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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
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 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
"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 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
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."