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In re A.C.

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Cesarean Section↗

In re A.C.

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Cesarean Section↗

In re A.C.

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Adult↗

In re A.C.

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Cesarean Section↗

Terminal care and the pregnant woman: ethical reflections on In Re: A.C.

In June 1987, a Washington, DC, court, stating that it had an interest in protecting viable fetal life, ordered a 27-year-old woman dying of cancer to undergo a cesarean section to deliver a 26 1/2-week fetus. The child died within hours, and the woman within days, of the surgery. The ruling was appealed. In April 1990, the court vacated its order, stating that because the court had not first determined the woman's wishes, either as expressed by herself or through a substituted judgment, it was not possible to find a state interest in protecting fetal life which outweighed her own. Beyond this legal issue lie the ethical questions of appropriate care for the pregnant, terminally ill woman. This article argues that it is important to distinguish a decision not to deliver at this time from a decision to terminate a pregnancy. Further, because a cesarean section, unless there is a threat to her life, is not of any clear benefit to the woman, it is wrong to insist that a dying woman must always endure burdensome treatment for the sake of a viable fetus. Should the mother decide to take on such burdens, it is important also to recognize that a cesarean section is not always in the interest of the fetus simply because it is viable. Given the ambiguity of the prognosis for survival and the risks of significant handicaps for the preterm or low birth weight fetus, it may be ethically appropriate to omit an act on behalf of the fetus. Finally, the fact that the fetus' only chance of survival is a preterm delivery does not make the delivery ethically mandatory. The issue is not whether a preterm delivery is the fetus' only hope, but whether a preterm delivery is in the interest of the fetus.

Adult↗

In Re A.C., 16 June 1987.

The plaintiff hospital sought a declaratory order that a cesarean section be performed on a woman expected to die within two days who was in her twenty-sixth week of pregnancy and objected to the operation. On appeal of a decision granting the order, the Court ruled that the privacy rights of the mother against bodily intrusion should be subordinated to the interests of the unborn child and the state and refused to stay the order even though that might mean that the mother's lifespan would be shortened by a few hours.

Americas↗

Resolving the clinical and ethical dilemma involved in fetal-maternal conflicts.

A serious ethical dilemma occurs when a pregnant woman refuses a medically indicated intervention. Should respect for her autonomy preclude any approach other than to accept her decision? Should the caregivers have recourse to "gentle persuasion"? Is there ever a justification for invoking the power of court-ordered intervention? The societal views on this subject are first developed from an ethical perspective. The pertinent court cases that reflect on this topic are reviewed. The process of developing guidelines within our institution is related. Finally, the guidelines that were eventually developed are offered.

Beneficence↗