Refusal to Undergo Cesarean Supported : Supreme Court: Justices clear way for Pentecostalist to await natural labor. Doctors say fetus is endangered.

The U.S. Supreme Court on Saturday declined to order a new hearing in the case of a pregnant woman who, for religious reasons, has refused a Cesarean section that doctors say is necessary to save her fetus.

The high court decision clears the way for the woman to wait until she begins labor naturally--a delay that doctors have claimed could cause brain damage or even death to the fetus. The woman is now 37 weeks pregnant.

With the court ruling apparently sealing off further legal action, the woman and her husband “will pray and wait for the natural birthing process to begin,” said Colleen K. Connell, an attorney with the American Civil Liberties Union of Illinois who represented the couple.

The woman, who has been identified in court papers only as “Mother Doe,” has refused requests from doctors to take steps to deliver the baby before labor begins naturally, either by inducing labor or undergoing a Cesarean procedure, saying that such intervention violates her religious beliefs. The woman and her husband are Pentecostal Christians.

“The courts have been very clear that patients cannot be forced to accept medical care that is inconsistent with their religious beliefs,” Connell said. “An important part of the Pentecostal tradition is faith in the Almighty’s intervention and the natural healing processes.”

The Supreme Court ruling capped more than a week of concentrated legal maneuvering in a complex intersection of law, ethics and medicine.

The case began in November, when a doctor at the St. Joseph Hospital and Medical Center in Chicago concluded during an examination of the woman that the fetus was not receiving enough oxygen from the placenta and urged her to undergo a Cesarean operation or to accept attempts to induce labor.

The doctor later narrowed his recommendation to urging the Cesarean procedure, Connell said.

After the woman refused, the hospital contacted the Cook County state’s attorney’s office, which joined with the public guardian of Cook County to began legal proceedings on Dec. 9.

A trial court rejected the state’s pleas to appoint a court-ordered guardian for the fetus and to require the woman to undergo the Cesarean operation.

In a hearing before the Illinois Appellate Court last Tuesday, the state backed down somewhat, saying that it wished to require the woman to accept a Cesarean only after labor begins naturally, Connell said. But the court rejected the state’s arguments again.

At that point, the state attorney’s office dropped the case. But the public guardian, Patrick Murphy, pressed on to the Illinois Supreme Court. That court rejected his petition on Thursday. So on Friday afternoon, Murphy filed an application with Supreme Court Justice John Paul Stevens, urging the high court to order a new hearing in the case.

Early Saturday, the high court rejected Murphy’s petition, with only Justice Harry A. Blackmun supporting the request, court spokeswoman Toni House said. “In some respects,” Murphy said afterward, “it’s exceedingly disappointing and it’s depressing to me that I’ve lost a client.”

As is customary, the court did not indicate the reasons for its decision.

Connell left open the question of whether the woman might accept a Cesarean procedure, if necessary, once labor begins naturally, saying that “what she objected to was the doctors’ effort to force her into court to have the Cesarean.”

John N. Seibel, attorney for the hospital, said the woman had told physicians that she desires to “undergo spontaneous labor and a vaginal delivery.” But, he added, it is the opinion of the doctors that “the infant could not survive” conventional labor.

Brownstein reported from Washington and Shryer from Chicago.