July 2014 Bar Bulletin
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July 2014 Bar Bulletin

The Right to Privacy: Pregnant Women's Health Care Directives in Washington

By Sherry Bosse Lueders


Last November, a Texas woman, Marlise Munoz, was preparing a bottle for her toddler when she collapsed on her kitchen floor in the middle of the night. She was 14 weeks pregnant. Her husband, Erick, discovered her motionless body at 2 a.m., and paramedics rushed her to the emergency room at a nearby hospital.

Doctors informed her family that she was brain dead and would never regain consciousness, but she would nonetheless remain connected to a ventilator. Munoz, a former paramedic, had a health care directive that indicated she did not want treatment continued if doctors diagnosed her as permanently unconscious, and her family argued vehemently for her wishes to be honored.

She remained on life support because she was pregnant and had the misfortune of collapsing in Texas.1 Why? The hospital believed that discontinuing life support for Munoz would violate a provision of the Texas Advance Directives Act, which prohibits medical providers from terminating life support for pregnant women.2

After two months of arguing with the hospital to remove his wife from life support, which was keeping her brain-dead body alive to support a fetus that doctors agreed was not viable, Erick Munoz filed a lawsuit and won. On January 24, Texas District Court Judge R.H. Wallace, Jr. ordered the hospital to remove the machines that had been keeping Marlise alive, ruling that the law did not apply to her since her diagnosis of brain death meant she was already legally dead.3

Would the same scenario play out for a Washington resident? Maybe.

The New York Times article covering the Munoz story cited a study4 that included Washington among the 12 states that, like Texas, automatically invalidate a pregnant woman's advance health care directive. And, indeed, the default health care directive language in Washington's Natural Death Act contains a provision invalidating a directive during pregnancy.5

Washington's advance directive law can be distinguished from the Texas law, however. The Texas law goes much further than Washington's in invalidating a woman's wishes as stated in her health care directive when pregnant:

The Texas Advance Directive Act states, "a person may not withdraw or withhold life-sustaining treatment ... from a pregnant patient." The hospital treating Munoz feared removing her from the ventilator while she was still pregnant would violate that provision of the law.

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