Drama in the Womb: A Matter of Life and Death Winds Up in Court

As a young, pregnant woman lay dying of cancer, a three-judge appellate panel convened by telephone and upheld a judge’s decision to force her to undergo a Caesarean section surgery against her will.

The baby girl, delivered in the 26th week of pregnancy at George Washington University hospital here last June, died a few hours later. The mother, identified only as Angie, died two days later.

The American Civil Liberties Union, joined by 34 feminist, religious, civil rights and medical groups, last month asked the District of Columbia Court of Appeals to rehear the case, fearing it could set a legal precedent for courts to make a broad range of decisions over the objections of pregnant women or the terminally ill.

Precedent-Setting Case

“This case sets precedent for court orders that could require pregnant women to stay in bed, to stay home from work, or to eat certain foods if such activities were beneficial to the fetus,” said ACLU attorney Lynn Paltrow, a member of the Union’s reproductive freedom project. “It also sets a precedent to balance the life of any terminally ill person against another, and could force them to donate organs or other body parts for the sake of other people.”

The woman, Angie, had been diagnosed with bone cancer at age 13 and had to have a leg amputated. Believing her cancer was in remission, she married and became pregnant. During a regularly scheduled visit at the hospital’s high-risk pregnancy clinic, Angie complained of shortness of breath and back pain. Doctors discovered a cancerous tumor in her lung. She was soon admitted to the hospital in pain and with a grim prognosis.

Court documents state that it was the court’s understanding that before Angie was sedated, she had indicated that she would choose to relinquish her life so that the fetus could survive, should such a choice present itself at the fetus’ gestational age of 28 weeks--considered by many medical experts to be the point at which a fetus has a fairly good chance of survival.

The ACLU appeal claims that Angie “was never explicitly asked that question. Further, to the extent that the question came up implicitly, the record is clear that she consistently expressed a desire to maintain her quality of life throughout pregnancy.”

Opposed to Operation

Angie’s physicians and the hospital’s obstetrics staff were opposed to the operation, according to court papers. Throughout her pregnancy, Angie had consistently expressed a desire to prolong her own life, including taking medicine that she knew could harm the fetus, according to Sylvester. After Judge Emmet Sullivan issued his ruling but before the emergency appeal was heard by the appellate panel, she regained consciousness and twice told her doctor she did not want the Caesarean section.

“I don’t want it done. I don’t want it done,” she said, according to the ACLU petition.

During the hearing, Sullivan was told that the baby had a 50%to 60%chance of surviving the operation and less than a 20% chance of having a handicap, such as cerebral palsy or blindness. Angie’s physicians also said that the operation could hasten her death and that the obstetrics staff was reluctant to perform it.

The three-judge appellate panel considered the case during a conference call. Angie, at the same time, was being readied for surgery. When the panel refused to block Sullivan’s order, Angie was wheeled into the operating room.

In an opinion filed this month to explain the appellate panel’s ruling, Appeals Court Judge Frank Q. Nebeker wrote that “with an unborn child, the state’s interest in preserving the health of the child may run squarely against the mother’s interest in her bodily integrity.”

He continued later: “The Caesarean section would not significantly affect A.C.’s (Angie’s) condition because she had, at best, two days left of sedated life; the complications arising from surgery would not significantly alter that prognosis. The child, on the other hand, had a chance of surviving delivery, despite the possibility that it would be born handicapped.”

The appeal asks, among other things, that a rehearing correct what it considers to be a number of factual errors contained in the previous court proceedings. The appeal claims that Angie’s physicians had not given up attempting to prolong her life, and notes that optimistic fetal fatality statistics presented at the hearing by the hospital’s top neonatologist “applied to fetuses generally and not to the fetus in this case.”

The hospital sought the legal ruling on advice of its lawyers, a spokesperson said. The hospital had no further comment on the case while in litigation.

In an emotional press conference early this month, Angie’s parents presented their side.

“On Tuesday morning they called us early to tell us that Angie was not doing very good,” said Nettie Stoner, 47, the woman’s mother. Stoner was in a wheelchair, disabled by an auto accident.

“We called a priest to come immediately,” she said. “He gave her the last rites and then only a few minutes later the hospital staff told us we were needed at a short meeting. They did not tell us it was a court hearing. It took all day. Poor Angie, first she’s told she’s dying and the next thing everybody abandons her and leaves her alone in her room. . . .

“Then even before the hearing was over they started prepping her for surgery. She was already in so much pain.

“We told the judge she didn’t want the surgery, that we didn’t want her to suffer anymore, that we didn’t think the baby would live. But they didn’t listen. After the surgery and after they told her the baby was dead, I think Angie just gave up.”

Angie’s father, Daniel Stoner, said, “For 14 years our daughter was considered terminally ill and what right did the court have to decide that her life was over?

‘Didn’t Want Baby’

“After they said she was going to die, she didn’t want the baby, and she didn’t want the pain. She’d been through an awful lot in her life. And, we were clear that we wanted what she wanted, and we all knew this baby wasn’t going to live.”.

Speaking at the press conference on behalf of the American College of Obstetricians and Gynecologists, Dr. Jack Graham said the group is opposed to court-ordered treatment of pregnant women, noting that other options such as power of attorney, living wills and family consensus are preferable.

Researchers in the area of maternal-fetal conflicts have found 11 previous cases of court-ordered Caesarean sections that were performed despite the woman’s objection, none of them performed on a dying woman. These surgeries were performed on women who objected to surgery for religious or personal reasons.

Seven of the fetuses were judged by doctors to be in fetal distress, three of the women had had previous Caesarean sections and physicians feared injury by vaginal birth (a very controversial area of obstetrics) and two had a condition called placenta previa, which places the child at risk during birth. Other court-ordered procedures on fetuses have included blood transfusions, primarily when women have objected for religious reasons.

A San Diego Case

In San Diego last year, Pamela Rae Stewart was arrested and charged with causing her son’s death by allegedly waiting “many hours” before seeking medical help after she noticed vaginal bleeding and began experiencing uterine contractions. The child was born with brain damage and died within six weeks. Stewart was also accused of harming the child by allegedly engaging in sexual intercourse with her husband late in the pregnancy and taking amphetamines and marijuana against her doctor’s advice. The case was dismissed.

Writing in the Hasting Center Report, researcher Dawn Johnsen asks:”To what extent should the law allow the state or other third parties to control the behavior of pregnant women by asserting concern for the well-being of the fetuses they bear? The legal and medical communities are sharply divided on this matter.

“The legal system has begun to treat the maternal-fetal relationship as it does conflicts between two distinct and independent entities--by weighing the claims and interests of one against those of the other and then declaring a winner.”

Even if a woman and a fetus are judged to be two different people, each with full civil rights, Americans are not required by law to undergo any medical procedures for the sake of saving another person.

In 1978 a Pennsylvania man went to court in an attempt to force his cousin to donate 21 ounces of bone marrow in a transplant doctors regarded as his only chance to survive aplastic anemia. Judge John Flaherty denied the request, stating: “The common law has consistently held to a rule which provides that one human being is under no legal compulsion to give aid or to take action to save (another) human being.”

Looking at the Angie case in this perspective of one person being forced to undergo surgery to save the life of another, the ACLU feels this amounts to the courts saying that a person who is terminally ill loses her right to refuse surgery, simply because she is not in good health. “The fetus was treated as a person-plus,” said Paltrow.

The appeals court is expected to issue a response to the ACLU appeal by the end of the year. If the petition to re-hear the case is turned down, “we will definitely file with the Supreme Court,” Paltrow said.