Two Moral Persons, One Court Decision

By: Michael Menconi

On November 24th, Erick Munoz discovered his 33-year-old wife, Marlise Munoz, unconscious on the floor of their Texas home. A tragic consequence of a pulmonary embolism, Marlise was rushed to John Peter Smith Hospital and declared brain dead in the emergency room. She was moved to the intensive care unit where she remained on life support for six weeks against the wish of her husband, who maintained she would not wish to live in this incapacitated condition if she were given the choice. Significantly complicating the situation and simultaneously launching the case to the forefront of national debate, however, was the fact that Marlise was 14 weeks pregnant at the time of her clinically diagnosed brain death.

Initially, the hospital refused to honor the Munoz family’s wishes in accordance with Texas law, and kept Marlise on life support despite the family’s clear objections. Texas law states, “a person may not withdraw or withhold ‘life-sustaining treatment’ from a pregnant patient”.  However, following a successful appeal by the family, on the morning of January 27th, doctors removed all life-sustaining medical interventions from Marlise and pronounced her dead. Marlise’s death therefore resulted in the death of her 20-week old fetus, enraging the pro-life community on a national scale. Pro-life activists responded immediately to the news, claiming, “Baby Munoz was executed by judicial tyranny.”

Though this case raises many important bioethical issues, I will specifically address the issue of the competing autonomy of Marlise and her fetus.   In this particular case, the moral status of Marlise must be balanced against the moral status of the fetus.  I will argue that the future, and not the past, accounts for the moral status of those who are not currently rational and self-aware and therefore the fetus should be considered a person with a right to life. It is this potentiality of persons, or the ability of a biological entity to become a living, breathing human being that gives moral value to Marlise’s fetus, beginning at the moment of conception. The fetus is therefore established as a potential person, with a moral value equivalent to any current member of society.

Pro-life supporters consistently cite Evangelium Vitae, where John Paul II states, “the human being is to be respected and treated as a person from the moment of conception,” thus ensuring this embryo’s “inviolable right to life.”  Based on this premise, the rights and autonomy of the fetus – as it is the next stage of development for the embryo, which is considered a person – is explicitly supported by the Catholic Church.

Even though the fetus is not rational or self aware, (which are common and universal parameters for the contemporary definition of a living human person), keeping Marlise biologically alive in the interest of delivering a fetus is a sound and valid ethical decision, based on the fetus’s right to life and autonomy. The state, healthcare professionals, and even Marlise’s family do not have the moral authority to violate the future autonomy of the fetus. It is my view that the fetus has a right—and depending on one’s theological or philosophical perspective—duty, to live.

Not all bioethicists and moral philosophers agree with privileging future autonomy based on potential rationality in isolation from other moral aspects of being. For example, according to feminist Catholic theologian Margaret Farley, “persons are ends in themselves not only because they can freely determine themselves but because they can know and be known, love and be loved, as both embodied and free.”  Following this definition of personhood, Farley argues that autonomy, or freedom, “rises out of relationality and serves it. Freedom is for the sake of relationship-with ourselves and with all that can be known and loved.” Having achieved this, some may argue that Marlise’s right to die on her own terms takes precedence over objectifying and using her body as simply a means to some other’s end. I argue, though, that Marlise’s capacity to love and “know” was terminated upon the death of her “rational self,” yielding a loss of all future relational abilities which are fundamental, necessary components of human autonomy and freedom.  However, the fetus, while it has yet to acquire those relational abilities, has the future potential to do so.

Why choose the interests of the future person over Marlise, who has lived an extensive, biographical past? Any biological entity with Homo-sapiens DNA that has greater than zero percent chance of becoming rational and self-aware should be deemed a person (or a potential person, which, I argue, carries identical moral value). In essence, the interests of a person, or the fetus, take precedence over the autonomy and interests of a non-living human.  Even if physician predictions that the child will be born with severe deformities are proved true, the probability of the fetus becoming a potentially autonomous person is greater than that of Marlise, whose autonomy is no longer present.

It becomes evident with these polarizing, complex bioethical issues that the pro-life and pro-choice debate is not merely a two-sided issue, nor is it a valid topic of political or ideological discourse without first understanding the intricacy of moral status and personhood.  If Marlise was not pregnant, the consideration of another potential person would be absent, thereby simplifying the rational decision to remove her from the ventilator shortly after the clinical diagnosis of brain death. Permitting and facilitating the birth of this child brings another human being into the world, along with the potential of this being to make a valuable contribution to society.

Michael Menconi (FCRH ’15) is currently completing a B.S. in Cognitive Psychology, with minors in Bioethics and Sociology. An aspiring physician and public health professional, Michael’s research interests include public health and community medicine, with particular emphasis on the social mechanisms behind child abuse and the consequent effects of toxic stress on child development.

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