Death: Who decides when it’s time to let go?

It’s been said that living is hard, dying is easy. But headline-grabbing cases this month have shown that dying isn’t always a simple matter.

In this Friday, Jan. 3, 2014 photo, Erick Munoz stands with an undated copy of a photograph of himself, left, with wife Marlise and their son Mateo in Haltom City, Texas. Munoz filed a lawsuit in state district court in Fort Worth, Texas, where his wife has been on life support since he found her unconscious in their home on Nov. 26, 2013. She was 14 weeks pregnant at the time. (AP Photo/The Fort Worth Star-Telegram, Ron T. Ennis)
Erick Munoz talks about his wife Marlise and their son Mateo in Haltom City, Tex.  (Ron T. Ennis/Fort Worth Star-Telegram via Associated Press)

In Texas, Erick Munoz filed a lawsuit Tuesday against the hospital keeping his pregnant wife on a ventilator. Marlise Munoz collapsed in November, most likely due to a pulmonary embolism, or blood clot in the lungs, but the cause cannot be determined until an autopsy is done.

The 33-year-old was 14 weeks pregnant with the couple’s second child when her husband found her on the kitchen floor Nov. 26.

Administrators at John Peter Smith Hospital in Fort Worth claim the Texas Advance Directives Act forces them to keep the pregnant woman on a ventilator until the baby can be delivered, although no one’s even sure the fetus is viable after being deprived of oxygen. The hospital has not released the woman’s condition due to privacy laws.

Munoz, in his lawsuit, says his wife is brain dead and as such, is no longer a “pregnant patient” as defined by law but is deceased. He wants her body released.

“To further conduct surgical procedures on a deceased body is nothing short of outrageous,” the lawsuit states.

In California, the situation is reversed: The family of 13-year-old Jahi McMath has gone to herculean efforts to keep the brain-dead teenager on life support. Nailah Winkfield waged a court battle to keep her daughter, declared brain dead Dec. 12 after complications following a tonsillectomy, on a ventilator. McMath’s body was released to the county coroner who then turned her over to Winkfield; McMath is being cared for in “an undisclosed facility,” according to an attorney.

In New Mexico, meanwhile, terminally ill patients like Aja Riggs, who has advanced uterine cancer, may choose physician-assisted suicide after a court ruling Monday.

The state court ruling makes New Mexico the fifth state to allow competent, terminally ill patients to ask doctors for prescription medication that will allow them to die. As Riggs said during the trial that led to the decision, “I don’t want to suffer needlessly at the end.”

Second Judicial District Judge Nan Nash agreed, writing, “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.”

Complicating the debate is the fact that technology has outpaced the religious, ethical and legal considerations of dying. A patient whose brain and brain stem no longer function can appear to be alive as machinery or drugs keep the heart beating. But when there’s no activity in the brain at all, “brain death” has occurred. There’s no hope of recovery.

That’s different from a persistent vegetative state — like Terri Schiavo’s case — or a coma — such as the late Ariel Sharon, former Israeli prime minister.

It seems obvious in McMath’s case that the teenager is, tragically, dead. Turning her body over to her family for continued care sets a dangerous precedent.

But what about Marlise Munoz? She and her husband were both paramedics; they had discussed death, and she had made it clear she did not want to be kept alive on machines. Her parents agree.

A clear-cut decision — except that she is pregnant. Even if she had had a living will expressing her wishes, 29 states have laws that would make exceptions.

I can understand the desire to save a child after the death of the mother. But it’s not always as simple as the title of a 2010 study in the journal BMC Medicine might lead you to believe: “One life ends, another begins.” Some (but not all) brain-dead women have been supported medically long enough for a fetus to develop and be delivered by caesarean section. The exact numbers are unknown for the success of these “cadaveric incubators.”

The study authors suggest a team of physicians provide input on the condition of the fetus so that the family can make an informed decision.

Ethicist Arthur Caplan, a professor at New York University’s Langone Medical Center, goes further. In an essay for NBC News, he wrote that keeping a brain-dead pregnant patient on life support is an experimental treatment, and families have the right to accept or reject experimental therapies. “The legislature ought not be compelling a husband and a family if they do not wish a pregnancy to proceed facing long odds,” he said.

On the other hand, I would argue that the family who wants to take that gamble should have the right to do so.

Same for the terminally ill. Those who don’t want to prolong their suffering should have that legal option.

It comes down to having the legal option to make your own choice.

 

Diana Reese is a journalist in Overland Park, Kan. Follow her on Twitter at @dianareese.
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