Remember Terry Schiavo, the woman who spent 15 years in a vegetative state while her husband and parents battled over whether to keep her on life support? Her case prompted a lot of people to establish Advance Directives to make their wishes clear in the event that they could no longer make their own medical decisions. But an ongoing case in Texas is bringing new attention to how much (or how little) power Advance Directives actually have.
In the early hours of November 26, Erick Munoz found his wife Marlise unconscious in their home in Texas. He performed CPR and called 911, but her brain had already been deprived of oxygen for over an hour. Marlise and Erick are both paramedics, and had discussed their wishes not to be kept alive by artificial means. While it’s not clear whether Marlise had an Advance Directive, it really doesn’t matter, because she was 14 weeks pregnant – and that means the state, not Marlise or her family, gets to decide what happens to her.
Texas (and 11 other states) automatically invalidate a woman’s Advance Directive if she is pregnant. 14 states abide by the Uniform Rights of the Terminally Ill Act (URTIA), which requires that a pregnant woman be put on life support if it is probable that the fetus could be carried to term. (Only 4 of those states make an exception if carrying to term will cause the women physical harm or untreatable pain.) Some states use a ‘fetal viability standard’ to determine whether to honor a woman’s wishes, and 14 states have no language on the subject, leaving room for ambiguity and protracted legal battles. Only 5 states allow women to specify different directives based on whether or not they’re pregnant.
It’s important to understand that these laws don’t result in a hospital visit from a government official whose job it is to determine whether a woman’s wishes should be honored. What they really do is control doctors and hospitals by threatening legal action if patients’ wishes are honored. (The consequences of that threat were made terribly evident earlier this year in the death of Savita Halappanavar in Ireland.)
Today, Marlise Munoz remains on life support, against her wishes and those of her husband and family. No one knows how long her fetus was without oxygen or nutrients, and it will be another 6 weeks before doctors can determine whether and when it can be delivered.
You can learn more about Advance Directives and end-of-life rights in your state here.