Facts
- Jessie Mae Jefferson was a competent, 39-week pregnant outpatient receiving prenatal care at a county hospital in Georgia.
- A physician diagnosed Jefferson with complete placenta previa and advised that vaginal delivery carried a near-certain risk of fetal death and a substantial risk of maternal death, while a caesarean section before labor offered an almost certain chance of survival for both.
- Jefferson refused a caesarean section and refused any blood transfusion, citing religious beliefs.
- The hospital petitioned a superior court for an order authorizing a caesarean section and any necessary transfusions if Jefferson presented for delivery, asserting an obligation to treat emergency patients and a need to protect the lives of both mother and unborn child.
- The superior court found the fetus viable and capable of independent life, and issued an order authorizing the procedures.
- Separately, the state child-welfare agency sought and obtained a juvenile-court order granting temporary custody of the unborn child to the state and directing the hospital to perform the caesarean; custody was to expire upon birth or death.
- Jefferson appealed, challenging state authority to override her refusal of medical treatment.
Issues
- Whether a court may compel a competent, near-term pregnant woman to undergo a caesarean section and related procedures, including possible blood transfusions, over her religiously motivated objection.
- Whether the state’s interest in protecting the life of a viable fetus outweighs a pregnant woman’s rights to bodily integrity, refusal of medical treatment, free exercise of religion, and parental autonomy.
Decision
- The Supreme Court of Georgia affirmed the orders authorizing and effectively compelling the caesarean section and any necessary blood transfusions.
- The court accepted the finding that the fetus was viable and treated the state’s interest in preventing fetal death at the threshold of birth as compelling.
- Balancing interests, the court concluded the intrusion on Jefferson’s liberty and religious exercise was outweighed by the state’s duty to protect the viable unborn child from death before birth.
- The court relied heavily on the medical risk disparity: refusal was likely to cause fetal death (and posed serious risk to Jefferson), while a caesarean offered a near-certain chance of survival for both.
Legal Principles
- When a fetus is viable and medical evidence shows a proposed obstetrical intervention will almost certainly prevent fetal death (and protect maternal life) while refusal will almost certainly cause fetal death and materially endanger the mother, the state may order the intervention despite the mother’s refusal.
- A pregnant woman’s rights to refuse treatment and to religious exercise are not absolute and may yield to a sufficiently compelling state interest in protecting a viable fetus.
- State child-protection and parens patriae authority may be used, in limited circumstances, to protect a viable unborn child through judicially ordered medical treatment.
Conclusion
The court held that, given fetal viability and the extreme medical risks of refusal, the state’s compelling interest in preserving fetal life justified compelling a caesarean section and necessary transfusions over the mother’s religious and autonomy-based objections.