WASHINGTON — 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.
"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.