Should the government be allowed control over your medical decisions? A lot of us most likely have the necessary paperwork to instruct our loved ones of our wishes upon a timely accident or a life ending circumstance. However, in the state of Texas, this is not always enough to suffice depending on the circumstances. Did John Peter Smith Hospital act appropriately when placing Marlise Munoz on life support? Was cultural relativism a deciding factor when medical professionals were weighing the rights of the patient? The state of Texas has taken away these rights from individuals in certain circumstances as a futility review process was enacted in 1999, allowing health care providers the right to make that final decision based on individual circumstances. Texas Advance Directives Act of 1999 (TADA) in part states that “a person may not withdraw or withhold life sustaining treatment under this subchapter from a pregnant person” (Texas, §166.046). No one wants to see or experience the suffering and prolonging of the inevitable in the one they love when the end is near. Unfortunately, that is exactly what happened to the Munoz family in Texas last November. Marlise Munoz, a daughter, wife and mother of a 15 month old son who was 14 weeks pregnant when she suffered from a pulmonary embolism and was placed on life support against her own wishes as well as those of her family. The attending physician at John Peter Smith Hospital declared Marlise officially brain dead but due to her unborn fetus placed her on life support against the wishes of her family, citing TADA. When the family petitioned state District Judge R.H. Wallace to force the hospital into removing the life support, the hospital refused to do so, once again citing TADA as their legal stance. Removing life support at this point would cause an unviable fetus to succumb to death. Texas is the sixth ranking most protected pro-life state. They are the 12th state to pass the strictest ever abortion law; banning abortions after 20 weeks and will “force the closure of all but a handful of the clinics that perform them” (O’Neil, 2013). With this very controversial issue, could there have been a political fallout in the community had the fetus not been supplied life support via Marlise? Could there be a heavy decline in state and community donations to the hospital that resides in a dominant pro-life state? On the day the fetus entered its 22nd week, records indicated the fetus was not viable; it was not developing correctly, evidence of "water on the brain and heart problems”, (Baker & Campbell, 2014). With this discovery on January 26th, John Peter Smith Hospital followed the order made by Judge R.H. Wallace and removed Marlise Munoz from the life support system. Lawyers for the Munoz family are concluding that the law was misapplied by the hospital. Thomas Mayo, medical ethicist and assistant law professor at Southern Methodist University assisted in revising the advance directive section of this particular Texas Health and Safety Code in 1999. Mayo stated that when the statute was being revised the prospect of a brain-dead person coming into play was not discussed. “The statute was meant for making treatment decisions for patients with terminal or irreversible conditions”, (Mayo, 2014). There are more than 30 states that have this type of pregnancy provisional but this is the first known case of a hospital insisting on life support over family objection. In conclusion, did the hospital perhaps act unethically first by placing Marlise Munoz on life support against the wishes of her family? Secondly, was John Peter Smith Hospital negligent and morally unethical by forcing the misapplication of TADA? Because the hospital exercised what appears to be cultural relativism; believing it was right because the law says it is, in turn caused additional and tremendous grief for the Munoz family. This family was at the mercy of a hospital that exerted an inappropriate law forcing them to suffer through months of agony for their wife and daughter.
References Baker, M.B. & Campbell, E. (2014). Texas law didn’t anticipate Munoz case, drafters say. Retrieved from http://www.star-telegram.com Colb, S. (2014). Verdict – Legal Analysis and Commentary from Justia. Excluding pregnant women from the right to terminate life support. Retrieved from http://www.verdict.justia.com Collins, D. (2012). Business Ethics: How to design and manage ethical organizations. Hoboken, New Jersey: Wiley Deruy, E. (2013). Texas passes strict abortion law. Retrieved from http://www.fusion.net Kaplan, K. (2014). Marlise Munoz: Can a fetus survive after mother becomes brain-dead? Retrieved from http://www.latimes.com O’Neil, T. (2014). Prolife State Rankings Released: 6 Best, 5 Worst, 4 Most Improved States for Life. Retrieved from http://www.christianpost.com Painter, R.W. (2009). Developments in Texas Advance Directives. Publication of the Houston Bar Association. Retrieved from http://www.thehouselawyer.com
Rovner, J. (2013). State laws limiting abortion may face challenges on 20 week limit. Retrieved from http://www.npr.org Silverman, L. (2014). Life support battle over pregnant Texas woman heads to court. Retrieved from http://www.npr.org
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