Angela Carder
Encyclopedia
In re A.C. was a 1987 D.C. Circuit reproductive rights
case. It was the first appellate court decision to "take a stand against" forced caesarean sections. Angela Carder (née Stoner) was forced to undergo a life-threatening Caesarean section
in an unsuccessful attempt to save the life of her fetus. The case stands as a landmark in United States case law
establishing the rights
of pregnant women to determine their own health care.
and radiation therapy
she was declared to be in remission. She got married and sought her doctor's advice on whether she could become pregnant with her health history. Since her cancer had been in remission for several years, her obstetrician said to go ahead and get pregnant, which she did.
In 1987, when Carder was twenty-six weeks pregnant, her cancer was discovered to have recurred and metastasized to her lung. Her initial plan was to begin radiation and chemotherapy immediately as she had been through too much already not to at least try to prolong her life, regardless of risks to the fetus. The doctors at George Washington University Hospital
in Washington, D.C.
immediately gave Carder only days to live and disagreed with her choice to put her own life ahead of that of the fetus. Instead of treating the cancer, they ignored her protests and inserted an oral feeding tube into her and administered sedatives in an effort to delay her death and increase her fetus' chance of continued development.
Whatever her choice, the administrators of the hospital – who were also the liability risk managers – were concerned that she had not elected to have an immediate C-section. Fearing a lawsuit by aggressive pro-life
activists, they convened a court hearing at the hospital and obtained separate counsels for Carder, her fetus, and the hospital. At the hearing, family members, including Carder’s husband, opposed the C-section on the grounds that she would be unlikely to survive it and that she would not want it (Carder herself, now gravely ill and heavily sedated, did not testify). Her treating physicians also opposed the procedure. However, a neonatologist not personally familiar with her medical status testified that the fetus would have at least a 60% chance of survival – nearly that of a healthy woman’s fetus at the same gestational age. Carder’s own long-term oncologist was not contacted; he has since stated that he would have called the procedure "medically inadvisable both for Angela Carder and for the fetus".
Nonetheless, and despite medical testimony that such a procedure would probably end Carder’s life, an order was issued authorizing the hospital to perform an immediate C-section. Obstetricians at the hospital initially refused to carry out the procedure, but eventually one reluctantly agreed. A three-judge appellate panel upheld the decision in an emergency telephone appeal, despite Carder’s own repeated pleas of "I don’t want it done."
Exactly how long the fetus survived is a matter of some dispute; the most commonly cited figure is two hours. Susan Faludi
quotes the obstetrician who performed the surgery as saying attempts to inflate the fetus’s lungs were "like trying to ventilate a rock".
Angela Carder was informed of her baby's death and survived her surgery for two days before lapsing into a coma and dying thereafter.
’s Reproductive Freedom Project asked the D.C. Court of Appeals to vacate the order and its legal precedent, on grounds that the order had violated Carder's right to informed consent and her constitutional rights of privacy and bodily integrity. One hundred and twenty organizations joined amicus briefs on Carder’s behalf, including the American Medical Association
and the American College of Obstetricians and Gynecologists. Only two groups defended the forced surgery. One of them was the Americans United for Life. The other was the United Catholic Conference, now known as the USCCB. The USCCB filed an amicus brief arguing that the lower court's decision to force Angela to undergo surgery that was likely to and did contribute to her death, was "the correct choice." The USCCB has never repudiated their position in this case. One attorney for the hospital argued that it was appropriate to sacrifice a dying woman for her fetus; an appeals court judge is reported to have replied, "Are you urging this court to find that you can handcuff a woman to a bed and force her to give birth?" On April 26, 1990, the court issued the ruling In re A.C., which vacated the previous decisions and ruled that Angela Carder had the right to make health-care decisions for herself and her fetus.
At the same time as the Court of Appeals case, the ACLU and Carder’s parents, Daniel and Nettie Stoner, instituted a civil action, Stoners v. George Washington University Hospital, et al., suing the hospital for deprivation of human rights, discrimination, wrongful death and malpractice, among other charges. In November 1990, days before the scheduled trial was to begin, the hospital settled out of court for an undisclosed amount of money and a promise of new hospital policies protecting the rights of pregnant women.
Laura Pemberton: Speaking on Her Experience of a Court-ordered Cesarian Surgery
Reproductive rights
Reproductive rights are legal rights and freedoms relating to reproduction and reproductive health. The World Health Organization defines reproductive rights as follows:...
case. It was the first appellate court decision to "take a stand against" forced caesarean sections. Angela Carder (née Stoner) was forced to undergo a life-threatening Caesarean section
Caesarean section
A Caesarean section, is a surgical procedure in which one or more incisions are made through a mother's abdomen and uterus to deliver one or more babies, or, rarely, to remove a dead fetus...
in an unsuccessful attempt to save the life of her fetus. The case stands as a landmark in United States case law
Case law
In law, case law is the set of reported judicial decisions of selected appellate courts and other courts of first instance which make new interpretations of the law and, therefore, can be cited as precedents in a process known as stare decisis...
establishing the rights
Pregnant patients' rights in the United States
Pregnant patients' rights regarding medical care during the pregnancy and childbirth are specifically a patient's rights within a medical setting and should not be confused with pregnancy discrimination...
of pregnant women to determine their own health care.
Facts
At age thirteen, Angela Stoner was diagnosed with a rare and usually fatal form of cancer, Ewing's sarcoma. Despite numerous doctors warning her of imminent death she survived. After years of chemotherapyChemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
and radiation therapy
Radiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
she was declared to be in remission. She got married and sought her doctor's advice on whether she could become pregnant with her health history. Since her cancer had been in remission for several years, her obstetrician said to go ahead and get pregnant, which she did.
In 1987, when Carder was twenty-six weeks pregnant, her cancer was discovered to have recurred and metastasized to her lung. Her initial plan was to begin radiation and chemotherapy immediately as she had been through too much already not to at least try to prolong her life, regardless of risks to the fetus. The doctors at George Washington University Hospital
George Washington University Hospital
The George Washington University Hospital is a hospital in Washington, D.C. in the United States. It opened on On August 23, 2002, with 371 beds in a 400,000 sq. ft. building, housing than $45 million of medical equipment and cost more than $96 million to construct...
in Washington, D.C.
Washington, D.C.
Washington, D.C., formally the District of Columbia and commonly referred to as Washington, "the District", or simply D.C., is the capital of the United States. On July 16, 1790, the United States Congress approved the creation of a permanent national capital as permitted by the U.S. Constitution....
immediately gave Carder only days to live and disagreed with her choice to put her own life ahead of that of the fetus. Instead of treating the cancer, they ignored her protests and inserted an oral feeding tube into her and administered sedatives in an effort to delay her death and increase her fetus' chance of continued development.
Whatever her choice, the administrators of the hospital – who were also the liability risk managers – were concerned that she had not elected to have an immediate C-section. Fearing a lawsuit by aggressive pro-life
Pro-life
Opposition to the legalization of abortion is centered around the pro-life, or anti-abortion, movement, a social and political movement opposing elective abortion on moral grounds and supporting its legal prohibition or restriction...
activists, they convened a court hearing at the hospital and obtained separate counsels for Carder, her fetus, and the hospital. At the hearing, family members, including Carder’s husband, opposed the C-section on the grounds that she would be unlikely to survive it and that she would not want it (Carder herself, now gravely ill and heavily sedated, did not testify). Her treating physicians also opposed the procedure. However, a neonatologist not personally familiar with her medical status testified that the fetus would have at least a 60% chance of survival – nearly that of a healthy woman’s fetus at the same gestational age. Carder’s own long-term oncologist was not contacted; he has since stated that he would have called the procedure "medically inadvisable both for Angela Carder and for the fetus".
Nonetheless, and despite medical testimony that such a procedure would probably end Carder’s life, an order was issued authorizing the hospital to perform an immediate C-section. Obstetricians at the hospital initially refused to carry out the procedure, but eventually one reluctantly agreed. A three-judge appellate panel upheld the decision in an emergency telephone appeal, despite Carder’s own repeated pleas of "I don’t want it done."
Exactly how long the fetus survived is a matter of some dispute; the most commonly cited figure is two hours. Susan Faludi
Susan Faludi
Susan C. Faludi is an American feminist, journalist and author. She won a Pulitzer Prize for Explanatory Journalism in 1991, for a report on the leveraged buyout of Safeway Stores, Inc., a report that the Pulitzer Prize committee thought showed the "human costs of high finance".-Biographical...
quotes the obstetrician who performed the surgery as saying attempts to inflate the fetus’s lungs were "like trying to ventilate a rock".
Angela Carder was informed of her baby's death and survived her surgery for two days before lapsing into a coma and dying thereafter.
Court proceedings
In the wake of the surgery, Carder’s family and the American Civil Liberties UnionAmerican Civil Liberties Union
The American Civil Liberties Union is a U.S. non-profit organization whose stated mission is "to defend and preserve the individual rights and liberties guaranteed to every person in this country by the Constitution and laws of the United States." It works through litigation, legislation, and...
’s Reproductive Freedom Project asked the D.C. Court of Appeals to vacate the order and its legal precedent, on grounds that the order had violated Carder's right to informed consent and her constitutional rights of privacy and bodily integrity. One hundred and twenty organizations joined amicus briefs on Carder’s behalf, including the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
and the American College of Obstetricians and Gynecologists. Only two groups defended the forced surgery. One of them was the Americans United for Life. The other was the United Catholic Conference, now known as the USCCB. The USCCB filed an amicus brief arguing that the lower court's decision to force Angela to undergo surgery that was likely to and did contribute to her death, was "the correct choice." The USCCB has never repudiated their position in this case. One attorney for the hospital argued that it was appropriate to sacrifice a dying woman for her fetus; an appeals court judge is reported to have replied, "Are you urging this court to find that you can handcuff a woman to a bed and force her to give birth?" On April 26, 1990, the court issued the ruling In re A.C., which vacated the previous decisions and ruled that Angela Carder had the right to make health-care decisions for herself and her fetus.
At the same time as the Court of Appeals case, the ACLU and Carder’s parents, Daniel and Nettie Stoner, instituted a civil action, Stoners v. George Washington University Hospital, et al., suing the hospital for deprivation of human rights, discrimination, wrongful death and malpractice, among other charges. In November 1990, days before the scheduled trial was to begin, the hospital settled out of court for an undisclosed amount of money and a promise of new hospital policies protecting the rights of pregnant women.
See also
Pemberton v. Tallahassee Memorial Regional CenterPemberton v. Tallahassee Memorial Regional Center
Pemberton v. Tallahassee Memorial Regional Center is a case in the United States regarding reproductive rights...
Laura Pemberton: Speaking on Her Experience of a Court-ordered Cesarian Surgery
- In re Fetus Brown, 689 N.E.2d 397, 400 (Ill. App. Ct. 1997) (overturning a court-ordered blood transfusion of a pregnant woman)
- In re Baby Boy Doe, 632 N.E.2d 326 (Ill. App. Ct. 1994) (holding that courts may not balance whatever rights a fetus may have against the rights of a competent woman, whose choice to refuse medical treatment as invasive as a cesarean section must be honored even if the choice may be harmful to the fetus).
- Stallman v. Youngquist, 531 N.E.2d 355, 359-61 (Ill. 1988) (refusing to recognize the tort of maternal prenatal negligence, holding that granting fetuses legal rights in this manner “would involve an unprecedented intrusion into the privacy and autonomy of the [state’s female] citizens”).