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Jane Ahlin, Published January 11 2014

Ahlin: In abortion politics, even the dead don’t get to die

Here is the certainty about 33-year-old Marlise Munoz: She is legally dead. Her husband, Erick, and her parents, Lynne and Ernest Machado, say that doctors declared her brain dead – likely from a pulmonary embolism. Lynne Machado said, “They did a CAT scan and an EEG and there was no brain activity. She was clinically declared brain dead. The doctors said she had been without oxygen for well over an hour.”

When told Munoz was brain dead, the family was in total agreement that she should be taken off machine support and her body laid to rest. A primary reason they were so unified in their decision is that Marlise, who was a paramedic herself, had made her wishes known. She did not want to be kept artificially alive.

Her mother told NBC News that the family had discussed life support after Marlise’s brother died tragically years before. And interviewed by a writer from his hometown Texas newspaper, the Fort Worth Star-Telegram, Erick Munoz said, “(Marlise) always said, ‘If I am in a vegetative state I want you to discontinue life support and be a good father to our son and raise him to be a good man.’ ”

Unfortunately, Marlise was 14-weeks pregnant and in Texas at the time she collapsed: Her family had no say. In fact, even if Munoz had left a written advance directive, it would have been automatically invalidated under Texas law. Politicians took charge of her body.

Forget that her doctor thought the right thing to do was to let her expire. (The family said the doctor was as stunned as they were that Texas law invalidated their right to let her die.) And forget that she had rights when she was a living human being, which, at her stage of pregnancy, would have included a constitutional right to abortion. Doctors and family members were sidelined as the state decreed her brain-dead body would be a gestation chamber – an incubator – for as long as the state thought appropriate. (Why do the “decanting bottles” where fetuses mature under state control in Aldous Huxley’s futuristic 1932 novel “Brave New World” come to mind?)

That was in November. Ernest Machado said that touching his daughter’s skin many weeks later is like touching a “mannequin.” He finds it “very hard … to go up (to the hospital) and visit” because he does not “want to remember her as a rubber figure.”

Appallingly, this is the way Texas claims to support “life.” And Texas is not alone. Eleven other states deny pregnant women and their families the ability to decide in consultation with their doctors either to end – or not to start – life support, no matter how early in pregnancy the woman is when she goes into a vegetative state. (To be clear about this case, one of the arguments being made by ethicists who object vehemently to the hospital’s decision to keep Munoz on life support is that she is not in a vegetative state. People in vegetative states have some brain activity. With brain death, brain activity ceases; thus, she cannot be a “patient.” She is dead. That her heart can be kept beating does not restore life.)

According to a 2012 report released by the Center for Women Policy Studies, along with the 12 states that allow no exemptions in keeping women on machines to gestate fetuses, 25 other states have laws that range across a spectrum of restriction. All limit the exercise of “do not resuscitate” orders, living wills and medical proxy directives but not to the same degree.

Minnesota guarantees that advance directives concerning pregnant women will be followed. North Dakota and South Dakota do not. Although their statutes include an exception “if continuing treatment will be physically harmful to the woman or prolong severe pain which cannot be alleviated by medication,” they also contain vague language suggesting leeway for the states to invalidate directives.

Such intrusion by the state into the grief of families and expert counsel of physicians is wrong. As Marlise Munoz’s mother said, “No family should have to go through this. It’s been pure hell.”


Ahlin writes a Sunday column for The Forum.