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Seven weeks after collapsing from a suspected pulmonary embolism, 33-year old Marlise Muñoz remains artificially alive in a Fort Worth hospital’s intensive care unit. By fiat of Texas law, she can’t be permitted to die because she’s pregnant. Her fetus is alive but still weeks away from viability outside the womb.
The tragedy has thrust her family into a maelstrom of medical, legal, philosophical and political questions, turning their private agony into a very public issue in the Lone Star State.
The family says it wants to switch off the machines and let Muñoz die with dignity. All she is now is “a host for a fetus,” her father, Ernest Machado, told The New York Times. But John Peter Smith Hospital has invoked a state law prohibiting the withdrawal of life-sustaining treatment from a pregnant patient. The hospital argues it cannot legally allow the woman — and therefore her fetus — to die.
Very little about the case lends itself to easy answers.
The health of the fetus remains unknown. If it is delivered on the edge of viability, as it’s expected to be, the child will face a host of serious potential medical problems. Brain hemorrhage, respiratory complications, heart failure and vision loss are just some of the risks, according to medical experts. Also, babies born prematurely can face long-term intellectual, physical and developmental delays.
Hoping for a legal exit from this ongoing catastrophe, Marlise Muñoz’s husband Erick Muñoz last week filed a civil lawsuit against John Peter Smith Hospital. According to the filing, doctors told Erick Muñoz there was no activity in his wife’s brain stem. The life-sustaining treatment required by the statute was pointless in this case, he argued, because the hospital was forcing medical treatment on someone who is no longer alive.
The cost of living
Erick Muñoz’s lawyers, Jessica Janicek and Heather King of KoonsFuller Family Law, told Al Jazeera they had received Marlise Muñoz’s medical files. The chart confirms she is “clinically brain dead and therefore deceased under Texas law,” the lawyers said in a joint emailed statement. Both parties now await a date for a court hearing.
Meanwhile, Marlise Muñoz has spent two months and counting in one of the most expensive wards of the hospital, and an already enormous medical bill gets bigger every day. John Peter Smith Hospital said in an emailed statement to Al Jazeera that it wasn’t appropriate to discuss the average costs of its intensive care unit because each patient has different needs.
However, a 2002 study estimated the cost for an ICU bed in an average U.S. hospital is $2,000 to $3,000 per day. Marlise Muñoz has been in the ICU since Nov. 26. If her fetus survives delivery, it will be cared for in the neonatal intensive care unit, an even pricier cost center in any hospital. According to a recent report by the March of Dimes, the average hospital charge for infants born before 32 weeks of gestation runs to more than $280,000.
This specialized care, which her family has said it did not want, could total more than half a million dollars. John Peter Smith Hospital will not say who will foot the bill.
“When appropriate, the finance department will pursue its customary process for identifying payers and reimbursement,” hospital spokeswoman J.R. Labbe said by email.
Debating personal decisions
Yet it’s not the fetus’ medical bills but the fetus itself at the heart of the political storm. Its potential for life pitches its rights into dramatic tension against the right of its mother to die.
NARAL Pro-Choice America, a reproductive-rights advocacy organization, circulated a petition to support the mother’s end-of-life wishes.
“Difficult personal decisions, like end-of-life care, belong to women and families — not politicians,” the appeal argued.
Meanwhile, anti-abortion groups and protesters held vigils outside the hospital and rallied for the child.
Lt. Gov. David Dewhurst, who was instrumental in passing a far-reaching anti-abortion bill in the state, weighed in on the side of the fetus.
“In the midst of this debate, we cannot lose sight of the fact that we’re talking about a baby who deserves the full protection of the law,” he told The Texas Tribune.
Some pro-abortion-rights advocates say this approach ignores the needs of the child once he or she is delivered.
“If you look at Texas’ social policies, it’s clear that the legislature’s interest in the fetus ends once it’s born,” said Heather Busby, executive director of NARAL Pro-Choice Texas.
That sentiment strikes a chord with others too. The Center for Public Policy Priorities, a left-leaning think tank, notes the portion of Texas’ state budget geared toward children’s well-being has remained small, even as the child population has exploded. State legislators have continued to make cuts to public education and infant-health and safety-net services, causing child poverty rates to spike. The center released a report last month showing that Texas ranks 42nd among the states for overall child well-being.
“We have a very limited safety-net support for parents with dependent children in Texas,” said Anne Dunkelberg, the center’s associate director.
Critics of Texas’ latest anti-abortion law note that conservative legislators rejected any policy provisions that might have improved the lives of children born because their mothers couldn’t get an abortion.
The state’s stance
During the passage of House Bill 2 last summer, the Republican-controlled legislature rejected amendments that would have ensured postpartum visits for low-income mothers; provided cash, food and health benefits to members of the woman’s household; enabled women to leave unwanted children with an emergency care provider without prosecution; and exempted victims of sexual assault and incest from abortion restrictions.
That Republican stance has triggered attacks from opponents.
Democratic state Rep. Donna Howard told Al Jazeera that Republican lawmakers in Texas are “pro-life up to the point of birth.”
Dewhurst’s office did not respond to Al Jazeera’s inquiries about the availability of state-funded services to support the Muñoz child’s long-term health and social-care needs.
Against this political and policy backdrop — often illustrated with fierce public debates — the legal rights of the Muñoz family continue to hang in limbo.
Echoing many colleagues on both sides of the floor, Howard expressed discomfort about bringing the tragic circumstances of the family into the political debate.
“However, that is the situation before us,” she said, “and it does bring up very difficult ethical and political dilemmas.”