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The Ethics of Refusing a Caesarean Section

April 2004
e -Cases in Ethics

* In January of 2004, Melissa Ann Rowland—a young woman with a long history of mental illness—refused to undergo a Caesarean section that doctors said was necessary to protect the lives of her unborn twins. Doctors told her that low amniotic fluid and poor growth placed the twins in danger, but she refused the surgery until too late, reportedly on cosmetic grounds—she is alleged not to have wanted the resulting vertical scar.

* In 1987, Angela Carter, who was dying of cancer, also refused a C-section. She sought to remain pregnant until the 28th week of pregnancy, the point at which doctors had once told her her baby would have the best chance to survive. At 26 weeks, however, physicians felt that the child had a 50% chance of surviving outside Angela’s dying body, and virtually none if the surgery was not performed. Angela’s condition had deteriorated to the point that her understanding of the implications of refusing the surgery was unclear, but she seemed to refuse the operation. Her distraught husband and mother would not consent to the surgery.

It is hard to imagine anyone reading either of these stories and not having a strong reaction. Reactions are radically different, however, depending on the ethical principles on which they are grounded. For example, there are those whose arguments stem from the belief that there is an ethical duty, rooted in beneficence, to save innocent human life—even if unborn, and especially when as close to term as the ones discussed here. On the other hand, there are those whose arguments are grounded in the belief that the paramount ethical duty in these cases is to respect the autonomy of the mother. They echo Supreme Court Justice Benjamin Cardoza, who established in 1912 that “Every human being of adult years and sound mind has a right to determine what shall be done with his own body.” To force a woman to undergo surgery against her will violates the critical ethical requirement for informed consent.

When balancing ethical questions regarding the protection of human life against respect for personal autonomy, it is obvious that cases involving pregnant women present uniquely thorny challenges. Is a pregnant woman a person who carries within her body a human with fewer rights than she, or is she carrying a person with the same rights and human dignity that she herself possesses? Even for those who believe—as the Catholic Church clearly and unequivocally teaches—that an unborn child is from the moment of conception a person with all the human dignity of one who has been born, the answers are not simply “either/or” matters. That is, we cannot settle for respecting either the rights of the mother or those of the fetus; the rights of both must be both honored and carefully balanced.

There are many questions that deserve critical consideration regarding the extent to which society can intervene to keep an unborn child from harm’s way. Should we (or could we), for example, physically confine all mothers who smoke, use drugs, or consume alcohol? What about busy expectant mothers who disregard doctor’s orders to rest? More pressing, and more relevant to health care, are questions that ask the extent to which a pregnant woman might be obliged to put herself at risk by consenting to fetal surgery. These issues hover in the background throughout the discussion here of cases in which C-sections are believed necessary to save a viable fetus from what is believed to be certain death. In Angela’s case, medical professionals believed such surgery to be the only real hope of survival for her child, despite the fact that surgery would probably hasten the end of Angela’s own exceedingly tenuous grasp on life. In Melissa’s case, doctors also argued that a C-section was required for the sake of her unborn twins, while accepting that it placed Melissa herself at minimally greater risk than would a...
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