This week Texas takes center stage, yet again, in the political battle over a woman’s right to choose. A Texas judge begins hearing arguments today in the case of Eric Muñoz v. John Peter Smith Hospital. At the heart of this latest controversy is the Muñoz family, who for the last eight weeks has been fighting to exercise the wishes of Marlise Muñoz. Their struggle began on the morning of November 26, 2013 when Muñoz collapsed onto the floor of her Fort Worth, Texas, kitchen after suffering what doctors believe was a blood clot in her lungs. The clot rendered her motionless and left her brain without oxygen for over an hour before her husband discovered her. Paramedics transported her to nearby John Peter Smith Hospital where she was placed on life support and pronounced “brain dead” by her physician. According to the Muñoz family, before her collapse, Marlise, a former paramedic, made her wishes clear: She didn’t want to be kept alive on life support should the situation ever arise. However, her family was stunned to learn that the hospital would not comply with her wishes. At the time of her collapse, Marlise was 14 weeks pregnant. Hospital officials explained that in accordance with Texas state law, a pregnant woman cannot be removed from life support. Texas is one of more than two dozen states that restricts the removal of life support systems to a pregnant woman. That Munoz’s fetus is still weeks away from reaching potential viability outside of the womb is inconsequential in the face of a law that requires that “life-sustaining treatment” not be withdrawn from a woman in any stage of pregnancy.
While the outcome of this case will likely determine the scope of Texas women’s rights, the case also deserves attention for what it reveals about the rhetorical dimensions of medicine and science. As the family’s fate hangs in the balance, medical experts and social advocates, perched in a variety of political camps, grapple with the definitions of life and death. In 1968, following a public announcement of a committee of Harvard medical faculty in the Journal of the American Medical Association, death was officially defined as the non-functioning, or death, of the brain. Medically speaking, Muñoz is dead; because her brain is unable to maintain even the most basic of bodily processes, her vital bodily functions, including the pumping of her heart and respiration of her lungs, are sustained by a complex of medical devices. However, the Muñoz case reveals the rhetorical indeterminacies that animate even the most objective fields of inquiry: science and medicine.
Definitions do more than attempt to describe objective reality, definitions argue. As numerous rhetorical scholars have demonstrated, definitions not only shape the meaning of things, they also advance arguments and are politically inflected with personal, social, and institutional interests. Advances in medical science and technology introduce new ethical and rhetorical dilemmas and hence require reevaluation of operative terms. Indeed, the redefinition of medical death in 1968 came on the heels of the first successful heart transplant.[i] In the wake of the procedure, questions about the details of the donor’s death swirled. Had her heart stopped before doctors took her off of the respirator, asked reporters? This question points to the still widely held belief that the presence of a heartbeat indicates life. Ultimately, the case prompted public reflection on the meaning of death and exposed ambiguities in the medical definition of death. Perhaps not coincidentally, the 1968 Harvard committee that convened to examine the “problems of the hopelessly unconscious” arrived at a definition of death that was extremely favorable to organ transplantation—not an unsurprising conclusion considering their stated goal of “advancing the cause of organ transplantation.” In most cases medical death is fairly easy to identify; brain, heart, and other bodily functions expire conterminously. Muñoz and similar high profile controversies, such as the protracted, thirteen-year battle over Terri Schiavo’s life, challenge our otherwise straightforward understanding of death.
Both the Muñoz and Schiavo cases illuminate how the act of defining something, even something as taken for granted as death, harbors political, as well as personal, consequences. As rhetorical scholar Edward Schiappa suggests, definitional ruptures occur when the status of a word is challenged. When advocates champion new definitions, they seek to alter the behavior of specific audiences.[ii] By defining death as brain death, for example, the 1968 Harvard committee sought to anticipate and quiet public fears surrounding organ donation. However, the definitional clarity achieved within the technical field of medicine has not eliminated disputes over the meaning of bodily death, as the Muñoz case makes clear, and medical notions of death often collide with lay understandings of bodily death. Indeed, the medical language itself invites misunderstanding. In medicine, though brain death is death, the term suggests an incomplete, or partial death—the failure of an organ, but not death of the entire organism, and “life support” suggests the opposite, that there is still life within the body. The language gives hope for recovery. Among those not trained in medicine, the absence of other vital signs such as a heartbeat or breathing, signify death. But in cases like Muñoz’s where two heartbeats exist in a body still capable of supporting fetal life, for some, the medical pronouncement of death appears inaccurate or premature.
For pro-life advocates, the relationship between life and the presence of a heartbeat is of great importance. Legislation newly introduced in several states by pro-life advocates seeks to outlaw abortion once a fetal heartbeat is detected. Although the meaning of life, as opposed to death, generally takes center stage in the abortion debate, Muñoz’s case situates death at the center of this increasingly high-stakes contest. Weakening or complicating the link between the presence of a heartbeat and the unequivocal existence of life could potentially disturb the essential connection that pro-life advocates hope to build in the public imaginary between these two phenomena. For the Muñoz family, definitional ruptures are made painfully real. They accept the medical definition of death and argue that because Marlise is deceased, she should no longer be considered a treatment-receiving patient of the hospital and is, therefore, not subject to the laws prohibiting hospitals from denying pregnant women life-sustaining treatments. Marlise Muñoz’s body unmasks the oft hidden reality that, even within the technical spheres of medicine and science, the practices of naming and defining phenomena frequently exceed the boundaries of objective, apolitical observation and rather are informed by a range of personal and political agendas. Trapped in a definitional gray area, neither alive nor dead, Marlise Muñoz’s story serves as testament to the ways in which anti-abortion laws both constrain an individual’s bodily autonomy and grant sovereignty over an individual’s body to the legal and medical establishments.