had no brain activity, he expected that the family could decide to have life support withdrawn, he said.

So he was surprised when a physician at John Peter Smith Hospital told the family that the 1999 Texas Advance Directives Act requires an expectant mother to be kept alive until her fetus is delivered.

The doctor was apparently surprised as well. "I just found out about this law five minutes ago," Erick Muñoz quoted the doctor as saying.

A low-key, private man -- Marlise, he said, was the spirited extrovert in the family -- Muñoz nonetheless decided to go public with his family's plight.

"I have yet to meet anyone who knew about this law, not a single doctor," Muñoz said. "We want people to know because it has the potential of affecting others. People should have the right to make these decisions because they know the person better than some legislator down in Austin."

His predicament has led to regional and national TV exposure. He has gotten support, as well as some online scorn, in return. Co-workers at the Crowley Fire Department, who have rallied and set up a fund for the family at a local bank, carefully vet a crush of media inquiries.

JPS says its hands are tied. "We follow the state law. Period," said J.R. Labbe, the county hospital system's vice president of communications and community affairs. That law states, "A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient."

"There is no gray in this," Labbe said. And since Erick Muñoz has not signed a release, she said, JPS cannot discuss his wife's medical condition.

By 2005, Texas and 17 other states had enacted laws that require keeping a brain-dead pregnant woman alive against the family's wishes, or even in opposition to the woman's living will, until a viable baby can be delivered, usually after 24 weeks, according to an article in the Vermont Law Review.

The article said such laws around the country seem to conflict with the landmark Roe v. Wade decision, which allows abortions before the fetus is viable outside the mother's womb, about 24 to 28 weeks. Current Texas law permits abortions before the 20th week, a requirement Marlise Muñoz met when she collapsed. She enters her 20th week today.

A month after Gov. George W. Bush signed the law, a probate judge ordered a Houston woman kept on life support against the family's wishes and only rescinded the order a week after doctors declared her and the fetus to be dead, the Vermont journal said, quoting a Houston Chronicle report.

Such cases are rare but not unheard of, said Dr. Arlo Weltge, a member of the Texas Medical Association and a Houston emergency room physician who teaches the specialty. "It comes up every six to 10 years in Texas," Weltge said.

Last year, a comatose mother in Michigan gave birth to twins, said Jeffrey Patterson, executive director of the Texas Catholic Conference, which supports the Texas law. "The church certainly understands and has the greatest amount of sympathy for those going through this grief and tragedy. But the fact is this is still a life. Life begins at conception," Patterson said. "What is to be gained by removing life support for the mother which ultimately leads to removing life support to the child?"

A medical ethicist disagrees.

"I think the Texas law cannot apply to the dead," said Art Caplan, director of medical ethics at NYU Langone Medical Center in New York. "I think the hospital is wrong to insist that it does.

"I think the husband should find a lawyer and go to court to challenge the law both in terms of its application to a dead woman and as an unconstitutional infringement on his right to do what his wife would want," Caplan said.

Three Texas experts, including two who helped draft the 1999 law, told The Associated Press last week that it doesn't apply in the Muñoz case. "This patient is neither terminally nor irreversibly ill," said Dr. Robert Fine, clinical director of the office of clinical ethics and palliative care for Baylor Health Care System. "Under Texas law, this patient is legally dead."

Erick Muñoz has neither sought advice from attorneys nor been approached by any, he told the Star-Telegram. He said he doesn't know his options but would look at challenging the law in the future so others don't have to endure what he is going through.

A perfect balance

On leave from the Crowley Fire Department, Muñoz spends his days at his wife's hospital bedside in Fort Worth, periodically dashing to a modest brick home in Haltom City to feed their two dogs, then stopping to see his 14-month-old son, Mateo, whose maternal and paternal grandparents are caring for him.

Drawing strength from his family, Muñoz said he has not requested pastoral support from clerics. He had some church ties although his wife broke away after the death of a brother. (Since late November, members of her mother-in-law's church have provided him with support without proselytizing, he said.)

Born in San Diego, Marlise spent much of her childhood in Germany, where her San Antonio-reared father was based with the Air Force. Her parents put her in local schools and the whole family became so fluent in German that they continued to speak it at home after moving to Norman, Okla., where she attended high school.

Erick Muñoz, who helped out at his father's flooring business, became interested in becoming an emergency medical technician after talking with a family friend. He decided to pursue the career after meeting Fort Worth Fire Department paramedics at a career night at Polytechnic High School, where he graduated in 2005. After taking the required courses, he joined the Everman EMS.

Marlise Muñoz worked in emergency services in Oklahoma before being recruited by MedStar to move to North Texas as a field paramedic. She also taught various classes in house and worked part time in Everman, where she met Erick and helped him prepare for the paramedic's exam.

"We were opposites, but a perfect balance," he said of a friendship that blossomed into romance. Marlise, who was previously married, "was very spontaneous, outgoing. Her smile lighted up the room. I am quiet, reserved. It was easy to be myself with her, easy to be relaxed. I just loved being around her."

They had a hectic life. Marlise, pregnant with their second child, was taking courses at Tarrant County College to become a nurse and planned to transfer to the University of Texas at Arlington to finish. Then it would be his turn to return to school, her husband said.

"Our lives revolved around our family and work," Erick Muñoz said. He did 24-hour shifts in Crowley; she had 12-hour stints at Children's Medical Center in Dallas, working 11 a.m. to 11 p.m. After her long commute home, she'd find "I had the baby in bed and food cooked."

"It was not unusual for us to have dinner at midnight and talk to 1 a.m.," he said. They both loved movies, but it was easier, he said, to rent a film and order a pizza than go out.

'Emotional marathon'

Nov. 25 was an off day for both and they went to her parent's home in Azle for a pre-Thanksgiving dinner to meet an aunt from California.

That night they were waked by Mateo's cries. "Let me help," Erick recalls calling out. He quoted her as replying: "No, you've got to go to work tomorrow. I'll take care of it."

A couple of hours later, Erick Muñoz woke to the baby's cries. "She wasn't in bed next to me. I thought she might have fallen asleep in the baby's room. I peeked in, but she wasn't there." He checked the living room couch, then found her on the kitchen floor.

"It was anger, disbelief. Why is this happening to us?" Weeping as he recalled the event, Muñoz said, "I started begging for her not to go." Distraught, he punched a hole in the wall.

"I ran and grabbed the phone and called 911, and turned on the outdoor lights," He gave her CPR until the ambulance arrived; one of the EMTs had worked with Marlise at Medstar. They decided to take her to JPS, where doctors suspect she suffered a pulmonary embolism but wouldn't know for sure without an autopsy, he said.

"She arrested a few times and they brought her back. Her father said, 'If she arrests again, let her go.' We knew what she wanted." But they were told they couldn't under Texas law.

Erick Muñoz patiently answered questions, detailing an all-too-personal ordeal that has entered its seventh week.

"The whole process has been a mental drain, an emotional marathon," he says. "She always said, 'If I am in a vegetative state I want you to discontinue life support and be a good father to our son and raise him to be a good man.'

"That's what's driving me. That was her wish."

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