A judge can order a cesarean section over the objections of a woman and her treating physicians if the woman is close to death, a three-judge panel of the D.C. Court of Appeals ruled yesterday in a decision that legal experts said could have broad implications for the terminally ill and pregnant women.

At the same time, in an unusually emotional appeal for the court, the panel urged hospitals and legislative bodies in the city to create some kind of "quasi-official body" to review bioethical decisions so that judges are not forced to make the "final mortal decision" under emergency circumstances.

It was only the second time that an appellate court in the United States has addressed the issue of court-ordered cesarean sections, an area of growing concern because of the increasing number of cesareans being performed. The Public Citizen Health Research Group reported last week that 24 percent of babies born in the United States last year were delivered by cesarean section, an increase attributed in part to the growing fear of malpractice suits.

Civil liberties advocates immediately attacked the ruling as infringing on the rights of pregnant women and said the decision could open the door to medical abuses of the terminally ill.

"The implications of this case are enormous," said Lynn M. Paltrow of the American Civil Liberties Union, which submitted a friend-of-the-court brief. "What it says is that dying people can have their bodies raided for living organs . . . . What it says to pregnant women is that you don't have rights to bodily integrity."

In the case before the court, a D.C. Superior Court judge ordered a cesarean section operation in June for a 27-year-old patient at George Washington University Hospital who was in her 26th week of pregnancy and terminally ill with cancer.

Hospital attorneys had sought a ruling to decide whether the hospital had a duty to perform the cesarean section in an effort to save the baby's life when it appeared that the woman's death was imminent.

The woman's physicians, as well as the hospital's obstetrics staff, were opposed to the operation, and the woman had expressed some ambiguity about having a cesarean section before she slipped into unconsciousness. Later, after the judge had issued his ruling and shortly before an emergency appeal was heard by the appellate panel in an extraordinary telephone conference call, the woman regained consciousness and twice told her doctor that she did not want to have the cesarean section.

The appellate panel refused to block D.C. Superior Court Judge Emmet Sullivan's order to perform the operation, and the woman, who was being readied for surgery as the appeal was heard, was wheeled into the operating room. The baby died shortly after the cesarean section, and the woman died two days later.

During the emergency hearing, physicians told Sullivan that the baby had a 50 to 60 percent chance of surviving the operation and that if the child did survive the baby would have less than a 20 percent chance of having a handicap, such as cerebral palsy or blindness.

Also, the physicians said that the operation could hasten the mother's death and that the obstetrics staff was reluctant to perform a cesarean section.

Although the George Washington University Hospital case in effect ended with the death of the mother and child, the appellate court panel said it wanted to explain the June decision in order "to assist others" and to provide a precedent.

In the 15-page opinion issued yesterday, Judge Frank Q. Nebeker wrote that the government's interest in preserving the health of the child was more important than the mother's "right against bodily harm" in a case in which it appeared that the mother had "at best two days left of sedated life."

"We well know we may have shortened {the woman's} life span by a few hours," wrote Nebeker.

In the ruling, the panel said it declined to indicate whether it would have blocked the cesarean section had the woman been in better health, but it noted that the government's "interest in protecting innocent third parties from an adult's decision to refuse medical treatment, however, may override the interest in bodily integrity."

The American Civil Liberties Union reacted strongly the other way.

"This is a complete and unjustified departure from American legal tradition," Paltrow said. "We do not permit individuals to appropriate other people's bodies for their organs no matter what condition the people are in."

Court-ordered cesarean sections have become a subject of major concern among doctors and patients as the number of cesarean sections continues to rise. Doctors nationwide have recommended that the procedure be performed less often. In addition, a recent statement by the American College of Obstetricians and Gynecologists opposed court-ordered treatment for pregnant women.

The three-judge panel also called for less judicial intrusion.

"It would be far better if, by legislation, these bioethical decisions could be made by duly constituted and informed ethical groups within the health care system and, if desired, appellate review as provided in other administrative proceedings," the panel wrote . . . . The balancing of the very factors presented ought, however, to be left to a sort of quasi-official body where the judiciary plays an appropriate and limited reviewing role, rather than the primary adjudicator in a highly charged and short time frame."