{{Short description|1990 District of Columbia court case}} {{Use American English|date=February 2026}} {{Use mdy dates|date=September 2023}}
{{Infobox court case |name = In re A.C. |court = [[District of Columbia Court of Appeals]] |image = |imagesize = |imagelink = |imagealt = |caption = |full name = In re A.C., Appellant. |date decided = {{start date|1990|04|26}} |citations = {{law report|573|A.2d|1235}} |ECLI = |transcripts = |judges = [[Judith W. Rogers]], [[Theodore R. Newman Jr.]], [[John M. Ferren]], [[James A. Belson]], [[John A. Terry]], [[John M. Steadman]], [[Frank E. Schwelb]], [[Julia Cooper Mack]] |number of judges = 8 |decision by = Terry |concurring = Rogers, Newman, Ferren, Steadman, Schwelb |dissenting = |concur/dissent = Belson |prior actions = |appealed from = |appealed to = |subsequent actions = |related actions = |opinions = |keywords = {{Hlist|[[Bodily integrity]]|[[Informed consent]]|[[Pregnant patients' rights in the United States|Rights of pregnant patients]]}} |italic title = }} '''''In re A.C.''''', 573 [[Atlantic Reporter|A.2d]] 1235 (1990), was a [[District of Columbia Court of Appeals]] case. It was the first American appellate court case decided against a forced [[Caesarean section]], although the decision was issued after the fatal procedure was performed.<ref name=":2">{{Cite journal|last=Feitshans|first=Ilise|year=1995|title=Legislating to Preserve Women's Autonomy during Pregnancy|journal=Medicine and Law|volume=14|pages=397–412|via=HeinOnline}}</ref> Physicians performed a [[Caesarean section]] upon patient Angela Carder (née Stoner) without informed consent in an unsuccessful attempt to save the life of her baby.<ref name=":0">{{Cite journal|last=Bourke|first=Leon|year=1990|title=In re A.C.|journal=Issues in Law & Medicine|volume=6|pages=299–305|via=EBSCOhost}}</ref> The case stands as a landmark in United States [[case law]] establishing the [[pregnant patients' rights in the United States|rights]] of informed consent and bodily integrity for pregnant women.
==Background== [[File:George Washington University Hospital - 2012.JPG|thumb|George Washington University Hospital]] At age thirteen, Angela Stoner was diagnosed with a rare and usually fatal form of cancer, [[Ewing's sarcoma]]. After years of [[chemotherapy]] and [[radiation therapy]] she was declared to be in remission.<ref name="aclu" /> At twenty-seven, she married and became pregnant.<ref name=":0" /> Carder was referred to George Washington University Hospital's high-risk pregnancy clinic during her fifteenth week due to her medical history.<ref name=":0" />
During a routine hospital visit on June 9, 1987, Carder received an X ray due to complaints of back pain and shortness of breath.<ref name=":0" /> Her cancer was shown to have returned in the form of an inoperable tumor, causing her to be admitted to hospital two days later.<ref name=":0" /> When Carder was twenty-six weeks pregnant, her cancer was discovered to have recurred and metastasized to her lung. The doctors at [[George Washington University Hospital]] in [[Washington, D.C.]] 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. On June 12, Carder initially expressed a desire to deliver the baby.<ref name="aclu" /> Her condition worsened and physicians notified Carder of her terminal illness on June 15, leading Carder to consent to palliative care.<ref name=":0" /> The intent of such treatment was to prolong her life, raising the survival rate of the fetus.<ref name=":0" /> Carder was again inquired as to whether she wished to deliver the baby, to which she provided an ambiguous answer.<ref name=":0" />
== Initial Hearing and Procedure == On June 16, administrators of the hospital convened a court hearing at the facility to request an emergency Caesarean section. Carder's husband, parents, and personal obstetricians opposed the C-section on the ground that neither Carder nor the fetus would survive.<ref name="aclu">{{cite web|url=https://www.aclu.org/coercive-and-punitive-governmental-responses-womens-conduct-during-pregnancy|title=Coercive and Punitive Governmental Responses to Women's Conduct During Pregnancy|date=September 30, 1997|author=American Civil Liberties Union|access-date=2016-01-29}}</ref> Evidence to the court hypothesized that the fetus currently had a fifty to sixty percent chance of survival, which would decrease if the procedure was delayed.<ref name=":1">{{Cite journal|last=Plomer|first=Aurora|year=1997|title=Judicially Enforced Caesareans and the Sanctity of Life|journal=Anglo-American Law Review|volume=26|pages=235–270|via=HeinOnline}}</ref> The court was informed that the fetus was viable, or could live outside the mother, but would be unlikely to survive a post-mortem delivery.<ref name=":0" /> It was also stated that Carder was likely to die sooner as a result of such a procedure.<ref name=":1" /> However, doctors' testimony to the court was contradicting in regards to the prognosis of the procedure.<ref name=":0" /> The judge had also been unable to identify Carder's wishes or her level of competency.<ref name=":1" /> Ultimately, an order was issued by the judge authorizing the hospital to perform an immediate Caesarean section. The judge based the decision on both evidence provided by the hospital and precedent of ''In Re Madyun.''<ref name=":1" />
Carder was informed of the court's order once she became conscious and she was asked if she wanted to proceed with the Caesarean section. Although she initially confirmed her intent to proceed, she reportedly contradicted herself a few moments later.<ref name=":0" /> The court maintained its decision and ordered the procedure to continue. Given the apparent change in circumstances, Carder's family and attorney attempted to gain a [[stay of proceedings]] from the judge, but the request was denied.<ref name="aclu" />
Thus, Carder underwent the operation. The fetus reportedly survived for three hours after the surgery, while Carder survived two days before her death.<ref name=":2" /> Some physicians suggest that she would have lived a few days longer if not for the Caesarean section.<ref name=":2" />
==Appeal Proceedings==
In the wake of the surgery, Carder's family and the [[American Civil Liberties Union]]'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.<ref name="aclu" /> One hundred and twenty organizations joined [[amicus brief]]s on Carder's behalf, including the [[American Medical Association]] and the [[American College of Obstetricians and Gynecologists]]. Two groups defended the forced surgery: the [[Americans United for Life]] and the United Catholic Conference, now known as the [[United States Conference of Catholic Bishops]] (USCCB). On April 26, 1990, the court vacated the initial court order by issuing the ruling ''In re A.C.''<ref name=":1" /> The decision found the judge had failed to properly balance the rights of Carder not to consent to the procedure and the interests of the state.<ref name=":1" /> In re A.C. is commonly lauded as a victory for women's rights, but it did not grant absolute autonomy of a woman against procedures ordered by the state.<ref name=":1" /> Instead, it asserted that in "virtually all cases," a patient's desires must be adhered to if they are deemed competent.<ref name=":1" />
== Civil Suit == 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.<ref name="aclu" /> 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 Center]]'' * ''[[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"). * [[Use of restraints on pregnant women]]
==Notes== {{Reflist}}
==References== * Gallagher, Janet. Prenatal Invasions & Interventions: What's Wrong with Fetal Rights, ''Harvard Women's Law Journal'', Volume 9, 1987. * [[Gellman, Barton]]. Agreement in D.C. Affirms Medical Rights of Pregnant Women, ''Washington Post'', Nov. 19, 1990. *{{cite book | author=Susan Faludi | author-link=Susan Faludi | title= Backlash: The Undeclared War Against American Women | publisher=Three Rivers Press | year=2006 | isbn=978-0-517-57698-4 }} *{{cite book | author=Katha Pollitt | author-link=Katha Pollitt | title= Reasonable Creatures: Essays on Women and Feminism | publisher=Vintage | year=1995 | isbn=978-0-679-76278-2 }} * Thorton, Terry E. & Paltrow, Lynn. [http://advocatesforpregnantwomen.org/main/publications/articles_and_reports/the_rights_of_pregnant_patients_carder_case_brings_bold_policy_initiatives.php The Rights of Pregnant Patients:Carder Case Brings Bold Policy Initiatives], ''Health Span'', Jan. 31, 1991. *[[George Annas]]. Letter to the Editor, ''The New England Journal of Medicine'', May 7, 1987. *Annas, George. Foreclosing the Use of Force: A.C. Reversed, ''Hastings Center Report.'', July/Aug., 1990. *Annas, George. She's Going to Die: The Case of Angela C., ''Hastings Center Report'', Feb/Mar., 1988.
== External links == {{caselaw source | case= In re A.C. | courtlistener= https://www.courtlistener.com/opinion/1938095/in-re-ac/ | justia= https://law.justia.com/cases/district-of-columbia/court-of-appeals/1990/87-609-4.html | leagle= https://www.leagle.com/decision/19901808573a2d123511799 }} * [http://vimeo.com/4895023 Laura Pemberton: Speaking on Her Experience of a Court-ordered Cesarian Surgery]
[[Category:United States reproductive rights case law]] [[Category:1990 in United States case law]] [[Category:Legal issues in pregnancy]]