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Cesareans and Samaritans

Published online by Cambridge University Press:  28 April 2021

Extract

Until recently, if one asked the proverbial person on the street to list maternal-fetal conflicts, he or she would have mentioned abortion and, when pressed to continue, looked at the questioner blankly. Now, however, the populace is becoming aware of a host of maternal-fetal conflicts. Indeed, mother-and-child, long a somewhat romanticized unity, are increasingly being treated by physicians, courts, and the media as potential adversaries, locked in battle on the rather inconvenient battleground of the woman's belly.

Some of these newly publicized conflicts—pregnant women abusing drugs or alcohol, or continuing to work in occupations hazardous to fetal health—are not all that new: the hazards of various substances have been known for years. Other of the conflicts are new, inasmuch as doctors could not recommend Cesareans or other procedures for the fetus benefit until they could detect fetal problems during or before labor. But probably what is most unprecedented is that now, suddenly, physicians are seeking court intervention to protect these imperiled fetuses—intervention that, inevitably, constitutes a significant intrusion into the woman's conduct during pregnancy or birth.

Type
Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 1987

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References

This article is a shortened version of “The Judge in the Delivery Room: The Emergence of Court-Ordered Cesareans,” which appeared in the California Law Review 1987, 74: 1951.Google Scholar
Only one of these cases—Jefferson v. Griffin Spalding County Hospital Authority, 274 S.E.2d 457 (Ga. 1981)—has been officially reported. Another case—In re Unborn Baby Kenner, No. 79 JN 83 (Colo. Juv. Ct. Mar. 6, 1979)—has been reported in medical literature; see Bowes, WA, Selgestad, B, Fetal versus maternal rights: Medical and legal perspectives, Obstetrics & Gynecology 1981, 58(1): 109, 211. A recent report of a large-scale survey indicates that courts in eleven states have ordered Cesarean deliveries. Kolder, VEB, Gallagher, J, Parsons, MT, Court-ordered obstetrical interventions, New England Journal of Medicine 1987, 316(19): 1192-96, 1194.Google ScholarPubMed
See, e.g., In re Baby Jeffries, No. 14004 (Mich. P. Ct. May 24, 1982). Developments in the Jeffries case are described in a series of newspaper articles. See Detroit Free Press, May 29, 1982; June 13, 1982; and June 16, 1982.Google Scholar
North Central Bronx Hospital Authority v. Headley, No. 1992–85 (N.Y. Sup. Ct. Jan. 6, 1986).Google Scholar
For discussions of in utero therapy, see, e.g., Robertson, JA, The right to procreate and in utero fetal therapy, Journal of Legal Medicine 1982, 3(3): 333–66; Ruddick, W, Wilcox, W, Operating on the fetus, Hastings Center Report 1982, 12(5): 10-14; Barclay, WR, et al., The ethics of in utero surgery, Journal of the American Medical Association 1981, 246(14): 1550-55.Google ScholarPubMed
Jefferson v. Griffin Spalding County Hospital Authority, 274 S.E.2d 457 (Ga. 1981); In re Unborn Baby Kenner, No. 79-JN-83 (Colo. Juv. Ct. Mar. 6, 1979); In re Baby Jeffries, No. 14004 (Mich. P. Ct. May 24, 1982) (order authorizing surgery); North Central Bronx Hospital Authority v. Headley, No. 1992–85 (N.Y. Sup. Ct. Jan. 6, 1986) (order authorizing surgery). There is no written decision in the case where the judge refused to authorize surgery. Interview with Judge Margaret Taylor, Family Court, in New York City (Nov. 6, 1985) (describing 1982 case where attorneys for St. Vincent's Hospital sought an order, but she refused to issue one).Google Scholar
410 U.S. 113 (1973).Google Scholar
Jefferson v. Griffin Spalding County Hospital Authority, 274 S.E.2d 457 (Ga. 1981); North Central Bronx Hospital Authority v. Headley, No. 1992–85 (N.Y. Sup. Ct. Jan. 6, 1986), slip op. at 5; In re Unborn Baby Kenner, No. 79-JN-83 (Colo. Juv. Ct. Mar. 6, 1979), slip op. at 6–9.Google Scholar
410 U.S. at 163–64.Google Scholar
North Central Bronx Hospital Authority v. Headley, No. 1992–85 (N.Y. Sup. Ct. Jan. 6, 1986); In re Unborn Baby Kenner, No. 79-JN-83 (Colo. Juv. Ct. Mar. 6, 1979).Google Scholar
410 U.S. at 163–64.Google Scholar
439 U.S. 379 (1979).Google Scholar
Id. at 400.Google Scholar
Late abortion methods include induction of labor with substances such as prostaglandin or oxytocin—procedures likewise used to induce labor when a live birth is desired (especially oxytocin)—and hysterotomy, a procedure similar to a Cesarean. Pritchard, J, Macdonald, P, Gant, N, Williams' obstetrics, 17th ed., 1985: 428.Google Scholar
National Institute of Health, U.S. Dept. of Health and Human Services, Pub. No.82–2067, Cesarean childbirth: Report of a consensus development conference, Oct. 1981: 268.Google Scholar
See, e.g., Jefferson v. Griffin Spalding County Hospital Authority, 274 S.E.2d 457 (Ga. 1981); Myers, DBE, Abuse and neglect of the unborn: Can the state intervene?, Duquesne Law Review 1984, 23(1): 1, 2631; Robertson, , supra note 4, at 352, 357–58.Google Scholar
For example, in Matter of Jensen, 633 P.2d 1302 (Or. App. 1981), despite the parents' religious objections, the court ordered surgery for a fifteen-month-old child with hydrocephalus (accumulation of fluid in the brain) because her condition, if untreated, could cause major mental and physical disability. Id. at 1305–6. See also Prince v. Massachusetts, 321 U.S. 158, 166–67 (1944) (right to practice religion does not include liberty to expose child to communicable disease, ill health, or death).Google Scholar
See generally Myers, supra note 16.Google Scholar
Annas, G, Women as fetal containers, Hastings Center Report 1986, 16(6): 1314.Google ScholarPubMed
See, e.g., Matter of Quackenbush, 383 A.2d 785 (N.J. Super. 1978) (ruling that competent patient with gangrene may refuse recommended leg amputation even though refusal will result in death); Lane v. Candura, 376 N.E.2d 1232 (Mass. App. 1978) (holding that irrationality of patient's refusal of amputation docs not justify conclusion of incompetence and that surgery cannot be performed against patient's will); In re Melideo, 390 N.Y.S.2d 523 (N.Y. S.Ct. 1976) (Jehovah's Witness' refusal of blood transfusion upheld even though possibly necessary to save her life). These cases illustrate that courts today are likely to hold that the patient's right to privacy overrides that state's interest in preserving life.Google Scholar
See In re President and Directors of Georgetown College, Inc., 331 F.2d 1000, 1008 (D.C. Cir.), reh. denied en banc, 331 F.2d 1010, cert. denied 377 U.S. 978 (1964); Powell v. Columbian [sic] Presbyterian Medical Center, 267 N.Y.S.2d 450 (Misc. 2d 1965). Cf. In re Osborne, 294 A.2d 372 (D.C. 1972) (upholding Jehovah's Witness father's refusal of blood transfusion, noting that even if he died, his children's financial and emotional needs would be met by close relatives and the ongoing family business).Google Scholar
At least one court has held that a parent's competent decision to refuse treatment simply supersedes the state's interest in protecting children from the loss of a parent; see In re Pogue, No. M-18-74 (D.C. Nov. 11, 1974). See also In Re Jamaica Hospital (reported in the New York Law Journal, May 17, 1985, at 15) (ordering transfusion for pregnant Jehovah's Witness to save fetus, but noting that if woman, a mother of ten, were the only one whose life were at stake, she could refuse the treatment).Google Scholar
See Tribe, L, American constitutional law, Mineola, N.Y.: Foundation Press, 1978: 918.Google Scholar
Prosser, W, Keeton, W, The law of torts, 5th ed., St. Paul: West Publishing Co., 1984, §56, 376–77.Google Scholar
See, e.g., Vt. Stat. Ann. tit.12, §519(3) (1973); Minn. Stat. Ann. §604.05.01 (West Supp. 1986).Google Scholar
European countries, which generally do require rescue, exempt physically hazardous rescues. See, e.g., Code Penal, art. 63 (Fr.).Google Scholar
10 Pa. D. & C.3d 90 (1978).Google Scholar
Id. at 92 (emphasis in original).Google Scholar
This terminology is from Judith Jarvis Thomson's famous article defending abortion on the grounds that requiring a woman to continue a pregnancy is requiring her to be a “Splendid Samaritan,” a requirement not imposed on anyone else in society. See Thomson, JJ, A defense of abortion, Philosophy & Public Affairs 1971, 1(1): 4766, 48-52.Google Scholar
Feldman, GB, Freiman, JA, Prophylactic Cesarean section at term?, New England Journal of Medicine 1985, 312(19): 1264–67, 1265.Google ScholarPubMed
Banta, HD, Thacker, SB, Assessing the costs and benefits of electronic fetal monitoring, Obstetrical and Gynecological Survey 1979, 34(8): 627–42, 628-29.Google ScholarPubMed
Id. at 629.Google Scholar
Leveno, KJ, et al., A prospective comparison of selective and universal electronic fetal monitoring in 34,995 pregnancies, New England Journal of Medicine 1986, 315(10): 615–19; Haverkamp, AD, Orleans, M, An assessment of electronic fetal monitoring, Women & Health 1982, 7(3-4): 115-34, 116.Google ScholarPubMed
In EFM cases, there will seldom be time for more than a hasty phone call to a judge. Even when counsel is appointed for the woman, he or she often has little or no time to prepare the case. In Jefferson, Ms. Jefferson's counsel was appointed at 11 a.m. on January 23, 1981; the case was argued at noon that same day. Letter from Hugh Glidewell (July 24, 1981). In Headley, North Central Bronx Hospital was represented by Bower and Gardner, a firm specializing in health law, while the woman was not represented at all. Telephone interview with Nancy Gold, of Bower and Gardner, who represented North Central Bronx Hospital (Jan. 13, 1986). According to the survey by Kolder et al., in 88 percent of the cases reported to them, the court order was obtained in six or fewer hours. See Kolder et al., supra note 1, at 1193.Google Scholar
People v. Stewart, No. M508197 (San Diego Mun. Ct. Feb. 26, 1987). Developments in the Stewart case were reponed in several newspaper articles. See New York Times, Oct. 9, 1986; and Feb. 27, 1987.Google Scholar