District of Columbia Court of Appeals, In re A.C., 573 A.2d 1235 (1990)

The Court transcripts tell us that Angela Carter

". . . was first diagnosed as suffering from cancer at the age of thirteen. In the ensuing years she underwent major surgery several times, together with multiple radiation treatments and chemotherapy. [She] married when she was twenty-seven, during a period of remission, and soon thereafter became pregnant. She was excited about her pregnancy and very much wanted the child. Because of her medical history, she was referred in her fifteenth week of pregnancy to the high-risk pregnancy clinic at George Washington University Hospital.

"On Tuesday, June 9, 1987, when she was approximately twenty-five weeks pregnant, she went to the hospital for a scheduled check-up. Because she was experiencing pain in her back and shortness of breath, an x-ray was taken, revealing an apparently inoperable tumor, which nearly filled her right lung. On Thursday, June 11, she was admitted to the hospital as a patient. By Friday her condition had temporarily improved, and when asked if she really wanted to have her baby, she replied that she did.

"Over the weekend her condition worsened considerably. Accordingly, on Monday, June 15, members of the medical staff treating Ms. Carter assembled, along with her family, in her room. The doctors then informed her that her illness was terminal, and she agreed to palliative treatment designed to extend her life until at least her twenty-eighth week of pregnancy. The 'potential outcome [for] the fetus,' according to the doctors, would be much better at twenty-eight weeks than at twenty-six weeks if it were necessary to 'intervene.' Ms. Carter knew that the palliative treatment she had chosen presented some increased risk to the fetus, but she opted for this course both to prolong her life for at least another two weeks and to maintain her own comfort. When asked if she still wanted to have the baby, she was somewhat equivocal, saying something to the effect of 'I don't know, I think so.' As the day moved toward evening, her condition grew still worse, and at about 7:00 or 8:00 p.m. she consented to intubation to facilitate her breathing.

"The next morning, June 16, the trial court convened a hearing at the hospital in response to the hospital's request for a declaratory judgment. The court appointed counsel for both Ms. Carter and for the fetus, and the District of Columbia was permitted to intervene for the fetus. . . .The court heard testimony on the facts as we have summarized them, and further testimony that at twenty-six and a half weeks the fetus was viable, i.e., capable of sustained life outside of the mother, given artificial aid. A neonatologist testified that the chances of survival for a twenty-six-week fetus delivered at the hospital might be as high as eighty percent, but that this particular fetus, because of the mother's medical history, had only a fifty to sixty percent chance of survival. Dr. Edwards estimated that the risk of substantial impairment for the fetus, if it were delivered promptly, would be less than twenty percent. However, she noted that the fetus' condition was worsening appreciably at a rapid rate, and another doctor-an obstetrician who was one of Ms. Carter's treating physicians-stated that any delay in delivering the child by caesarean section lessened its chances of survival."

The Court authorized the hospital to perform a caesarean section, in an effort to save the life of Ms. Carter's unborn child. The operation was performed, but both the mother and the child died. A few months later, that decision to allow the C-Section was vacated (despite the fact that it was now a moot issue), and it was ordered that the entire panel of appeals judges consider the case on its merits. The full panel did, and concluded in 1990 that:

We are confronted here with two profoundly difficult and complex issues. First, we must determine who has the right to decide the course of medical treatment for a patient who, although near death, is pregnant with a viable fetus. Second, we must establish how that decision should be made if the patient cannot make it for herself - more specifically, how a court should proceed when faced with a [dying] pregnant patient, who is apparently incapable of making an informed decision regarding medical care for herself and her fetus. 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. If the patient is incompetent, or otherwise unable to give an informed consent to a proposed course of medical treatment, then her decision must be ascertained through the procedure known as substituted judgment.

Because the trial court had not followed that procedure, the panel vacated its decision, concluding that the decision of Ms. Carter or her surrogate decision makers should have been enforced. (Also see competence, the Principle of Human Dignity, and the Principle of Respect for Autonomy.)