Nursing Law and Ethics

emphasis on a US caseRe AC?1990). In a number of cases courts in the USA were
prepared to order pregnant women to be given a caesarean section despite their
refusal of treatment [25]. InRe ACthe court initially ordered a caesarean section on
awoman dying of cancer. This order was overturned on appeal after AC had died.
The court said that in `virtually all cases' a refusal could not be overridden. They
did admit there may be exceptional circumstances in which a caesarean may be
ordered. An example given in discussion in the case was very similar to the facts in
Re S.NeverthelessRe ACis widely seen as the case which curtailed judicially
ordered caesarean sections in the USA [26].
In many waysRe Scan be regarded as an exceptional case ± an aberration [27].
After the decision the Royal College of Obstetricians and Gynaecologists ?RCOG)
published a consultation paper stating that:

`It is inappropriate and unlikely to be helpful or necessary to invoke judicial

intervention to overrule an informed and competent woman's refusal of a

proposed medical treatment even though her refusal may place her life and that

of her foetus at risk'. [28]

Despite this ,in a number of subsequent cases judicial intervention was sought and
the courts authorised the performance of caesarean sections upon women who
had refused such procedures ?Rochdale NHS Trustv.C?1996),Norfolk & Norwich
NHS Trustv.W?1996)). The Court of Appeal were given an opportunity to rule on
this issue inRe MB?1997). MB had a fear of needles. This had led her to refuse to
have blood samples taken during pregnancy. In the late stages of pregnancy it was
discovered that the fetus was in the breach position. A caesarean section was
proposed. MB initially agreed; however she was opposed to administration of
anaesthetic by needles. MB then went into labour. She agreed to a caesarean sec-
tion and the administration of anaesthetic by mask ,but at the last moment refused
the anaesthetic [29]. The hospital then sought a court order ,which was given by
Mr Justice Hollis. He found that MB was incompetent because of the effects of the
needle phobia on her decision-making powers. She asked her lawyer to appeal. She
then herself agreed to the caesarean section and the operation was carried out the
following day.
MB challenged the legality of the procedure. On appeal to the Court of Appeal
the right of the competent patient to refuse treatment was confirmed [30]. However
it was also recognised that ,in an emergency ,treatment could be given where a
patient lacks capacity ,as long as this was on the basis of necessity ,the procedure
not extending beyond what was reasonably required by the patient. Lady Butler
Sloss noted the judgment of Lord Donaldson inRe Twhere he stated that the
doctor must assess carefully whether in that case the patient had the capacity
`commensurate with the gravity of the decision' she purported to make. The Court
of Appeal referred to the three-stage test for capacity set out by Mr Justice Thorpe in
Re Cdiscussed above. Lady Butler Sloss commented that:

`A competent woman who has the capacity to decide may ,for religious reasons ,

other reasons ,for rational or irrational reasons or for no reason at all ,choose not

to have medical intervention ,even though the consequence may be the death or

serious handicap of the child she bears ,or her own death. In that event the

106 Nursing Law and Ethics