Court Backs Women’s Medical Rights

A pregnant patient’s decision to refuse medical treatment is almost always paramount, even when survival of a fetus is at stake, the District of Columbia’s highest court ruled Thursday.

The decision in a widely watched case is binding only in the district, but it is expected to influence other courts wrestling with questions of maternal and fetal rights in connection with medical treatment and abortion.

“We hold that in virtually all cases the question of what is to be done is to be decided by the patient--the pregnant woman--on behalf of herself and the fetus,” the D.C. Court of Appeals said in a 7-1 decision.

“We do not quite foreclose the possibility” that the patient’s wishes may be overridden, the panel said, “but we anticipate that such cases will be extremely rare and truly exceptional.”

The court ruled in the case of Angela Carder, 27, a terminal cancer patient pregnant with a 26-week-old fetus. The D.C. Superior Court found it unclear what the heavily sedated Carder wanted done with the fetus and told George Washington University Hospital to perform an emergency Cesarean section.

The premature infant died 2 1/2 hours after the surgery; her mother died two days later. The Cesarean section was listed as a contributing cause of Carder’s death.

Writing for the majority, Judge John A. Terry said the lower court should have tried to determine what Carder would have wanted to happen had she been able to make a clear decision.

Instead, the judge wrote, the court proceeded straight to a “balancing analysis” weighing Carder’s rights against the interests of the state--in this case the survival of the fetus--and found for the fetus.

In a separate opinion, Judge James A. Belson said he agreed with the lower court’s decision to weigh the interests of Carder, her fetus and the state. The judge said an unborn child’s interests and the state’s interest in preserving human life are entitled to “substantial weight” when they are in conflict with a patient’s decision on medical treatment.

The American Civil Liberties Union and the National Organization for Women, which fought the court-ordered procedure, said the appeals court decision affirmed the rights of pregnant women to control their own medical treatment.

The ACLU said the decision “stands as solid authority” for rejecting the idea that a fetus has rights superseding those of a person already born.

ACLU attorney Lynn Paltrow, who brought the case, said the lower court treated Carder as if she were dead. “The bottom line is you can’t deny women their civil rights. You can’t treat women as dead just because they’re pregnant,” she said.