Citation. 573 A.2d 1235, 1990 D.C. App.
Brief Fact Summary. A.C. was diagnosed with inoperable cancer while pregnant. Her condition worsened until she was unable to adequately communicate, and a hearing was held to determine if a caesarean section should be performed, during which there was conflicting testimony as to if A.C. would have consented to the operation.
Synopsis of Rule of Law. The procedure of substituted judgment must be used to ascertain the wishes of an incompetent patient to submit to treatment unless there are truly extraordinary or compelling reasons for overriding the patient’s wishes.
Facts. A.C. was diagnosed with cancer at the age of thirteen. She married and became pregnant during a period of remission at twenty-seven. At approximately twenty-five weeks into the pregnancy, she was diagnosed with an inoperable tumor. She was asked if she really wanted to have her baby, and said that she did. Shortly thereafter her condition was deemed terminal, and she agreed to palliative treatment intended to extend her life to at least twenty-eight weeks of pregnancy to increase the potential outcome for the fetus if intervention was necessary. The treatment presented increased risk for the fetus, but was intended to prolong her life and maintain her comfort. She said at this point that she thought she still wanted to have the baby. Her condition quickly deteriorated and she was unable to communicate. A hearing was held to determine if a caesarean section should be performed. Testimony established that the fetus had a fifty to sixty percent chance of surviving a caes
arean section at twenty-six weeks. There was considerable debate as to whether A.C. would have consented to the caesarean at twenty-six weeks. The trial court found that A.C. would probably die within a day or two, that the caesarean would probably hasten the death of A.C., but would increase the chance of survival for the fetus. The court also found that it did not clearly know A.C.’s current views, but that the state had a legitimate interest in protecting the viable fetus. The caesarean was performed, but the baby died after a few hours and A.C. died of cancer two days later.
Issue. Who has the right to decide the course of medical treatment for a patient near death and pregnant with a viable fetus?
If the patient cannot make the decision for herself, how should the decision be made?