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ACLU * ACLU * ACLU * ACLU * ACLU * ACLU * ACLU * ACLU * ACLU NEWS RELEASE * NEWS RELEASE * NEWS RELEASE * NEWS RELEASE Legal Battle Over Court-Ordered C-Section Ends; George Washington University Develops Groundbreaking Policies For IMMEDIATE RELEASE November 28, 1990 WASHINGTON -- In the first settlement of its kind, the George Washington University Medical Center and the American Civil Liberties Union have agreed to end a three-year legal battle that arose from the treatment of Angela Carder, a Maryland woman with cancer who died at the medical center following a court-ordered cesarean section. This civil rights and medical malpractice case, Stoners v. G.W.U., was the first of its kind in the country. Although 23 hospitals in the last decade have sought court direction on how to treat pregnant women to protect their fetuses, the ACLU's case on behalf of the Stoners is the first to challenge a hospital's request for court involvement. As part of the settlement, the hospital has developed new policies affirming the autonomy of pregnant patients. "These policies," said Christine St. Andre, the Administrator of the Medical Center, "reflect the Medical Center's commitment to respect the views of our patients and their physicians." "No party," St. Andre added, "should be the mere instrument of another. In shared decision-making, the act of informed consent or informed refusal affirms and protects patient autonomy while acknowledging the physician's commitment to professional standards. We strongly believe that difficult medical decisions should be made within the doctor-patient relationship and not by the courts." The agreement also includes a monetary amount, which the parties have agreed not to disclose, to be paid by the Medical Center to Carder's parents, Daniel and Nettie Stoner, and to the Carder estate. "If these policies had been in place in 1987, what happened to my daughter might never have occurred," Daniel Stoner said. Nettie Stoner added: "Angela was a fighter. She would have been pleased to know that what happened to her will improve how pregnant women are treated." The Stoners were represented by ACLU cooperating attorneys Lorna Schofield of Debevoise and Plimpton in New York City, and Terry Thornton of Lowenstein, Sandler, Kohl, Fisher & Boyland in Roseland, New Jersey. Lynn M. Paltrow of the ACLU's national Reproductive Freedom Project filed the original suit and oversaw the litigation. The Medical Center and several of its physicians were represented by Joseph Montedonico and Patricia Tazzara of the firm of Montedonico and Mason, Chtd., in Washington, D.C. "By agreeing to this settlement, George Washington University Medical Center has taken a leadership role in protecting women's reproductive rights," Schofield said. Thornton added: "In the past, hospitals and physicians have worried about being sued if they failed to protect a fetus, even if it meant sacrificing the woman. This settlement returns the focus of the hospital's obligations to its pregnant patients." The Medical Center and its physicians have historically recognized the importance of patient autonomy generally, and the unique responsibilities entailed in caring for pregnant women, St. Andre said. "We are proud of this policy because it guides physicians and pregnant patients toward decisions that promote our patients' health and values," she added. "This case motivated the hospital to examine carefully this area of the law and ethics to establish an effective institutional framework for responding to complex situations in the future and to prevent the unneccessary and sometimes detrimental resort to the courts to advise the hospital in a particular situation. "With this framework in place," she added, "the Angela Carder case should not be repeated." The case began while Ms. Carder, who had successfully battled cancer for many years, was receiving care for her pregnancy at George Washington University Hospital. In June 1987, when Ms. Carder was approximately 25 weeks pregnant, she was admitted to GWU for diagnostic tests and cancer treatment after doctors learned that she had developed a tumor in her lung. On June 16, 1987, without consulting her family, the hospital petitioned the Superior Court of the District of Columbia to decide what GWU should do in the interest of Carder's fetus, specifically whether to intervene and attempt to save its life. Over the objections of Carder's family and, despite the desire of her attending obstetricians to abide by the family's wishes, the court ordered the delivery of the fetus by cesarean section while acknowledging that it likely would shorten Ms. Carder's life. A three-judge panel of the District of Columbia Court of Appeals denied a motion to stay the order of the Superior Court and GWU staff physicians performed the surgery. The baby died within hours of delivery. Ms. Carder died two days later on June 18, 1987. Several weeks later the three-judge panel issued an opinion explaining its decision not to stop the operation. The ACLU, along with court-appointed counsel Robert Sylvester, arguing on behalf of the Estate of Angela Carder, petitioned the entire nine-judge Court of Appeals to hear the case. The case, In Re A.C., became the focus of a national debate over whether courts may balance the rights of pregnant women against the asserted interest of a fetus. The Court vacated both prior decisions and concluded that "in virtually all cases the question of what is to be done is to be decided by the patient -- the pregnant woman -- on behalf of herself and the fetus." The Court of Appeals reaffirmed for pregnant women a longstanding tradition that the patient with her doctors--not courts--make the legally valid and binding choice of medical care and that they have control over their bodies, lives and destinies. The Court also pointed out the importance of insuring that surrogates are appropriately chosen and informed in the event that the patient is incapable of making a decision herself. The settlement resolves civil claims against the hospital for deprivation of human rights, discrimination, wrongful death, malpractice and other claims arising out of the treatment of Ms. Carder and GWU's decision to request a court decision. The new policies insure that the decision in In Re A.C. is incorporated into the hospital's standard practices, procedures and policies. The new policies recognize that it will "rarely be appropriate to seek judicial intervention to resolve ethical issues" relating to the care of the pregnant patient, including disagreements regarding the course of medical treatment. The hospital has also agreed to adopt additional new policies, including plans for advising patients and facilitating access to proper legal counsel whenever court action is considered. The hospital will also maintain a list of counsel experienced in protecting women's reproductive rights. "This settlement finally puts an end to three years of difficult litigation for the Stoners and George Washington University," the ACLU's Paltrow said. "By adopting these new policies, the hospital has made it possible for this tragedy to be turned into something positive for women. "The settlement of this case should encourage other hospitals to adopt policies that recognize appropriate ethical and legal standards," Paltrow added, "and which will avoid the unnessary and destructive effects of cases like this."


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