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"from his motherís womb Untimely ripped"

I'm a C-section baby, born a month premature in a particularly silly breech-birth with the umbilical cord busily trying to strange me. Besides proving that I was uncoordinated even prior to birth, it's one reason I've been following the Utah case of a woman charged with first-degree murder for allegedly refusing to undergo a Caesarean with some interest. According to prosecutors her refusal to submit to the procedure was purely aesthetic.

Facts on the case are particularly difficult to find, and even if it goes to trial I'm unsure things will get sorted out. According to the NYT, the woman involved claims she was never informed of the danger to her babies. Others state that the idea that she wanted to avoid surgical scars is absurd because she had already had one or more c-sections. (I've only seen this claim in one place, though I'm looking for more.) So I'm withholding judgment on the merits of this particular case.

On the other hand, I'm disturbed by the reaction of people like Sherry Colb in her Findlaw column. My libertarian-leanings agree with her on principle: that forcing a woman to go through a C-section for any reason is an unwise policy and against our conception of liberty. But she seems absorbed by the same impetus that dominates many pro-abortion advocates, a kind of moral blind-spot that instinctively makes me question why I agree.

Look through the column and you'll find that she makes a strong, if not compelling, case for bodily integrity and against 'Good Samaritan' laws. You'll find that she questions the facts of whether Rowland really was motivated by cosmetic concerns. But in a column in which she spends inches making a questionable statistical case (see below), she spares barely a line to indicate any moral qualms about even a hypothetical woman who chooses to risk her child's life for reasons of her bodily aesthetic:

To avoid creating the impression that I take the responsibilities of pregnancy lightly, let me be clear in stating that I believe a woman who intends to carry her pregnancy to term has a moral obligation to attempt to avoid situations and activities that will harm her unborn child.

Note that even this line doesn't indicate any belief that a woman has a moral--not a legal, but a moral obligation--to take actions that would save her unborn children at the risk of slight bodily harm. This unwillingness to confront the fact that such a choice, even if the legal right of a woman, is ethically disturbing makes it difficult for me to credit much of the rest of Colb's argument.

One of the reasons I'm willing to hold what libertarian beliefs I have is a conviction that even without use of legal and governmental force, there are social factors which will--and should--control our actions, and that impose social costs upon those who transgress them. One of those social processes is the public condemnation of some choices that are socially unacceptable, even if legal. Choosing to risk the life of your child in order to avoid a scar visible only to your lovers is deplorable, pure and simple. If that's not what happened here, so be it, but it disturbs me that Colb seems unwilling to make that statement plainly and outright.

What small common-cause I hold with the anti-abortion movement lies on this fact: that the arguments frequently used by pro-abortion proponents often trivialize the intrinsic sanctity of life, indeed the sanctity of anything except a certain subset of personal preferences. The process of pregnancy presents men and women with often incredible moral choices. The man who listens numbly as the doctor explains that his wife is unconcious, they can't stop the bleeding, and there may soon be a choice between saving the life of the woman he loves or the child she's carrying--the man who is either implicitly or explicitly being asked to guess which his wife would choose--faces decisions that I hope to God never to make. But a life or scar tissue? I can't believe it's even a question.

Explanation of "a statistically questionable case": One thing about Reg. State, it helps in that class to keep an eye on what people do with statistics. Colb's probably right that we perform too many C-sections in the U.S. (my intuition from other sources) but she gives a questionable array of statistics leading to that conclusion. Simply put, you can't get there from here:

As it turns out, though, the premise that an obstetrician's surgical recommendation ought to be followed is itself questionable. In the U.S., approximately one quarter of all babies are delivered by C-section. According to the World Health Organization's Safety Standards, however, there is no justification for a C-section rate of higher than 10 to 15 percent.

That is, roughly one half of the C-sections in the U.S. are performed unnecessarily. Furthermore, as it turns out, the risk of maternal death is between twice and four times greater when a woman has a C-section than when she undergoes a vaginal delivery.

But doesn't the U.S. offer the best obstetrical care in the world? No. If we look at comparative C-section rates across industrialized nations, the U.S. rates -- as of 1995 -- were higher than those of at least ten other countries, including England, France, and Spain, where infant mortality rates were also lower.

C-sections are thus risky not only to pregnant women but to their babies as well -- a fact that certainly has some bearing on whether doctors who recommend surgery are necessarily practicing good medicine.


(emphasis in original) The troupble with this is that she implies causation between numbers without it necessarily being there. For instance, the reason that maternal death during c-section may be higher than vaginal birth may simply be that they include emergency c-sections--like mine--where the mortality risk in vaginal birth was desperately high as well. That's why the c-section was chosen in the first place. This might be a compelling number if it were restricted to elective c-sections, but that's not clear here.

Similarly, are the unnecessary c-sections the one which result in greater rates of death or infant mortality? It might be true, but it's unclear from the statistic given, which doesn't separate things out between emergency or elective c-sections. Further, is the difference in infant mortality between the U.S., England, France, and Spain a result of a greater number of c-sections, or a result of other differences between the women involved (e.g. average age, prevalence of drug-use among the pregnant, diet, etc.).

On those numbers alone a practitioner's suggestion to have a c-section shouldn't be questioned. There may be other reasons, of course, but they're not there.

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Comments

like you, I too have been following this case and the thing that I keep seeing is that the woman has a history of mental illness and was unable to make herself understood at the proper moment. Still, I do find the whole cause of action against her pretty silly. It's a tragedy, definitely, to lose a child... but it's a bigger tragedy to dick around with someone who already has too many problems. (Not that I'm trying to trivialize it! but the history of mental illness is what I'm referring to.)
I've also been following this case as I believe it may have the potential to set a dangerous legal precedent. While we may find it morally reprehensible that a woman would, allegedly, choose her appearance over the welfare of her child, a woman should have the right to decide whether or not she wants an invasive surgical procedure without state interference. Would this case have come to trial if the woman had said she didn't want it done because of the health risks involved? My own mother almost died during her c-section with my younger brother,(her kidneys failed), and this is a reality that women should be allowed to consider. What is also not mentioned are the other possible side effects of c-sections, including the potential damage to reproductive organs leading to infertility. No matter what we may feel about this woman as a person, we need to protect our personal freedom to refuse medical care, no matter why we refuse it. The state should not have the right to force anyone to submit to an invasive, and potentially dangerous, medical procedure for any reason.
Mariah: Oh, agreed, and I think I was pretty clear that I don't think it should be made criminal. However, I think in saying that, there's also a moral obligation to mention that not choosing the c-section for purely cosmetic reasons is pretty reprehensible.
Sorry! You did make it clear in your post, and I wasn't trying to call you out or anything...I just like putting my own 2 cents out there sometimes (go ahead and ask Justin about that, he'll give you an earful about me and my big mouth)... Great blog, BTW!
Didn't think you were--just clarifying my own position. It's a pretty miserable case, the more I follow it, anyway... lots of bad luck and bad situations combining.
Just a quick question - because of course I am not as up to speed on this as you are at this point - but I thought that the other baby tested positive for alcohol and drugs in any case. (which makes me wonder if it's actually fair to quote her thoughts on this matter - I mean, a high, drunk woman in labor might not actually be capable of articulating all the reasons she doesn't want an invasive procedure) If she had only had that one baby, with the various intoxicants in its system, the state would have stepped in at that point and removed the child as it does consider it has an intereste in the wellbeing of babies after birth. I think that part of the issue here is when the child is seen as an independent being and at what point the woman's responsibility becomes one of parenting, rather than one of self-preservation. At what point should the state identify a mother who is a danger to her fetus on any of these levels (mental illness, drugs, alcohol use, vanity) and usurp her right to determine her own medical needs? and beyond that, who broke the HIPAA laws and went public with her case?

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