She's Going to Die: The Case of Angela C

She's Going to Die: The Case of Angela C Angela C was a twenty-eight-year old married woman who was approximately twenty-six weeks pregnant. She had suffered from cancer since she was thirteen years old, but had been in remission for approximately two years before she became pregnant. The pregnancy was planned, and she very much looked forward to the birth. Her health seemed reasonably good until about the twenty-fifth week of pregnancy, when she was admitted to George Washington University Hospital, and a tumor was found in her lung. Within a few days the physicians determined that her condition was terminal and she would die within weeks. At approximately 4:00 p.m. on June 15, 1987, she was told that she might die much sooner. Because her fetus would have a much better chance to be born healthy at twenty-eight weeks or more gestation, she agreed to treatment that might help her survive longer, but insisted that her own care and comfort be primary. Ms. C's husband, her mother, and her physicians agreed that keeping her comfortable while she died was what she wanted and that her wishes should be honored. The next morning this information was communicated to hospital administration. Legal counsel was consulted, who decided to consult the university's outside counsel. Outside counsel asked a judge to come to the hospital to decide what to do. The Hearing Judge Emmett Sullivan of the District of Columbia Superior Court summoned volunteer lawyers, and with a police escort rushed to the hospital where he set up "court." Legal counsel was, of course, present for the hospital. In addition, lawyers were appointed to represent Ms. C, and her fetus, and the judge invited the District of Columbia Corporation Counsel to participate as well. The lawyer for the hospital opened the proceeding: [T]he apparent desire of the patient and her family is that if the patient is to die, that no intervention be done on behalf of the fetus.... The hospital is seeking declaratory relief from the court to direct the hospital as to what it should do in terms of the fetus, whether to intervene and save its life. The lawyer for the fetus expressed the view that the fetus was "a probably viable fetus, presumptively viable fetus, age twenty-six weeks," and that the court's task was to "balance" the interests of the fetus "with whatever life is left for the fetus's mother...." Ms. C's lawyer argued simply that she opposed surgical intervention to remove the fetus. Her attending physician, Louis Hamner, testified that Ms. C had agreed to have the child at twenty-eight weeks, but that because the odds of a major handicap were much higher at twenty-six weeks gestation, she did not want the fetus delivered earlier. He said Ms. C was heavily sedated, and would likely die within twenty-four hours. A neonatologist testified hypothetically, having "had no direct involvement with the mother or the family." She strongly supported intervention on the basis that for any individual fetus, survival and morbidity are "very difficult to predict." When pressed she put the likelihood of fetal viability at 50 to 60 percent and the risk of serious handicap at less than 20 percent. The patient's mother testified that the previous day, after her daughter had been informed that her condition was terminal, she said, "I only want to die, just give me something to get me out of this pain." Hospital counsel then asked the court to decide "what medical care, if any, should be performed for the benefit of the fetus of [Ms. C]." The lawyers' arguments focused not on what Ms. C wanted or even on her best interests, but on the best interests of the fetus and on Ms. C's terminal condition. The lawyer for the fetus, for example, urged that a cesarean be performed because, "sadly, the life of the mother is lost to us no matter what decision is made at this point." Ms. …