## Facts

- A.C., a pregnant woman with a history of leukemia, was diagnosed during pregnancy with a malignant lung tumor and given a terminal prognosis.
- Physicians discussed attempting to continue the pregnancy to approximately 28 weeks to improve fetal survival prospects; A.C.’s statements about intervention before 28 weeks were contested.
- At approximately 26 weeks’ gestation, A.C. was in critical condition, heavily sedated to breathe, and the fetus showed signs consistent with oxygen deprivation.
- The hospital sought an emergency declaratory order authorizing a cesarean section, primarily to attempt to save the fetus.
- At an emergency hearing, evidence conflicted on whether A.C. would have refused an early cesarean due to risk of severe fetal impairment or would have agreed to surgery to benefit the fetus.
- The trial court authorized the cesarean based on fetal viability and the asserted state interest in protecting potential life.
- Shortly after the order, A.C. briefly appeared lucid; she initially consented and then quickly withdrew consent, with the clarity and finality of any refusal disputed.
- The hospital performed the cesarean under the court order; both A.C. and the fetus died.

## Issues

1. Under emergency conditions, when the pregnant patient’s competence and wishes are uncertain or disputed, may a court authorize a cesarean section primarily to attempt to save a viable fetus?
2. What level of appellate intervention is appropriate on an emergency request to stay such an order, given limited ability to resolve disputed medical facts in real time?

## Decision

- The District of Columbia Court of Appeals denied A.C.’s emergency request to stay the trial court’s order authorizing the cesarean section.
- In a later-filed opinion explaining the emergency disposition, the court treated the matter as an extreme, time-sensitive case turning on contested facts about consent and fetal viability.
- The court emphasized the trial judge’s superior position to assess live testimony and make immediate findings in a fast-moving medical emergency.
- The court did not announce a broad rule compelling surgery for fetal benefit; it justified its outcome as an emergency decision made under severe informational and temporal limits.

## Legal Principles

- Emergency appellate review of compelled medical-treatment orders may be constrained by the need for rapid action and by the appellate court’s limited capacity to resolve disputed factual questions on an abbreviated record.
- In an emergency setting, an appellate court may defer to trial-court fact-finding based on live medical testimony when the patient’s competence and contemporaneous wishes cannot be reliably established within the available time.
- When a fetus is plausibly viable, the state’s asserted interest in potential life may be treated as weighty in the trial court’s evaluation, particularly where the mother’s informed refusal is not clearly ascertainable at the decisive moment.
- Courts recognized the institutional difficulty of resolving urgent, morally charged medical disputes through emergency litigation and suggested that structured medical-ethical decision processes, if authorized by law, would better address such situations than ad hoc judicial orders.

## Conclusion

The court upheld the emergency authorization of a cesarean section by denying a stay, reasoning that the case required immediate action, depended on disputed questions about A.C.’s consent and condition, and warranted deference to the trial court’s on-the-spot assessment in light of a claimed state interest in a viable fetus.


In re A.C., 533 A.2d 611 (D.C. 1987)