In Re A.C.—An affirmation of ACOG committee opinion number 55: Maternal-fetal conflict

Abstract

I n April 1990, the District of Columbia Court of Appeals issued its opinion In Re A.C., the much-publicized case involving a court-ordered cesarean section performed on a dying woman June 1987.1 The court's decision holding that in virtually all cases the question of what is to be done is to be decided by the pat ient-the pregnant w o m a n o n behalf of herself and the fetus, is a precedent-setting reaffirmation of a pregnant woman's autonomy making her own health care decisions. Although there is rarely a conflict of interest between a recommended medical treatment thought to be beneficial to a fetus and the pregnant woman's choice concerning medical care, recent cases concerning court-ordered cesarean sections and drug use by pregnant women have brought to public attention the tension that can exist between a woman's right to determine her health care treatment and concerns for the well-being of the fetus. As the representative organization of board-certified obstetricians and gynecologists, the American College of Obstetricians and Gynecologists (ACOG), through its Committee on Ethics, was the first medical specialty society to issue a public statement on this issue. Committee Opinion Number 55, Patient Choice: Maternal-Fetal Conflict, of October 1987, is a document that supports a woman's autonomy making health care decisions. As such, it provides important guidance for many troublesome medical/legal situations. On occasion, physicians and hospital administrators have sought court orders to require a pregnant woman to undergo a certain medical or surgical procedure to which she will not consent, on the grounds that it is necessary to protect the health of the fetus. 2-4 Of the numerous documented instances which a court order has been sought to require a woman to undergo an emergency cesarean delivery, only one case has been described the literature which the judge refused to grant the order. 4 Concern about the inappropriateness of the courtroom as a forum for medical decision making as well as concern about the deleterious effect judicial intervention has on a woman's autonomy and on the physician-patient relationship prompted the ACOG Ethics Committee document. It rejects the © 1990 by The Jacobs Institute of Women's Health 1049-3867/90/$3.50