In re A.C. - 573 A.2d 1235 (D.C. 1990)

Rule:

If a patient is competent and has made an informed decision regarding the course of her medical treatment, that decision will control in virtually all cases. Sometimes, however, a once competent patient will be unable to render an informed decision. In such a case, the court must make a substituted judgment on behalf of the patient, based on all the evidence. This means that the duty of the court, as surrogate for the incompetent, is to determine as best it can what choice that individual, if competent, would make with respect to medical procedures. Under the substituted judgment procedure, the court as decision-maker must substitute itself as nearly as may be for the incompetent, and act upon the same motives and considerations as would have moved her. The concept of substituted judgment is intended to allow courts to make dispositions from the estates of incompetents akin to those that the incompetents would have made if competent.

Facts:

The mother was 26 weeks pregnant. She was suffering from cancer and was unconscious. The mother's doctors filed a petition requesting permission to perform a cesarean section to deliver the child. During the proceedings, the mother briefly regained consciousness and seemed to have mouthed words to the effect that she did not want the operation performed. The trial court granted the petition in an effort to save the life of the unborn child. A panel of the court denied a stay pending appeal, and the operation was performed. Both mother and child died. Respondent representative of mother appealed.

Issue:

Did the trial court err in granting the doctors’ petition to perform a cesarean section to deliver the child, notwithstanding the wishes of the mother?

Answer:

Yes.

Conclusion:

The court heard the case en banc, and vacated the trial court's judgment. The court held that if the mother had been competent, she would have had the right to decide whether or not the operation would be performed. The court held that because the patient was not competent, the trial court should have determined how to proceed based on substituted judgment, or what the mother would have done had she been competent. The court held that the trial court erred when it based its judgment on the viability of the child instead of on the substituted judgment of the mother.