Refusal of Caesarean=murder?

March 16, 2004 5:06 AM

Refusal of Caesarean=murder? Anyone seen/heard this? [Search didn't turn up anything, spare me if I overlooked.]
posted by yoga (111 comments total)

The portrait of a bad mother beset by drug troubles may not earn Rowland much public sympathy, but it doesn't warrant a murder charge, critics say.

How about manslaughter?

When do you stop protecting mothers (from jail, prosecution at least) and start protecting children (from death)? I'm surprised the doctors couldn't operate without her permission to save the child. And before anyone reacts too quickly, we are talking about a child here as doctors obviously thought the baby could sustain life away from the mother (hence the request for C-section).

This is just another story that shows people need a licence to be a parent.
posted by SpaceCadet at 5:47 AM on March 16, 2004

Goddam psychos. Don't they know that C-sections are unnatural, and therefore "against God"?

Obviously, this woman is a bit of a scumbag, but this murder-of-the-unborn tactic that the pro-lifers keep trying is dirty pool.

I'm surprised the doctors couldn't operate without her permission to save the child.

Oh what a fascist-utopia that would be, huh?
posted by jpoulos at 5:50 AM on March 16, 2004

I'm surprised the doctors couldn't operate without her permission to save the child.

Oh what a fascist-utopia that would be, huh?

Second that! Geez, now we should assume every doctor to be the last word, restrain the woman, and perform surgery? Whoa.
posted by LouReedsSon at 6:00 AM on March 16, 2004

What we need to do is capture free-roaming 'mothers', strap them to a bench and cut their spawn out of them, before they even get an inkling to do this kind of thing.

The safety of our future consumers cannon-fodder, demands pre-emptive liberation from the wombs of terror.
posted by Blue Stone at 6:04 AM on March 16, 2004

It infuriates me that they can charge her with murder after the delivery, but didn't attempt to bring the issue to court before the delivery so the baby would have survived. Didn't everyone involved have a degree of responsibility, especially in light of the fact that she may have mental issues?

Is "I told you so" an acceptable endpoint for the obligations of those entrusted in protecting and maintaining life?
posted by VulcanMike at 6:05 AM on March 16, 2004

What if that baby had lived? She could have killed the next Wade Boggs or Bob Barker! Monster! Burn her!
posted by Mayor Curley at 6:05 AM on March 16, 2004

I can see both sides of the debate, but I have to come down on the side of the mother.

Her body, her rights. That's just the way that it is. Also, there are multiple reasons why someone would not want a C-section.. from plain fear to (as jpoulos pointed out) religious beliefs against science/medicine/cutting/non-holistic methods.

Did they offer any other options? How about inducing? Oh, maybe if they induced and she conceived naturally, the babies wouldn't have survived, eh? So, how does that change the argument of 'surviveability'?

(and then you can fly down the slipperly slope of mothers that drink, smoke, do drugs while pregnant.. or maybe those who just don't eat right, or get prenatal care, or take some tylenol for a back ache..)
posted by rich at 6:16 AM on March 16, 2004

rich, ain't it lucky your mother either didn't need a C-section or did need one, and didn't mind the yucky scar!

On the flipside, I agree that it's OK to have an abortion to save a mother's life (this is common sense) - how about saving a child's life with the only side-effect being a physical scar for the mother? Is a mother's vanity more important than a child's life? (and let's not get into semantics - by the time the mother is in labour, there is a child in her womb, not a fetus).

As for physical scars, I'm sure glad I had my appendix out, that's all I can say. I love my scar - it reminds me of how a doctor saved my life.
posted by SpaceCadet at 6:24 AM on March 16, 2004

Obviously, this woman is a bit of a scumbag, but this murder-of-the-unborn tactic that the pro-lifers keep trying is dirty pool.

And please, this is NOT an abortion issue people. Apples and oranges. This is about disobeying doctor's instructions for vanity reasons - result: stillborn child. Nothing to do with abortion. jpoulos: reading the article will save you from further embarrassing posts.
posted by SpaceCadet at 6:27 AM on March 16, 2004

I think she should have the right to choose whether she wanted be operated on to save her baby. People aren't legislatively required to go to hospital to have a baby are they?
posted by Onanist at 6:32 AM on March 16, 2004

rich, ain't it lucky your mother either didn't need a C-section or did need one, and didn't mind the yucky scar!

A C-section is not a minor procedure. It's fairly major surgery. Obviously the woman should have consented--but murder charges?

jpoulos: reading the article will save you from further embarrassing posts.

I read the article. And really, the only person here who should be embarrassed is you. Forced surgery? Do you call yourself an American?

If you don't see the agenda underlying this case, you're not paying attention.
posted by jpoulos at 6:37 AM on March 16, 2004

> And please, this is NOT an abortion issue people.

Hello?! This is totally an abortion issue.

Whie the situation in question does not involve abortion, the fact that a legal decision will be made regarding the life of an unborn child will certainly be germaine in future abortion debates.
posted by o2b at 6:38 AM on March 16, 2004

the only side-effect being a physical scar for the mother

It is my guess that you have never had a surgeon run through all the possible dangers. There are risks with any surgery and some of those related to cesaerians are not nice.

I am sickened by this woman's attitude both her unborn child and her daughter:

Rowland has a previous child endangerment conviction, stemming from a 2000 incident in which she punched another daughter in the face for eating a candy bar in a supermarket without paying for it.

However, I cannot see that her actions constitute a murder charge.
posted by davehat at 6:44 AM on March 16, 2004

This Rowland woman really is pretty awful but there's more here than meets the eye.


She says she's had two C-sections before and denies refusing another one for vanity's sake.
She also delivers this quote, which betrays my elitism because it sounds wrong to my ears coming from the kind of woman who smokes weed while nine months pregnant and punches her kid in the face in a supermarket:

"This to me is tantamount to Roe v. Wade," Rowland said Monday.
posted by CunningLinguist at 6:44 AM on March 16, 2004

This is not like the abortion question, except insofar as the right to self-determination is relevant.

Here's a continuum of cases that might help focus our moral compass:

1. I have a kidney that is compatible with my neighbor, who needs a new one. Without it, he will die. Can I be forced to give up a kidney to save my neighbor?

2. I have a child who needs a kidney, and mine would work for him. Without my kidney, he will die. Can I be forced to give him my kidney?

Now, we generally say that in #1, there'd be no legal obligation to provide the kidney. Also, there really is no legal obligation in #2; however, I think we have a sense that a parent should want to help a child in a case like #2.

But that notion of "should want" is distinct from the "legally obligated" notion.

And that's what we have to distinguish in this particular case. Yes, the mother should have wanted to save her child, at any cost to herself. I personally cannot agree with her decision. However, I don't see how she was legally obligated to subject herself to an invasive medical procedure in order to benefit another person.
posted by yesster at 6:47 AM on March 16, 2004

I think she should have the right to choose whether she wanted be operated on to save her baby.

(my emphasis - to show this is NOT an abortion issue)

on preview: o2b : Whie the situation in question does not involve abortion, the fact that a legal decision will be made regarding the life of an unborn child will certainly be germaine in future abortion debates.

How so? You mean mothers who want to abort at a legally early stage because of the possibility of C-section? How would that be affected by this case (they still can abort legally)?

Going against doctor's advice for vanity reasons that leads to a stillborn child is indefensible (still some of you here are having a good try at it).
posted by SpaceCadet at 6:50 AM on March 16, 2004

Can we also prosecute mothers who won't give up a kidney to save their children's lives? Failing to save a life has never been first degree murder -- manslaughter at worst. While I may not agree with her actions here, I don't think that anyone should be compelled to be cut open against their will regardless of the reason.

I wouldn't worry about SpaceCadet -- From his posting history, it seems that he would be in favor of cutting women open just for the hell of it.

That said, if her mental illness really made her incompetent to make medical decisions, I do wonder why the hospital didn't try to get a guardian appointed for her.

On preview -- damn it, yesster beat me to my kidney comment.
posted by LittleMissCranky at 6:54 AM on March 16, 2004

COMMENT DELETED ON PREVIEW
God damnit - I was just about to write the exact same kidney argument. Yay for collective conciousness.
posted by twine42 at 7:01 AM on March 16, 2004

However, I cannot see that her actions constitute a murder charge.

davehat, me neither, but manslaughter, yes. Remember we're talking about a human being that died here, resulting from the negligance of his mother, going against doctor's advice. How to prevent another human being dying in similar circumstances? Is that a concern of anyone here?

It is my guess that you have never had a surgeon run through all the possible dangers. There are risks with any surgery and some of those related to cesaerians are not nice.

I know first-hand about the risks of surgery. I'm very happy to be alive. Also I know of several mothers who've had C-section. It's quite common, you know. What's (thankfully) uncommon are stillborn births. What's even more uncommon are completely preventable stillborn births that doctors predict and plan against, yet are allowed to happen.
posted by SpaceCadet at 7:02 AM on March 16, 2004

SpaceCadet -

Your comment is disingenuous. Not only do you know nothing about me to make such a personal remark (which if you were standing in front of me, I would smack you upside the head for), but your post is both ignorant of the facts around childbirth as well as ignoring the crux of what I stated.

Also, if this was about ignoring doctor's recommendations, then the issue is more of a no-brainer - it is not illegal to ignore a doctor's recommendations (and indeed, for a number of perfectly legal reasons, people do ignore doctor's orders).

Everyone else;

While the woman is obviously not a poster child, you can't pick and choose who you are going to let be protected under the law. Again, this goes to the woman's right (and in fact, anyone's right - man or woman) to their own body (which is really the issue behind pro-choice, not abortion, per-se).

Again, I ask - could the child have survived a natural childbirth? The answer would be an interesting addition to the debate, don't you think?

But to the main point; as has been stated before, C-sections are *major surgery*. Regardless of the commonality of them. Also, this is all about the right to your own body. What if everyone would be better off with an implant of some kind? Or how about forced sterilization?

The only thing that pops to my head is depraved indifference, but even then you're treading on a person's right to their own body. And you can't regulate how women act for the 9 months they are pregnant. So, while I don't think the woman acted very well, and she probably is not a fit mother to begin with, she had every right to refuse medical service and wait to give birth naturally, regardless of the end result.
posted by rich at 7:05 AM on March 16, 2004

Failing to save a life has never been first degree murder -- manslaughter at worst

I agree.

I wouldn't worry about SpaceCadet

I wouldn't worry about me either - I'm just saying what I feel. I don't worry about anyone here.
(I'll ignore your snark - but keep it on topic, and less on the ad-hominem)
posted by SpaceCadet at 7:05 AM on March 16, 2004

This is idiotic - anyone can refuse a medical procedure.
posted by agregoli at 7:08 AM on March 16, 2004

Actually, there are 25,000 stillbirths a year in the United States. Not all that rare.

How many of them were "completely preventable?" I don't know, and neither do you. Do we count maternal drinking? Drug use? Failure to take enough folic acid? How about not getting enough bed rest.

It's great that c-sections are common, but that doesn't change the fact that it's major surgery. I don't think that the state should get to decide when someone accepts the risks associated and when they don't.
posted by LittleMissCranky at 7:14 AM on March 16, 2004

Hey, did you have to pick my comment earlier SpaceCadet? :) I was going to put in another line saying I don't care whether it's an abortion issue or not. It's just my uninformed opinion that people should have the right to refuse surgery on themselves. If you're not required by law to give birth in a hospital then this charge seems unfair to me.
posted by Onanist at 7:14 AM on March 16, 2004

Your comment is disingenuous. Not only do you know nothing about me to make such a personal remark

You must be referring to this comment I made:-

rich, ain't it lucky your mother either didn't need a C-section or did need one, and didn't mind the yucky scar

And the alternative is.....?

Did you not understand the logic of my comment you refer to? Either your mum has had a C-section or she hasn't. I know that much about your mum, and in fact, I know that much about all the mums of the world.

which if you were standing in front of me, I would smack you upside the head for

You typed those words to an anonymous stranger. I can take such rubbish on the interweb - but sonnyjim, just try mouthing those words actually stood in front of me. My, my the heckles get raised so easily.

Again, I ask - could the child have survived a natural childbirth? The answer would be an interesting addition to the debate, don't you think?

Then why did the doctor's advise on a C-section? Are you suggesting you know more than they do?

This is idiotic - anyone can refuse a medical procedure.

True, but what if denying a medical procedure results in the death of another person?
posted by SpaceCadet at 7:18 AM on March 16, 2004

From his posting history, it seems that he would be in favor of cutting women open just for the hell of it.

LittleMissCranky, I tip my hat to you, ma'am. Very, very funny (and accurate)!
posted by Mayor Curley at 7:18 AM on March 16, 2004

True, but what if denying a medical procedure results in the death of another person?

And here's where we get to abortion. The fetus was stillborn. It's not legally a person--unless cases like this set a legal precedent defining unborn fetuses as such.

See how it works, SpaceCadet?

We also get to the kidney analogy. What if I deny my neighbor or mother or son a life-saving kidney? Like it or not, people have a right to do with their body as they please. Just because we find something morally reprehensible doesn't mean we can just declare it illegal. There's a bigger picture here.
posted by jpoulos at 7:25 AM on March 16, 2004

Anyone seen/heard this? [Search didn't turn up anything, spare me if I overlooked.]

Do you mean here? Or do you mean you overlooked the 728 stories which have been published about it since March 11?
posted by Mo Nickels at 8:00 AM on March 16, 2004

SpaceCadet;

Talking about my mother is not in your purview. And anyone, especially a "stranger on the interweb" (as you so put it) would get a smack from me talking about her or anyone in my family. Keep it to the topic. The disingenuous point was towards making a personal comment about me, as well as you blantantly ignoring the counterpoints to your argument.

And on the topic, you continue to ignore the points being made against your argument. You aim for the emotional discussion because under the law, your arguements do not hold water.

My point about the natural childbirth is thus: if the unborn child was in distress, such that it would not have survived (and indeed, did not) survive naturally, then you are saying that no one has the right to refuse extraordinary measures in any situation. A parallel to this would be living wills.

People have raised very good points around the kidney parallel, right to refuse medical service, the legal standing as a person, regulating pregnant women, and people's rights to their own body.

As to refusing medical service that results in the death of someone - it happens in many cases, most notibly in religions that eschew surgery, science and modern medicine.
posted by rich at 8:03 AM on March 16, 2004

This is idiotic - anyone can refuse a medical procedure.

True, but what if denying a medical procedure results in the death of another person?

SpaceCadet, it's obvious at this point that your being willfully obtuse. As yesster clearly pointed out, your question is analogous to the kidney problem. Instead of asking others to see your point of view that this woman should be raked over the coals, answer this, if you please: Should a parent refussing transplant of thier kidney to their child (that refusal resulting in death of the child) be prosecuted for manslaughter? That precisely relates to the question you've asked, doesn't it?

on preview, I see that rich made the point very succinctly:

And on the topic, you continue to ignore the points being made against your argument. You aim for the emotional discussion because under the law, your arguements do not hold water.
posted by Wulfgar! at 8:12 AM on March 16, 2004

I know first-hand about the risks of surgery. I'm very happy to be alive. Also I know of several mothers who've had C-section. It's quite common, you know.

I know they are common. I was present when my son was delivered this way.

However, my partner, despite the agony she was going through, signed a consent to surgery form. I'd venture that all the people you know who delivered this way also signed a consent form.

I am not a lawyer, or a doctor, but as far as I am aware, medical advice is not legally binding. If this is the case, then this is not murder. Or manslaughter.
posted by davehat at 8:13 AM on March 16, 2004

Actually, there are 25,000 stillbirths a year in the United States. Not all that rare.

If we take 1998 as an example, 25,000 out of 3,941,553 births is very rare I'd say. In fact it's only 0.63% of all births. I can't be bothered doing the Google, but I'd say C-sections are way way more common than stillbirths.

Hey, did you have to pick my comment earlier SpaceCadet? :) I was going to put in another line saying I don't care whether it's an abortion issue or not. It's just my uninformed opinion that people should have the right to refuse surgery on themselves. If you're not required by law to give birth in a hospital then this charge seems unfair to me.

That's OK - you're entitled to your opinion. Still think it's crazy that the mother wanted to keep her child, but not have surgery that would save her child.

on preview, rich, you still don't get it. Lighten up fella. It was not a personal comment. Think logically, not emotionally, and you'll discover that all births in the entire universe are either C-section or they are not. How is it personal to point out such an axiom, and that your very own mother is included in this universal truth? If your mother had needed a C-section, and had chosen not to go through with the operation for vanity reasons, you would not be contributing to this thread right now. Same with my mum, or any other mum.
posted by SpaceCadet at 8:19 AM on March 16, 2004

Crazy is, and should be, distinct from illegal.
posted by LittleMissCranky at 8:29 AM on March 16, 2004

So Spacecadet: should any woman who delivers a stillborn baby, who ignored her doctor's advice and spent her pregnancy as anything other than barefoot and pregnant also be brought up on murder charges?
posted by bshort at 8:32 AM on March 16, 2004

and you'll discover that all births in the entire universe are either C-section or they are not.

How does this at all apply to the argument at hand?
posted by agregoli at 8:35 AM on March 16, 2004

From the way the woman talks about the c-section it would seem that no doctor made an even halfway decent attempt to explain the specifics of the procedure to her. In particular she seems to have thought that the incision was vertical and running "from breast-bone to hip-bone".

Perhaps someone should have explained that over half of the births in the US are done by Cesarean section. Then again the whole thing took place at an LDS hospital, and presumably in Mormon country, so there may have been additional factors involved there that aren't mentioned in what I've seen on this case.

Still, I have to be with the mother on this one. It's not exactly like the state gives a flying f*ck whether you live or die once you're born, so why this obsession with foetuses?
posted by clevershark at 8:38 AM on March 16, 2004

davehat, I totally agree with the legal aspect. Howeverm I'm debating from a moral perspective (my very first words were "how about manslaughter?" - it was a question). I have been asking "what if...?" all along.

In the case of a kidney transplant, this thread is regarding moral issues (at least I'm debating that) - not law. Either you are on the side of the person not wishing to be a kidney donor and go through with the operation (his/her rights to deny medical procedure), or you're on the side of the person needing a donor (his/her rights to live, not be stuck on dialisys for years). For me this is a no-brainer, but I understand we all have different opinions and I respect that. I just wish some of you here would be a little less heated (though don't worry I have rhinoskin when it comes to ad hominems).

Crazy is, and should be, distinct from illegal.

I know a lot of crazy things that are illegal coz they're well....crazy. Driving down the road with 10 pints of beer in your system is one.

They are not mutually exclusive.
posted by SpaceCadet at 8:43 AM on March 16, 2004

Crazy is, and should be, distinct from illegal.

Right. We just can't legislate all bad choices out of existence. I don't defend this woman or her decision - she sounds like a complete and utter mess. She reportedly tried to sell the surviving twin, for heaven's sake. But I will defend her right to refuse to submit to surgery.
posted by orange swan at 8:43 AM on March 16, 2004

If I can throw this in the mix...this was the response from one of my friends...a woman who is incredibly level headed, intelligent...and doesn't spook easily.

I'm going to take the radical step of discussing this from the perspective of someone who has, to some extent, been there.

Keep in mind while you read this that I was college educated, married, employed, privately insured, healthy as a horse and (not to put too fine a point on it) my ancestors did not have enough sense to stay where it was warm during the ice age, if you know what I mean and I think you do, none of which should affect the quality of the deference you receive in New York hospitals but all of which do.

My OB was the head of obstetrics at the teaching hospital where I was scheduled to have HM. He was, that year, one of the top ten OBs in the city by the votes of his fellow doctors according to the rankings in a local magazine. He was fine with my using the Bradley method (an obscure form of torture where you force an entire person out of a 10cm hole without the assistance of pain medication). As a matter of fact, he recommended my coach.

When forty weeks went by without the appearance of my young friend, he scheduled weekly ultrasounds and heart traces, but he saw no reason to induce labor since she showed no signs of distress (unless that's what she was trying to express by kicking me regularly in the kidneys).

At what turned out to be my final ultrasound appointment, the young intern who had taken the OB rotation took a different view.

He felt, on the basis of his many months of experience, that the size of the baby meant that she should come out immediately, and he announced to me that he was going to admit me so that he could administer pitocin (a drug that induces labor, and which poses some risk to the baby).

I explained that the head of his program, who was my private doctor, did not agree, and that I had no intention of allowing an induction.

He told me that he could have security guards keep me there if he had to.

I explained to him that if he involved the hospital, that they were certainly going to speak to my private physician, who was in fact the head of their obstetrical program, before they did anything; that they were not going to go ahead without my consent; that it would not help his residency if I had him arrested and sued him for every cent he ever saw; and that if I had to go through him to get out the door it would not diminish my enthusiasm for doing so.

I am not sure whether it was the force of my arguments or the fact that I had eight inches and (none of your business) pounds on him and I was quite perturbed, but he decided not to try and keep me.

Most likely he figured I would back down in the face of his threats and it wouldn't become an issue.

It seems to me unlikely that a woman who had the scars of two previous caesarians would tell a doctor that she refused one because the cosmetic appearance of her abdomen was more important to her than the lives of her children. I very much wonder, since Melissa Ann Rowland was uneducated, unmarried, uninsured, unattractive (a number of people with blogs have had a great deal to say on that point) and "defiant," how much trouble the doctors took to explain the situation to her.


My belief is that Ms. Rowland was set up. And no matter what the facts turn up, the neotheocrats have already been able to set the meme of "That woman killed her kid. It shouldn't be legal to kill your kids. "

If they convict her of murder, then it blows the doors wide open to refight the abortion issue. If a fetus is a person, then abortion is murder. If abortion is murder, then any and all pregnant women must be forced to carry to full term. Smoking, drinking, not doing your exercises, eating the wrong food, refusing to allow any and all medical people to have complete carte blanche over your body...all of those can be prosecutable offenses if this woman is convicted.

This was a brilliantly chosen case, from the "anti-abortion, kids are more important than the package that carries them" perspective. Ms. Rowland is a hard case to defend, I won't deny it.

But there's a much bigger issue at stake here. And the issue is that women are not just fetus containers. We do not abrogate our rights as individuals just because we become fecund. All people of sound mind have the right to deny surgical procedures which put them at risk of death. The rights of the fetus do not, and cannot be allowed to override the rights of the woman.
posted by dejah420 at 8:44 AM on March 16, 2004 [1 favorite]

I thought I read that she'd had C-sections before?
posted by agregoli at 8:45 AM on March 16, 2004

SpaceCadet;

I get it fine. You originally made a snarky, personal comment to get an emotional response from me and now you are backpeddling trying to justify doing so through poor logic.

Your comment was purely: Hey - you wouldn't be around if it wasn't for c-sections! This was disengenuous.

The inference that someone wouldn't be around to contribute to this conversation because their mother made the same choice this woman did has no bearing on the issue. Which also adds to its disingenuous nature. The point is whether she had the right to make such a decision - not the fact that the stillborn baby will not contribute to some Metafilter thread in the future.

Also, you continue to insist the decision was made on vanity. I'm tending to consider this more ignorant of you, being that you continue to ignore the fact that c-sections can be risky surgery, or that someone might have other reasons to want to give birth in that manner.

I'm sure most of us would agree that we would most likely not make a similar decision given perfect circumstances. However, we are not discussing that. We are discussing that the right to be able to *make* that decision should exist without penalty of law.

On preview - this is the first you mentioed of arguing from a 'moral perspective.' Which, I find laughable, since everyone here has made it painfully clear that we are supporting the lagality of her making the decision she did, and the bad precident trying to be made for the pro-life movement. Not to mention most of us have said we didn't agree with her, but supported her decision.
posted by rich at 8:49 AM on March 16, 2004

A sane society imposes a balance between rights and responsibility, and a case like this is as good a place as any to test the boundary.

This case does not implicate Roe, which preserved the states' rights to prefer the interests of a third-trimester baby above those of his/her mother (insofar as she might choose to exercise those rights to cause the death of the baby). Needless to say, Utah rules on such matters are not one milimeter more liberal than that required by Roe.

When the law elects to treat a third-trimester baby as possessed of the right to life and imposes a positive burden upon the mother to protect that life (as it certainly does in Utah), then murder can absolutely be inferred from a demonstration of callous indifference. Since callous indifference never involves the accused pulling the trigger, it doesn't require that one definitively disprove other causes of death (which is a fixation of some commentators on the case).

If it went to trial, the case would turn not on whether she rejected the medical advice, but why she rejected the medical advice. The prosecution will put up testimony that she said she "didn't want to ruin [her] life with a scar" and the defense can put up evidence that she didn't say that, or (as I suspect is more likely) that she lacked the moral or mental capacity to make the decision in the first place.

However, the case is very unlikely to go to trial. The constitutional issues are going to work their way through the courts first; if the courts decide to let the indictment stand, the mother is not going to roll the dice with a death-qualified jury -- the prosecutors will offer, and she'll accept, a manslaughter plea, and 3-5 years or something like that.
posted by MattD at 8:51 AM on March 16, 2004

I know a lot of crazy things that are illegal coz they're well....crazy. Driving down the road with 10 pints of beer in your system is one.

They are not mutually exclusive.

No one is arguing that crazy actions and illegal actions are mutually exclusive. Little Miss Cranky said that they should be "distinct", and that is a good term. Driving down the road drunk while a "crazy action", is not illegal because it's a risk to the drunk driver's health and safety. It's illegal because it endangers others besides the driver. Insisting that drivers drive sober makes the road safer for others while incurring no extra risk to the driver.

Surgery, on the other hand, does incur risks and no one should be legally obligated to put herself in danger for the sake of her unborn child.
posted by orange swan at 8:55 AM on March 16, 2004

so why this obsession with foetuses?

Clevershark, a stillborn after full-term pregnancy is not a fetus. I'll repeat: this is not an abortion issue, however hard people are trying to make it one (and therefore dichotomise and polarise the issue, and let cliches fly).

bshort:So Spacecadet: should any woman who delivers a stillborn baby, who ignored her doctor's advice and spent her pregnancy as anything other than barefoot and pregnant also be brought up on murder charges?

No is the answer to that.
(I already stated in this thread that I didn't agree with the murder charges)
posted by SpaceCadet at 8:57 AM on March 16, 2004

I'm cesarean born. Can you tell?

Whenever I want to go outside, I leave through the window.

/steven wright
posted by Stynxno at 9:04 AM on March 16, 2004

Anyone got any stats on C-sections and mortality rates in the US?
posted by SpaceCadet at 9:17 AM on March 16, 2004

The "vanity" thing is a red herring here, put in by the prosecutors to make this lady seem like a villain.

In the accounts by the hospital personnel, it is clear that the woman was paranoid and perhaps delusional. Her description of a Caesarian--an operation she had had before--as a full-body incision shows how out of touch she was with reality.

I doubt she thought the operation would "ruin her life" in that it would make it harder for her to find work as a swimsuit model. Rather, she had imagined some other threat.

I have had several friends who have had C-sections, and two of them have had serious medical complications after the birth; one was in the hospital for almost three weeks. For someone who is mentally ill and economically marginal, a three-week hospitalization alone would seem like it would "ruin her life".

I think that the hospital is trying to avoid a negligence lawsuit (since the woman was obviously a "threat to herself or others", and they didn't pursue any involuntary commitment options), and thus have leaned on the DA's office to paint the woman as the villain.
posted by Sidhedevil at 9:21 AM on March 16, 2004

My mother was saving up for an abortion in case my father wouldn't marry her. My father married her, and I was born. Does this mean I am against abortion because I came close to being aborted?

Hell no. I believe every woman has dominion over her own body.

I have had two caesarians. The first one wasn't performed soon enough, and my son was stillborn. Does this mean I would agree to a ruling forcing all women to have caesarians if necessary?

Hell no. I believe every woman has dominion over her own body. And until there arises a law that effects men in exactly the same way, I cry sexism. You pass a law that cuts off the penises of convicted child molesters, and maybe I will rethink my position.
posted by Secret Life of Gravy at 9:44 AM on March 16, 2004

Did you see her picture? It's not a vanity issue.

Actual citizens deserve more rights than potential citizens, or aliens for that matter. So, until the baby is born and thereby proves its viability, its only a potential citizen and not an actual citizen.

So, the mother gets to decide how she wants to have her baby, even if doing so may not be safe for either. Once its born, though, it becomes an actual citizen, and can be taken away from her because she's a delusional crack addict.

I also love how "your mamma" has gotten involved in this conversation. What are we, the third grade?
posted by ewkpates at 9:45 AM on March 16, 2004

I believe every woman has dominion over her own body

SLoG, are you advocating abortion right up to full-term, for no medical reason whatsoever, simply because "every woman has dominion over her own body"? Do you draw a line anywhere?
posted by SpaceCadet at 10:20 AM on March 16, 2004

But there ARE medical reasons/risks to ceserean.
posted by agregoli at 10:48 AM on March 16, 2004

Anyone got any stats on c-sections and mortality rates in the US?

Sure. But first you need to understand that a c-section is one of the most overused surgical procedures in America, and that the Public Citizen Health Research Group estimates that as many as 50% of the nearly 1 million cesareans that are performed in the US each year are not medically necessary. There are currently efforts underway to attempt to educate doctors and reduce the number of c-sections, but c-sections are often still put forward as the first, best option

You might also find this UK study - Why Mothers Die to be interesting reading. Pregnancy can actually be a fairly dangerous medical condition, and adding major abdominal surgery on top can and does lead to a much higher mortality rate (in the UK 2.84 times higher than the mortality rate for vaginal births) for women who undergo c-sections.

Other risks to the mother include anesthesia accidents, damage to blood vessels, accidental extension of the uterine incision, damage to the urinary bladder and other abdominal organs, decreased fertility, increased miscarriage, and increased chance of ectopic pregnancy in subsequent pregnancies, as well as the well-known (but slight) risk of uterine rupture during any subsequent vaginal birth. The most common risk is infection - some 20% of women develop infections and fever following a c-section. There are risks to the baby as well, although in emergency c-section (as opposed to elective) these risks are often outweighed by the apparent distress of the infant.

In the US, the death rate is about 31 deaths per 100,000 women (or 1 death per 3,225 surgeries). By contrast, the mortality rate for spontaneous vaginal birth is about 6 deaths per 100,000 women (or 1 death per 16,666 vaginal births). ICAN cites slightly different numbers, but overall the trend is clear: cesarean section is more hazardous than vaginal delivery
posted by anastasiav at 10:58 AM on March 16, 2004

Regardless of the specifics in this case, the (over)use of cesarean delivery in the US is a major issue for women's health:

Cesarean rates are at record levels
More than one fourth of all children born in 2002 were delivered by cesarean; the total cesarean delivery rate of 26.1 percent was the highest level ever reported in the United States.

Cesarean rates should be lower
Clearly there is no justification in any specific geographic region to have more than 10 - 15 % caesarean section birth.

Cesarean deliveries are performed for the wrong reasons
Stories of cesarean sections performed for motivations other than maternal or fetal well-being have been making headlines in recent years. They reflect a rise in elective cesareans for reasons such as avoidance of labor pain, patient or provider convenience, legal concerns of the provider or questionable assumptions about the origin of incontinence in women. There is no question that lives can be saved by the judicious use of cesarean section; but, in a nation with seemingly endless resources, easy access to information and multiple sites for clinical training as can be found in the United States, a national cesarean rate of 24% is not a sign of progress, but rather misplaced priorities.

"The list of reasons women must not think that surgical birth is safer than vaginal birth is long and ranges from the increased incidence of drug resistant infections, to the potential for life threatening complications from blood transfusions," according to ACNM President Mary Ann Shah, CNM, MS, FACNM. "Women risk permanent damage to abdominal and urinary tract organs, longer recovery times, little-to-no chance for a subsequent vaginal birth and a premature end to their ability to safely bear children. Technology is an alluring panacea for ills, but blind devotion without critical evaluation, places women at great risk."

Cesarean surgery is very risky
A review of the medical literature reported these specific incidences:

Surgical injury to bowel, bladder, uterus, or uterine blood vessels: two percent.

Hemorrhage: Between one and six percent of women needed a transfusion. Hemorrhage may sometimes require a hysterectomy.

Infection: 8 to 27 percent. Antibiotic resistant infections are starting to be a problem as well.

Paralyzed bowel: one percent.

Blood clots: 6 to 18 women per 1,000 experienced leg-vein clots; 1 to 2 per 1,000 threw a clot into the lung (pulmonary embolism).

Maternal death: An analysis in Great Britain revealed that women were 5.5 times more likely to die of an elective cesarean, than a vaginal birth (9 versus 2 per 100,000). A Dutch study found that c-sections caused seven times more deaths than vaginal births (28 versus 4 per 100,000). Obviously some factors that lead to c-section also threaten the mother’s life. However, the British study used elective cesarean to minimize that possibility and the Dutch study investigated the exact cause of death. The numbers in the British study may also be low. Data culled from vital statistics undercount cesarean death rates by 40 to 50 percent.

Cutting the baby: This complication occurred in a little over one percent of head down babies and six percent of breech babies in one hospital and in one percent of babies overall in another.


Put aside the specifics of this case and consider the general principle behind the issue. The suggestion that a doctor (or a judge) should be able to compel a woman to submit to a surgery this hazardous by threatening her with criminal prosecution is far more authoritarian and paternalistic than I am comfortable with. Giving the state this sort of leverage to interfere with the right of an individual to determine her own medical treatment violates her rights as a human being.

SpaceCadet, your argument is arrogant, factually imprecise, ethically flawed, and viscerally repellant.
posted by monkey.pie.baker at 11:03 AM on March 16, 2004 [1 favorite]

Every woman has a right over what happens in and to her body. BUT - the woman did not abort in the relevant period, so presumably she wanted to give birth to them at that stage. However, I'm of the opinion that although a foetus has little or no 'human' rights in the early stage, these rights increment over the term, especially when independent survival outside the mother is possible. So I would therefore say that at such a late stage the mother has a duty, having not chosen to abort - effectively 'contracting' to have the child(ren) - a duty to the unborn to ensure its safe arrival into the world. It seems mindblowing to me that anyone would refuse an operation against medical advice in this circumstance. In short, the mother has a duty to the foetus which increases over the pregnancy.
posted by boneybaloney at 11:09 AM on March 16, 2004

I've always been an absolute supporter of ROE V. WADE; it strikes me as instinctively obvious that a woman has domain over her own body, as SLoG phrased it.

But when a developing fetus has crossed over into viability - and there have been surviving children delivered as early as 28 weeks of gestation - then I do believe the rights of that unborn person need to be considered. Should they be an absolute trump over the rights and needs of the mother? No. But those people who insist that it is still just a ball of cells without any humanity to it strike me as amazingly callous. The story does not specify - or if it does, I missed it - that both children were alive in utero when they recommended the C-section, but it doesn't make sense that they would do that if they did not have evidence that both were still alive.

This is a very different case than a woman having a first or even second trimester abortion. Is it murder? Without actually knowing all the real facts, it is impossible to say. I kind of doubt it is murder in this case, though. While the woman in question is no poster child for solid citizenship, she also appears to be somewhat unbalanced emotionally.

Tragic, yes. Murder? No.
posted by John Smallberries at 11:09 AM on March 16, 2004 [1 favorite]

SLoG, are you advocating abortion right up to full-term, for no medical reason whatsoever, simply because "every woman has dominion over her own body"? Do you draw a line anywhere?

I'm not SLoG, but I draw the line at the outer end of the birth canal, myself. I think that's a very reasonable place for the line to be drawn.
posted by me & my monkey at 11:12 AM on March 16, 2004

So I would therefore say that at such a late stage the mother has a duty...

I'm glad we're not legislating duty these days.
posted by agregoli at 11:24 AM on March 16, 2004

boneybaloney:the woman did not abort in the relevant period, so presumably she wanted to give birth to them at that stage. However, I'm of the opinion that although a foetus has little or no 'human' rights in the early stage, these rights increment over the term, especially when independent survival outside the mother is possible. So I would therefore say that at such a late stage the mother has a duty, having not chosen to abort - effectively 'contracting' to have the child(ren) - a duty to the unborn to ensure its safe arrival into the world.

Well said...this encompasses completely my moral viewpoint.

anastasiav and money.pie.baker, thanks for the links.

on preview: me & my monkey, do you support the full-term pregnancy abortion of a healthy child? I didn't quite understand your answer (you seem to not take development of fetus/child into account, but only the physical space of where the fetus/child is).
posted by SpaceCadet at 11:26 AM on March 16, 2004

This isn't about abortion.
posted by agregoli at 11:30 AM on March 16, 2004

do you support the full-term pregnancy abortion of a healthy child?

I do; it's called birth.

I keep rereading the article, and the one thing I'm not seeing is any explanation of exactly what advice Rowlands was given. Those who want to use the idea of duty as moral leverage had best accept that duty involves clear choice. Duty without choice is called slavery. Remember here that the duty implied is to the child, not to doctors, lawyers, policeman, or the morally outraged. So I ask you:

Was she (a possibly mentally disturbed woman) told that if she didn't have a C-section that her child (or children) would die?
posted by Wulfgar! at 11:39 AM on March 16, 2004

And if she was told that, isn't that coercive? Considering that it's only a possibility they will die, since one lived?
posted by agregoli at 11:45 AM on March 16, 2004

do you support the full-term pregnancy abortion of a healthy child?

I do; it's called birth.

Haha. What about just before birth though?

This isn't about abortion.

Yup, but I'm free to respond to posts.
posted by SpaceCadet at 11:47 AM on March 16, 2004

Of course you're free to respond to posts. Tsk, tsk, so defensive. But this case isn't about abortion.
posted by agregoli at 11:50 AM on March 16, 2004

Tsk, tsk, so defensive. But this case isn't about abortion.

Yes, and neither are some of the posts I'm responding too - yet, I'm free to respond to posts.
posted by SpaceCadet at 11:57 AM on March 16, 2004

True, but what if denying a medical procedure results in the death of another person?

SpaceCadet, you're arguing that there's a moral imperative for this woman to submit to unwanted surgery to save the life of the child. Where do you draw that line? Is it permanent injury for the mother? Death? Does it extend beyond the mother?

Just out of curiosity, do you still have both kidneys? Both lungs? All of your liver? Ever had your bone marrow harvested? How often do you give blood?
posted by joaquim at 12:00 PM on March 16, 2004

I was responding to everyone then. It's not about abortion. And YES YOU'RE FREE TO RESPOND TO POSTS. When did I ever say you weren't?
posted by agregoli at 12:04 PM on March 16, 2004

If there's a moral imperative to save a life where does it stop? If my third cousin twice removed needs expensive medical treatment and the insurance company refuses to pay does that make an insurance company party to murder? A conspirator? I hate this woman's decision, it sickens me, but I can't see charging her with murder.
posted by substrate at 12:12 PM on March 16, 2004

on preview: me & my monkey, do you support the full-term pregnancy abortion of a healthy child? I didn't quite understand your answer (you seem to not take development of fetus/child into account, but only the physical space of where the fetus/child is).

I would support the legal right of the mother to have such an abortion, yes. I think that the "physical space" thing is pretty important. I probably wouldn't approve of it, personally - I might find it pretty repugnant - but that doesn't mean it should be illegal.
posted by me & my monkey at 12:17 PM on March 16, 2004

SpaceCadet would prefer to talk about abortion than to admit that he bought the prosecutors' ridiculous "she was vain" story about this case.

This is supposed to distract us from his earlier arguments that hospitals should be permitted to perform elective surgery on patients regardless of their wishes in the matter.

The irony of SpaceCadet telling anyone in the thread to "lay off the ad hominem" is especially rich and delicious.
posted by Sidhedevil at 12:29 PM on March 16, 2004

Moral imperatives do not translate into legal requirements.

Should she have done something, morally? Maybe.

Should people have right to terminate a healthy 3rd trimester baby? While I probably never would, I'm not going to speak for other people and their personal circumstances. So, I have to say, it should remain their right to choose.

I can think of a few non-health related reasons to do so. Asking if I would is again delving into the personal emotional argument, as opposed to the legal argument.

It's always the way when there are no good arguments for someone's opinion to go back to "What if it was you?" and try to get moral and emotional. But you see, it's not me. And it's not you. There is no possible way for you to take into account all the possible circumstances and individual nuances in each and every case (or even this Rowlands one) to force a self-righteous opinion on everyone else, regardless of the greater moral good you think you are forwarding.

That is why morals are not law and laws are not morals.
posted by rich at 12:39 PM on March 16, 2004

Well said...this encompasses completely my moral viewpoint.

You've totally moved the ball here, spacecadet. I don't see anyone arguing that this woman is a saint, just that she had a legal right to refuse the surgery. You, on the other hand, began this thread by suggesting that doctors should have the legal right to operate against a patient's will.

The woman is either a complete asshole or mentally ill. But a criminal she is not.
posted by jpoulos at 12:46 PM on March 16, 2004

SpaceCadet insists this woman should get charged with manslaughter and then says that his argument is not legal but moral. SpaceCadet insists (several times) that this argument is not about abortion but then proceeds to ask others when an abortion should be illegal. SpaceCadet likes moving goalposts.

The problem with a story like this is that the public perceive it as a no-brainer: of course the woman should have had a c-section therefore the law should require women be forced to have c-sections when it will save the life of the unborn child.

But the reality is that laws are bad at enforcing morality and past evidence has shown that the legal system just can't do it. Prohibition came about because drunkenness was considered immoral, but it resulted in greater alcoholism and the (far more) immoral mafia making a killing. Bans on abortion have resulted in pregnant women being killed by immoral back street abortionists - and while for many the jury is still out on wether abortions constitute murder, most would agree that killing women of child bearing age is.

Having said this, laws are made for moral reasons - just look at the woeful war on drugs. So let's say that doctors are legally obliged to carry out c-sections when it will save the life of the unborn child.

Firstly, you'll want a clause in your new law that allows protection of the mother if the doctor believes she could be endangered by the operation. Now we all know that doctors aren't gods, they make mistakes like anyone else but because the operation is not the patients choice any more, the fault will lie entirely with the doctor. I'm sure there are very few doctors who want that sole responsibility.

But doctors aren't stupid either and they'll know that all they have to do is behave much as they did before - ask the patient what they want to do and if they don't want to have the operation then simply provide some reason why they believe the patient won't survive a c-section. This way the doctor is protected but then the law is rendered entirely useless.

So what happens then? Maybe some special interest groups see what's happening and start suing doctors and hospitals? That could be pretty unpleasant, having complete strangers dragging you to court over an issue that doesn't concern them. Oh, and of course it would be too late by then anyway. Maybe these special interest groups would seek a toughing of the law so that doctors can't wriggle out? But then what - remove the clause and ensure women die?

And if this law did exist can you really imagine women being cut open against their will? And let's not forget you're suggesting a law here that (obviously) would only affect women and which would have no equivalent for men. Women tend to get a bit upset about that sort of thing so, SpaceCadet, I wouldn't use this as a chat up line.

However I look at this I can't see a single way you could realistically legislate against this without uproar. And if you don't want to legislate against it then this whole thread is basically a very long way of saying "gosh, aint it awful."
posted by dodgygeezer at 1:35 PM on March 16, 2004

Mo Nickels: searched here. Seemed like a good issue to discuss. Carry on.
posted by yoga at 2:03 PM on March 16, 2004

If the woman had obeyed doctor's advice, she'd most likely have two healthy twins now. She wanted to have both twins, so again, I'm at a loss as to why she didn't follow the doctor's advice. The article offers just one possible reason - for vanity. I can't see any other reason offered in the article. There are no other links to support the story, so I go by the article itself. Many here have drawn up possibilities as to why she disobeyed the advice, but with just one article to go by, they'll remain possibilities.

To those arguing about the rights of pregnant mothers, I think you're all barking up the wrong tree in specific regard to this article. I think she was either completely unaware of the dangers posed to her unborn children through either incapacitation, or because she simply made a grave misjudgement of the dangers. I don't see anywhere in the article that indicates she felt she had "dominion over her body" or such extreme views raised here, and that she could do what she liked with her body. Everything points to her misjudgement / incapacity to realise the dangers. Like I say, I disagree with the murder charge, completely (3rd time I've stated this). I raised the question however, "how about manslaugher?". Manslaughter charges can be brought when somebody is negligent. Going against doctor's advice is pretty negligent in my book. I understand law, but remember law never stands still - precedents are set.

Everyone here has brought their own preconceptions to this one article (myself included). Knowing this, I respect a difference of opinion - all I ask is the same (however, this is Metafilter, I should know better). And.....ad hominem all you like (means little to me), though I'm curious as to whether you think this is a good method of supporting your argument. To me, it's just a reactive, emotional response.

joaquim: Just out of curiosity, do you still have both kidneys? Both lungs? All of your liver? Ever had your bone marrow harvested? How often do you give blood?

I'm a donor-card carrier. Not only does it mean they can do what they like with my organs when I die, but I'm also on the bone-marrow list in case someone who needs bone-marrow matches my own (took blood-test to identify my type). I have both my lungs, my kidneys and all of my liver. I give blood once every 4 months (can't do it less than once every 4 months in the UK).
posted by SpaceCadet at 2:29 PM on March 16, 2004

can't do it less than once every 4 months in the UK

....more than once every 4 months.....
posted by SpaceCadet at 2:34 PM on March 16, 2004

One thing that must be considered is this woman's history with the medical community. How did her previous C-sections turn out? What if she had some of the complications m.p.b. brought up - I had some of the those during previous pregnancies, I might be inclined to take my chances with a vaginal birth.

And I'd like to know what mental illness she was diagnosed with. If she has something in the schizophrenic spectrum it might account for her seeming callousness - people with the more severe types of these disorders often have very flat affect (no visually observable emotional reaction to the world around them), have lousy impulse control, and have difficulty anticipating consequences to their actions. It's easy to detect if you know what to look for. If that's the case, why didn't the docs put her on a hold when she was at the hospital until she could be checked over by a psychiatrist?

That being said, the woman is a damn liar in regards to her drug use - as far as I know, cocaine metabolizes and is flushed from the system fairly rapidly, like within 48 hours, if memory serves me correctly.
posted by echolalia67 at 2:50 PM on March 16, 2004

Going against doctor's advice is pretty negligent in my book.

That's funny. A doctor's advice had me on ulcer medication for two years, and I almost died when my gall-bladder shut down all my internal organs ... because of that advice.

And you're absolutely wrong about one of your assertions: I brought no preconceptions to this article, unlike you. All I (and oh so many others) have done is to ask you to justify your preconception that "her misjudgement / incapacity to realise the dangers." should be prosecuted. What others have pointed out is that making bad decisions about your own body is not a crime, nor should it be. So why don't you quit pussy-footing around and say what you're obviously thinking: That the child inside a woman is a social responsibility, and that the mother must accept whatever society demands ... for the sake of the child.

If you'd just be honest about your argument, SpaceCadet, you'd probably find yourself more ably engaged, here.
posted by Wulfgar! at 2:58 PM on March 16, 2004

Going against doctor's advice is pretty negligent in my book.

I don't know that I agree that it's truly negligent, unwise perhaps, but not negligent. Doctors are not infallible, therefore their advice is not always sage (see the above links about the vast numbers of unncessary C-sections), therefore going against their advice cannot be reliably said to be negligent behaviour, especially when one takes into account the risks involved with a C-section (and no guarantee of a healthy baby), and the lack of proof that a C-Section was absolutely required in this case (since one survived a vaginal birth anyway).

And what echolalia67 said, I'd be interested in knowing just how competent this woman was to understand what was being explained to her in the first place (i.e. was this a truly informed decision not to have the surgery).
posted by biscotti at 2:59 PM on March 16, 2004

SLoG, are you advocating abortion right up to full-term, for no medical reason whatsoever, simply because "every woman has dominion over her own body"?

Yes, although I wouldn't say I am "advocating abortion" but rather, I am advocating the right to have an abortion.

The article offers just one possible reason - for vanity. I can't see any other reason offered in the article. There are no other links to support the story, so I go by the article itself. Many here have drawn up possibilities as to why she disobeyed the advice, but with just one article to go by, they'll remain possibilities

When you have a caesarian, even an emergancy caesarian, you are left with a scar along the pubic hair line, four to six inches long. If you have another caesarian, they excise the scar tissure from the first, so that again you end up with one scar four to six inches long. You don't end up with multiple scars. So having another caesarian would not have changed her appearance in any way.
posted by Secret Life of Gravy at 3:03 PM on March 16, 2004

SpaceCadet: I have both my lungs, my kidneys and all of my liver.

Why? There are people dying for lack of a good kidney or lung. Wouldn't the moral structure you are trying to impose on this woman require that you give up spare organs to save a life? I'm surprised the doctors couldn't operate without your permission to save a life.
posted by joaquim at 3:09 PM on March 16, 2004

Yes, although I wouldn't say I am "advocating abortion" but rather, I am advocating the right to have an abortion. (this refers to abortion of a full-term, healthy baby - the question I posed).

SLoG, why?

There are people dying for lack of a good kidney or lung. Wouldn't the moral structure you are trying to impose on this woman require that you give up spare organs to save a life? I'm surprised the doctors couldn't operate without your permission to save a life.


joaquim, your point is valid - I could do more. I agree with you. The doctors do have permission, just not while I'm alive. I could do better (as we all could). It's down to my fear and procrastination as to why I don't remove all the possible organs of my body to help others.

Doctors are not infallible, therefore their advice is not always sage

True, but in this case, clearly the doctor(s) saw what was coming, and correctly predicted complications if a C-section wasn't performed. You have to weigh up the amount of times doctors are right with the amount of times they are wrong. Also, doctors are liable to negligence. We can't have a situation where "the patient knows best". It's often not in the patient's best interests to do their own thing - and this woman lost a child because of an unestablished reason why she refused the doctor's advice. This is the central point of the article.
posted by SpaceCadet at 3:59 PM on March 16, 2004

If the woman had obeyed doctor's advice,
What makes all this a tough issue too, is the word, "if".
posted by thomcatspike at 4:28 PM on March 16, 2004

When you have a caesarian, even an emergancy caesarian, you are left with a scar along the pubic hair line, four to six inches long.

It depends on how urgent it is to deliver the baby. In case of life-threatening maternal or fetal distress, some doctors will still use a vertical cut in the interest of speed. The horizontal cut is not only more aesthetically pleasing, but also increases the chances of successful a VBAC with subsequent children.
posted by eilatan at 4:51 PM on March 16, 2004

For those of us who aren't medically trained, would folks 'round here mind using words instead of acronyms, or is this an authority type intimidation thing? Just asking ...
posted by Wulfgar! at 5:17 PM on March 16, 2004

It's down to my fear and procrastination as to why I don't remove all the possible organs of my body to help others.

I can understand you feeling like you need to say that to maintain consistency in your argument, but do you truly believe that?
posted by turaho at 5:26 PM on March 16, 2004

SpaceCadet, fair enough. Thanks for the candor.
posted by joaquim at 5:50 PM on March 16, 2004

We can't have a situation where "the patient knows best". It's often not in the patient's best interests to do their own thing - and this woman lost a child because of an unestablished reason why she refused the doctor's advice

I'm sorry, but it's not at all clear that her refusal of the C-section was the only reason she lost the child (or that having the C-Section would definitely have resulted in a live birth), and I find it very frightening that you feel that a patient doesn't know best what's right for themselves. Medical personnel are there to provide care and educated advice, they are not there to impose their will on people or force people to accept care they do not want. The patient absolutely DOES know best, perhaps not from where you're standing (or even where I am standing, in this case), but it's their decision to make (and I say this as a former nurse who's seen her fair share of frustrating patients who refuse to do what seems, objectively, to be what's best for them, but I absolutely respect and protect their rights to make those decisions for themselves assuming they are of sound mind).

The best determinant of someone's best interests is that person themselves (with information and advice provided by experts), assuming that they are compos mentis, they are the only ones who fully understand their situation, and they are also the only ones who have to deal with the repercussions of their decision 100% of the time for the rest of their lives.

Again, I think the real issue here is not whether or not this woman's decision was right/best/whatever, but rather whether or not she fully understood the procedure that was being recommended to her and made an informed decision.

(Wulfgar! VBAC is Vaginal Birth After Caesarian)
posted by biscotti at 5:51 PM on March 16, 2004

I can understand you feeling like you need to say that to maintain consistency in your argument, but do you truly believe that?

turaho, yes I truly believe those are my reasons for not donating organs/parts of organs that I'm not truly dependent on. It's not to maintain consistancy in my argument, it's simply being honest.

The patient absolutely DOES know best, perhaps not from where you're standing (or even where I am standing, in this case), but it's their decision to make (and I say this as a former nurse who's seen her fair share of frustrating patients who refuse to do what seems, objectively, to be what's best for them, but I absolutely respect and protect their rights to make those decisions for themselves assuming they are of sound mind).

How do you mean "knows best"? In terms of knowledge and experience? Or simply, it's their final decision? When I had appendicitis, I thought I had food poisoning (a common self-misdiagnosis) and simply rested and waited for my health to return. Then my appendix ruptured and I was in surgery hours later. I wish I'd seeked advice earlier as I spent 16 days in hospital on an anti-biotic drip (the ruptured appendix infected several organs). I definitely did not know best in that case. The hospital I was in takes on average 10 cases of appendicitis a day. Their experience meant they could treat me as a totally routine case. I trusted them completely - even if I didn't trust them, what do I know about appendicitis?

But, on the other hand, doctors make mistakes, and sometimes patients REALLY do know more than the doctor about a certain illness/predicament - it's typical for somebody to spend hours researching their own illness so they can find the answer (if they have the opportunity to do so) - there's the motivation to know all there is to know from the patient's perspective.

I'd just start from the point of trusting a medical professional though - and work towards suspicion if you start to have doubts. To assume patients know best is dangerous (if you mean knowledge and experience) - how many times have I been wrong about my own illnesses.....
posted by SpaceCadet at 4:20 AM on March 17, 2004

My mother was advised to get a cesarian. She said no. We are both fine. She also went against doctors advice and did not take thalidomide during her pregnancy even though the Doctors (plural) were insisting and literally handing her the tablets. I would never call my mother negligent for making those decisions.
posted by dabitch at 7:26 AM on March 17, 2004

My mother was advised to get a cesarian. She said no. We are both fine. She also went against doctors advice and did not take thalidomide during her pregnancy even though the Doctors (plural) were insisting and literally handing her the tablets. I would never call my mother negligent for making those decisions.

Your mother made the correct decision. Thalidomide is a fine example of where the medical profession have got it horribly, horribly wrong.

Each individual case has merits for both "sides" of the argument (to go with doctors advice or not). However, you never read about all the lives they save, thanks to their expertise - only when they make mistakes.
posted by SpaceCadet at 7:54 AM on March 17, 2004

There are plenty of other articles about this matter out there on the Interweb, Space Cadet. It is clear from every one of those other articles that the "vanity" argument is a figment of some prosecutor's imagination.

As this detailed article says, "Later the same day, Rowland showed up at Salt Lake Regional Hospital and told a nurse that she left LDS Hospital because a doctor there wanted to cut her "from breast bone to pubic bone" and this would "ruin her life," according to court records. In addition, she allegedly told the nurse that she would rather "lose one of the babies than be cut like that."

Obviously, someone in the prosecutor's office--a sane, middle-class, well-educated and well-adjusted person--projected his or her values on Rowland and assumed that the reason Rowland thought the surgery would "ruin her life" was vanity.

This is completely out of keeping with the socially marginal life of the woman in question. As I stated above, there are many more pressing reasons for an impoverished, mentally ill woman to fear surgery.

Per the same article:

'Rowland moved to Utah with a boyfriend and is either divorced or estranged from her husband, Sikora said. Court records show she was living on Social Security disability benefits and that managers of her apartment complex began eviction proceedings in late January after her arrest.

"This is major surgery," Sikora said of the Caesarian. "It would come as no surprise that a woman with major mental illness would fear it."'

So, let's see--Occam's Razor suggests that the threat of being homeless while recovering from major surgery seems like a far more pressing concern to Rowland than "vanity", doesn't it?
posted by Sidhedevil at 8:14 AM on March 17, 2004

To assume patients know best is dangerous (if you mean knowledge and experience)

Sorry if I wasn't clear that what I meant by "knows best" is in terms of making the final decision about something, obviously I know that not everyone has more knowledge or experience than a trained medical professional, but they certainly have more knowledge and experience of their own lives than anyone else, and as such are the only one capable of knowing whether any given procedure is right for them (with information supplied by the medical profession). It seemed clear to me that I wasn't implying that every Joe Average knows more about medicine than a doctor, but merely that every Joe Average has the right to determine for themselves whether a procedure is in their own best interests or not, and what may seem to be objectively in someone's best interests may or may not be how the situation looks and feels subjectively. Informed consent != unthinking obedience to medical advice - medicine should be a collaborative effort between medical staff and patient. Someone telling you that you had appendicitis and explaining that you needed surgery to save your life is perfectly appropriate, someone forcing you to accept surgery you didn't understand and didn't want is well outside the bounds of acceptable treatment. The bottom line is not who knows more, but who gets to make the decision, and deciding what's in someone else's best interests is an extremely dangerous precedent to set, the fact that a doctor knew more about your appendicitis than you doesn't mean that the doctor should be the one to decide about the surgery - recommend forcefully yes, decide, no (aside from in cases where you are incapable of consent, like if you're unconscious, in which case consent is assumed for lifesaving procedures).
posted by biscotti at 8:46 AM on March 17, 2004

SpaceCadet, you seem to cherrypick. Note that she nixed a cesarian, just like the woman on trial. Remember earlier when you spoke to Rich?

rich, ain't it lucky your mother either didn't need a C-section or did need one, and didn't mind the yucky scar

And the alternative is.....?

In this case: a healthy child born naturally despite doctors advice to have a cesarian. For the record, their worry was my navel cord around my neck.need a cesarian is quite relative. Bottom line, when it comes to surgery on your body, it is your call - and shouldn't be anyone elses, legally.
posted by dabitch at 8:56 AM on March 17, 2004

After reading Sidhedevil's link, I have a clearer understanding of what was going on. I have dealt with adolescents with Oppositional Defiant Disorder and they, along with people with severe Borderline Personality Disorder, are some of the most difficult people to deal with of all. They can become very aggravated and violent of over the most minor requests of those in authority. Add in a severe case Bipolar Disorder, which often includes delusional thinking and episodes of psychosis, and you have a person that most medical & social services workers dread having to deal with.

I had a client once who was very similar to this woman. She had a history of abusing alcohol, was very uncooperative and defiant, and because she had a history of violence, most staff kept their distance. I went on shift one day and read the staff notes from another counselor who noted that she looked a little jaundiced. She was strong>alot jaundiced but refused to go voluntarily to the hospital. In fact, staff had been trying to get her to go to the doctor for weeks because she had been very sick with what we all thought was a severe case of the flu. She told us to fuck off. I finally had to have her taken to the hospital against her will. She fought the paramedics the whole way. She died of liver failure a week later.
posted by echolalia67 at 9:12 AM on March 17, 2004

In this case: a healthy child born naturally despite doctors advice to have a cesarian. For the record, their worry was my navel cord around my neck.need a cesarian is quite relative. Bottom line, when it comes to surgery on your body, it is your call - and shouldn't be anyone elses, legally.

Doctors give patients choices all the time. If choice A has a 70% chance of survival, but choice B has only a 10% chance and someone chooses B and survives, it doesn't mean the doctor was wrong if he recommended choice A. It's not always black and white. Doctors will always back the favourite. Maybe that's why the US has a 24 C-section births per 100 as doctors want to make sure of their odds.

This is interesting from the article Sidhedevil found:-

"We have not been granted authority to intervene in the life of an unborn child," said Carol Sisco, a spokeswoman for the Division of Child and Family Services. "We don't have jurisdictional authority."

The only agency with authority would have been a hospital, who could have petitioned to have a guardian appointed for the child. That guardian could have then petitioned a judge to force the medical procedure on Rowland.

According to this, it's not true that no-one can intervene and force such a C-section operation.
posted by SpaceCadet at 10:08 AM on March 17, 2004

According to this, it's not true that no-one can intervene and force such a C-section operation.

That's correct, but in order for a judge to make that determination it's likely (or perhaps better put it's hoped) that a very strong lot of evidence would have to be presented that a.) the mother was not competent to make medical decisions for herself and b.) in the equation, the greatest risk to all parties involved would be to forgo the c-section.

Rutger's Law prof Sherry Colb dissected the legal problems with the Rowland case far better than any commentator I've read to date.
posted by Dreama at 11:53 AM on March 17, 2004

SpaceCadet: According to this, it's not true that no-one can intervene and force such a C-section operation.

Yes, but if they did, they would have to first find that she was incompetent to make medical decisions for herself. Here in California, unless she was ruled to be an imminent theat to her own well-being, that would require that she be assigned to a conservator (a lengthy process in and of it's self).

If that succeeds, that person would then have to take her before a judge and successfully argue that she is incapable of making rational decisions regarding her own well-being. That is rarely successful, as "competent to make your own decisions about your medical care" is usually a matter of answering "yes" to "Are you aware that you are sick? Are you aware that by not getting treatment, you may likely become sicker and even die?".

I had a very delusional low-functioning client whose conservator tried to force him to get medical treatment because the client's teeth had become so rotted that he had constant abcesses in his mouth. In case you don't know, these abcesses can eat through the bones in the face and become life-threatening, septecimia being a major concern. The judge ruled in favor of the client.

One of my major gripes about the mental health system is that it's so focused on protecting the client's "rights", that it is allowing many people to become sicker and sicker as they get sucked into the bizarro world of their delusions, becoming less and less capable to make rational decisions about their own well-being. How is it protecting someone's rights if it means that they die homeless in the streets because their delusions overrode their ability to act in the interest of their own self-preservation ?
posted by echolalia67 at 11:59 AM on March 17, 2004

Of course they could have forced her to have the operation, but would it have been legal, or just an abuse of the system?

My vote would be for the latter. And I think it's awfully creepy that some see no problem with forcing a woman to have an operation against her will for the sake of an unborn child.
posted by turaho at 12:05 PM on March 17, 2004

And I think it's awfully creepy that some see no problem with forcing a woman to have an operation against her will for the sake of an unborn child.

Point taken. If it were my call, I would put her on a hold until a psych doc, psych nurse, psych nurse practioner or a LCSW (social worker)could speak to her and tease out precisely what her fears were and explain exactly why the doctors wanted to do a c-section. And, if necessary (which seemed to be the case) get her lined up with services and shelter to ease the last few weeks of the pregnancy.

Medical folks are often not very good at communicating with the mentally ill - I often had to explain to them the precise nature of a client's mental illness and the cognitive level at which they were operating in order to make the medical appointment run smoothly.

That being said, aside from the risk to her unborn children, her condition couldn't have been all that healthy for her either, compounded by the stress and hazards of living on the street. I would argue that some sort of an intervention should have been made to protect HER physical well-being.
posted by echolalia67 at 5:01 PM on March 17, 2004

How is it protecting someone's rights if it means that they die homeless in the streets because their delusions overrode their ability to act in the interest of their own self-preservation ?

I would argue that some sort of an intervention should have been made to protect HER physical well-being.

A lot of people here are going on about "rights" and saying how dangerous C-section is, yet the doctors obviously weighed up the possibilities and felt C-section was the best choice to make. Rowland didn't make that choice and she gave birth to one healthy child and one stillborn. Her "rights" were observed to her own and her child's detriment. I'd ALWAYS want a third party to abuse my "rights" if it was for the good of my own physical health - but that's just me.

Of course they could have forced her to have the operation, but would it have been legal, or just an abuse of the system?

Read Sidhedevil's article - it is perfectly legal - not an abuse of the system. Why do you say "abuse of the system"? Do you think people would do this for any other reason but for the woman and child's health? I think you're more that a little paranoid on this issue, turaho.

I admit I didn't know they could force C-section, albeit in a convoluted way. It seems a lot of others didn't know here too, as it invalidates the kidney transplant analogy.
posted by SpaceCadet at 10:32 AM on March 18, 2004

Space Cadet..

Again.. you do support that some sort of charges, albet manslaughter, be brought against her.

All the same arguements against murder hold against manslaughter that have been put forward already.

If you didn't get that, then you just don't get it.

Also, Sidhedevil's article does not say it is completely legal for the hostipal to force a C-section. It is possibly legal (albet untested) in a very narrow (very very very narrow) sense.

I think any application of this 'option' would be hotly contested, as I only see it being applied to the poor, the mentally handicapped, or similarly protected sector of the population.

It is an abuse of the system simply because the only people it would apply to are those not able to avoid the issue. It is inherently unequal in its potential application.

Regardless, it's all a red herring. The issue is if she did anything resembling murder, manslaughter or depreaved indifference, under the law. And there is no supporting evidence to support any kind of charges, regardless of the moral issues involved.
posted by rich at 11:25 AM on March 18, 2004

A lot of people here are going on about "rights" and saying how dangerous C-section is, yet the doctors obviously weighed up the possibilities and felt C-section was the best choice to make.

I must point out though, that forcing a medical procedure on this woman, who wasn't entirely in her right mind would be pursuing a very extreme option that may have done more harm than good.

Oftentimes with the mentally ill it's best to find a temporary compromise, like geting her a hospice bed in a half-way house and getting her to see a doc or a psych nurse practioner every other day to monitor her condition.

Then, during these visits they could have developed some rapport and trust with her, continue to explain how serious her condition was, exactly what and what kind of options she had in regards to the type of c-section she could have, alternatives to that procedure such as inducing labor early and so on.

I cannot stress how important someone like a Psych NP (of which there are far too few) or an MD experienced in treating the mentally ill (again, too few of them) are to dealing with these kind of issues. Regular MDs and RNs don't have sufficent knowledge of how to effectively provide treatment to the mentally ill and are often very hostile toward them. I wouldn't be supprised if that were the case with the doctors who initially treated her.
posted by echolalia67 at 12:13 PM on March 18, 2004

Also, Sidhedevil's article does not say it is completely legal for the hostipal to force a C-section. It is possibly legal (albet untested) in a very narrow (very very very narrow) sense.

Look Rich, you don't have to disagree with me out of habit. I just pointed out what the article said:-

"We have not been granted authority to intervene in the life of an unborn child," said Carol Sisco, a spokeswoman for the Division of Child and Family Services. "We don't have jurisdictional authority."

The only agency with authority would have been a hospital, who could have petitioned to have a guardian appointed for the child. That guardian could have then petitioned a judge to force the medical procedure on Rowland.

(my emphasis on authority)

I translate jurisdictional authority as being "legal". If it were illegal any judge would not even be able to review such a petition. And how do you know this is unprecedented?

Sorry to be a pedant, but I'll pull anyone up on lazy knee-jerk comments borne out of habitually going against anything a particular person says.

As for charges of manslaughter, why not? If it's proven she was completely unable to make a rational decision, that would be mitigating circumstances. In fact, it could even be brought to light that the hospital was negligent by not properly informing her/organizing help for her predicament (as echolalia67 suggests) and a new case against them could be brought up by the defence.

If it was proven she was fully aware of the dangers, she prevented a doctor from carrying out a course of action to save a baby's life (or at least a chance to).

I think too many people are overlooking the fact that the unborn have rights too. This is a fact acknowledged by the United Nations' declaration of the rights of the child :-

In 1948 the United Nations published the universal declaration of human rights as a standard for all nations. In the declaration of the rights of the child the UN declared in 1959 that: "The child by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection before as well as after birth".

Most laws draw the line at viability (now around 19 weeks) - the time at which a baby could survive on his or her own. From that point on - they are certainly due to be protected by human rights.

What about the rights of the unborn? If you're all for individual rights, why champion rights for some and not others? Or does your moral code preclude those who you cannot relate to? (a trait of empathy)

Moral relativism - I hear you.
posted by SpaceCadet at 1:09 PM on March 18, 2004

Most laws draw the line at viability (now around 19 weeks) - the time at which a baby could survive on his or her own. From that point on - they are certainly due to be protected by human rights.

It's my understanding that "viability" means that the fetus could survive outside the womb with relatively minimal medical support. If so, then 5 months is far too early to be considered viable.

I think the problem many of us have with this is that those pursuing this case seem to have an agenda - creating legal precedence for allowing government to define a fetus at ANY stage of development as a person and thus allowing governmernt to outlaw abortion altogether. In other words, judical activism, the thing that conservatives claim to be opposed to. That certainly gives me a severe case of the wiggins.

Again, the focus here should have been first and foremost the health and safety of the woman. Mentally ill, drug abuse (which can make schizophrenia and bipolar disorders worse), and a high-risk pregnancy all are good reasons to intervene in the interests of HER well-being. Take care of her health and the well-being of her babies will naturally follow.
posted by echolalia67 at 2:10 PM on March 18, 2004

I would like to say, for the record, that Big Government cutting open a mother and stealing her baby from her womb is beyond the pale, even for me, a Big Government liberal.
posted by Ptrin at 2:28 PM on March 18, 2004

that Big Government cutting open a mother and stealing her baby from her womb is beyond the pale

????

echolalia67, as for viability - depends how you define "viable" (absolutely no medical support? 29 weeks according to a number of websites). Anywhere between 19-29 weeks depending on how much medical support is offered.

You managed to side-step the whole issue of the rights of the unborn (the "viable" unborn). Like I say, does your moral code preclude those who you cannot relate to? If so, moral relativsm is fine, just don't go trying to say laws should be based on your own limited view of life (as all our views are limited). Laws are for everyone, not just those we can relate to - laws aren't based on sympathy or empathy alone.
posted by SpaceCadet at 3:05 PM on March 18, 2004

as for viability - depends how you define "viable" (absolutely no medical support? 29 weeks according to a number of websites). Anywhere between 19-29 weeks depending on how much medical support is offered.

I'd split the difference on those two numbers to what ever number means "75 - 90% chance of survival with standard medical assistance from premature infants", not "massive intensive medical intervention on a Herculean scale and it's still more likely than not that the baby won't survive and if they do, they'll be probably be severely brain-damaged". Five months seems to be a case of the latter, unfortunately.

You managed to side-step the whole issue of the rights of the unborn (the "viable" unborn). Like I say, does your moral code preclude those who you cannot relate to? If so, moral relativsm is fine...

I was speaking in terms of what an appropriate legal reason to intervene in this case would be, not a moral reason. This woman was a risk to herself whether she was pregnant or not. Her pregnancy, however, made the situation more critical to intervene because she very well could have eventually died in childbirth without appropriate medical care.

When the courts address issues like this in the way that they are going about it, it raises my hackles. They are trying to get a foot in the door in order to create a precedent that allows government to regulate a woman's access to abortion. That, I have a really big problem with.

Believe me, I find this woman morally repugnant. I used to work with Severely Emotionally Disturbed/Developmentally Disabled children and a sizable portion of them were in that condition because their mothers abused alcohol and drugs while pregnant. I hated their parents for doing that to them. I quit the job eventually, when I became severely depressed because I realized that there were more and more of these kids coming down the pike every day.

Pro-lifers may call abortion selfish; I think continuing a pregnancy without making the appropriate lifestyle changes to ensure the birth of a healthy baby to be the ultimate in selfishness. However, I realize that it's not that simple, chemical dependency is near impossible to beat without some sort of help. Sadly, access to treatment for chemical dependency or mental illness is nearly non-existent in much of this country, and that pretty much guarantees that this will happen over and over again. If you are really interested in the well-being of viable unborn children, then take to the street and harangue public officials to increase funding to make treatment more accessable.
posted by echolalia67 at 4:24 PM on March 18, 2004

"for" premature infants not "from"
posted by echolalia67 at 4:26 PM on March 18, 2004

Pro-lifers may call abortion selfish; I think continuing a pregnancy without making the appropriate lifestyle changes to ensure the birth of a healthy baby to be the ultimate in selfishness.

I agree.

I also agree that each person has "dominion over their body" as SecretLifeofGravy puts it - but a viable baby is a separate human being with his/her own rights to life. Physically the viable baby is still in the womb, but can live outside of the womb independent of the mother (hence viable). This must be the one exception where you must weigh up the baby's right to live and the mother's right to choose surgery or not (given that C-section is LESS dangerous than natural birth). The doctor was actually offering a safer route to delivery for Rowland herself - and she refused it.

Yes, a mother has physical dominion over the child in the womb (obviously), but not dominion as in she can do whatever she wants with impunity. There's as much responsibility to ensure a safe birth as there is to ensure the safety of a baby after birth. The law recognises this and punishes heavily hospitals that make mistakes.

It's clear Rowland acted wrecklessly - no-one is going to disagree with that - the only point to argue is her state of mind during her pregnancy and how aware she was of her options. I think it's a fair call if the doctor strongly advises a patient that unless they take a course of action (e.g. surgery), they will almost certainly lose their child and may even face criminal charges. Look at it this way: if the doctor didn't advise C-section, he/she would be prosecuted for negligence (there would be evidence - ultra-sound scans etc) to prosecute him/her for not spotting the need for a C-section. The only person without legal repurcussions is the mother.

However, I think the law is harshly treating Rowland by accusing her of murder (why not manslaughter? Did she actually intend to kill just the one child and not the other?), but that's typical US of A. Either you're on the extreme left or extreme right, and in the middle there is the clear blue water of common sense. Yes, she should be tried though (I just disagree with the charge), to forge new laws. The trial may bring to light the need for better mental health treatment, better training for doctors in this situation. Just letting a baby die to observe another person's rights is wrong, and the law has recognised this.

Shrugging shoulders and saying "hey, she had her right to do what she did" is just amoral and also has no legal basis (thankfully).
posted by SpaceCadet at 6:17 AM on March 22, 2004

Just for the archives.....this news is just in:-

Conservatives Win Big With Fetus Bill
posted by SpaceCadet at 11:38 AM on March 27, 2004

Pro-lifers may call abortion selfish; I think continuing a pregnancy without making the appropriate lifestyle changes to ensure the birth of a healthy baby to be the ultimate in selfishness.

I agree.

But you cherry-picked out that one statement without giving consideration to the ideas that followed it. Morally speaking, it is wrong for a society to prosecute a woman for choices she made while in a mentally incapacitated and drug addicted state when it does little or nothing to provide treatment for both conditions. Dually Diagnosed individuals such as this woman need intensive help that most local, state, and federal goverments are not willing to fund. Otherwise, they continue to deteriorate and die in the street.

It's easy to have contempt for people like her, but try attempting to get her the services and medical care she needs and you will see how completely inadequate and callous the system is in terms of providing help. I just went through this with a loved one and I spent 3 weeks running all over town from one agency to another taking care of the paperwork required to get this person into a drug treatment program that would accept individuals with a mental illness.

I was lucky that I had experience working within the system, lived somewhere that had a pretty decent public health system, was unemployed and had a car. If I didn't know anything about the public mental health system, or if I had to hold down a full-time job, or if I didn't have a car, my loved one and I would have been completely fucked. They certainly weren't capable of doing it on their own at that time and could have very easily slipped into homelessness. And San Francisco is one of the better, more enlightened cities in terms of providing care to people with drug and mental health problems. I highly doubt that Salt Lake City is doing an equivalent or better job in providing comprehensive, compassionate care to Dual Dx'd homeless people.

There is no reason for prosecuting this case unless that they are trying to create a legal precedent that will allow them to eventually create a law that allows the government to have a say in whether or not a woman can legally have an abortion. It'd be much better if their intent was to create a legal precedence that would make it easier to intervene when someone's mental illness prevents them from making rational decisions about their physical well-being, but it's pretty obvious that they don't really care about that particular issue.
posted by echolalia67 at 9:12 PM on March 27, 2004