THE SETTLEMENT reached between George Washington University Hospital and the American Civil Liberties Union, representing the family of the late Angela Carder, is welcome. It follows a decision by the D.C. Court of Appeals last April, affirming the right of a pregnant woman to make her own decisions about health care even if her choices endanger her fetus. This week's settlement of the civil suit broadens the hospital's commitment to secure the rights of such patients.
From the perspective of her family, the lawyers who had been appointed to represent her and the medical community in general, Angela Carder's case was initially handled in the worst possible way. She entered the hospital in June of 1987, terminally ill with cancer and 26 weeks pregnant. Two days before she died, the university went to court for guidance about whether to deliver her child by Caesarean section without her consent and over the strong objections of her family. A court order was issued and the operation proceeded. The child, who was delivered prematurely, lived only three hours. In order to ensure that this scenario won't be repeated and in order to keep these cases out of court whenever possible, the hospital has now adopted guidelines for its in-house ethics committee, emphasizing patients' rights. In addition, incoming patients will be given information that will enable them to make their own wishes known or appoint a surrogate who will act for them before a crisis arises.
While this agreement binds only George Washington University Hospital, patients everywhere soon will benefit from legislation enacted during the final days of the last Congress. A measure sponsored by Sen. John Danforth (R-Mo.) and Rep. Sander Levin (D-Mich.) and passed as an amendment to the budget reconciliation bill, is directed at averting situations like that faced by the hospital and the family of Angela Carder. The new law, which will take effect in a year, requires all health facilities that receive Medicare or Medicaid funding to inform patients about their right to make decisions about their own care. They will be offered options, be told about how to designate surrogates in case they become incompetent and advised about matters such as living wills. None of this is designed to intimidate, coerce or frighten patients and the more routine these discussions become, the less disturbing they will be.
The Supreme Court, in the Cruzan case decided last spring, acknowledged that individuals have the right to refuse treatment but stressed that intent must be clearly and unequivocally expressed. The new law will facilitate the exercise of that right and encourage thoughtful decision making in advance of crisis.