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.