pitocinrespring

William&MaryJournalofRace,Gender,andSocialJusticeWilliam&MaryJournalofRace,Gender,andSocialJusticeVolume4(1997-1998)Issue2William&MaryJournalofWomenandtheLawArticle4April1998State-CompelledFetalSurgery:TheViabilityTestisNotViableState-CompelledFetalSurgery:TheViabilityTestisNotViableKristaL.
NewkirkFollowthisandadditionalworksat:https://scholarship.
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edu/wmjowlPartoftheFamilyLawCommonsRepositoryCitationRepositoryCitationKristaL.
Newkirk,State-CompelledFetalSurgery:TheViabilityTestisNotViable,4Wm.
&MaryJ.
Women&L.
467(1998),https://scholarship.
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law.
wm.
edu/wmjowlNOTESSTATE-COMPELLEDFETALSURGERY:THEVIABILITYTESTISNOTVIABLE"Betweenthemomentofconceptionandthemomentofdelivery,somuchcangowrongthatittrulyisamiraclethatsomuchgoesright.
"'I.
INTRODUCTIONImagineawomanwhoisintheeighteenthweekofhersecondpregnancywhenshebeginstofeelthatsomethingisnotquiteright.
Themothernoticesthatthefetusisveryactiveandbelievesthatthefetusisinpain.
Themothergoestoherdoctor,whoperformsanultrasoundtest.
Thetestrevealsthatthefetusissufferingfromhydrocephalus,abuild-upoffluidintheventricals,normallyemptychambersofthebrain.
2Thisbuild-upcancausebraindamagebeforebirth.
Ifashuntisnotsurgicallyimplanted,thefluidbuild-upcanraiseintracranialpressureandenlargethehead,makingnormalpassageofthefetusthroughthebirthcanalimpossible.
Ifthepressureremainselevated,itcandestroywhitebrainmatterandcausementalretardation.
Thedoctorinformsthemotherthatshehasfouroptions.
Thefirstoptionistohaveanabortion.
Thisispossiblebecausethefetusisnotyetdeterminedtobeviable.
Themother'ssecondop-tion,deliveringthebabybycesareansectiontoavoidtraumatothefetalhead,isdiscouragedbecausethefetus'lungsarenotyetfullydeveloped.
Thisheroicmeasurewouldthereforepresentanun-acceptablerisktoboththemotherandthefetus.
3Themother'sthirdoptionistoletthebabydevelop,continuingthepregnancyuntillaborbeginsspontaneously.
If,duringbirth,thefetalheadistoolargetopassthroughthebirthcanal,aneedle1.
B.
D.
Colen,SavingBabies;theRisks,DilemmasandRewardsofFetalSurgery,HEALTH,Aug.
1986,at59,availableinLEXIS,Nexislibrary,MAGSfile.
2.
Seeid.
at61.
ThisscenariowasbaseduponthecasestudyofSaraHannanwho,unlikethewomaninthescenario,chosetoundergotheproceduretohelpherfetus.
Unfortunately,herbabysufferedfromproblemsassociatedwiththehydrocephalusformanyyearsafterhisbirth,despitetheeffortstocorrecttheproblemsinutero.
3.
SeeCarsonStrong&KathyKinlaw,MaternalRights,FetalHarms;CaseStudyandCommentariesonTreatmentofPrenatalHydrocephalusandtheEthicsofCephalocentesis,21HASTINGSCENTERREP.
21(1991),availableinLEXIS,Nexislibrary,RXMEGAfile.
468WILLIAM&MARYJOURNALOFWOMENANDTHELAW[Vol.
4:467canbeinsertedintothecraniumandcerebrospinalfluidextractedtoreducethefetus'headsize.
Theadvantageofthisapproachisthatitallowsthemothertomaintainherautonomyandminimizesthephysicalrisksofboththecesareansectionoptionandthefetalsurgeryoption.
Thedrawbacktothisoptionissignificant:thisformof"cephalocentesisalmostalwaysresultsinstillbirthorneo-nataldeathwithinafewdays,duetotherapiddecompressionoftheheadorneedle-inducedhemorrhage.
4Thedoctortheninformsthemotherofherlastoption,cephalo-centesis.
Ashuntcanbeplacedinthefetus'headinutero,allowingthefluidfromthebraintodrainintotheamnioticfluid.
Thepro-cedure,whichlastsalittleoveranhour,beginswiththedoctorsmakingthreetinyincisions,approximatelythewidthofapencil,intheabdomen.
Usinganultrasoundmonitor,thedoctorsguideathin-walledneedle,abouttwomillimetersindiameter,throughtheincisionandintotheamnioticcavity,thenthroughthebaby'scra-niumintotheenlargedventricle.
Whentheneedleisinpositionthestyletinsidetheneedle,similartothepointandcartridgeofaballpointpen,iswithdrawnallowingacathetertobethreadedthroughthehollowneedle.
Theotherendofthecatheterisleftintheamnioticcavitytoallowthefluidtodrainfromthebrain.
5Thedoctorthenexplainsthatcephalocentesisisnotalwayssuccessful,andsometimestheprocedurecausescomplications.
Forexample,sometimesthefetusremovestheshunt,andtheproceduremustbeperformedagain.
'Theprocedurealsoposesaslightrisktothemother'sreproductivesystemthatcouldaffectherabilitytobearfuturechildren.
7Furthermore,thereisanincreasedriskofpretermlabor,whichcanbecontrolledtoagreatextentwithdrugstosuppresslabor.
Theriskofpretermlabor,however,isreducedifthefetalsurgeryisperformedearlyinafetus'gestation.
8Theparentsshouldalsoweighthecostoftheprocedureagainstthebenefits.
Doctorsarenotalwaysabletodetermineifafetuswillreceiveagreaterbenefitfrominuterotreatment,orwhetherthehydrocephaluswillnotadvance,allowingthefetustobetreated4.
Id.
at23.
5.
SeeCherylCrooks,HealingtheUnborn,PARENTS'MAG.
,June1988,at138(providingadescriptionofthesurgery,itscomplications,andtheeffectsuponthemotherwhochosetohavethesurgeryperformedanduponhersonforwhomthesurgerywasperformed).
6.
Seeid.
Seealso,Colen,supranote1,at60(describinghowthedoctorswerealmostforcedtogiveupthesecondtimetheyperformedtheprocedurebecausethefetuswouldnotholdstill).
7.
SeeCrooks,supranote5,at140.
8.
Seeid.
STATE-COMPELLEDFETALSURGERYmoreeffectivelyafterbirth.
9Furthermore,thereisthechancethatevenwithinuterocephalocentesis,furthertreatmentswillberequiredafterbirthandwhilethechilddevelops.
"°Themotherandfatherlistencarefullytothedoctors'explan-ationsofthefouroptions.
Themotherisconcernedaboutthehealthofherfetusandwantstocarrythebabytoterm.
Shequick-lydismissestheabortionoption.
Themotherhasconcernsaboutanyinvasiveprocedure.
Shedeliveredherpriorchildbynaturalchildbirthandhasastrongbeliefinholisticmedicine.
Aftercare-fulconsiderationshedeterminesthatsheisopposedtoanyinvasiveprocedure,evenifitisjusttheinsertionofaneedlethroughasmallincision.
Themothersaysthatsheisawarethatthismayplaceheratriskbecauseofthepossibilitythatthefetus'headwillbetoolargetopassthroughherbirthcanal,andthatsheisawarethatthebabymaybeseverelymentallyretarded,ormayevendie.
Sheisconvinced,however,thatsheismakingtherightdecisionandthatthroughmeditationandholisticmedicineshecanpreventanyfurthercomplications.
Sheisnotopposedtocephalocentesisafterthebabyisbornandtheriskofhydrocephalushasbeenbetterevaluated.
Themother,however,doesnotwantanyinvasivepro-cedureperformeduponherbody,includinginsertionofneedlesoracesareansection.
"Theissuesbecomemoreproblematicwhentheabovescenarioischangedinoneimportantway-whenthefetusistwenty-sixweeksoldinsteadofeighteenweeksold.
Becausethefetusisdeemedtobeviableatapproximatelytwenty-fourtotwenty-five9.
Seeid.
10.
Seeid.
at141.
11.
SeegenerallyLoisShepherd,ProtectingParents'FreedomToHaveChildrenwithGeneticDifferences,1995U.
ILL.
L.
REV.
761.
Shepherdarguesthatthecourts,byinterferingwithdevelopingfetuseswhichmayhavemedicalproblems,suchasdeafness,labelthechildren-to-be"defective.
"Id.
at765.
Shepherdasksthequestion,"Doesachildhavearighttobebarnfreeofgeneticdisabilities,especiallyconsideringhowwetendtoregardgeneticdifferencesas'defects.
'Id.
at766(citingLewisCope,2010:ArthurCaplanLooksattheFutureofMedicineToday,STARTRIB.
(Minneapolis-St.
Paul),May17,1994,at1E).
ShouldamotherbeheldliablebecauseshewantsherchildtobebornthewaynatureorGodintendeditPerhapswhatsocietyconsiders"defects"themotherseesasuniqueness.
DoesthestatetrulyhaveacompellinginterestinguaranteeingthatchildrenarebarnasclosetoperfectaspossibleShepherdseestheadvancesoftechnologyona"collisioncourse"withagreateracceptanceofpersonswithdisabilities.
"Scientificandmedicaladvancesmakeitincreasinglyeasiertoavoidthebirthsofindividualswithdisablinggeneticdifferences,justaswenowareappearingtodevelopthecapacitytoacceptsuchdifferences,andperhaps,eventoappreciatethem.
"Id.
at763(citingJamesC.
Dugan,Note,TheConflictBetween"Disabling"and"Enabling"ParadigmsinLaw:Sterilization,theDevelopmentallyDisabled,andtheAmericanswithDisabilitiesActof1990,78CORNELLL.
REV.
507(1993)).
1998]469470WILLIAM&MARYJOURNALOFWOMENANDTHELAW[Vol.
4:467weeks,'2theconsiderationsandargumentsforandagainstinuterosurgerymaychangesignificantlywithinatimeperiodofjustafewweeks.
Althoughtheoptionoffetalsurgeryhasexistedforoveradecade,therehasyettobeacasebroughtbythestateorbyafathertocompelawomantoundergofetalsurgery.
Asfetalsurgerydeve-lopsandbecomesmoreaccepted,itwillbemorereadilyavailableasaviableoptiontoassistmothersandfetuses.
Astheprocedurebe-comesmoreavailableandlessexperimental,wecanexpecttoseeacaseofcompelledfetalsurgeryariseinthecourts.
Whilemanyhavevoicedconcernsaboutwomenrefusingtoparticipateinfetalsurgery,inrealitywomenhavegoneto,andcontinuetogoto,extrememeasurestoprotectandinsurethehealthoftheirunbornbabies.
'"Atthistimefetalsurgeryorther-apymaybeusedtocorrectavarietyoffetaldisorders.
Manyofthesedisordersareveryserious,suchas:correctingobstructiveuro-pathies(blockedrenalorurinarytracts);4cysticadenomatoidmal-formation;5diaphragmatichernia;6sacrococcygealteratoma(fetaltumors);7abnormalchorionicbloodvesselsintwinsconnectingthecirculationofthefetuses;8heartblocks;9obstructivehydro-cephalus;2°pulmonaryoraorticvalveobstruction;2'andtracheal12.
Viabilitywasdefinedasthefetus'potential"toliveoutsidethemother'swomb,albeitwithartificialaid.
Viabilityisusuallyplacedataboutsevenmonths(28weeks),butmayoccurearlierevenat24weeks.
"Roev.
Wade,410U.
S.
113,160(1973).
13.
See,e.
g.
,JohnBarbour,FetalSurgery'sFutureDoctorsOfferAidAsSoonAsPossible,L.
A.
DAILYNEWS,Aug.
5,1990,atAl(describingfetalsurgeryproceduretocorrectanimproperlydevelopingdiaphragm,andstatingthatonlytwofetuseshadsurvivedoutofsixattemptsatthistypeofsurgery).
SeealsoScience/MedicineSurgerySavesLifeofFetus,L.
A.
TIMES,Oct.
22,1990,atB3.
Thearticledescribesaninuterosurgerytocorrectcongenitalcysticadenomatoidmalformation(adeformedlung).
The72-minuteprocedureinvolvedmakinganincisioninthemother'suterusandpullingtheleftarmandchestofthefetusthroughtheopening.
Surgeonsthencutopenthechestofthefetussurgicallyremovedthemalformedlunglobe,putthefetusbackinthewombandclosedtheincision.
Id.
SeealsoMarrowShotsProtectFetus,WASH.
POST,Dec.
6,1995,atA2(explainingtheprocedureperformeduponafetus,savingitslife,wheredoctorsinjectbonemarrowtakenfromthefatherintotheabdominalcavityofthefetusatsixteen,seventeen,andeighteenweeksofgestation).
SeealsoColen,supranote1;Crooks,supranote5.
14.
SeeWolfgangHolzgreve&MarkI.
Evans,NonvascularNeedleandShuntPlacementsforFetalTherapy,159W.
J.
MED.
333,334-35(1993).
15.
SeeMichaelR.
Harrison,FetalSurgery,159W.
J.
MED.
341,344-45(1993).
16.
Id.
at346.
17.
Id.
at347.
18.
Id.
19.
Id.
at347-48.
20.
Id.
at348.
Seetextaccompanyingsupranotes1-10.
21.
Id.
STATE-COMPELLEDFETALSURGERYatresia(airwayobstruction).
22Somearemerelycosmetic,suchascleftlipandpalatereparation.
23Althoughnocasesconcerningcompelledfetalsurgeryhaveyetarisen,thisNotewilldiscussthestateofthelawanditsproperexpansioninlightofdevelopingtechnology.
InSectionTwo,thisNotewillexaminecourts'decisionsinthecasesmostanalogoustostate-compelledfetalsurgery-state-compelledcesareansection.
ThisNotewillanalyzethetwodoctrinallyopposedstate-compelledcesareansectioncasesofInreA.
C.
24andJeffersonv.
GriffinSpaldingCountyHospitalAuthority,2"aswellascasesthatappliedsimilarreasoningintherealmofforcedcesareansections,fetaltherapy,andpersonalautonomy.
InSectionThree,thisNotewillexaminetherightstowhichamotherisentitled.
TheNotewillthenanalyzethedutiescourtshavedeterminedamotherowedtoherunbornbaby.
TheNotewillanalyzehowtheserightsanddutieseffectamotherinacaseofstate-compelledfetalsurgery.
Finally,inSectionFour,thisNotewillexaminewhytheviabilitytestisillogicalandinappropriateincasesofstate-compelledfetalsurgery.
II.
THEFORCEDCESAREANSECTIONANDPERSONALAUTONOMYCASESTheUnitedStatesSupremeCourthasstatedthatacompetentpersonhasaconstitutionallyprotectedrighttorefusemedicaltreatment.
2"TheCourtalsostatedthatthisrightisnotabsoluteandmustbebalancedagainstthestate'sinterests.
Theseinterestsincludepreservinglife,preventingsuicide,maintainingtheethicalintegrityofmedicalpractice,andprotectinginnocentthirdparties.
27Inthecaseofforcedcesareansitistheseinterests,theindividual'sandthestate's,thatarebalanced.
Thestate'sinterests22.
Id.
23.
Id.
at349.
Thearticlenotesthattheadvantageoffetalsurgeryisthatfetusesdonotscar,apparentlynomatterhowinvasivetheprocedure.
Thearticlealsonotes,however,that"thetheoreticalbenefitsofrepairofthesenonfataldefectsbeforebirthareunprovedanddonotjustifytherisksofintervention.
"Id.
24.
573A.
2d1235(D.
C.
1990).
25.
274S.
E.
2d457(Ga.
1981).
26.
Cruzanv.
Director,Mo.
Dep'tofHealth,497U.
S.
261,278(1990)('Theprinciplethatacompetentpersonhasaconstitutionallyprotectedlibertyinterestinrefusingunwantedmedicaltreatmentmaybeinferredfromourpriordecisions.
").
27.
See,e.
g.
,InreConroy,486A.
2d1209(N.
J.
1985)(citingSatzv.
Perlmutter,362So.
2d359(Fla.
1980));InreSpring,399N.
E.
2d452,456(Mass.
1979);InreTorres,357N.
W.
2d332,339(Minn.
1984);InreCoyler,660P.
2d738,743(Wash.
1983)).
1998]472WILLIAM&MARYJOURNALOFWOMENANDTHELAW[Vol.
4:467inthesecases,however,donotincludeconcernforthewelfareofthemotherasapatient.
Thesecasesrecognizethestate'sinterestinanotherpatient-thefetus.
Inthecaseswherethecourthasrecognizedthestate'sinterestsinthefetus,thecourthasoverriddenthemother'srighttorefusemedicaltreatmentandorderedthatthewomanundergoacesarean.
2"28.
SeeJefferson,573A.
2d1235(D.
C.
1990).
MichelleHarrisonprovidesausefuldescriptionofacesareansection,emphasizingtheinvasivenessoftheprocedure:Thesurgeontakesascalpelfromthenurseandwithonestronganddefinitemotioncreatesacrescent-shapedincisionalongthewoman'spublic[sic]hairline.
Astheskiniscut,thesubcutaneoustissuebulgesupwardasthoughithadbeenstrainingtogetthroughallthetime.
Withinmomentsthisfattytissue,interconnectedbythintransparentfibers,becomesdottedandthencoveredwithbloodthatoozesoutoftinyvessels.
Withscalpelandforceps-delicatetweezers-thesurgeoncutsdeeperbeneaththesubcutaneoustissue,toathicklayeroffibroustissuethatholdstheabdominalwallinplace.
Oncereached,thisfibrouslayerisincisedandcutalongthelinesoftheoriginalsurfaceincisionwhilethemusclesadheringtothetissuearescrapedoffandpushedoutoftheway.
Theuterusisnowvisibleundertheperitoneum,alayerofthintissuelookinglikeSaranWrap,whichcoversmostoftheinternalorgansandwhich,wheninflamed,producesperitonitis.
Theperitoneumisliftedawayfromtheuterusandanincisionismadeinit,leavingtheuterusandbladdereasilyaccessible.
Thebladderispulledawayfromtheuterus,forthebabywillbetakenoutthroughanincisionintheuterusunderneathwherethebladderusuallylies.
.
.
.
Theuterusofthepregnantwomanislarge,smoothandglistening.
Shapedlikeahugepear,thetopandsidesarethickandmuscular,thelowerendthinandflexible.
.
.
.
Theobstetricianextendstheinitialcuteitherbyputtingtwoindexfingersintothesmallincisionandrippingtheuterusopenorbyusingblunt-endedscissorsandcuttingintwodirectionsawayfromtheinitialincision.
Ifthemembranesarestillintact,theyarenowpuncturedbytoothedforceps,andthefluidspillsoutontothetable.
Inthenormalposition,thebaby'sheadisdownandundertheincision,sotheobstetricianplaces.
onehandinsidetheuterus,underthebaby'shead,andwiththeotherhandexertspressureontheupperendoftheuterustopushthebabythroughtheabdominalincision.
Theassistantalsousesforcenowtohelppushthebabyout.
.
.
.
Therestofthesurgeryismoredifficultforthewoman.
Thereismorepainandwomenoftenvomitandcomplainofdifficultbreathingaswehandletheirorgansandrepairthedamage.
.
.
.
Theplacentaseparatesfromorispulledofftheinsideoftheuterus.
Then,sincetheuterineattachmentsareallatthelowerend,nearthecervix,thebodyoftheuteruscanbebroughtoutoftheabdominalcavityandrestedontheoutsideofthewoman'sabdomen,thusaddingbothvisibilityandroominwhichtowork.
Withlargecircularneedlesandthickthreadacombinationofrunningandindividualstitchesisusedtosewclosedtheholeintheuterus.
Adrugcalledpitocinisaddedtothewoman'sIVtohelptheuteruscontractandtodecreasethebleeding.
Smallsuturesareusedtotieandretiebleedingbloodvessels.
The"gutters,"spacesintheabdominalcavity,areclearedofbloodandfluid.
Theuterusisthenplacedbackintheabdominalcavity.
Thebladderissewnbackontothesurfaceoftheuterus,andthenfinallytheperitoneumisclosed.
STATE-COMPELLEDFETALSURGERYInthecaseofJeffersonv.
GriffinSpaldingHospitalAuthority,"theSupremeCourtofGeorgiagrantedthestate'spetitionfortem-porarycustodyoftheunbornchild,providingthestatewith"fullauthoritytomakealldecisions,includinggivingconsenttothesur-gicaldeliveryappertainingtothebirthofthischild.
"0TheSuper-iorCourtofGeorgiafirstnotedthatthe"child"wasviableandfullycapableofsustaininglifeindependentofthemother,andthenframedtheissueofthecaseas"whetherthisunbornchildhasanylegalrighttotheprotectionofthe[c]ourt.
"31ThecourtnotedthattoabortachildatthisstageintheproceedingwouldbeacriminaloffenseinGeorgia.
32Thecourtfurtherstatedthat"[b]ecausethelifeofdefendantandoftheunbornchildare,atthemoment,inse-parable,the[c]ourtdeemsitappropriatetoinfringeuponthewishesofthemothertotheextentitisnecessarytogivethechildanopportunitytolive.
"3Thecourtthenorderedthedefendanttosubmittoasonogram.
Ifthatsonogramindicatedthattheplacentapriviawasstillblocking"thechild'spassageintothisworld"thenthedefendantwasorderedtosubmittoacesareansectionand"relatedproceduresconsiderednecessarybytheattendingphysi-ciantosustainthelifeofthischild.
"34ThisdecisionwasbasedNowspongesarecountedtobesurenonehavebeenleftinsidetheabdominalcavity,andthenclosureoftheabdominalwallbegins.
Musclesoverlyingtheperitoneumarepushedbackinplace,andaresometimessewnwithloosestitches.
Fascia,thethickfibrouslayer,isthemostimportantone,sinceitholdsalltheabdominalorgansinsideandkeepsthemfromcomingthroughtheincision,especiallyifthewomancoughsorsneezes.
Thereforethislayerisclosedwithheavythreadandmanyindividualstitchessothat,evenifathreadbreaks,thestitcheswon'tallcomeout.
Thesubcutaneoustissue,mostofwhichisfat,isclosedinloosestitchesthatmainlycloseanyairspaceswhichmightbecomesitesforinfection.
Skin,thefinallayer,isclosedwitheithersilkornylonthreadormetalstaples.
.
.
.
Adrybandageisplacedoverthewoman'sincisionandthentapedtoherskin.
Thedrapesareremoved.
Ababyhasbeenborn.
MICHELLEHARRISON,AWOMANINRESIDENCE81-84(1982),quotedinJanetGallagher,PrenatalInvasions&Interventions:What'sWrongwithFetalRights,10HARV.
WOMEN'SL.
J.
9,36n.
137(1987).
Somefetalsurgeryproceduresaresimilarlyinvasiveastheytooinvolveenteringthewomb.
See,e.
g.
,supranotes5,13,15-23.
29.
274S.
E.
2d457(Ga.
1981).
30.
Id.
at459.
31.
Id.
at458.
32.
Seeid.
(citingGA.
CODEANN.
§§26-1201,26-1202(1980)).
33.
Id.
Itshouldbenotedthatthecourt'sopiniondoesnotevenaddressthereligiousbeliefsofthemother,andherrefusalbaseduponthosebeliefs.
ThereligiousissueisaddressedonlyintheconcurringopinionofJusticeSmith,whereheanalogizesthecurrentsituationtoreligionrequiringhumansacrifices.
Seeid.
at461(Smith,J.
,concurring).
34.
Id.
at459-60.
1998]473474WILLIAM&MARYJOURNALOFWOMENANDTHELAW[Vol.
4:467uponthepremisethatthestatehasaninterestinprotectingthelivesofunborn,viablechildren.
3"ThecourtinInreJamaicaHospital6tookasimilarapproach.
Thecourtrecognizedthestate'sinterestinprotectinglife,evenpotentiallife,asacompellinginterest.
Byholdingthatthisinterestwascompelling,thecourtwasabletorulethatthestate'sinterestoverrodethewoman'srighttobodilyintegrity.
37Thecourtheldthatthestate'sparenspatriaepoweroverrodethewoman'srighttorefusetreatment.
Thecourtoverrodethemother'srighttobodilyintegrityeventhoughtheeighteen-week-oldfetuswasnotyetviableand,therefore,thestate'sinterestwasnotcompellingunderRoeV.
Wade.
Thecourtheldthat"thestatehasahighlysignificantinterestinprotectingthelifeofamid-termfetus,whichoutweighsthepatient'srighttorefuseabloodtransfusiononreligiousgrounds.
""8Notethatthestatewouldnothaveacompellinginterestinthenon-viablefetus,norwouldithavea"highlysignificantinterest,"sufficienttoallowittopreventthemotherfromhavinganabortion.
Itisincongruoustoholdthatthestatehasaninterestsignificantenoughtoovercomethemother'spersonalprivacy,autonomy,andfreeexerciseofreligion,andcanrequirethemothertohaveacesareansection,butdoesnothaveaninterestsufficienttorequirethemothermerelytocarrythefetustoterm.
InthecaseofTaftv.
Taft,39thecourtexaminedwhetherahusbandcouldcompelhiswifetoundergoa"pursestring4°opera-tiontopreventherfromhavingaprobablemiscarriage.
Thewo-manhadrefusedtheprocedurebaseduponherreligiousbeliefsas35.
Seeid.
at460(JusticeHill,concurring).
InthecaseofInreMadyun,573A.
2d1235(D.
C.
1990),theSuperiorCourtoftheDistrictofColumbiafollowedthecourt'sdecisioninJeffersonv.
GriffinSpaldingandheldthat"thestatehasan'importantandlegitimateinterestinprotectingthepotentialityofhumanlife.
'"Id.
at1262(quotingRoev.
Wade,410U.
S.
113,162(1973)).
SeeRebekahR.
Arch,TheMaternal-FetalRightsDilemma:HonoringaWoman'sChoiceofMedicalCareDuringPregnancy,12J.
CONTEMP.
HEALTHL.
&POLY637,654-56(1996)(providinganin-depthlookatthecourt'sanalysisanddecision).
36.
491N.
Y.
S.
2d898(Sup.
Ct.
1985).
37.
Seeid.
at900.
38.
Id.
(emphasisadded).
Notetheimportanceofthecasetothescenariopresented.
Thecourtdidnotrequirethatthefetusbeviabletoprovidethestatewithacompellinginterestinprotectingthefetus.
Acourtcouldeasilyextendthisholdingtofetalsurgeryofthetypedescribed,becausethecephalocentesisarguablyinvolvesaminimalamountofintrusion,muchlikeabloodtransfusion.
39.
446N.
E.
2d395(Mass.
1983).
40.
Thisisaprocedurewherethecervixissuturedsothatitwillholdthepregnancy.
Themotherhadundergonethisprocedureforallofherthreepriorchildren.
Herfourthpregnancywasterminatedduetoamiscarriagebecausethewiferefusedtheprocedure.
Seeid.
at396.
STATE-COMPELLEDFETALSURGERYanewly"bornagainChristian.
"41Thecourtdoesnotdecidethequestionof"whether,insomesituations,therewouldbejustifi-cationfororderingawifetosubmittomedicaltreatmentinordertoassistincarryingachildtoterm.
"2Thecourtdoesnote,how-ever,thatthestate'sinterest,insomeundefinedcircumstance,mightbesufficientlycompellingto'justifysucharestrictionoftheconstitutionalrightofprivacy.
'43Thecourtdidnotstateclearlyuponwhichconstitutionalright,privacyorreligion,itwasbasingitsopinion.
Itappearstobeacombinationofboth.
"Thisdecisioncarefullynotedthelackofmedicaldataconcerningthenecessityofthesurgerytopreventthedeathofthemotherorthefetus,andoftheriskscausedbythesurgerytoboththemotherandtheunbornchild,therebyallowingforthefutureapplicationofthebalancingtest,usedinothercases,whichcouldcompelthemothertoundergomedicalproceduresagainstherwill.
45ThecourtinthecaseofInreA.
C.
46addressedasimilarissueinarguablymoreexigentcircumstances.
A.
C.
,themother,wasclosetodeathfromcancerandwastwenty-sixandone-halfweekspregnant.
47AlthoughA.
C.
wasonlifesupport,shewasarguablycompetenttomakedecisions,andtherewastestimonythatshede-cidednottoconsenttothecesarean.
Thetrialcourtorderedthatthecesareanbeperformed,andababygirlwasdelivered.
Trag-ically,thebabygirldiedafteronlylivingtwoandone-halfhours,andthemotherdiedtwodayslater.
48Theappellatecourtheldthatthebalancingtestappliedbythemotionsdivisionofthedistrictcourtswasnotproper.
Themajoritybaseditsdecisiononitsanalysisofthedoctrinesofinformedconsent,bodilyintegrity,dueprocess,substitutedjudgmentandpolicyconsiderations.
Thecourtheldthat41.
Id.
42.
Id.
at397.
43.
Id.
44.
Seeid.
Thecourtstatesthatitknowsofnocaseinwhichacourtorderedapregnantwomantosubmittoasurgicalprocedureinordertoassistincarryinganon-viablefetustoterm.
ThecourtthencitedJeffersonv.
GriffinSpauldingCountyHosp.
Auth.
,274S.
E.
2d457(Ga.
1981),andthecaseofPaulMorganMemorialHosp.
v.
Anderson,201A.
2d537(N.
J.
)(percuriam)cert.
denied,377U.
S.
985(1964),bothofwhichrequiredawomantoundergomedicalprocedures,againstherreligiousbeliefstopreventherunbornchildfromdying.
Seeid.
at397n.
4.
45.
Arguably,thecourtusesJeffersonv.
GriffinSpauldingCountyHosp.
Auth.
andPaulMorganMemorialHosp.
VAnderson,toprovidesomepersuasiveprecedencefortheapplicationofsuchabalancingtest.
Seesupranote44.
46.
573A.
2d1235(D.
C.
1990).
47.
Itisquestionablewhether,undertheviabilitystandardsestablishedinRoev.
Wade,thefetuswasviable.
Seesupranote12.
48.
See573A.
2dat1238.
1998]475476WILLIAM&MARYJOURNALOFWOMENANDTHELAW[Vol.
4:467invirtuallyallcasesthequestionofwhatistobedoneistobedecidedthebythepatient-thepregnantwoman49-onbehalfofherselfandthefetus.
Ifthepatientisincompetentorotherwiseunabletogiveaninformedconsenttoaproposedcourseofmedicaltreatment,thenherdecisionmustbeascertainedthroughtheprocedureknownassubstitutedjudgment.
'ThecourttookspecialnoteofthecaseofMcFallv.
Shimp,5"inwhichthecourtrefusedtoorderShimptodonatebonemarrowtohiscousineventhoughShimp'srefusaltodosowouldmeandeathforMcFall.
ThecourtwouldnotorderShimptohavehisbodyinvadedagainsthiswill,stating,Thecommonlawhasconsistentlyheldtoarulewhichprovidesthatonehumanbeingisundernolegalcompulsiontogiveaidortotakeactiontosaveanotherhumanbeingortorescue.
Forourlawtocompeldefendanttosubmittoanintrusionofhisbodywouldchangeeveryconceptandprincipleuponwhichoursocietyisfounded.
Todosowoulddefeatthesanctityoftheindividual,andwouldimposearulewhichwouldknownolimits,andonecouldnotimaginewherethelinewouldbedrawn.
2Theargumentthatfetalcasesaredifferentbecause"awomanwho'haschosentolendherbodytobring[a]childintotheworld'hasanenhanceddutytoassurethewelfareofthefetus,sufficienteventorequirehertoundergocaesareansurgery"wasdismissedbythecourt.
53Thecourtstatedthatafetuscannothaverightssuperiortothoseofapersonwhohasalreadybeenborn.
4Thecourtfurthernotedthattherighttorefusemedicaltreatmentisofconstitutionalmagnitude.
5549.
Id.
at1237.
Notethatthecourtcarefullydifferentiateswhothepatientis-thepregnantwoman.
Thisisindirectconflicttothecasesdiscussedsuprawherethecourtalsoexaminedtherightsofthefetalpatient.
50.
Id.
51.
10Pa.
D.
&C.
3d90(1978).
52.
Id.
at91,quotedinInreA.
C.
,573A.
2d1235,1244(D.
C.
1990).
53.
InreA.
C.
,573A.
2dat1244(quotinganddiscussingJohnRobertson,ProcreativeLibertyandtheControlofConception,Pregnancy,andChildbirth,69VA.
L.
REV.
405,456(1983)).
54.
Seeid.
at1244.
55.
Seeid.
(citingInreBryant,542A.
2d1216,1218(D.
C.
1988);InreBoyd,403A.
2d744,748(D.
C.
1979);InreOsborne,294A.
2d372(D.
C.
1972).
Thecourtalsonotesthatothercourtshavefoundconstitutionalbasisforrefusingmedicaltreatment.
See,e.
g.
,UnitedStatesv.
Charters,829F.
2d479,491nn.
18-19;Beev.
Greaves,744F.
2d1387,1392-93(10thSTATE-COMPELLEDFETALSURGERYThecourtalsoreliedupontheSupremeCourt'sdecisioninWinstonv.
Lee.
56InWinston,aVirginiacourtorderedarobberysuspecttoundergosurgerytoremoveabulletfromhisshoulderforuseasevidenceofhisguiltorinnocence.
TheSupremeCourtheldthatthiswouldviolatethedefendant'sconstitutionalrights.
TheCourtstatedthatthemainfunctionoftheFourthAmendmentisto"protectpersonalprivacyanddignityagainstunwarrantedintru-sionbytheState,"andthatthesevalueswere"basictoafreesociety.
57TheSupremeCourtalsoheldthatthisprocedure"wouldbean'extensive'intrusiononrespondent'spersonalprivacyandbodilyintegrity"anda"virtuallytotaldivestmentofrespondent'sordinarycontroloversurgicalprobingbeneathhisskin.
"58TheA.
C.
courtalsonotedthattheSupremeCourtinWinstonstatedthattheFourthAmendmentneither"forbidsnorpermitsallsuchintrusionsThecourtinInreA.
C.
notesthatthe"state'sinterestinpreservinglifemustbetrulycompellingtojust-ifyoverridingacompetentperson'srighttorefusemedicaltreat-ment.
"'IncomparisontothepetitionerinWinston,thewomaninthehypotheticalwouldbesubjectedtothreeincisions,notone.
Al-thoughtheincisionsmightnotbeverydeep,theinsertionofthein-strumenttodrainthefluidmightbequitedeep,andprobablywouldbedeeperthantheproposedincisioninWinston.
Furthermore,inWinstontheprocedurewasproposedaspartofasearchforevidenceofacriminalaction.
Womenmaybedeterredfrombecomingpregnant,ormain-tainingtheirpregnancy,iftheyrealizethatiftheyallowtheirfetusestoreachtheageofviabilitythestatemayinvadetheirbodiestothesameorgreaterdegreeasasuspectedcriminal.
Manywomenheavilyweighthemanydetrimentaleffectsevenuncom-plicatedpregnanciescanhaveontheirbodies.
Manyofthesewomen,especiallyfeminists,mayreactstronglytotheknowledgeCir.
1984),cert.
denied,469U.
S.
1214(1985);Rasmussenexrel.
Mitchellv.
Fleming,741P.
2d674,681-82(Ariz.
1987).
56.
470U.
S.
753(1985).
ThecourtinInreA.
C.
alsorelieduponSchmerberv.
California,384U.
S.
757(1966);Rochinv.
California,342U.
S.
165,169(1952);andUnionPacificRy.
v.
Botsfor,141U.
S.
250(1891)("Norightisheldmoresacred,orismorecarefullyguarded,bythecommonlaw,thantherightofeveryindividualtothepossessionandcontrolofhisownperson,freefromallrestraintorinterferenceofothers,unlessbyclearandunquestionableauthorityoflaw.
").
57.
Id.
at760(quotingSchmerberv.
California,384U.
S.
757,767(1966)).
58.
Id.
at764-765,quotedinInreA.
C.
,573A.
2dat1245.
59.
Id.
at760,quotedinInreA.
C.
,573A.
2dat1245.
60.
InreA.
C.
,573A.
2dat1246(citingInreOsborne,294A.
2d372(D.
C.
1972);Tunev.
WalterReedArmyMed.
Hosp.
,602F.
Supp.
1452,1455-56(D.
C.
1985)).
1998]477478WILLIAM&MARYJOURNALOFWOMENANDTHELAW[Vol.
4:467thatoneofthepossibleeffectsofpregnancyontheirbodiescouldbeastateordertoundergoinvasivemedicalproceduresthatthestatecouldnotforceacriminal,orachargedcriminal-defendant,toun-dergo.
Thesewomenmayrefusetosubjectthemselvestothepossi-bilityofstatesubjugation.
Thestate,ifittrulyhasaninterestinthewelfareoffamiliesandchildren,shouldnotenforceapolicythatcouldhavethistypeofbacklash.
ThecourtinInreA.
C.
alsostatedthatanadditionalargumentforhonoringA.
C.
'sobjectionstoacesareanwasprovidedbytheAmericanPublicHealthAssociationinitsamicuscuriaebrief:Ratherthanprotectingthehealthofwomenandchildren,court-orderedcaesareanserodetheelementoftrustthatpermitsapregnantwomantocommunicatetoherphysician-withoutfearofreprisal-allinformationrelevanttoherproperdiagnosisandtreatment.
Anevenmoreseriousconsequenceofcourt-orderedinterventionisthatitdriveswomenathighriskofcomplicationsduringpregnancyandchildbirthoutofthehealthcaresystemtoavoidcoercedtreatment.
6'Thecourtalsoexaminedthepolicyargumentofadequaterepresentation,whichitbelievedtobeevenmorecompellingthanthedoctor-patientrelationships.
62Thecourtnotedthat,duringtheexigentcircumstancesinwhichthesecasestendedtoarise,theattorneysforthepatientcouldnotexpecttobeadequatelypre-pared,thatproceduralflawswerelikelytooccur,andthatthefactswerelikelytobeincomplete,ifpresentatall,forconsiderationbythecourt.
63Thecourtalsoexaminedtheissueofsubstitutedjudgment,holdingthatitwasthebestproceduretofollowinacasesuchasthisonebecauseitmostclearlyrespectsthepatient'srighttobodilyintegrity.
Thesubstitutedjudgmenttestisasubjectivetestrequir-ingacourttodetermine,asnearlyaspossible,whatthepatientwoulddoifthepatientwerecompetent.
6461.
Id.
at1248.
Acourtfootnotereferstoacaseinwhichawomanwhowascourt-orderedtoundergoacesareansectionwentintohidingandgavebirthtoherchildvaginally.
Id.
at1264n.
16(citingNancyK.
Rhoden,TheJudgeintheDeliveryRoom:TheEmergenceofCourt-OrderedCesareans,74CAL.
L.
REV.
1951,1959-69(1986)).
62.
Seeid.
63.
Seeid.
SeealsoRhoden,supranote61,at1959-69.
64.
SeeInreA.
C.
,573A.
2dat1249.
Theimportanceoftheapplicationofthesubjectivetestshouldnotbeoverlooked.
Usingsubstitutedjudgment,thecourtdoesnotperformabalancingtest,buttriestoascertainwhatthepatientwoulddo.
Seeid.
Therefore,ifthepatientwascompetent,asinthescenarioprovided,thecourt,whenfollowingthepremisebehindthesubjectivesubstitutedjudgmenttest,shouldadheretothepatient'swishes.
STATE-COMPELLEDFETALSURGERYAlthoughwomen'srightsactivistshailedInreA.
C.
asavictoryfortheirmovement,thecourtstillleftthedooropen.
Thecourtstat-edthat,whilethemother'swishesarecontrollinginvirtuallyallcases,thecourtdidnot"foreclosethepossibilitythataconflictingstateinterestmaybesocompellingthatthepatient'swishesmustyield,[while]anticipat[ing]thatsuchcaseswillbeextremelyrareandtrulyexceptional.
"5ThecourtinthecaseofInreBabyBoyDoe66appliedtheA.
C.
court'sreasoning:Thefactthatthestatemayprohibitpost-viabilitypregnancyterminationsdoesnottranslateintothepropositionthatthestatemayintrudeuponthewoman'srighttoremainfreefromunwantedphysicalinvasionofherpersonwhenshechoosestocarryherpregnancytoterm.
.
.
.
[I]t[is]clearthat,eveninthecontextofabortion,thestate'scompellinginterestinthepotentiallifeofthefetusisinsufficienttooverridethewoman'sinterestinpreservingherhealth.
67Thecourtappliedthebalancingtest,weighingthemother'srighttorefusemedicalcareagainstthefourstateinterests:"thepreser-vationoflife,thepreventionofsuicide,theprotectionofthirdpar-ties,andtheethicalintegrityofthemedicalprofession.
"6Thecourtquicklydisposedofthestate'sinterestinthepreservationoflifeandthepreventionofsuicideasirrelevant.
Thecourtstatedthat,"[a]lthoughitmightbearguedthattheStatehasaninterestinthepreservationofthepotentiallifeofthefetus,courtshavetraditionallyexaminedtherefusaloftreatmentasitimpactsuponthepreservationofthelifeofthemakerofthedecision.
"69AgreeingwiththereasoningofInreDubreuil,v°thecourtinInreBabyBoyDoestatedthat"thirdparties"referstofamily65.
Id.
at1252(footnoteomitted).
SeegenerallyTraceyE.
Spruce,TheSoundofSilence:Women'sVoicesinMedicineandLaw(March4,1997)(unpublishedmanuscript,onfilewiththeWilliam&MaryJournalofWomenandtheLaw).
Sprucedescribeshowthecourtfailedtotellthestoryofthemother,A.
C.
SprucefurtherstatesthatbynotdeterminingwhatA.
C.
'swisheswere,thecourtfollowedalonglineofcourtsanddoctorsthatdonotlistentotheirpatients.
Seeid.
66.
632N.
E.
2d326(Ill.
App.
Ct.
1994).
67.
Id.
at334(citingPlannedParenthoodofSoutheasternPa.
v.
Casey,505U.
S.
833(1992)).
68.
Id.
69.
Id.
Thecourtnotedthatthecesareansectionwouldhavepresentedagreaterrisktothemother.
Thecourtincludedinitsfindingsthatthechancesofamotherdyingduringacesareansectionareabout1in10,000,whiletheoddsofamotherdyingduringnormalbirthareabout1in20,000to1in50,000.
Seeid.
at328.
70.
629So.
2d819(Fla.
1993).
Seealsoinfranote95andaccompanyingtext.
19981480WILLIAM&MARYJOURNALOFWOMENANDTHELAW[Vol.
4:467membersandinparticularto,"thechildrenofthepersonrefusingtreatment.
"7"Whereanindividual'sdecisiontorefusetreatmentwillresultinorphaninganalready-bornchild,courtshaveindica-tedthatthisisonefactortheymightconsider.
"72Thecourtnotedthatthefinalfactorofthebalancingtest,theethicalintegrityofthemedicalprofession,weighsinthemother'sfavorratherthanintheState's.
73Thecourtobservedthatthemedicalprofessionstronglyupholdsthemother'sautonomy.
74Thecourtstatedthat,inkeepingwiththedoctrineofinformedconsent,theproperactionbythemedicalprofessioninasituationwherethemotherrefusesmedicaltreatmentthatmayaffectherfetusisto"urgehertoseekconsultationandcounselingfromavarietyofsources.
"75ThecourtstatedthattheactionstakenbythemedicalprofessionalsinInreBabyBoyDoeappearedtobeincongruouswiththeethicalpositionoftheprofession.
76III.
WHATARETHEMOTHER'SRIGHTSANDDUTIESA.
TheMother'sRights1.
Privacy,Autonomy&BodilyIntegrityApregnantwoman'srighttomakedecisionsregardingherhealthandwelfareiswellestablishedaspartofthecommonlawrightsofbodilyintegrityandself-determination,alongwiththeprivacyrightsfoundintheFourth,EighthandThirteenthAmend-mentstotheConstitution.
77Thisrightofprivacywasfirstesta-blishedinGriswoldv.
Connecticut.
78Thegovernmentmayonlyinterferewiththefundamentalrightofprivacyifitcanestablishacompellinginterestthatcannotbefacilitatedinalessrestrictivemanner.
7971.
InreBabyBoyDoe,632N.
E.
2dat334.
72.
Id.
(citingInreBrooksEstate,205N.
E.
2d435(IlM.
1965);Wonsv.
PublicHealthTrust,500So.
2d679(Fla.
Dist.
Ct.
App.
1987)approved,certifiedquestionanswered,541So.
2d96(Fla.
1989);WinthropUniv.
Hosp.
v.
Hess,490N.
Y.
S.
2d996(Sup.
Ct.
1985)).
73.
Seeid.
74.
Seeid.
at334-35(citingReport,LegalInterventionsDuringPregnancy:CourtOrderedMedicalTreatmentsandLegalPenaltiesforPotentiallyHarmfulBehaviorbyPregnantWomen,264JAMA2663,2670(1990)).
75.
Id.
at33576.
Seeid.
77.
SeeGallagher,supranote28,at28.
78.
381U.
S.
479(1965).
SeeGallagher,supranote28,at28&n.
99.
79.
SeeGallagher,supranote28,at28-29.
STATE-COMPELLEDFETALSURGERYNotonlyhastherightofprivacybeenestablishedformarri-age,oprocreation8'andabortion,82butithasalsobeenestablishedinthecontextofchilddevelopment83andfamilylife.
84Thereisastrongpresumptionthatparentsareactingintheirchild'sbestinterestwhentheymakedecisionsregardingtheirchild'smedicalcare:Thelaw'sconceptofthefamilyrestsonapresumptionthatparentspossesswhatachildlacksinmaturity,experience,andcapacityforjudgmentrequiredformakinglife'sdifficultdecisions.
Moreimportant,historicallyithasrecognizedthatnaturalbondsofaffectionleadparentstoactinthebestinterestsoftheirchildren.
85Thesecases,highlightingcourts'reluctancetoexaminethedecisionsmadebyparents,arestrikinglyinconsistentwiththereasoningofthestate-compelledcesareancases.
"Althoughcourtswillgenerallyauthorizetheimmediate,lifesavingtreatmentofchildrenoverparentalobjections,theyonlyreluctantlyinvade'theveryheartofafamilycircle[themostprivateandmostpreciousresponsibilityvestedintheparentsforthecareandnurtureoftheirchildren.
"'6Roev.
Wadehasbeenusedintheargumentsofboththewomen'sandfetalright'smovements.
Thosearguingforwomen'srightsrelyuponthefactthat"Roemakes[it]clearthatawoman'slifeandhealthoutweighanystateinterestthatmaybeassertedinthepotentiallifeofaviablefetus.
"87Fetalrightsadvocatesrely,however,uponthefollowingpassage:WithrespecttotheState'simportantandlegitimateinterestinpotentiallife,the"compelling"pointisatviability.
Thisissobecausethefetusthenpresumablyhasthecapabilityofmeaningfullifeoutsidethemother'swomb.
.
.
.
Ifthestateis80.
SeeLovingv.
Virginia,388U.
S.
1,12(1966).
81.
SeeGriswold,381U.
S.
at491.
82.
SeeRoev.
Wade,410U.
S.
113,152-53(1973).
83.
SeePiercev.
SocietiesofSisters,268U.
S.
510,535(1925).
84.
SeeMeyerv.
Nebraska,262U.
S.
390,399(1923).
85.
Gallagher,supranote28,at30&n.
108(quotingParhamv.
J.
R.
,442U.
S.
584,602(1979);(citingInreL.
H.
R.
,321S.
E.
2d716,722(Ga.
1984);Haldermanv.
PennhurstStateSchool&Hosp.
,707F.
2d702,707(3dCir.
1983))).
86.
Id.
at30&n.
110(quotingWeberv.
StonyBrookHosp.
,456N.
E.
2d1186(N.
Y.
1983)(rebuffingeffortsofstrangertovetoparents'choiceofmedicaltreatmentforseverelyillnewborn)).
87.
Gallagher,supranote28,at15-16(citingThornburghv.
AmericanCollegeofObstet.
&Gynecol.
,476U.
S.
747(1986)).
1998]482WILLIAM&MARYJOURNALOFWOMENANDTHELAW[Vol.
4:467interestedinprotectingfetallifeafterviability,itmaygosofarastoproscribeabortionduringthatperiod,exceptwhenitisnecessarytopreservethelifeorhealthofthemother.
88Undertheviabilitytest,asproposedbyRoev.
Wade,amother'sprivacyinterestsoutweighthestate'sinterestinanon-viablefetus.
Thestate'sinterestsarenotcompellingunlessthefetusisviable.
89Theinvasivenessofthestate'sactionsinpreventingabortions,how-ever,ismuchhigherthanthepotentialforinvasivenessproposedinthefetalsurgeryoptioninthescenariowhichbeganthisNote.
Whilethestate'sinterestinapre-viablefetushasneverbeenheldbytheSupremeCourttooutweighamother'srighttopersonalautonomyandprivacy,themother'srighttoprivacyhasbeenrecognizedtothepointofconceptionandbefore.
0Itmaybearguedthatthestatehasaneconomicinterestintryingtoguaranteethatthehealthiestchildrenpossiblearebornwithinitsborders.
Thisargumentfailsunderthepre-viabilityconcernbecauseitisinoppositiontotheargumentopposingabor-tion.
Itwouldbeinconsistentforthestatetoargueforthebirthofchildrenthatarenotwantedbytheirmothers,thereforeposinganeconomichardshiponthestate,whilearguingthatthestate'seconomicinterestinpreventingthecostofmalformedchildrenwarrantsviolatingawoman'sfundamentalrightofprivacy.
2.
InformedConsentThedoctrineofinformedconsentisstronglyrootedinthecon-ceptofautonomyandplacesadutyuponthedoctortoreasonablydiscloseinformationaboutaproposedproceduretothepatient.
9'Thisinformationmustincludeadescriptionoftherisksofunder-going"andnotundergoingtheprocedure.
93Therearethreegroundsunderwhichinformedconsentprocedures,oreventhepatient'sdecisiontoundergoornotundergotheproceduremaybe88.
Id.
at15(quotingRoev.
Wade,410U.
S.
113,163-64(1973)).
89.
SeeRoe,410U.
S.
at163.
90.
See,e.
g.
,Griswoldv.
Connecticut,381U.
S.
479,491(1965).
91.
SeeKatherineA.
Knopoff,CanaPregnantWomanMorallyRefuseFetalSurgery,79CAL.
L.
REV.
499,513-14(1991).
92.
See,e.
g.
,id.
at513-14&n.
78(citingCanterburyv.
Spence,464F.
2d772,782(D.
C.
Cir.
),cert.
denied,409U.
S.
1064(1972);Cobbsv.
Grant,502P.
2d1,10(Cal.
1972);Natansonv.
Mine,350P.
2d1093,1106(Kan.
1960)).
93.
See,e.
g.
,Knopoff,supranote91,at514n.
79(citingTrumanv.
Thomas,611P.
2d902,906(Cal.
1980)).
STATE-COMPELLEDFETALSURGERYsetaside:ifthepatientisincompetent;94ifthepatientconsentsorrefusesaprocedurebaseduponinadequateinformation;andforpublicpolicyreasons.
95Intheissueathand,thethirdrationaleistheonlyrelevantone.
Thestate'sinterestinthepatient'shealthmightallowthestatetosetasidethepatient'sdecisioninordertoprotectthemother'slife.
96Intheintroductoryscenario,themother'shealthcouldbeaffected.
Ifthecephalocentesisisnotperformed,thefetus'headmayswelltothepointthatitwouldbeunabletopassthroughthemother'sbirthcanal.
Whilethe-mother'ssafetymayjustifytheprocedureifthebaby'sheadweretobecomelodgedatthetimeofthebirth,theprocedurewouldnotbejustifiedbeforeanyproventhreattothemothercouldbedetermined.
Untilthen,themotherhastherighttorefusemedicaltreatment.
Aslongasthedoctorfullyinformsheroftherisk,herdecisionwouldnotriskinvalida-tionas"notfullyinformed.
"97Theprotectionofthemother'slifehasbeenjustifiedbythestate'sinterestinthefateofthirdpartiesifthemotherwastodie.
98TheAppellateCourtofIllinoisfacedthequestionofwhetheracourt"canbalancewhateverrightsafetusmayhaveagainsttherightsofacompetentwomantorefusemedicaladvicetoobtainacesareansectionforthesupposedbenefitofherfetus.
"99ThecourtinInreBabyBoyDoeheldthat"awoman'scompetentchoiceinrefusing.
medicaltreatmentasinvasiveasacesareansectionduringher94.
See,e.
g.
,Khiemv.
UnitedStates,612A.
2d160(D.
C.
App.
1992)(affirmingdecisionthatdefendantchargedwithmurdermaybecommittedandtreatedtorenderhimcompetenttostandtrial,despitehisobjections).
Seealso,e.
g.
,D.
C.
CODEANN.
§21-2201(a)(1989).
EntitledtheHealth-CareDecisionsAct,thepurposeoftheactis"[Toaffirmtherightofallcompetentadultstocontroldecisionsrelatingtotheirownhealthcareandtohavetheirrightsandintentionsinhealthcaremattersrespectedanimplementedbyothersiftheybecomeincapableofmakingorcommunicatingdecisionsforthemselves.
"Id.
,citedinKhiem,612A.
2dat169.
95.
See,e.
g.
,InreDubreuil,629So.
2d819,827(Fla.
1993)(statingthatifthepatientrefusestoconsenttoaprocedurewhichcouldsaveherlife,andherdeathwouldresultinthetotalabandonmentofherchildren,thestatemayoverrideherrefusaltoconsent).
96.
Thebalancingtest,applyingthestate'sinterestsin:protectingthirdpartieswhoaredependentonthemother,preventingsuicide,andmaintainingethicalintegrityofthemedicalprofession,onlyjustifies"protectingthepatient'shealth-neverathirdparty's.
"SeeKnopoff,supranote91,at516n.
88(citingSuperintendentofBelchertownStateSchoolv.
Saikewicz,370N.
E.
2d417,425(Mass.
1977)).
'Therefore,thestatecouldnotjustifyoverridingamother'srefusaltodonateanorgantosaveherchild'slife,althoughitmightjustifyforcinghertoacceptanorgantransplanttosaveherown.
"Id.
97.
SeeKnopoff,supranote91,at538-39(proposingastatutethatwouldspecificallystatethattheinformedconsentdoctrineappliestofetalsurgery).
98.
Butseetextaccompanyinginfranotes118,119,123,126-28.
99.
InreBabyBoyDoe,632N.
E.
2d-326,326(Ill.
App.
Ct.
1994).
1998]483484WILLIAM&MARYJOURNALOFWOMENANDTHELAW[Vol.
4:467pregnancymustbehonored,evenincircumstanceswherethechoicemaybeharmfultoherfetus.
"'"Thecaveatof"invasive"maymakethiscaseuselessifacasesuchastheintroductoryhypotheticalweretoariseinIllinois.
Theinvasivenessofthreesmallincisions"°'hardlycomparestothatofacesarean.
02Thecourtnotedthatmothersshouldnotbesubjecttoextremescrutiny.
03Everyactionamothertakeswhilepregnantaffectsherunbornchild.
4Althoughthecourtnotedtheinvasivenessofthecesareaninitsholding,thefollowingstatementmayhaveastrongerimpactonafetalsurgerycase:[T]herelationshipbetweenapregnantwomanandafetusisunique,and"unliketherelationshipbetweenanyotherplaintiffanddefendant.
Nootherplaintiffdependsexclusivelyonanyotherdefendantforeverythingnecessaryforlifeitself.
Nootherdefendantmustgothroughbiologicalchangesofthemostprofoundtype,possiblyattheriskofherownlife,inordertobringforthanadversaryintotheworld.
Itis,afterall,thewholelifeofthepregnantwomanwhichimpactsuponthedevelopmentofthefetus.
.
.
.
[I]tisthemother'severywakingandsleepingmomentwhich,forbetterorworse,shapestheprenatalenvironmentwhichformstheworldforthedevelopingfetus.
Thatthisissoisnotapregnantwoman'sfault;itisafactoflife.
"'05Thecourtfurtherheldthatawomandoesnothaveadutytoguaranteethehealthofherchildatbirth.
'063.
FreedomfromServitudeInvoluntaryservitudeisdefinedas"astateofbondage;theownershipofmankindaschattel,oratleastthecontrolofthelaborandservicesofonemanforthebenefitofanother,andtheabsenceofalegalrighttothedisposalofhisownperson,propertyand100.
Id.
at330(emphasisadded).
101.
SeesuprapartI.
102.
Seesupranote2S.
103.
SeeInreBabyBoyDoe,632N.
E.
2dat331.
104.
Seeid.
105.
Id.
at331-32(quotingStallmanv.
Youngquist,531N.
E.
2d355,360(In.
1988)(holdingthatamotherwasnotliableforunintentionalinflictionofprenatalinjuriesbecausetheeffectofsuchaholdingwouldsubjectawoman'severyactwhilepregnanttostatescrutiny,thusviolatingherrighttoprivacyandbodilyintegrity)).
106.
Seeid.
at332.
STATE-COMPELLEDFETALSURGERYservices.
"'7TheThirteenthAmendment,oneoftheAmendmentsusedtodefinetheConstitutionalrighttoprivacy,prohibitsthisstateofbeing.
"8Thedueprocessclausefurtherfortifiesthepro-scriptionofservitude.
Apersoncannotbeheldagainsttheirwillwithoutdueprocess.
"Becauseournotionsoflibertyareinextric-ablyentwinedwithourideaofphysicalfreedomandself-determina-tion,theCourthasoftendeemedstateincursionsintothebodyrepugnanttotheinterestsprotectedbytheDueProcessClause.
"'09Theprocedureofcephalocentesis,thoughnotveryinvasive,stillrequiresthemothertospendextratimeinthehospitalandbesubjectedtomonitoring.
Itmayalsorequirethatthemothertake,againstherwill,drugsthatwouldhelptodiminishtheriskofpre-maturelabor.
"0Ifamotherisforcedtogothroughtheprocedure,remaininthehospital,undergomonitoringandtakedrugs,thatwoman'srightshavebeensubordinated,orevenwaived,onbehalfofthefetusandthestate.
Forcedfetalsurgeryandthecorrespondingtreatmentswouldbeanalogoustotheconstraintsofslaveryor,attheveryleast,ninemonthsofindenturedservitude.
"'B.
.
TheMother'sDutiesandLiabilities1.
TransplantAnalogyInexaminingamother'sobligationtoundergoinvasiveprocedurestoenhancethequalityoforsavethelifeofherbaby,itisimportanttounderstandwhatthemother'sobligationwouldbetoundergoinvasiveproceduresafterthechildisborn.
Incasesdealingwithbonemarrow112ororgantransplants,thecourtshave107.
AliciaOuellette,NewMedicalTechnology:AChancetoReexamineCourt-OrderedMedicalProceduresDuringPregnancy,57ALB.
L.
REV.
927,955(1994)(citingPlessyv.
Ferguson,163U.
S.
537,542(1986)).
108.
"Neitherslaverynorinvoluntaryservitude,exceptasapunishmentforcrimewhereofthepartyshallhavebeendulyconvicted,shallexistwithintheUnitedStates,oranyplacesubjecttotheirjurisdiction.
"U.
S.
CONST.
,amendXII,§1,citedinOullette,supranote107,at955n.
210.
109.
Cruzanv.
Director,Mo.
Dep'tofHealth,497U.
S.
261,287(1990).
110.
Seetextaccompanyingsupranote8.
111.
SeeOuellette,supranote107,at955-56.
112.
Notethesimilaritybetweenabonemarrowtransplantandthecephalocentesisproceduredescribedinthescenario.
Bothinvolveusingalargeneedletodrawoutmatter.
CompareJanetB.
Korins,Curranv.
Bosze:TowardaClearStandardforAuthorizingKidneyandBoneMarrowTransplantsBetweenMinorSiblings,16VT.
L.
REV.
499,502(1992)(describingbonemarrowtransplantprocedure),withsuprapartI(describingcelphalocentesisprocedure).
Thecephalocentesisisarguablymoreinvasivebecauseitwouldinvolvesmallincisionsandagreateramountofmonitoringaftertheprocedure.
Seesupranotes6-8andaccompanyingtext(notingtherisksofthecephalocentesisprocedure).
1998]485486WILLIAM&MARYJOURNALOFWOMENANDTHELAW[Vol.
4:467absolutelyrefusedtocompeltransplantsifthepartyfromwhomthetissueistobetakenhasrefusedtheprocedure.
"3InthecaseofInreGuardianshipofPescinski,14thecourtbarredakidneytransplantfromaninstitutionalizedmentalpatienttoayoungersister.
"'Thecourtsoheldbecausetherewasnoshow-ingofconsentbythedonororbyanyguardianofthedonor,therewasnoshowingofbenefittotheproposeddonor,andthecourtlackedpowertoauthorizeanysurgicalprocedureonalivingperson.
116TheIllinoisSupremeCourtinCurranv.
Boszerefusedtocompeltwinminorstodonatebonemarrowtoahalf-sibling.
"7Thecourtnotedthattheprocedureposedverylittlerisktothetwins,wasnotveryinvasive,andthatthesibling'slifedependedonthebonemarrowtransplant,butneverthelessrefusedtocompeltheminorstoundergotheprocedure,orevenabloodtesttodetermineifthetwinswerecompatibledonors.
"8Interestingly,thepartyrequestingthecourttoorderthebonemarrowharvestofthetwinsarguedthatthecourtshouldapplythesubstitutedjudgmenttest"9113.
SeeMcFallv.
Shimp,10Pa.
D&C.
3d90(1978).
SeealsoPlessyv.
Ferguson,163U.
S.
537,542(1896).
114.
226N.
W.
2d180(Wis.
1975).
115.
Seeid.
at181.
116.
Seeid.
117.
Curranv.
Bosze,566N.
E.
2d1319,1325-36(1990).
118.
TheAppellateCourtofIllinoisreliedonCurraninInreBabyBoyDoe,632N.
E.
2d326,333(1994).
ThecourtalsoreliedonInrePescinski,226N.
W.
2d180(Wis.
1975),stating,Ifasibingcannotbeforcedtodonatebonemarrowtosaveasibling'slife,ifanincompetentbrothercannotbeforcedtodonateakidneytosavethelifeofhisdyingsister,thensurelyamothercannotbeforcedtounderacesareansectiontobenefitherviablefetus.
InreBabyBoyDoe,632N.
E.
2dat333-34(citationomitted).
119.
SeeCurran,566N.
E.
2dat1322.
Thesubstitutedjudgmenttestrequiresthecourttolooktotwosourcestodeterminewhatthepatientwouldhavechosenifshewerecompe-tent.
Thefirstsourcerequirestheguardianto'"determineifthepatienthadexpressedex-plicitintentregardingthistypeofmedicaltreatmentpriortobecomingincompetent.
"'Id.
at480(citingInreEstateofLongeway,133Ill.
2d33,49(1989)).
Iftheguardiancansupplyno"clearevidenceofsuchintent,"thentheguardianmustbeguidedbytheincompetentpatient'spersonalvalues.
[Elvenifnopriorspecificstatementsweremade,inthecontextoftheindividual'sentirepriormentallife,includinghisorherphilosophical,religiousandmoralviews,lifegoals,valuesaboutthepurposeoflifeandthewayitshouldbelived,andattitudestowardsickness,medicalprocedures,sufferinganddeath,thatindividual'slikelytreatment/nontreatmentpreferencescanbediscovered.
Familymembersaremostfamiliarwiththisentirelifecontext.
Id.
at480-81(citationsomitted).
Notetheubiquitousnessofthesecondsourceforthesub-stitutedjudgmenttest.
Thesecondsourcebecomesthegeneralviews,beliefs,andphilo-sophiesoftheincompetentpatient,therefore,theguardianhasalmostcompletecontroltoadvisethecourtofwhatshesubjectivelybelievestobethepatient'sintent.
Thistestreliesstronglyonthebenevolenceandobjectivityofthefamily,guardian,orsurrogate.
STATE-COMPELLEDFETALSURGERY-thesametestproposedandapprovedbythecourtinInreA.
C.
"'Thecourtrefusedtousethesubstitutedjudgmenttestbecausethetestwasdeemednotapplicabletotwinswhowereonlythree-and-a-halfyearsold.
Thecourtdecidedthatthe"bestinterestofthechild"testwasapplicableandruledthatduetothelackofarelationshipbetweenthetwinsandtheirleukemia-strickenhalf-brother,andalackofsupportfromthemotherofthetwins,theharvestingofbonemarrowwasnotinthebestinterestofthetwins.
121AlthoughthiscaseisnotasapplicableasMcFallv.
Shimp,122thecasesareespeciallyapplicableinsituationswherethemotherisunconsciousorotherwisedeemedincompetent.
123Ifacourtap-pliesthesubstitutedjudgmenttestthenitwillfirstlooktoseeifthemothermadeanyexplicitintentionalstatement,whilestillcom-petent,regardingherinterest.
24Ifthemotherhasmadenosuchstatementthenthecourtwilllooktothemother'sphilosophy.
Itisdifficulttoimagineacasewherethecourtcouldsaythatthemother'sphilosophy,values,orinterestsdidnotencompassthebestinterestofherfetus.
Furthermore,iftheguardianisthepersonwhotestifiesregardingthewoman'sinterests,andtheguardianhasastrongdesiretoprotectthefetus,'25thenthemotherwillalmostcertainlybefoundtowanttosaveherunbornbaby.
Inaddition,ifthefetusisviable,andthestatehasapolicyofprotectingviablefetuses,26thenthefetus'interestsinitspotentiallifewillbegivenheavyconsideration.
Evenwithoutanincompetentmother,thetransplantanalogyisveryhelpfulwhenappliedtothepre-viabilityversuspost-via-bilitybrightline.
Generallyinfetaltherapysituations,theearlierinthedevelopmentofthefetusthataprocedureisperformed,thegreaterthebenefittothefetusandthelesserthedetrimenttoboththemotherandthefetus.
Intheintroductoryscenario,theearlierthemotherundergoesthecephalocentesisthelowertheriskof120.
573A.
2d1235,1248(D.
C.
1990).
Seesupranote64andaccompanyingtext.
121.
SeeCurran,566N.
E.
2dat1345.
122.
Seesupranote51andaccompanyingtext.
123.
SuchwasthecasewithInreA.
C.
Seetextaccompanyingsupranotes46-65.
124.
Seesupranote119andaccompanyingtext(statingthecourt'sdeterminationofsourcesforthesubstitutedjudgmenttest).
125.
Thisdesirecouldbeespeciallystrongifthemother,likeA.
C.
,hadaterminalillnessandtheanticipatedbabywastheonlyconnectionthefamilywouldhavewiththeterminalmother.
126.
SeeinfrapartIII.
B.
3(discussingSouthCarolina'sstrongpolicyregardingfetusesandcriminalliability).
19981488WILLIAM&MARYJOURNALOFWOMENANDTHELAW[Vol.
4:467prematurelabor.
127Ifthestateisabletocompelamothertoundergofetalsurgerypost-viability,itwouldbemorelogicaltoextendthestate'srighttocompelfetalsurgerytopre-viability:Thestate,however,doesnotcurrentlyhaveacompellinginterestinthepre-viabilityfetus.
Itmaybearguedthatthepre-viability/post-viabilitydeter-minantofcompellinginterestisarbitraryandworkstothedetri-mentofboththefetusandthemother.
Inthecaseofthetrans-plantanalogy,however,itismoreimportanttolookatthecommonlawdutytoaidanotherinthescenariosofpre-andpost-birth.
ThecourtinJeffersonv.
GriffinSpaldingheldthatthestatecouldforceamothertoundergoaninvasiveproceduretoaidanother"person"atthepre-birthstageoflife,eventhoughthefetus'post-birthlifewasnotguaranteedduetothemanyfactorsthatcouldstillcausethefetustobestillborn.
YetthecourtinMcFallv.
Shimpstated:Forasocietywhichrespectstherightsofoneindividual,tosinkitsteethintothejugularveinorneckofoneofitsmembersandsuckfromitsustenanceforanothermember,isrevoltingtoourhard-wroughtconceptsofjurisprudence.
Forcibleextractionoflivingbodytissuecausesrevulsiontothejudicialmind.
SuchwouldraisethespectreoftheswastikaandtheInquisition,reminiscentofthehorrorsthisprotends.
'28Whilethefetusisnotthe'livingbodytissue"describedintheMcFallcourt'slanguage,thecourtsemotionalresponsetothevio-lationofhumanautonomyisrelevanttothescenariopresented.
129Ifthecourtcouldnot"sinkitsteethintothejugular"ofoneindividualtoprovidelifeforanother,thenthecourtshouldnotmakeanexceptionto"sinkitsteethinto"thewombofamothertoprovidelifetoherfetus.
127.
Seetextaccompanyingsupranote8.
128.
McFallv.
Shimp,10Pa.
D&C.
3d90,92(1978),citedinJeffreyP.
Phelan,TheMaternalAbdominalWall:AFortressAgainstFetalHealthCare,65S.
CAL.
L.
REv.
461,482(1991).
129.
SeegenerallyRhoden,supranote61,at1979(drawingananalogybetweenthecourt'sholdinginMcFallv.
Shimpandtheforcedcesareancases).
ButseePhelan,supranote128,at482-485(refutingRhoden'sanalogybyanalogizingthedoctor'sdutytorespondtothefetusindistresstothelifeguard'sdutytosaveadrowningchild,evenifthemotherrefusestosavethechild).
1998]STATE-COMPELLEDFETALSURGERY4892.
DutyNotToAbandonAFloridaappellatecourtwentastepfurtherinthecaseofInreDubreuil.
"3°InDubreuil,ahospitalsoughttocompelanewmothertoundergobloodtransfusionswhichsheneededtolive.
'Themotherrefusedthebloodtransfusionsbecausetheywereagainstherreligiousbeliefs.
ThemotherinDubreuilwasnotpreg-nant.
Herbabywasnot"heldcaptive"inherwomb.
Shehadalreadygivenbirthbycesarean,butrequiredbloodbecauseofcom-plications.
Thecourtnotedthatifthemotherdiedbecauseofherrefusaltoundergoabloodtransfusion,herfourchildren,includingthenewborn,wouldbeabandoned.
132Thecourtinvokedthestate'sparenspatriaepowerandorderedthewomantoundergothetrans-fusion.
"13TheSupremeCourtofFloridaoverturnedthedecisionofthelowercourtsinDubreuil.
'34Itsanalysis,however,isstilldistur-bing.
TheSupremeCourtofFloridabeginsitsopinionbynotinghowsignificantthestate'sinterestmustbeifitistooutweighthepatient'sconstitutionalrights-bothtorefusemedicaltreatment,andtofollowherreligiousbeliefs.
'35Thecourtthenstatesthattherightsofthemothermaybesubordinatedtothestate'sinterestinthechildrenifthereisashowingthatthechildrenwillindeedbeleftabandoned,withnofamilymemberstoprovidethemwithadequatecare.
3'130.
603So.
2d538(Fla.
Dist.
Ct.
App.
1992),jurisdictionaccepted,613So.
2d3(Fla.
1993).
131.
Seeid.
at539.
132.
Seeid.
at540-41.
133.
Seeid.
ThecourtinInrePresidentandDirectorsofGeorgetownCollegeInc.
,331F.
2d1000(D.
C.
Cir.
),cert.
denied,377U.
S.
978(1964)cametoasimilarresult,orderinglife-savingbloodtransfusionswhichwereagainstthewoman'sreligiousbeliefsinordertopreventherfromdyingandleavingbehindherseven-month-oldbaby.
Seeid.
at1007.
Thecourtbasedthisdecisiononthelawofabandonment,statingthatbecauseamotherwouldnotbeallowedtoabandonachild,thestateshouldnotallowthemother"thismostultimateofvoluntaryabandonments.
"Id.
at1008.
Thecourtheldthat,therefore,thestatehadaninterestinpreservingthelifeofthemother.
Seeid.
134.
InreDubreuil,629So.
2d819(Fla.
1993).
135.
Seeid.
at823.
136.
Seeid.
at827("Nonetheless,wedeclineatthistimetoruleoutthepossibilitythatsomecasenotyetbeforeusmaypresentacompellinginteresttopreventabandonment.
").
Whatisevenmoreinterestingisthedissent'sargumentthatamother'snurturingisdesperatelyneededbythechild.
Seeid.
at829(McDonald,J.
,dissenting).
Childrenneedandareentitledtohave,theirmothers;thisneedissufficientlygreattooutweighone'sfreeexerciseofreligiousbeliefs.
.
.
.
Isuggestthatparenthood,undersomecircumstancesatleast,canindeeddepriveonoftherighttoliveinaccordwithone'sowbeliefs.
Parenthoodrequiresmanyadjustmentsandoftengreatsacrificeforthewelfareofaperson'schildren.
490WILLIAM&MARYJOURNALOFWOMENANDTHELAW[Vol.
4:467ThedrivingforcebehindtheDubreuilcourt'sdecisionmaywellbetheconceptofamother'sdutytoherbaby.
Ifthisdutyissogreatthatitoutweighstheconstitutionalrighttofreedomofreligion,privacy,andpersonalautonomy,thenusingthisconceptofdutytorequireamothertoundergofetalsurgeryisnotabigstep.
137Ifamother'sconstitutionalrightstofollowherreligiousbeliefs,torefusemedicalcare,andtodiedonotoutweighthestate'sinterestinpreventingachildfrombeingabandoned,howdotheserightseffectastate'sinterestincompellingfetalsurgeryThecourt'slogicisflawed.
Ifamothermayfreelychooseto"abandon"herbabyafterbirthbyplacingitforadoption,thecourtshouldnotbeabletodenyamother'sconstitutionalrightsinordertopreventherchildrenfrombeingplacedforadoptionafterherdeath.
Again,theviabilitytestisillogical.
Beforeviablity,amothermay"abandon"herbaby-to-bebyabortingit.
Afterbirth,amothermay"abandon"herbabybyplacingitforadoption.
Duringviability,however,themotheristrapped.
Bythereasoningoftheabovecasesshehas,bycarryingthefetustothetwenty-fourtotwenty-eightweekpointofgestation,waivedherconstitutionalrights.
Herdutyistokeepliving.
Sheistotake(possibly)anymeasuresnecessarynotonlytoensurethelifeofherfetus,buttomakesurethatthebaby-to-be'slifeandhealthwillbeasclosetonormal,orbetterthannormal,aspossible.
3.
CriminalLiabilityInwhatareconsideredgroundbreakingcases,mothersarenowbeingprosecutedforchildneglect,childabuse,anddistributionofNearlyeverylivingcreatureofeveryspeciesrecognizesthedutytonurtureitsoffspring.
Theirlivesarechangedindoingso.
Humansshouldnotallowreligiousbeliefs,nomatterhowdeeplyseatedorappropriatelyheld,toneglectthisfundamentalduty.
Mothersdonotabandonthenest.
Id.
(emphasisadded).
Theeffectsofthisreasoningshouldbecomeimmediatelyclear.
Women,whentheydecidetobecomemothers,losetheirconstitutionalrights.
Thoserightsaresubordinatedtowhatisdeemedtobethebestinterestofthechild.
Whatshouldalsobedisturbingisthelackofanymentionregardingthefathers.
Men,apparently,donotgiveuptheseconstitutionalrightswhentheydecidetobecomefathers.
Thedoubleedgetothisswordisthat,ifthelogicfollows,afather'sinterestswillbesubordinatedtothemother'sinterestsinthechildrenbecauseofthemother'sspecialbond.
Afterall,ifthemother'snurturingnatureissospecialtothechild,afather'sinterestscouldneveroutweighthatrelationship,unlessthemother'srelationshipwiththechilddoesnotmeetthisideal.
Attheveryleast,fatherswishingcustodyshouldbeappalledbythislanguage.
137.
Especiallyconsideringthehypotheticalpresentedatthebeginningofthepaper.
Truetheintereststhatwouldbeprotectedinafetalsurgerycasewouldnotbetheinterestsofanactual"person,"however,therearenotnearlyasmanyconstitutionalrightstoovercomeinthehypothetical:onlytheinterestsofprivacyandpersonalautonomy.
STATE-COMPELLEDFETALSURGERYdrugstoaminoriftheyingestillegaldrugswhilepregnant.
SouthCarolinahasstatedasamatterofpolicythatitwillprosecute,forchildneglect,pregnantwomenwhohaveingestedillegaldrugs.
138InWhitnerv.
SouthCarolina,SouthCarolina'sSupremeCourtstatedthatunderSouthCarolina'sabuseandendangermentstatute139"theword'child'.
.
.
includesviablefetuses.
"'40Whitnerpledguiltytocriminalchildneglect'4'aftercocainemetaboliteswerediscoveredinherbaby'sblood.
Shehadsmokedcrackcocaineduringthethirdtrimesterofherpregnancy.
Thecourtnotedthatthepolicyofthissectionofthestatecodeistopreventchildren'sproblemsandtheproblemsoftheirfamilies.
'42Thecourtthennotedthattheeffectsofchildabuseafterbirthoftenpaleincomparisontotheeffectswhilethechildisinutero.
"'Whitnerarguedthatbyincludingaviablefetusinthedefinitionofaperson,motherscouldbeprosecutedforingestingharmful,yetlegal,substancessuchasalcoholornicotine.
'44ThecourtdidnotagreewithWhitner'sconclusionthatthisresultwouldbe"absurd.
'45Instead,thecourtstatedthatparentsmaybeprosecutedforcriminalchildneglectiftheydrinktoexcessandthusendangertheirchild.
14Ifprosecutingapregnantwomanfordrinkingorsmokingwhilepregnantisnotconsideredanabsurdresult,thiscourtvastlyexpandedthepossibilitiesforcriminalandcivilliabilitywhenitstatedthataviablefetusisapersonunderchildneglectstatutes.
147138.
SeeSallyB.
Donnelly,ThePostpartumProsecutor,TIME,Dec.
15,1997,at4.
TheauthorinterviewsCharlesCondon,SouthCarolina'sAttorneyGeneral.
Condonstates,"AfetushasinalienablerightsthatcomefromGod.
"Id.
Condonalsoreferstothefetusas"afellowSouthCarolinian.
"Id.
139.
S.
C.
CODEANN.
§20-7-50(LawCo-op.
1985).
140.
Whitnerv.
State,492S.
E.
2d777,778(S.
C.
1995).
141.
See§20-7-50.
Thestatutestates:Anypersonhavingthelegalcustodyofanychildorhelplessperson,whoshall,withoutlawfulexcuse,refuseorneglecttoprovide,asdefinedin§20-7-490,thepropercareandattentionforsuchchildorhelplessperson,sothatthelife,healthorcomfortofsuchchildorhelplesspersonisendangeredorislikelytobeendangered,shallbeguiltyofamisdemeanorandshallbepunishedwithinthediscretionofthecircuitcourt.
Id.
142.
See§20-7-20(C).
143.
SeeWhitner,492S.
E.
2dat780.
144.
Seeid.
at781.
145.
Seeid.
146.
Seeid.
at781-82.
147.
Seeid.
at782.
AlthoughtheSupremeCourtdoesnotfindthispossibilityabsurd,thisissuemaybesubjecttothebroaddiscretionofthestateprosecutor.
SouthCarolinaAttorneyGeneralCondonstates,"IwouldbeonalegalslipperyslopeifItriedtoprosecutewomenwhousedlegalsubstances.
"Donnelly,supranote138,at4.
Condonhas,however,warned1998l492WILLIAM&MARYJOURNALOFWOMENANDTHELAW[Vol.
4:467Thecourtnotedthatmanyotherstateshaveoverturnedtheconvictionsofwomenwhohaveingesteddrugswhilepregnantbecausetheywerechargedunderdistributionstatutes.
Thecourtwentfurther,however,andstatedthatthosestates'decisionsaredistinguishablebecausethestateshaverefusedtodefineafetusasaperson.
'48ItistheveryextensionofthedefinitionofpersontoincludeafetusthatallowsthecourttobeginslidingdownwhatevenSouthCarolinaStateAttorneyGeneralCondonreferstoas"alegalslipperyslope.
"49Inlightofthestate-compelledcesareansectioncases,Condon'sstatementisillogical.
Whilethestatecannot,orwillnot,requireapregnantwomantostoptakinglegal,affirmativeactionswhichhurtherfetus-smokingordrinking-thestatecancompelawomantoundergoincrediblyinvasivesurgerybecauseshehasnotvoluntarilyactedtohelpherfetus.
Thisdichotomyisanalogoustothestatenotrecognizinganactionforamother'sassaultandbatteryofherchild,butrequiringawomantoriskherlifebyjumpinginalaketosaveadrowningchild.
TheFloridaSupremeCourt,inacaseverysimilartoWhitnerrestricteditsdefinitionof"person"toababyonceitisborn.
50Thissocialworkersanddrug-abusecounselorsthattheytooaresubjecttoprosecutioniftheyfailtoreportapregnantwomanwhoistakingdrugs.
Seeid.
TheSouthCarolinaSupremeCourtinWhitnernotesanumberofSouthCarolinabillsthatrequirethereportingofanywomenwhoarefoundtobeondrugs,andthemandatorytestingofallnewbornsfordrugs.
SeeWhitner,492S.
E.
2dat781n.
4.
Theimplicationsofsuchlegislationcouldbedevastating.
Womenmayrefusetoreceiveprenatalcareiftheydiscovertheywillbesubjecttoprosecution.
Pregnantwomenmayalsorefusetoseekdrugcounselingbecauseofthelackofprivilegeandpossibilityofprosecution.
Mothersmayalsogointohidingtogivebirthtoavoidthestate'smandatorytestingoftheirbabies.
Legislationintendedtosavechildrencouldendangerthem,possiblymorethanthemother'sinitialillegalact.
148.
SeeWhitner,492S.
E.
2dat783(citingJohnsonv.
State,602So.
2d1288(Fla.
1992);Commonwealthv.
Welch,864S.
W.
2d280(Ky.
1993);Statev.
Gray,584N.
E.
2d710(Ohio1992);Reyesv.
SuperiorCourt,141Cal.
Rptr.
912(1977);Statev.
Carter,602So.
2d995(Fla.
Dist.
Ct.
App.
1992);Statev.
Gethers,585So.
2d1140(Fla.
Dist.
Ct.
App.
1991);Statev.
Luster,419S.
E.
2d32(Ga.
Ct.
App.
),cert.
denied(Ga.
1992);Commonwealthv.
Pellegrini,No.
87970,slipop.
(Mass.
Super.
Ct.
Oct.
15,1990);Peoplev.
Hardy,469N.
W.
2d50(Mich.
App.
),app.
denied,471N.
W.
2d619(Mich.
1991);Commonwealthv.
Kemp,643A.
2d705(Pa.
Super.
Ct.
1994)).
149.
Donnelly,supranote138,at4.
HopefullytheUnitedStatesSupremeCourtwillgrantcertiorariandblockthisdownwardprogression.
SeeCrackMomAsksHighCourtforChanceToRaiseHerSon,DAILYPRESS(Williamsburg,Va.
),Mar.
15,1998,atA14.
Whitner,alongwithtwootherwomenwhohavebeenconvictedundersimilarcircumstances,plantoappealtotheUnitedStatesSupremeCourt.
Whitner'sattorneystatesthatSouthCarolinaAttorneyGeneralCharlieCondonandtheSupremeCourtofSouthCarolinahave"madeupanewcrimethatthelegislatureneverintended,andeverymedicalgroupopposes,andthatthesewomencouldnothaveknown.
"Id.
150.
Johnsonv.
State,602So.
2d1288(Fla.
1992).
ForanindepthlookatJohnsonandthehistoryofsociety'sviewofwomen'spregnancies,seegenerallyJuliaEpstein,TheSTATE-COMPELLEDFETALSURGERYdefinitioncausedthecourttonarrowitsdecisiontowhetherthelegislatureintendedthecrimeofdistributionofcocainetoincludedistributionthroughanumbilicalcordduringorafterthebirthingprocess.
5'Again,thecourt'sanalysishingedonthedefinitionof"person.
"'152Initscoupdegrace,thecourtdeclined"theState'sinvitationtowalkdownapaththatthelaw,publicpolicy,reasonandcommonsenseforbidittotread.
"'153Yetagain,theviabilitytesthasbeenabused.
Thosewhowishthestatetostepinandhelpfetusesbymakingmotherscriminallyliablelosetheirgreatestopportunitytohelpfetusesbecauseofthelimitsoftheviabilitytest.
Duringthefirsttrimester,whenthefetusismostvulnerable,thestatearguablycouldnotholdapreg-nantwomanliableforsubjectingherfetustodangerousandillegaldrugsbecausethewomanhastherighttoabortherfetus.
Thusthestatehaslostitsgreatestwindowofopportunitytohelpthebaby.
'Ontheotherhand,byimposingcriminalliabilityonpregnantdrugusers,andondrugcounselorsfornotreportingsuchanindividual,anaddictedpregnantwomanmaybeencouragedtoavoidprenatalcareafterviabilityandtoabortbeforeviability.
.
IV.
PRE-VIABIUTYVERSUSPOST-VIABILITYThedevelopmentofafertilizedeggfromzygotetoblastocysttoembryotofetustoviablefetusisfascinating.
5Justasfascinating,however,isthestate'sprogressionofinterestinthefetusasitdevelops.
Afteronlyafewcelldivisionsofthefertilizedegg,theblastocysts"5'inthecaseofDavisv.
Davisweredeterminedtobeneitherpersonsnorproperty,butto"occupyaninterimcategoryPregnantImagination,FetalRights,andWomen'sBodies:AHistoricalInquiry,7YALEJ.
L.
&HUMAN.
139(1995).
151.
Seeid.
at1292(citingFLA.
STAT.
ANN.
§893.
13(1)(c)1(West1989)).
152.
Seeid.
Nowitnesstestifiedinthiscasethatanycocainederivativespassedfromthemother'swombtotheplacentaduringthesixty-to-ninetysecondsafterthechildwasexpelledfromthebirthcanal.
Thatiswhenany"delivery"wouldhavetohavetakenplaceunderthisstatute,fromone"person"toanother"person.
"Id.
153.
Id.
at1297.
154.
Idonotbelievethatthestate'sinterestinthefetusshouldbeextendedtopre-viability.
Infact,Idonotbelievethatthemother'srightsshouldbesubjugatedatall.
SeePartIV.
155.
SeeDavisv.
Davis,842S.
W.
2d588,593-94(Tenn.
1992)(citationsomitted).
156.
Theblastocystswerefour-toeight-cellentities.
Seeid.
at593.
1998]493494WILLIAM&MARYJOURNALOFWOMENANDTHELAW[Vol.
4:467thatentitlesthemtospecialrespectbecauseoftheirpotentialforhumanlife.
"'57Atthestagesofdevelopmentbeforeviabilitythepreembryo,embryo,orfetusmaybeabortedbythemother.
5'Somestatesappeartohavedeterminedthatifamotherhastheintentionofcarryingherbabytoterm,thenshehaswaivedherrightstoabortthefetusortomaintainherpersonalautonomy.
Thestatemaythenpresumablyintervene,eventothepointofdenyingthewoman'srights,inordertoprotecttheunbornbaby.
'59Forex-ample,theanalysisinthecaseofInreJamaicaHospital"6wentbe-yondthebarrierofviabilitytoholdthatthestatehada"highlysignificantinterest''inthelifeofapreviablefetus.
'62AlthoughRoeheldthatthestatehasaninterestinprotectingthefetusfromabortionafterviability,somestatesnowclaimtohaveaninterestinthefetussufficienttoallowthestatetoinvadethewoman'sbodyandperformmedicalproceduresthatmayendangerthemother.
'63157.
Id.
at597.
Thisisafascinatingcase.
Forpossiblythefirsttime,thefatherwasallowedto"abort"thepreembryos.
Themotherandfatherofthepreembryosweredivorcedandthecourthadtodecidewhowouldreceive"custody"ofthecryogenicallyfrozenfertilizedeggs.
Themotherwantedtogivethemawayorsellthemtootherinfertilecouples.
Thefatherwishedtodestroythem.
Thecourtultimatelyawardedthepre-embryostothefatherfordestruction.
Seeid.
158.
SeeRoev.
Wade,410U.
S.
113(1973).
159.
Seetextaccompanyingsupranotes36-38.
160.
401N.
Y.
S.
2d898(Sup.
Ct.
1985).
Seesupranote38andaccompanyingtext.
161.
Seesupranote37andaccompanyingtext.
162.
Itshouldbenotedthatthis"highlysignificantinterest"wasenoughtoovercomethemother'sFirstAmendmentrighttothefreeexerciseofreligion,arightthatcannotbeovercomeunlessthestatehasacompellinginterest.
Foranotherexampleofaslipdowntheslope,seeGallagher,supranote28,at45.
In1986aSanDiegowomanwasarrestedandjailedforsixdaysonchargesofmedicalneglectofherfetusbecause,astheprosecutorsalleged,shehaddisregardedherdoctors'instructionsandhadcausedthebraindeathofherson.
Prosecutorschargedthemotherwithingestingstreetdrugs,havingsexualintercoursewithherhusband,andfailingtoimmediatelyreporttothehospitalwhenshebeganbleeding.
Id.
(citingJenniferWarren,WomanIsAcquittedinTestofObligationtoanUnbornChild,L.
A.
TIMES,Feb.
27,1987,at1).
Amunicipalcourtjudgedismissedthecharges,holdingthattheparentalsupportstatuewasnotintendedforthosepurposes.
Id.
(citingDoctorsAren'tPolicemen.
.
.
.
THESANDIEGOTRIB.
,Feb.
28,1987,atC-3,col.
1).
Astatelegislator,incensedbythecourt'sdecision,introducedlegislationextendingchild-endangermentstatutestofetuses.
Id.
(citingDanielC.
Carson,BillOfferedBasedonPamelaRaeStewartBabyCase,SANDIEGOUNION,Mar.
7,1987,atA-3col.
1).
163.
Inessencethestatehasdeclaredthatamotherhastheresponsibilitytorescueherfetus.
Thisrescuemaynotjustbetosavethelifeofthefetus.
Atsomepointthestatemayrequirethemothertorescuethefetusfrompossibleabnormality.
Butseesupranote11.
SeeGallagher,supranote28,at34(citingRobertson,supranote53,at456).
Inthefetalrights[advocates]view,thegenerallegalrulethatindividualshavenodutytorescuenolongerappliestopregnantwomen;ityieldstoanewSTATE-COMPELLEDFETALSURGERYTheSupremeCourtinRoev.
Wadeestablishedonlythatthestate'sinterestinthefetusbecomescompellingatthepointofviability,andthatafterthispointafetusmaybeprotectedbythestatefromamother'srighttochooseabortion.
164TheSupremeCourtdidnotsaythatthestate'sinterestinthefetusbecomessocompellingatthepointofviabilitythatthestatemaydenyawoman'srightstoautonomy,privacy,informedconsent,andre-ligion.
Byonlyaddressingtheissueofabortionandnotdiscussinganyothersituationseitherintheholdingorinthedicta,theSupremeCourtimplicitlyonlyextendedthestate'sinterestinthecaseofabortion.
TheSupremeCourt'sholdinginRoev.
Wade,establishingviabilityasdeterminativeofthelevelofthestate'sinterest,16isanillogicalbasisfordeterminingthestate'sinterestinthefuturehealthoftheunbornchildforthreereasons.
166First,thetest,asappliedbystatesinthecesareansectioncases,hasillogicalresults.
Undertheviabilitytestthestatemaynottakeanyaction,nomat-terhowinsignificant,beforeviabilitytobenefitthefetus.
Thestatecouldnotevenrequirethepregnantwomantotakefolicacid,arguablyaverynon-invasivemeasurethatmayprovideagreatbenefittothefetus.
Afterviability,however,thestatenotonlymayacttobenefitthefetus,thestatemaytakedrasticmeasures,suchasforcingacesarean,evenifitviolatesseveralofthemother'sconstitutionalrights.
Thisresultisillogicalbecauseitisduringtheearliestdevelopmentofthefetusthatthesmallest,leastinvasivechangesmaydothe.
mostgood.
Itisduringthefirsttrimesterwhenmostofthefetus'criticaldevelopment,includingthatofthemajororgans,takesplace.
Andyetitisduringthisverycriticalperiodthatthestatemaynotacttobenefitthefetus.
Tocounteractthisproblem,thestatecouldrequireapregnantwomantoregisteracertificateofintent.
67Thiscertificatewouldformulationunderwhichawomanwho"haschosentolendherbodytobringthechildintotheworld"assumesauniqueandmuchmoreexpansiveduty.
Id.
164.
SeeRoev.
Wade,410U.
S.
113(1973).
165.
Seesupranote12.
166.
ButseePatriciaA.
King,TheJuridicalStatusoftheFetus:AProposalforLegalProtectionoftheUnborn,77MICH.
L.
REV.
1647(1979)(arguingthattheviablitytestisapracticaltestfordeterminingwhenafetusshouldbegrantedlegalprotection,andthatthedevelopmentofmedicaltechnologyisinadequatetoovercomethelogicoftheviabilitycriterion).
167.
SeePhelan,supranote128,at489(citationomitted)("[P]otentialviabilityaloneshouldnotdeterminewhenthestate'sinterestbecomescompelling.
Thatinterestshouldariseatthepointinawoman'spregnancywhensheexercisesherreproductivechoiceand1998]495496WILLIAM&MARYJOURNALOFWOMENANDTHELAW[Vol.
4:467statethatthemotherintendedtogivebirthtothebaby.
Suchacertificateprobablycouldnotbeusedtodenyawomantherighttoanabortionifshechangedhermind,8'butitcouldallowthestatetointerferetobenefitthefetusbeforeviabilitybecauseofthemother'sstatementthatsheintendstogivebirthtoherfetus.
Acertificatelikethiswouldcauseseveralproblems.
First,requiringawomantodiscloseherintentiontogivebirthorabortmayviolateherrighttoprivacy.
Second,suchlegislationcouldcausewomentorefusetohavepregnancytestsperformedbydoctorsbecauseoftherequireddisclosure.
Awomancouldtestathome,keepherresultshidden,andforegothecertificateuntilshehadmadeadecision.
Bytestingathomeandwaitingtoseeadoctor,womenandtheirunbornbabieswouldpossiblynotreceivetheprenatalcarethatwouldmostbenefitthem.
Finally,thecertif-icatewouldbepracticallyuseless.
Womencouldavoidanyhasslebyclaimingthattheyintendedtoabort,eveniftheydidnot,topre-ventanystateinterference.
Thesecondargumentisthatitisimpropertousetheviabilitytest.
becauseabortionandfetalsurgeryaredifferentenoughtorequireapplicationofahigherstandardinthecaseofcompelledfetalsurgery.
TheSupremeCourtdeterminedthatthestatecanlimitamother'saccesstoabortionafterthefetusisviable.
Thisdecisiongrantstothestatetherighttopreventawomanfromtakinganaffirmativeactionthatkillsherunborn,butviable,fetus.
Thisisverydifferentfromallowingthestatetoinvadeawoman'sbody.
Inthecaseofabortion,thestateinterest'sinthefetusmayoutweighthepregnantwoman'sprivacyinterestatthepointofviability.
Inthecaseofcompelledfetalsurgery,thestate'sinterestinahealthy,orevenliving,fetuswouldhavetooutweighthemother'srightstopersonalautonomy,"9tobefreefromservitude,andtoinformedconsent.
Becauseofthepotentialforviolationofagrossnumberofrightsbythestateinthecaseofcompelledfetalsurgery,theviabilitytestshouldnotbethemarkerusedbytheelectsnottoterminateherpregnancy.
Often,thisdecisionismadepriortothetimeofpotentialviability.
').
168.
SeePlannedParenthoodofSoutheasternPa.
v.
Casey,505U.
S.
833(1992).
Caseymaylimitthestate'sabilitytoforceamothertogiveupherrighttoabortionbysigninganintentcertificatebecausethiswaiverwouldbeanundulyburdensomeobstacletoawoman'srighttoobtainanabortionbeforeviability.
169.
SeeDavidC.
Blickenstaff,Comment,DefiningtheBoundariesofPersonalPrivacy:IsThereaPaternalInterestinCompellingTherapeuticFetalSurgery,88Nw.
U.
L.
REV.
1157,1198-99(1994)(arguingthatalthoughthepaternalinterestisstrongerinthecaseoffetalsurgerythanabortion,"theintrusivenessoffetalsurgeryfarexceedstheintrusivenessofinfringingontheabortiondecision').
STATE-COMPELLEDFETALSURGERYcourtstodeterminewhatactionthestatemaytake.
Whatisatissuehereis"theultimateviolationof.
.
.
liberty.
"'7°Thereisjusttoomuchatstake.
Third,theviabilitytestisusedbystatestoclaimacompellinginterestandtherebyrequirethepregnantmothertorescueherfetus.
Abortionisthedeathofthefetusbytheaffirmativeactionofthemother.
Deathbyanaffirmativeactionisverydifferentfromdeathcausedbynegligenceorbyinaction.
Inacriminalcase,thedefendantmaybesubjectedtomedicaltestsoflimitedinvasivenesstodetermineifhecommittedthecrime.
7'Inacaseofnegligence,thedefendantmaynotbesubjectedtoinvasivemedicaltests.
71TheSupremeCourtdidnotintendfortheviablitytesttoextendbeyondtherealmoftheaffirmativeactionofabortion.
NordidtheSupremeCourtintendtorequireamothertobeforcedtorescueherfetus.
Althoughseveralcaseshaveallowedchildrentosueforprenatalinjuries,77thosecasesaremeanttosafeguardthefetusandtheparentsfromtheextramedicalandcarecostscausedbyintentionalactsornegligencebyallowingthechildren,uponbirth,tosueforcompensation.
Althoughthismayindeedindicateanerosionofparentalimmunity,74theliabilityofamotherforactsofnegligencedoesnotmeanthatamotherisrequiredtoactaffirmatively,ortoundergoinvasiveprocedures,toprotectherfetus.
It'sdifficulttoimagineacasewhereacourtwouldholdamotherliablefornotundergoing(evensomewhat)invasivemedicaltreatmenttohelpherchildren.
Justbecausethemotherispregnantatthetimethe"child"needsmedicalcaredoesnotmeanthestatecanthenforcethemothertoundergoaninvasivemedicaltreatment.
170.
Id.
at1199.
171.
Forexample,thedefendantmayberequiredtogiveasemensample,hairsample,DNAsample,orbloodsample.
172.
Tomyknowledge,theonlycivilcasewherethecourtmayorderapartytoacasetoundergoaninvasiveprocedureisasuspectedfatherinapaternitysuit.
Therethesuspectedfathermaybeorderedtoundergoabloodtesttodeterminewhoisthefatherofthechild.
Thisisdoneduetoapolicytoprovideforchildren.
Paternitytestingcouldbeanalogizedtothesituationathandbecauseinbothcasesthestateistryingtoprotectthechild.
Thedifferencesbetweenapaternitytestandthehypotheticalarefirst,thedegreeofinvasivenessbetweenabloodtestandthreeincisions,andsecond,thefactthatevenaviablefetushasnotbeendefinedasa"person,"andisnotsubjecttoprotection.
SeeRoe,410U.
S.
at162.
173.
See,e.
g.
,Procanikv.
Cillo,478A.
2d755(N.
J.
1984),citedinGallagher,supranote28,at39n.
151.
174.
SeeRobertson,supranote53,at439-42.
1998]497498WILLIAM&MARYJOURNALOFWOMENANDTHELAW[Vol.
4:467V.
CONCLUSIONInapplyingthedoctrineofstaredecisis,thejudicialsystemdoesnotalwaysstoptoconsiderwhethertheapplicationofateststillmakessense.
Whiletheviabilitytestmaystillbevalidinthecontextofabortion,itsapplicationinthecontextoffetalsurgeryisillogical.
Ifthestatehasacompellinginterestonlyafterthepointofviability,andthuscannotactuntilthatpoint,thenthestatehasmissedtheopportunitytodothegreatestgoodforthefetuswhilecausingtheleastamountoftraumatothefetusandthemother.
Furthermore,atestusedtodeterminewhenthestate'sinterestmaysubjugateamother'sprivacyinterestshouldnotbeusedtodeterminewhenthestatemayviolateamother'srightstoprivacy,personalautonomy,informedconsent,freedomfromservitude,andpossiblyreligiousfreedom.
Finally,itisnotpropertoextendtheviabilitytesttorequireamothertorescueherfetusbyinvasivemedicalprocedures.
ForthesereasonstheviabilitytestsetforthinRoev.
Wadeisinappropriatelyappliedinthescenariooffetalsurgery.
KRISTAL.
NEWKIRK