Summary
The news is full of unsettling accounts of women denied the chance to have a vaginal birth. More horrifying are the accounts of courts forcing a woman to have a c-section. There are alarming statistics that show a rise in c-section rates and a lack of improvement in maternal morbidity and mortality rates in the U.S. There has been little direct guidance from both medical professional organizations and jurisprudence on the topic of forced cesarean sections. What has been shown is a divide in both professions as to the interests of the fetus and the constitutional rights of the pregnant woman. Ultimately a pregnant woman must investigate the hospital and her state court decisions to ensure her constitutional rights are protected.
Facts, Accounts, and Health Concerns for Forced Cesarean
There have been many breakthroughs in OBGYN tools and techniques in an effort to deliver healthy babies into the world and make the process more comfortable for the woman. However, there have been several stories, cases, and studies that have show the U.S. rates of maternal mortality and morbidity have increased in the past decade in correlation with the relentless rise of cesarean sections. With c-sections becoming the most common medical procedure in the U.S., it is important to look at the effects of forcing women to undergo this medical procedure and the red flags raised surrounding the controversy.
Accounts of Forced Cesarean
In the Media
Cynthia Dermody reflects on her birthing experience when she attempted to have a home birth after cesarean (HBAC).[1] She explains that the doctors and nurses instructed her that if she didn’t do all of the things they were telling her that her baby would die. She also gave an account of the anesthesiologist claiming that the epidural was probably a waste and that she was “lucky” to have him there to help her. She was then forced to have a cesarean after being numbed by the epidural. She explains that the baby came out healthy but that she got an infection and had symptom of PTSD afterwards.
Joy Szabo is a resident of Page, Arizona who was denied a VBAC (Vaginal Birth After Cesarean) and forced to travel 350 miles just to find a “VBAC friendly” hospital.[2] Her Husband will have to miss the birth to take care of the kids at home and work. The risk for a major complication like uterine rupture is less than 1% according to ACOG, American College of Obstetrics and Gynecologists. Many Hospitals are rejecting the ability of the pregnant woman to have a natural birth due to liability fears and guidelines set by ACOG that require 24/7 assistance to the mother which can be expensive. Women who are not as fortunate to be able to travel such distances may be forced to have a C-Section. Presently, one in ten women are allowed to have a VBAC, and a third of all hospitals refuse to attempt them, resulting in more women forced into c-sections due to lack of availability of VBAC.[3]
Scripps Encinitas Hospital near San Diego, CA suspended Dr. Biter for what many say is his 7% C-Section rate.[4] He strongly believes in allowing the pregnant woman to determine when and how she will give birth. He has been widely popular and has a high successful and healthy birthrate. After his suspension, pregnant women, some in their 40th week, protested the suspension. There are plans for him to open up his own birthing center since he was reinstated at Scripps and immediately resigned. No misconduct charges were ever filed by the hospital and there were no clear reasons for the suspension.
In Jurisdictions Across the U.S.
In Georgia, the court forcibly compelled a pregnant woman to have a c-section after the court balanced her rights with those of the fetus.[5] In Connecticut, a pregnant woman signed papers refusing c-section during a VBAC, but the doctor performed an emergency C-section without her consent.[6] In New Jersey, a woman’s refusal of c-section was used as a factor in determining child neglect charges after the baby was born.[7] In Tennessee, a woman was forcibly removed from her home by the police and then sedated so that a c-section could be performed on her.[8] All are examples of forced coercion between the courts, the legislature, and hospitals.
Connection to Higher Maternal Mortality and Morbidity Rates
There has been a relentless rise in the c-section rate in the U.S. In 2006, 31.1% of births were by c-section making it the most common operating room procedure in U.S. hospitals.[9] A woman who has a c-section usually takes longer to recover than a woman who has had a vaginal birth. Full recovery takes 4 to 6 weeks with a hospital stay of 3 to 4 days, while the recovery from a vaginal birth is usually less with a hospital stay of only two days.[10] Risks to the baby include breathing problems, feeding, maintaining high enough body temperature, and Jaundice.[11] Risks to the mother include: increased bleeding that requires a blood transfusion; infections in the incision, uterus, and nearby organs; blood clots in the legs, pelvic organs, or lungs; and a small number of women die from these complications.[12] The World Health Organization (WHO) recommends the C-section rate for a country to be around 15%, making the U.S. over double the recommended rate.[13]
Maternal Mortality Rate and Cesarean
The U.S. is ranked 41st in the world in maternal mortality with 1 in 4800 women dying from pregnancy complications.[14] Black women are four times more likely to die from pregnancy related complications than white women regardless of socioeconomic status.[15] This is despite the fact that the U.S. spends more on healthcare than any other country.[16] C-sections have increased 50% in the last 10 years which has coincided with the rise in maternal mortality in the U.S.[17]As of 2006, California had a maternal mortality rate of 16.9 women per 1000 births.[18] Though the rise in the c-section rate is not the only factor, it is the factor that doctors can have the quickest impact and most control over in an attempt to reduce the maternal mortality rate.
Maternal Morbidity and Cesarean
A study done in 2003 published by the American Journal on Public Health Only 57% of women experienced delivery involving no form of maternal morbidity, and 31% experienced some type of maternal morbidity.[19] Maternal morbidity affects 1.7 million women annually.[20] There are several bills that attempt to control female reproductive choices that may also be a cause for increased maternal morbidity and increased the incidence of forced c-sections.[21] Maternal morbidity is connected to a rise in c-sections due to the wider range of complications for the mother and the longer recovery times. However, it seems that classifying what is maternal morbidity and gathering sufficient data has been an obstacle to understand pre and post birth pregnancy complications, such as Post Traumatic Stress Syndrome (PTSD).
Pressure of Laws on Physicians to Favor the Fetus May Influence the Maternal Morbidity Rate
As discussed by Beth A. Burkstrand-Reid in, “The Invisible Woman: Availability and Culpability in Reproductive Health Jurisprudence”, the court system seems to hold the woman culpable and wags a finger at her for not giving up her right to choose how she will give birth.[22] In addition, doctors have grown fearful of liability concerns and tend to perform and over-test to avoid being sued. In a study done by ACOG, the data showed that 76% of obstetricians had at least one litigation event in that year with an average award of 2.3 million dollars.[23] With the hefty damages looming over the heads of physicians, it is no wonder that ACOG’s study also revealed that in states where the insurance premiums were higher, there was a direct correlation to the amount of c-sections.[24] Also, new techniques that are widely used, like electronic fetal monitoring (used in 85% of births in the U.S.), have not proven to be more effective in reduced deaths but rather a catalyst for increases c-sections.[25] The guidelines set by ACOG are becoming more and more religiously followed, despite ACOG themselves acknowledging that they are only guidelines and every case presents unique problems that may require deviation from those guidelines.[26] It is important to recognize that both the legal system and the medical community need to address the issue of forced cesareans from all angles in order to find solutions to the varied circumstances physicians and courts face. A good start may be empathy and respect for pregnant women starting in medical and law school and continuing into practice.
Legal Overview
The courts have dealt with many issues concerning patient rights. From this jurisprudence, the rights invoked by pregnant women who are battling forced c-sections are that of bodily integrity and the right to refuse treatment.[27] Though the majority of patients receive these rights without much controversy, pregnant woman many times lose rights in favor of the fetus’s “well being”.[28] The central divide between legal philosophies rests on whether or not to balance the rights of the pregnant woman with the fetus’s well being.[29]
The Rights to Bodily Integrity and Refusal of Treatment
Though the Supreme Court lacks a major decision on forced c-sections, they have ruled on similar issues pertaining to bodily integrity and refusal of treatment. “The destiny of the woman must be shaped to a large extent on her own conception of her spiritual imperatives and her place in society”.[30] The Supreme Court recognized in Casey that it is imperative for a woman to make her own reproductive choices. In addition, protection from invasive procedures has been recognized as a due process right by the Supreme Court, “Due process clause protects an interest in life as well as an interest in refusing life-sustaining medical treatment.”[31] The court in In Re AC discusses the right to refuse treatment if the “nature of proposed treatment and any alternative procedures” are made aware to the patient by the doctor.[32] Also, courts usually do not compel a person to permit a significant intrusion upon his or her bodily integrity for the benefit of another person’s health.[33] However, the principles of bodily integrity and the right to refuse treatment have been ignored in some jurisdictions when there is a perceived conflict between the state’s interest in the fetus versus the constitutional rights of the mother.
The Supreme Court and The “Four State Interests”
In Thornburgh v. American College of Obstetricians and Gynecologists, the Supreme Court struck down a Pennsylvania statute which required that in cases of post-viability abortions, permitted under state law only when necessary to save the woman’s life or health, a physician must use the abortion technique providing the fetus to be aborted alive.[34] The Court found that a requirement of a “trade-off” between the woman’s health and the survival of the fetus is unconstitutional and any degree of additional risk to the mother‘s health is unacceptable.[35]
Four State Interests
The four primary state interests are: (1) the preservation of life, (2) the prevention of suicide, (3) the protection of third parties, and (4) the ethical integrity of the medical profession which are all considered when a court decides to override a competent treatment decision by the patient.[36] In In re Baby Boy Doe, the court shows that the “potential life” of the fetus is not enough to outweigh the risks to the mother, and is not enough alone to determine the state’s interest. The court also explains that the medical profession has written about the ethical need to let the mother decide her medical treatment.[37] However, in Pemberton v. Tallahassee Memorial Regional Medical Center, the court sided with the state, claiming that the state’s interest in the protection of the fetus and the preservation of life was more compelling than the woman’s constitutional right to refuse a c-section.[38] The split in jurisdictions concerning forced cesarean cases arises out of judicial philosophy on whether the holding in Roe v. Wade concerning the state’s interest can be applied outside of the abortion context, and with that, whether or not to balance the rights of the mother with the interest of the state.[39]
The Balance Test
The “Balance Test” used by some jurisdictions in forced cesarean cases is a product of language from Roe v. Wade and the interpretation of the unique legal status of the woman and the fetus. In Griffin, the court concluded, “A viable unborn child has the right under the U.S. Constitution to the protection of the State through such statutes prohibiting the arbitrary termination of the life of an unborn fetus. Citing Roe v. Wade, and, “Because the life of defendant and of the unborn child are, at the moment, inseparable, the Court deems it appropriate [emphasis added] to infringe upon the wishes of the mother to the extent it is necessary to give the child an opportunity to live.[40] There has been no direct guidance from the Supreme Court on the use of the Balance Test in forced cesarean cases, but there are compelling arguments that the rights of bodily integrity and refusal of treatment cannot be balanced with the state’s interest, and ultimately taken away from a woman simply because she is pregnant.[41]
Application of the Balance Test: Griffin to Pemberton
The balancing of individual rights and the state’s interest sounds harmless on its face, but it can have major impacts on the lives and protections of pregnant women. In Griffin, the court tipped the scales in favor of the state’s interest in preserving the life of the fetus and appointed temporary guardianship to the state over the fetus.[42] 18 years later in Pemberton, the court ordered police to “escort” a pregnant woman from her home back to a hospital for a c-section.[43] Ms. Pemberton claimed that her substantive due process rights were violated because her bodily integrity had been violated, that she had the right to refuse treatment, and the right to make important personal and family medical decisions with regard to undue government influence.
The court decides to apply a balance test that it derives from Roe by, what many scholars say misinterpreting Roe[44], to mean that once a child has reached viability that the state can use its “interest” to control situations outside of abortion.[45] In the courts opinion, the balance tips for the health of the fetus and the state’s interest in preserving life, and that the imposition of forcing a mother to bear an unwanted child is more intrusive on constitutional rights then “how” to bear a child.[46] If Roe is valid, then c-sections must not be such an invasion to offend constitutional rights.[47] The court in Pemberton side steps any case law signaling a rejection of the balance test by claiming each state should decide on what standard to use making it clear that the woman’s Federal Constitutional rights pale in comparison to fetal well being.[48]
Rejection of the Balance Test Prior to Pemberton
The Pemberton court discredited the trend in case law that rejected the balance test and held that a pregnant woman’s rights are superior to a fetus and the state should not intrude.[49] In 1990, the Washington D.C District Court of Appeals in In Re A.C. rejected the balance test, “a fetus cannot have rights in this respect superior to those of a person who has already been born”.[50] In addition, the court held that the mother’s wishes were to be considered as controlling on the court except in the rarest of occasions (which the court could not think of).[51] However the court did not outright reject the possibility of forcing a c-section if the mother’s interests were in direct conflict with fetal interests.[52]
In In re Baby Doe, The pregnant woman refused both induced labor and a cesarean birth because of religious reasons, despite being informed that there was a high chance of death or mental retardation to the fetus if she had a vaginal birth.[53] She was also informed that she would have a 1 in 10 thousand chance of surviving the cesarean and the baby would have near 100% chance of survival.[54] The state argued that under the Illinois juvenile court act that the fetus’s rights must be represented by the state.[55] The mother asserted her constitutional rights of refusal of treatment and her religious freedom.[56] The “Boy” ended up being born vaginally and underweight, but without the mental retardation predicted by the physicians.
The In re Baby Doe court addressed the right of privacy and the right of bodily integrity that was examined in a previous Illinois case Stallman v. Youngquist.[57] The court quotes their decision in Stallman as follows
“Unlike the relationship between any other plaintiff [Fetus] and defendant [Pregnant Woman]. No other plaintiff depends exclusively on any other defendant for everything necessary for life itself. No other defendant must go through biological changes of the most profound type, possibly at the risk of her own life, in order to bring forth an adversary into the world… It is the mother’s every waking and sleeping moment for which, for better or worse, shapes the prenatal environment which forms the world for the developing fetus. That this is so is not a pregnant woman’s fault; it is a fact of life.”[58]
The court clarifies that the fetus has rights against third parties for injuries, like the doctor for example, but that because the mother has a unique relationship it is her rights and wishes that should control.[59]
A few years later, in In re Fetus Brown, the Illinois Court of Appeals held that a Jehovah Witness who was forced to have blood transfusions to save her fetus was an error by the lower court and that her wishes should have been controlling regardless of the health risks.[60] There is a connection with the blood transfusion refusal and cesarean cases because they both concern the right of refusal of an invasive procedure.[61] Despite the repeated defenses of pregnant women’s liberty, the Pemberton court chose to ignore the constitutional rights of the woman involved.
Post Pemberton
After the 1999 decision in Pemberton, there have been a few court cases involving c-sections and the constitutional rights of women. In Harrison v. U.S., the court determined that a woman was not given proper information, or the opportunity to have a c-section, and thus violating her right to bodily integrity when she had induced labor.[62] In Wixtrom v. Dept. of Children and Families, the Florida court reiterated that a fetus is not a person and is not afforded the same rights as a person.[63] In Wixtrom, the court was presented with a severely mentally retarded woman who was a victim of sexual battery and became pregnant.[64] She was a assigned a guardian to make decisions in her best interest and the Dept. of Children and Families attempted to gain guardianship over the fetus because of the possible conflict of interests.[65] However, the court rejected the notion that the fetus could be assigned a guardian, as well as, rejecting any type of balancing of the fetal “interests” versus the woman’s interests.[66]
Though there has been progress in protecting pregnant women from forced medical procedures, it has largely been state and regional victories mixed with major defeats in pockets all over the U.S.[67] In 2006, there were a pair of cases that showed ways the state and hospitals could still force their decisions on the pregnant woman. In Dixon v. Crete Medical Clinic, the court held that the pregnant woman had received proper information and though she had made a form of request (she had repeatedly told the nursing staff to “get it out of her” and she claims she requested a c-section) that she only made the requests when she was in pain and was not “persistent enough in her requests”.[68] The other case, Duffy v. Flagg, involved a pregnant woman who requested a VBAC and executed written consent forms refusing c-section[69]. The Doctor attempted to deliver the baby vaginally but then performed an emergency c-section, which resulted in the baby’s death 8 days after birth.[70] The Appellate court had decided that the doctor should have informed the mother that he had lost babies in the past to c-section difficulties, but the Supreme Court of Connecticut reversed explaining that the doctor did not have to answer all questions related to the medical procedure.[71] This allows the doctor more discretion in the information passed on to the patient and also hurts the ability of the woman to choose a different physician, based on knowledge of physician preferences.[72]
Current Cases Involving the Forced Cesarean Debate
In Madrigal v. Mendoza, There was a cause of action for negligence against the doctor because he never offered the option of having a Cesarean birth.[73] The court ultimately found that the testimony from the plaintiff’s expert was not persuasive despite the fact that Madrigal was denied the choice of electing a cesarean birth, which may have reduced the injury that occurred to her child.[74] The court appears to side step the issue completely in this case by dealing only with the injury and its relation to the doctor’s delivery procedure, and not whether he properly informed her of the alternatives to vaginal birth. The constitutional protections seem to disappear in this instance.
In New Jersey Division of Youth and Family Services v. V.M. and B.G., a mother (V.M.) was charged with abuse and neglect of her child related to actions during pregnancy, including the fact she repeatedly refused a Cesarean procedure.[75] Though the majority largely sidesteps the issue of c-sections as a factor in determining retroactive neglect or abuse of a child, the concurring opinion goes at length on the issue.[76] The concurrence focuses on the fact that V.M. signed a form that refused all invasive treatment and that she maintained, even during psychiatric evaluations, that she did not want invasive procedures and specifically a C-Section.[77] The trial judge claimed that he “did not base his finding solely in V.M.’s reluctance to consent to a C-Section”, but still found negligence despite all of her protest stemmed from the fact she was afraid for her baby.[78]
The concurrence relies on a large amount of Amicus Briefs that all support that a judge “may not consider a woman’s refusal to consent to a c-section in the context of child welfare laws.[79] The concurrence then cites In re A.C. and In re Baby Doe as support for the constitutional protections a pregnant woman has over invasive procedures.[80] The concurring opinion holds that “the decision to undergo an invasive procedure such as a c-section belongs uniquely to the prospective mother after consultation with her physicians.”[81] Thus, the current trends are to avoid the issue of forced c-sections and block options for alternatives like VBAC. However, as evident by the concurrence above, there is a sense of moral and constitutional danger in the back of judges’ minds when considering forced c-sections.
Conclusion
It is apparent that there has been a steady rise in the c-section rates. It is also clear that there have been failed attempts on the part of the U.S. to reduce the maternal morbidity and mortality rates. While the rise in c-section rates is not the only factor contributing to the lack of progress made in U.S. maternal health, it is one that could be quickly altered to make a dent in the number of women who suffer during, and post-pregnancy. ACOG and other health organizations have not been clear on the guidelines of doctors except that the woman’s decisions should be given great weight and her preferences respected.
As far as legal issues are concerned, doctors are somewhat fearful of the consequences of not operating at the slightest sign of problems due to litigation fears. Since the law varies in whether the balance test is used, it can be confusing to many physicians as to whether they are required to ignore the mother’s wishes in favor of the fetus, or to place the woman’s decisions first and understand that they will not be liable for the death of the fetus. Though it seems there is an underlying trend for judges who recognize the woman’s right to bodily integrity and refusal of treatment, there needs to be a better source of information and assurance for physicians. Ultimately the law depends on the state, and if a balancing test is accepted in that jurisdiction, then the next factor is how interested the state is in the well being of the fetus. Basically it boils down to a view of the pregnant women as a free citizen of the United States versus a “Fetal Container”.
[1] Dermody, Cynthia, “My Birth Story: They Forced Me to Have Anesthesia”; May 13, 2010 at
http://thestir.cafemom.com/pregnancy/102905/My_Birth_Story_They_Forced
[2] Cohen, Elizabeth “Mom Won’t be Forced to have a C-Section”. May 13, 2010, http://www.CNN.com
[3] Neergaard, Lauran “Panel: Women Need Chance to Avoid Repeat C-Section”. March 10, 2010, http://www.huffingtonpost.com
[4] Colter O’Roarty, Abi “Why I’m Protesting for My Natural-Birth Friendly OB”. June 4, 2010 at http://www.huffingtonpost.com
[5] Jefferson v. Griffin Spalding County Hospital Auth., 247 Ga. 86 (1981)
[6] Duffy v. Flagg, 279 Conn. 682 (2006)
[7] New Jersey Div. of Youth and Family Services v. V.M. and B.G., 408 N.J. Super. 222 (2009)
[8] Pemberton v. Tallahassee Memorial Regional Medical Center, 66 F. Supp. 2d 1247 (1999)
[9] “Relentless Rise in Cesarean Section Rate” [Graph]February 5, 2008 at http://www.childbirthconnection.org
[10] “C-Section: Medical Reasons”. March of Dimes; July 2008 at http://www.marchofdimes.com
[11] Id.
[12] Id.
[13] Siegel-Itzkovich, Judy “At the Cutting Edge of Birth”. August 9, 2008. The Jerusalem Post
[14] Gosik, Ashley “U.S. Ranks 41st in Maternal Mortality”. 2007, COX News Service
[15] Id., See Also [Graph]“Infant, Neonatal, and Maternal Mortality Rates by Race: 1980 to 2005”. U.S. National Center for Health Statistics (2008)
[16] Roan, Shari & Lisa Girion “Rising Maternal Mortality Rate Causes Alarm, Calls for Action”. May 22, 2010. Los Angeles Times.
[17] Johnson, Nathaniel “More Women Dying from Pregnancy Complications; State Holds on to Report”.; February 2, 2010 at http://www.californiawatch.org
[18] Id., See also [Chart] “Tracking Maternal Mortality Rates”. Johnson, Nathaniel; February 2, 2010 at http://www.californiawatch.org
[19] “Magnitude of Maternal Morbidity During Labor and Delivery”. American Journal of Public Health accessed at http://www.medscape.com on June 18, 2010.
[20] Id.
[21] Paltrow, Lynn M. & Farah Diaz-Tello “Caution: Pregnancy May Be Hazardous to Your Liberty”. March 2, 2010 http://www.huffingtonpost.com
[22] Burkstrand-Reid, Beth A. “The Invisible Woman: Availability and Culpability in Reproductive Health Jurisprudence”. 81 U. Colo. L. Rev. 97at 102. Univ. of Colorado Law Review (Winter 2010)
[23] Hyer, Richard “ACOG 2009: Liability Fears May Be Linked to Rise in Cesarean Rates”. May 12, 2009 at http://www.medscape.com
[24] Id.
[25] Neergaard, Lauran “Overtreated: More Medical Care Isn’t Always Better”. June 7, 2010 http://www.huffingtonpost.com
[26] “Surgery and Patient Choice” No. 395. ACOG Committee on Ethics; January, 2008
[27] Knopf Levy, Joel “Jehovah Witnesses, Pregnancy, and Blood Transfusions: A Paradigm for the Autonomy Rights of all Pregnant Women”. 27 J.L. Med. & Ethics 17. Summer 1999.
[28] Pemberton v. Tallahassee Memorial Regional Medical Center, 66 F. Supp. 2d 1247, 1251 (North Dist. Ct. 1999).
[29] Cherry, April L. “Symposium: The Legacy of Roe: The Constitution, Reproductive Rights, and Feminism”. 6 U. Pa. J. Const. L. 723, 735-7.
[30] Planned Parenthood v. Casey, 505 U.S. at 852 (1992).
[31] Cruzan v. Director, Missouri Department of Health, 497 U.S. 261, 278 (1990)
[32] 573 A. 2d 1235, 1243 (D.C. Dist. Ct. App. 1990). citing Crain v. Allison, 443 A. 2d at 562; and In re Conroy, 98 N.J. 321.
[33] Id. at 1243-4. cites Bonner v. Moran, 126 F. 2d 121, 122 (App. D.C. 1941)]. In Moran, the court refused to compel a relative to donate an organ to a dying person.
[34] 476 U.S. 747 (1986)
[35] Id. at 403; This logic was used in the dissenting opinion in Gonzales v. Carhart, 550 U.S. 124 (2007), where the majority validated a law that did not require a health exception for an abortion regulation. Though it is likely that this is a narrow holding for abortion cases and not cesarean sections]
[36] In re Baby Boy Doe v. Mother Doe, 260 Ill. App. 3d 392, at 404-5 (1994).
[37] Id.; See ACOG Ethics Committee Reports, “Maternal Decision Making, Ethics, and the Law”. Number 321 Nov. 2005; See also, ACOG Committee Opinion: “Surgery and Patient Choice” Number 395 Jan. 2008. Both are opinions on ethical concerns regarding maternal choice and rights. ACOG reiterates the importance of giving the pregnant women the choice and respecting that choice in the vast majority of circumstances.
[38] 66 F. Supp. 2d 1247, 1254(North Dist. Ct. 1999).
[39] Cherry, April L “Symposium: The Legacy of Roe: The Constitution, Reproductive Rights, and Feminism”. 6 U. Pa. J. Const. L. 723 April 2004.
[40] Jefferson v. Griffin Spalding County Hospital Authority, 247 Ga. 86, 87 (1981)
[41] Knopf Levy, Joelyn “Jehovah Witnesses, Pregnancy, and Blood Transfusions: A Paradigm for the Autonomy Rights of all Pregnant Women”. 27 J.L. Med. & Ethics 17 (Summer 1999)
[42] Refer to FN 39
[43] Pemberton v. Tallahassee Memorial Regional Medical Center, 66 F. Supp. 2d 1247(North Dist. Ct. 1999).
[44] Cherry, April L “Symposium: The Legacy of Roe: The Constitution, Reproductive Rights, and Feminism”. 6 U. Pa. J. Const. L. 723 April 2004.
[45] Id. at 1251
[46] Id.
[47] Id. at 1252
[48] Id.
[49]Burkstrand-Reid, Beth A. “The Invisible Woman: Availability and Culpability in Reproductive Health Jurisprudence”. 81 U. Colo. L. Rev. 97 (Winter 2010).
[50] 573 A. 2d 1235, 1244 (D.C. Dist. Ct. App. 1990).
[51] Id. at 1247
[52] Id. at 1252
[53] In re Baby Boy Doe v. Mother Doe, 260 Ill. App. 3d 392 (1994)
[54] Id. at 393
[55] Id. at 394
[56] Id.
[57] Refer to FN 51
[58] Stallman v. Youngquist, 125 Ill. 2d 267, 278-9 (1988).
[59] In re Baby Boy Doe, 260 Ill. App. 3d at 403
[60] 294 Ill. App. 3d 159, 164,172 (Ill Ct. App. 1997).
[61] Knopf Levy, Joelyn “Jehovah Witnesses, Pregnancy, and Blood Transfusions: A Paradigm for the Autonomy Rights of all Pregnant Women”. 27 J.L. Med. & Ethics 17 (Summer 1999)
[62] 282 F. 3d 293, 301 (D.C. 2002)
[63] 864 So. 2d 534, 536 (Fla. App. 2004).
[64] Id. at 534-6
[65] Id. at 535, the potential conflict of interest discussed was the possibility of the guardian deciding to abort the fetus. However the Guardian of the mentally retarded woman was on record and introduced evidence that abortion was never in the plan for the woman’s best interests.
[66] Id. at 538-9
[67] Hoffman & Miller “Inconsistent State Court Rulings Concerning Pregnancy-Related Behaviors”. 22 J.L. & Health 279 (2009)
[68] 2006 U.S. Lexis 67613 (US Dist. Ct. NE 2006) (at 63)
[69] 279 Conn. 682, 685-6 (2006)
[70] Id.
[71] Duffy v. Flagg, 279 Conn. at 691
[72] An example of how this holding could cause a problem occurs if a pregnant woman asks what the physicians personal preference concerning c-sections and the doctor refuses or answers the question vaguely. The doctor may be shielded from divulging that important fact.
[73] 639 F. Supp. 2d 1026 (AZ 2009)
[74] Id. at 1028
[75] 408 N.J. Super. 222 (2009).
[76] Id. at 227-47
[77] Id. at 227
[78] Id. at 232
[79] Id. at 239
[80] Id. at 246-7
[81] Id. at 249
Healthy Rights 