Ms S, forcibly cut open to deliver her baby: the doctor's dilemma

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The Independent Online
The conflict between the rights of a mother and her unborn child will be scrutinised in a test case likely to become a cause celebre over the rights of pregnant women to choose to refuse medical intervention.

The case spotlights the dilemma faced by doctors when women refuse treatment, which has led to a growing trend of judges forcing mothers to undergo unwanted Caesarean operations.

The planned judicial review by a 29-year-old south London woman follows a decision by a social worker to section her under the 1983 Mental Health Act because of her refusal to accept treatment for pre-eclampsia, a condition involving high blood pressure.

After she was transferred from a mental to a general hospital, doctors secured an emergency court order giving the go-ahead for treatment, including a Caesarean, without the patient - identifiable only as Ms S - being legally represented.

The operation was carried out several hours later when the woman, who was 36 weeks pregnant, gave birth to a daughter, now aged 10 months.

The woman's experience is the latest instance of judges authorising Caesareans against a patient's will, provoking growing anxiety among groups promoting improved care and choice in childbirth.

She said outside the High Court: "I was prepared to take the risk that both of us would die for principles I feel very strongly about. It is a matter of public concern that hospitals can use underhand means to force patients to have treatment which they have quite clearly stated they don't wish to have."

Ms S is seeking permission for a review, claiming that a London Borough of Merton social worker, Louize Collins, wrongfully applied to two doctors under the Act for her admission to a mental hospital, that she was wrongfully detained by the National Health Service trusts running Springfield Hospital and St George's Hospital, Tooting, and unlawfully denied access to a court or a mental health tribunal. She also claims that she is the victim of sex discrimination.

Ms Collins had been contacted by a local GP after Ms S refused treatment for pre-eclampsia, which can require an urgent Caesarean in very severe cases, although he warned her that she was risking her own death and that of the unborn child. Ms Collins said in her report, extracts of which were read to the court yesterday, that Ms S "had little interest in her own survival and certainly none in the survival of the baby".

She also talked of punishing her former partner, with whom she no longer had a relationship, and said that she hoped he would feel guilty if she died. When told that she and the baby would probably die, she had said, "so be it". She had indicated more than once that "a dead baby would be a solution as she in no way wanted it", the court was told.

While the judge, Mr Justice Stuart White, adjourned the case yesterday, it is expected to return for hearing by a specialist judicial review judge within a few weeks.

Judy Crompton, secretary of the feminist professional group Positive Care in Obstetrics and Gynaecology, said: "There seems to be a view that if a woman is pregnant that gives other people rights over her person and her body."

British courts have fought shy of expressly suggesting that the rights of the unborn child should override those of the mother, but they have in effect treated them as at least equal. The theme running through a series of rulings, beginning in 1992, is that a woman has no right to take herself or her unborn child to destruction by refusing consent for a Caesarean, although the operation itself carries risks.

Ms S specifically indicated her opposition to intervention in writing, expressly told the hospital authorities that she wanted to challenge her detention and had asked for the court order to be faxed to a solicitor. Had she secured access to a lawyer she could have applied for a writ of habeas corpus.

Leading article, page 13