In re A.C.

Facts

At age thirteen, Angela Stoner was diagnosed with a rare and usually fatal form of cancer, Ewing's sarcoma. Despite numerous doctors warning her of imminent death, she survived. After years of chemotherapy and radiation therapy she was declared to be in remission. She got married and sought her doctor's advice on whether she could become pregnant with her health history. Since her cancer had been in remission for several years, her obstetrician said to go ahead and get pregnant, which she did.

In 1987, when Carder was twenty-six weeks pregnant, her cancer was discovered to have recurred and metastasized to her lung. Her initial plan was to begin radiation and chemotherapy immediately as she had been through too much already not to at least try to prolong her life, regardless of risks to the fetus. The doctors at George Washington University Hospital in Washington, D.C. immediately gave Carder only days to live and disagreed with her choice to put her own life ahead of that of the fetus. Instead of treating the cancer, they ignored her protests and inserted an oral feeding tube into her and administered sedatives in an effort to delay her death and increase her fetus' chance of continued development.

Whatever her choice, the administrators of the hospital – who were also the liability risk managers – were concerned that she had not elected to have an immediate C-section. Fearing a lawsuit by aggressive pro-life activists, they convened a court hearing at the hospital and obtained separate counsels for Carder, her fetus, and the hospital. At the hearing, family members, including Carder’s husband, opposed the C-section on the grounds that she would be unlikely to survive it and that she would not want it (Carder herself, now gravely ill and heavily sedated, did not testify). Her treating physicians also opposed the procedure. However, a neonatologist not personally familiar with her medical status testified that the fetus would have at least a 60% chance of survival – nearly that of a healthy woman’s fetus at the same gestational age. Carder’s own long-term oncologist was not contacted; he has since stated that he would have called the procedure "medically inadvisable both for Angela Carder and for the fetus".

Nonetheless, and despite medical testimony that such a procedure would probably end Carder’s life, an order was issued authorizing the hospital to perform an immediate C-section. Obstetricians at the hospital initially refused to carry out the procedure, but eventually one reluctantly agreed. A three-judge appellate panel upheld the decision in an emergency telephone appeal, despite Carder’s own repeated pleas of "I don’t want it done."

Exactly how long the fetus survived is a matter of some dispute; the most commonly cited figure is two hours. Susan Faludi quotes the obstetrician who performed the surgery as saying attempts to inflate the fetus’s lungs were "like trying to ventilate a rock".

Angela Carder was informed of her baby's death and survived her surgery for two days before lapsing into a coma and dying thereafter.

Court proceedings

In the wake of the surgery, Carder’s family and the American Civil Liberties Union’s Reproductive Freedom Project asked the D.C. Court of Appeals to vacate the order and its legal precedent, on grounds that the order had violated Carder's right to informed consent and her constitutional rights of privacy and bodily integrity. One hundred and twenty organizations joined amicus briefs on Carder’s behalf, including the American Medical Association and the American College of Obstetricians and Gynecologists. Only two groups defended the forced surgery. One of them was the Americans United for Life. The other was the United Catholic Conference, now known as the United States Conference of Catholic Bishops (USCCB). The USCCB filed an amicus brief arguing that the lower court's decision to force Angela to undergo surgery that was likely to and did contribute to her death, was "the correct choice." The USCCB has never repudiated their position in this case. One attorney for the hospital argued that it was appropriate to sacrifice a dying woman for her fetus; an appeals court judge is reported to have replied, "Are you urging this court to find that you can handcuff a woman to a bed and force her to give birth?" On April 26, 1990, the court issued the ruling In re A.C., which vacated the previous decisions and ruled that Angela Carder had the right to make health-care decisions for herself and her fetus.

At the same time as the Court of Appeals case, the ACLU and Carder’s parents, Daniel and Nettie Stoner, instituted a civil action, Stoners v. George Washington University Hospital, et al., suing the hospital for deprivation of human rights, discrimination, wrongful death and malpractice, among other charges. In November 1990, days before the scheduled trial was to begin, the hospital settled out of court for an undisclosed amount of money and a promise of new hospital policies protecting the rights of pregnant women.