WASHINGTON -- One of Washington's major hospitals, saying it hopes to start a nationwide pattern, agreed yesterday to let most pregnant patients decide for themselves whether to permit forced delivery designed to save a baby's life.
The promise by the George Washington University Medical Center came as part of a deal to settle a famous case -- the first of its kind -- involving a Maryland woman who died June 18, 1987, two days after a baby was delivered by Caesarean section, when the woman's wishes about the surgery were in doubt.
The child, whom the woman had carried about 25 weeks, died less than three hours after delivery.
The 27-year-old woman, Angela Carder of Clarksville, was close to death with leukemia at the time, but her lawyers have argued
that the forced surgery -- done with a local judge's approval -- was a cause of her death and may have hastened it.
At a time when pregnant women in increasing numbers across the country were being forced to have C-sections or other medical treatment to assure their fetuses' health or survival, the Carder case became a major test of pregnant women's medical and legal rights.
After her death, the woman's parents, Nettie and Daniel Stoner of Clarksville, sued the hospital and various doctors for $3 million in damages, claiming malpractice and a violation of Mrs. Carder's legal rights. Mrs. Carder's husband at the time, Rick, did not join in the lawsuit. That case had been due to go to trial in a local court this week, but the two sides disclosed yesterday that they had settled it.
At an earlier stage of the medical, ethical and legal dispute surrounding Mrs. Carder's surgery and death, Washington's highest lo
cal court, the D.C. Court of Appeals, ruled that pregnant women here have a constitutional right to refuse in almost all cases to undergo a forced delivery to save the life of their fetus.
Settlement of the parents' lawsuit was designed, lawyers on both sides said yesterday, to assure that that right exist as a practical matter in George Washington's in-hos
pital procedures. The settlement also included a payment of money to the parents, but the agreement included a pledge of secrecy about the amount.
Hospital administrator Christine St. Andre said at a news conference here that, "with this framework in place, the Angela Carder case should not be repeated." She and Dr. Gail Povar, who heads the hospital's ethics committee, said George Washington hopes its action will be imitated widely by other hospitals. They said it was the first to go so far to protect pregnant patients' preferences in treatment.
Terry E. Thornton of Roseland, N.J., one of the parents' lawyers, told reporters that the new hospital rules "will return the focus" of crisis pregnancy situations in the hospital "to the bedside group" -- the patient, her doctors and her family. When decisions for or against forced surgery move away from that group, Ms. Thornton said, "the risk is greatest that the decision will not reflect the patient's wishes."
Another of the Stoners' attorneys, Lynn Paltrow of the American Civil Liberties Union, called the settlement "an important victory for women's rights and for the medical community."
The lawyers involved stressed that the hospital -- which had gone to court to get a decision on what to do about Mrs. Carder -- would now not take treatment decisions for pregnant women to court except as a last resort.
The agreement itself says, "It will rarely be appropriate to seek judicial intervention to assess or override a pregnant patient's decision."
Although the hospital did promise to respect pregnant patients' choices most of the time, the agreement leaves it the option of sending the patient elsewhere if the patient makes a treatment decision the hospital considers "so ethically unsettling" that it does not want to be involved.