C-Section
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
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