In Re A.C.

573 A.2d 1235 (1990)

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Nature of the Case

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Facts

A.C. was suffering from cancer at the age of thirteen. She underwent major surgery several times, together with multiple radiation treatments and chemotherapy. During remission A.C. married and soon thereafter she became pregnant. She 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 P. At approximately twenty-five weeks she was experiencing pain in her back and shortness of breath, an x-ray was taken, revealing an inoperable tumor that nearly filled her right lung. A.C. was admitted to the hospital as a patient. Her condition had temporarily improved, and when asked if she really wanted to have her baby, she replied that she did. Her condition worsened and members of the medical staff treating A.C. assembled, along with her family, in A.C.'s room. The doctors informed her that her illness was terminal, and A.C. agreed to palliative treatment designed to extend her life until at least her twenty-eighth week of pregnancy. A.C. 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 comfort. When asked if she still wanted to have the baby, A. C. was somewhat equivocal, saying 'something to the effect of 'I don't know, I think so.'' A.C.'s condition grew still worse. The trial court convened a hearing at P in response to P's request for a declaratory judgment. The court-appointed counsel for both A.C. and the fetus and the District of Columbia was permitted to intervene for the fetus as parens patriae. Dr. Edwards testified that the fetus had only a fifty to sixty percent chance of survival. The fetus' condition was worsening appreciably at a rapid rate, and another doctor -- Dr. Weingold, an obstetrician stated that any delay in delivering the child by caesarean section lessened its chances of survival. Dr. Hamner, another treating obstetrician, testified that A.C. would probably die within twenty-four hours 'if absolutely nothing else is done. She had been heavily sedated in order to maintain her ventilatory function. There was no evidence before the court showing that A.C. consented to, or even contemplated, a caesarean section before her twenty-eighth week of pregnancy. There was considerable dispute as to whether she would have consented to an immediate caesarean delivery at the time the hearing was held. D opposed surgical intervention, testifying that A.C. wanted 'to live long enough to hold that baby' and that she expected to do so, 'even though she knew she was terminal.' The rest of the testimony was pure speculation as to A.C’s intent. “The court found that it does not clearly know what her present views are with respect to the issue of whether or not the child should live or die. She's presently unconscious. As late as Friday of last week, she wanted the baby to live. As late as yesterday, she did not know for sure.” The court ordered that a caesarean section be performed to deliver A.C.'s child. The court's decision was then relayed to A.C., who had regained consciousness. Dr. Hamner told the court: I explained to her essentially what was going on. . . . I said it's been deemed we should intervene on behalf of the baby by caesarean section and it would give it the only possible chance of it living. Would you agree to this procedure? She said yes. I said, do you realize that you may not survive the surgical procedure? She said yes. And I repeated the two questions to her again [and] asked her did she understand. She said yes. Dr. Weingold, together with D and A.C's husband, went to A.C.'s room to confirm her consent to the procedure. Dr. Weingold told her he would only perform it if she authorized it but it would be done in any case. She understood that. She then seemed to pause for a few moments and then very clearly mouthed words several times, I don't want it done. I don't want it done. Dr. Weingold thought the environment for an informed consent was non-existent because A.C. was in intensive care, flanked by a weeping husband and P. After hearing this new evidence, the court found that it was 'still not clear what her intent is' and again ordered that a caesarean section be performed. The baby lived for only a few hours, and A.C. died two days later. The matter was heard en banc.