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Mostly Dead Vs. All Dead

January 24, 2014

I wasn’t going to weigh in on the Jahi McMath situation.  It’s sad and it’s awful and it was handled badly on all sides.  ‘Nuf said.  But now here comes Marlise Munoz, another terrible story.  Mrs. Munoz suffered a massive pulmonary embolism (a big blood clot that plugs up the blood flow in and out of the lungs) at 14 weeks of pregnancy.  She’s brain dead now, too.  And, she’s brain dead and pregnant in Texas, which gives her a whole set of issues that Jahi didn’t have.  Poor Marlise is now at the mercy of Texas republicans, abortion rights folks, her loving family, the hospital, the terribly-named “Women’s Right to Know” act, and the political issues of fetal viability and fetal rights.

It seems that Billy Crystal’s character in The Princess Bride knew something back in the dark ages that has been lost in modern times.  He could tell the difference between mostly dead and all dead.  It makes a funny scene and a funny story, but the issue is very serious and the only thing funny about it is that it’s so hard to tell who’s dead these days.

According to the Uniform Determination of Death Act, adopted by most states, death is defined as “irreversible cessation of circulatory and respiratory functions” or “irreversible cessation of all functions of the entire brain, including the brain stem.”  The determination of death because of cessation of circulatory and respiratory function isn’t that helpful anymore, because dead people can be ventilated and provided with the electrical activity needed to keep the heart beating, up to a certain point.  The determination of death because of brain death is actually clearer.  We can’t artificially keep people conscious.  Yet.  Plus, doctors have a very strict and very comprehensive and very agreed-upon set of things that all have to be present for a person to be pronounced brain dead, and all the things are objectively demonstrable.  In other words, there are obvious and reproducible tests that absolutely guarantee brain death.  Jahi’s parents didn’t believe the doctors, partly because they felt rushed and bullied by them.  Marlise’s family does believe the doctors and the case would have been closed except for one very small problem.

The fetus.  Oh lord.  Now we really muddle the waters.  If a person is dead, the fetus is dead right?  But if the heart and lungs of the person are functioning, blood is flowing to the fetus, and since there’s no way of knowing the status of the fetus brain, as long as the fetus heart is beating the fetus is alive.  Inside a dead person.  Even Billy Crystal’s mind boggles.

Now, the Texas hospital is saying that Marlise is “seriously ill”.  But only living people can be seriously ill.  If she’s only seriously ill then Texas law states that the mother must be kept alive until fetal viability.  But Marlise isn’t alive.  If she’s dead and the hospital wants to keep her circulation going for the sake of the fetus, then we’re talking about experimenting with corpses and you have to go through a different committee for that.  There are no ethical considerations for corpses.  Yes, if you take Marlise off life-support the baby will die.  No question.  And that’s really what’s at issue.  The fetus’s right to be born.  Make no mistake about this.  The question in Jahi’s case was, is she dead or not?  The issue in the Munoz case is fetal rights.

When you have a massive pulmonary embolism, all circulation in your body stops.  It’s all plugged up at one spot and everything stops.  This includes circulation to the placenta and fetus.  Somehow, Mrs. Munoz’s baby’s heart survived this catastrophe, at least in that it is still beating by itself.  Other parts of the baby likely didn’t fare so well.  The Munoz family understand this and, though in great sorrow, they know that neither Marlise nor the baby would want the life they currently, or in the baby’s case, eventually will, have.  Their wishes should trump abortion politics.

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From → End-of-life Care

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