A dying woman's forced C-section launched a fight over fetal rights
In June 1987, Angela Carder was 26 weeks pregnant and dying of cancer. Sedated and on a ventilator, she was fading so fast that no one could ask her what she wanted to do about the fetus inside her.
So lawyers for George Washington University Medical Center put the question to a D.C. Superior Court judge. He ordered an emergency Caesarean section over the objections of her family and doctors, who believed she would not have wanted it. The baby died two hours after the operation; Carder, 27, died two days later.
In 1990, the District's highest court found that the judge should not have ordered the surgery because there was insufficient evidence Carder wanted it. A pregnant woman, the D.C. Court of Appeals ruled in a precedent-setting decision, had a virtually unlimited right to decide the course of medical treatment for herself and her fetus.
The Carder case served as one of the most dramatic and tragic examples of how perceived conflicts between maternal and fetal rights can unfold. Thirty-five years after her death, these conflicts have taken on renewed importance, following the Supreme Court decision overturning Roe v. Wade.
That June ruling has left states to decide how to balance a pregnant person's medical autonomy against a desire to preserve fetal life. News reports suggest doctors in some states are struggling to navigate new and confusing abortion restrictions, especially in cases where pregnant women and other pregnant individuals are sick or face complications.
"This case is truly, incredibly significant as we read it post-Roe," said Dana Sussman, acting executive director of National Advocates for Pregnant Women, an organization whose founder worked on the Carder case.
Sussman said pregnant women have less autonomy in their health-care decisions when fetal rights are prioritized, even in cases of wanted pregnancies. "More than abortion is at stake when we talk about Roe," she said.
Carder, whose family lived in Clarksville, Md., had survived two long episodes of cancer since she was first diagnosed with Ewing's sarcoma at age 13. She had multiple operations and lost a leg and half her pelvis. Her oncologists told her she was in remission and could get pregnant, according to a 1988 article in The Washington Post. And not long after she was married in 1986, she did.
All appeared well until she was in her sixth month of pregnancy and began to have trouble breathing. Doctors found a huge tumor in her lung. She would not be cured.
At 26 weeks, her fetus was considered potentially viable. However, her own doctors believed the fetus had a poorer prognosis than that of a healthy pregnant woman. And they believed they might have more time. On June 15, 1987, they suggested experimental chemotherapy or a powerful blast of radiation that might keep her alive for a few more weeks. Twenty-eight weeks, they told her, gave her baby a better shot at survival. Carder agreed.
But the next day, her condition deteriorated rapidly. She was in so much pain that she had to be heavily sedated. Would she want the Caesarean now, at 26 weeks, even though the chances of the fetus dying or being born with severe defects were high? No one had the chance to ask.
Her doctors initially believed they would perform a postmortem C-section, according to Ellen Alderman and Caroline Kennedy in their 1997 book "The Right to Privacy." The family objected. Her doctors agreed that the fetus's chances of surviving were slim and said they would respect the family's wishes.
But when they notified a hospital administrator, the hospital lawyers got involved. They called in a judge, arguing that the fetus was "clinically viable," a hospital source told The Post in 1988. "We figured everything would be post-mortem," the source said. "We never thought we'd get to where we did."
Superior Court Judge Emmet G. Sullivan convened a makeshift court at the hospital. A lawyer assigned to represent the fetus argued that the issue was "not a question of the woman's right to refuse treatment. This is the question of the state's obligation to protect this baby." Sullivan also heard emotional testimony from Carder's family about what she would have wanted.
Carder had agreed to chemotherapy and radiation a day earlier because she thought she had longer to live, said her mother, Nettie Stoner. "The only reason she would agree to any of this was because she thought she was going to live to hold this baby even though she knew she was terminal," Stoner said.
Sullivan, though, had heard conflicting information about the fetus's chances of survival. He said he still couldn't tell for sure what Carder herself wanted, so he "ruled for the fetus."
"It's not an easy decision to make, but given the choices, the court is of the view that the fetus should be given the opportunity to live," ruled Sullivan, now a federal district judge.
Carder's doctor went to the intensive care unit to inform Carder, who was now less sedated, but still groggy. When he asked if she wanted the operation performed, she said yes. But half an hour later, he returned to her room with another physician and her parents and asked again. Unable to make a sound due to the tube in her windpipe, she twice mouthed the words, "I don't want it done."
Sullivan said her intent was still unclear, and he let his original ruling stand. A three-judge panel of the D.C. Court of Appeals, which convened by an emergency conference call at the request of Carder's lawyer, upheld the decision.
Five doctors refused to perform the operation before a sixth one reluctantly agreed, according to "The Right to Privacy." The baby was delivered at 1.7 pounds, The Post reported, "with fingers the size of matchsticks and lungs so terribly undeveloped they could not function normally."
It was a girl, and Carder and her husband, Rick, had agreed to name her Lindsay Marie. When Carder came to, the family told her Lindsay had died. She wept. She was dead two days later. The Caesarean operation was listed as a contributing factor.
Lawyers acting on Carder's behalf requested a ruling from the full appeals court. In a 7-1 ruling in 1990, the court held that only in "rare and exceptional" cases would a state interest in the fetus be so compelling as to override the mother's wishes. "Indeed, some may doubt that there could ever be a situation extraordinary or compelling enough to justify a massive intrusion into a person's body, such as a Caesarean section, against that person's will," the judges wrote.
The dissenting judge, meanwhile, argued that "when the unborn child reaches the state of viability, the child becomes a party whose interests must be considered."
Carder's parents also sued George Washington Medical Center. As part of a 1990 settlement, the hospital agreed to enact groundbreaking policies to protect the rights of pregnant women without court interventions.
Carder's family doesn't talk much about those days in the hospital or the legal fight that followed, said her sister, Sherri Ashby. Nettie Stoner died in 2013; Carder's father, Dan Stoner, is now 86. The family lost touch with Carder's husband, Rick, years ago.
Ashby said she never stopped believing that her sister should not have had to undergo the procedure. "We wanted to let her die with her baby," Ashby said.
She thinks often of her sister, and sometimes about Lindsay. "Nowadays, that baby might have lived," she said. Ashby said she and her husband would have helped raise her, along with their own children.
Carder was buried in the same coffin as her baby girl, behind St. Mary of the Mills Catholic Church in Laurel, Md. "They wrapped Lindsay in a bundle," Nettie Stoner told The Post in 1988, "and put her in her mother's arms."
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Jodie Tillman is a freelance writer based in College Park.
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