Lawmakers Debate Whether Pregnant Women Should Get to Make Their Own End-of-Life Decisions


Above: Erick Muñoz, husband of Marlise Muñoz, addresses reporters at the Texas Capitol in March.

The House State Affairs Committee heard a bill Wednesday that would allow pregnant women and their families to make their own end-of-life decisions.  Currently, under Texas’ advance directive law, doctors “may not withdraw or withhold life-sustaining treatment … from a pregnant patient,” a little-known clause that drew national attention when a pregnant woman in Fort Worth was declared brain dead in 2013.

House Bill 3183 by state Rep. Elliott Naishtat (D-Austin) would eliminate this so-called “pregnancy exclusion” provision.

“Anybody can fill out an advance directive, but only women who are pregnant can have that advance directive voided by a hospital or by the state,” he told committee members. “That’s not fair, that hurts families very much, and this is a simple fix.”

Naishtat’s bill is inspired by the story of Marlise Muñoz, a 33-year-old mother and paramedic from North Texas who collapsed at her home and suffered a pulmonary embolism in November 2013. At 14 weeks pregnant, Marlise was declared brain dead after she was hospitalized in Fort Worth. Citing the state’s advance directive law, doctors refused to remove her from life support, despite the fact that she made it clear to her family years prior that she wouldn’t want to continue treatment in such a situation. Muñoz’s husband Erick and her parents Lynne and Ernie Machado sued the hospital and ultimately won their case, and the right to bury Marlise.

“For two months we watched our daughter’s body decompose,” Lynne told legislators Wednesday. “We knew the end-of-life wishes Marlise wanted. … Our hands were tied by the government. We felt the government had overstepped [its] boundaries.”

Rebecca Robertson with the ACLU of Texas, and Susan Hays, representing a coalition of reproductive health and advocacy groups, supported Naishtat’s measure. Hays said that the law treats pregnant women as “second-class citizens” by taking away their right to make end-of-life decisions.

“The case of Marlise Muñoz vividly illustrates why this law needs to change,” Hays said. “State law should never prevent medical professionals from providing medical care that is consistent with their ethical and professional obligations.”

Amid the emotional testimony from Marlise’s family, a handful of witnesses spoke against Naishtat’s bill, arguing that the life of Marlise’s fetus should have remained the priority in the case.

Cecilia Wood, an Austin-based attorney representing the Texas chapter of the conservative Concerned Women for America, opened her testimony by ensuring that she meant “no disrespect” for Marlise’s family. Wood went on to say that in no situation should Texas’ end-of-life law apply to a pregnant woman. Wood said that any pregnant woman should be kept alive “until the baby can be delivered.”

“I would say it would never be OK to abide by the wishes of the family, if it means taking the life of the child,” she said. “We need to realize that this is the life of a pre-born child.”

State Rep. Matt Krause (R-Fort Worth) has filed a bill that echoes Wood’s sentiment, though it has yet to be scheduled for a hearing. Krause’s House Bill 1901 would require a hospital to keep a pregnant woman on life support “regardless of whether there is irreversible cessation of all spontaneous brain function of the pregnant patient … and if the life-sustaining treatment is enabling the unborn child to mature.” It would also require the attorney general to appoint a lawyer for the fetus.

Jeremy Newman with the Texas Home School Coalition also testified against removing the pregnancy exclusion provision, arguing that a pregnant person may not fully understand the advance directive law, or that she is “potentially signing a death warrant for her child without knowing what’s happening,” he said.

“You’ve made a decision over which life is more important. … You’ve made an assumption that women don’t contemplate these situations,” state Rep. Jessica Farrar (D-Houston) told Newman. “I find that demeaning as a woman.”

For last 18 months, Erick Muñoz and Marlise’s parents have vowed to work to change state law so that a similar situation doesn’t happen again.

“Please give families the opportunity to avoid the pain and suffering my family had to face,” Erick pleaded with committee members.

The House State Affairs Committee left the bill pending.