We all know that the United States is a nation that holds so firmly to the fetishism of the foetus that it will go to incredible lengths in its ‘protection’ of foetuses, nonviable and not. The frenzy as conservatives try to convince themselves that foetuses across the land are in a critical state of danger makes it seem like now, more than ever, people with uteruses are not just obligated to reproduce, but required to act as incubators for the length of a pregnancy, come hell or high water.
Both of those came for Marlise Munoz, a Texan who collapsed in her home when she was just 14 weeks pregnant. This was a tragedy for both her and her husband, and it became even more dire when she had to be put on life support and was unable to participate in her care or decision making. Fortunately, she and her husband were paramedics, and they had discussed the possibility of such a situation and their advance wishes in detail. He knew that she didn’t want to kept alive with the assistance of life support, and it quickly became clear that from a neurological standpoint, all activity had ceased: Marlise, a young woman with a husband and a toddler, was dead.
Except that her body could still be sustained through extensive and very invasive means, including the use of complex medications, a ventilator, and constant monitoring. She had been emphatic about not wanting this, and her husband knew this, as did friends and family. Yet, when he asked the hospital to please stop providing life support, putting his wife on comfort care only to allow her to finish dying in comfort (something that likely would take only minutes, since her brain was unable to control any of the key involuntary processes that are needed to stay alive), the hospital refused.
Officials said that because of the pregnancy, they needed to keep her alive for the sake of the fetus. In fact, the hospital went a step further: officials argued that under Texas law, they were not allowed to withdraw life support, and could get in trouble for adhering to Marlise’s advance directive. Their hands were tied, they indicated, and while they might sympathise with the family, they certainly couldn’t take any steps to take Marlise off life support until all signs of life from the foetus had ceased, or until it had been safely delivered.
The problem, of course, is that the foetus might have been seriously injured by the same pulmonary embolism that killed Marlise; in fact, the extent of damage might be so severe that the foetus could have major developmental problems and other issues. Furthermore, the medications and measures needed to keep Marlise’s body functioning as a living incubator could pose their own hazards to the foetus, as, of course, would the interventions needed every time she required more aggressive medical care because of new developments in her situation.
The hospital was, very literally, arguing that it needed to keep a dead woman’s body hooked up to machinery in order to ensure that a foetus would be born, against her expressed wishes and the communicated desires of her partner and family. And the case raged on for weeks, and weeks, and weeks.
Marlise was dead: the situation was no longer about her, but about whether she could be peacefully buried so her family could move on. Would the loss of the foetus be traumatic? Of course–it was the result of a clearly wanted pregnancy, and it’s obvious that the family was looking forward to welcoming a new member and spending years of happiness together. Obviously, the family would be left mourning not just Marlise, but also the life that would have been, the foetus who never developed into a baby and never had an opportunity to live and grow up with a loving mother and father.
But the longer the case stretched on, the closer the foetus came to viability, thus raising uncomfortable and terrible ethical choices. Had Marlise been allowed to pass away peacefully at 14 weeks of pregnancy, mother and foetus would have been buried and mourned and a private matter would never have become a subject of national news and impassioned debates and arguments in favour of restricting reproductive rights and refusing to honour advance directives.
Instead, as the pregnancy proceeded, the situation became more complex. What does it mean to terminate life support to a patient who’s carrying a viable foetus? Have you then killed the foetus, committing a crime? I support the right to choose to terminate life support at any time in accordance with the expressed wishes of the patient, including during pregnancy, as I support the right to make other choices about your own body at all times. While it’s not unreasonable to attempt to deliver the foetus, if feasible and desired by the family members, this should never take precedence over the wishes of the pregnant person. In cases where the foetus is clearly dead, family members may want an opportunity to mourn and conduct private family rituals. In others, it may be possible to allow people some time with the foetus before death, as in the case of pregnancies involving terminal complications where parents still want to see the baby, or perhaps it will be possible to deliver prematurely and watch a child go on to grow up.
But these choices should not be in the hands of hospital officials or medical practitioners. They are private family matters–and they may be very difficult, emotionally wrenching choices in some cases. For the state to interfere during such a traumatic time is a travesty and a horror, and something no family deserves. Marlise deserved better. So do we all.
A note on the image: This statue sits on the fourth plinth in Trafalgar Square, and it depicts disabled artist Alison Lapper while pregnant. It was created by sculptor Mark Quinn. While Quinn noted that he wanted to increase the diversity of representation in art with this piece, it bears observation that he has had a very successful and vibrant career, including, of course, this commission, while Lapper has not enjoyed the same opportunities, though she is very well known and respected. The image is by Gareth, used under a Creative Commons license.