Court-ordered caesarian sections: in whose interests?

Abstract

In re S (adult: refusal of treatment),' Sir Stephen Brown, President of the Family Division of the High Court, granted a declaration that a caesarian section and consequential treatment could lawfully be performed upon a pregnant woman despite her refusal of consent. The case arose when Mrs S was admitted to hospital with ruptured membranes and in spontaneous labour. The child was in a position of 'transverse lie' and, in the opinion of Mrs S's medical advisors, there was the gravest risk that her uterus would rupture unless the doctors performed a caesarian section. Also, the baby could not be born alive unless the caesarian section was carried out. Mrs S refused consent to the operation because of her religious beliefs and it was found that her mental condition was such that she was competent to decide about her medical treatment. It was held that the operation was lawful 'in the vital interests of both Mrs S and of the unborn child.' As a consequence of the court's declaration the caesarian section was carried out, despite the fact that the unborn child, although alive when the declaration was made, had already died. The decision has been described as 'reigniting the debate over a woman's right to control her body.'2 Sir Stephen Brown P in re S established that the 'right' of an individual to choose whether to consent to medical treatment is not absolute, but may be qualified where the choice may lead to the death of a viable fetus. The possible significance of this decision is twofold. First, it casts doubt on the principle underlying the decision of the Court of Appeal in re T (adult: refusal of treatment)3 that a competent adult patient's refusal of consent to medical treatment may not be overridden in the patient's best interests. Second, it confirms fears that the courts may protect the interests of the unborn child at the expense of those of the mother. Although decisions similar to re S have been reached in the United States, this is the first time that an English court has declared that a caesarian section is lawful despite the woman's refusal. It is also the first decision to be based on the interests of both the mother and the unborn child. In the United States such declarations have been based solely on the basis of the interests of the unborn child.4