The right of a woman to control her own medical destiny took a significant step forward this week when the Florida District Court of Appeal ruled that Samantha Burton’s rights were violated when she was forced to remain hospitalized against her will after disagreeing with the hospital’s recommended treatment.

Ms Burton, an un-married mother of two, was twenty-five weeks pregnant when she started to show signs of premature labor.  At the urging of her obstetrician she sought emergency care at Tallahassee Memorial Hospital where doctors determined she was not in labor but ordered to remain on best rest for the next fifteen weeks until the end of her pregnancy.

When Burton said permanent bed rest for fifteen weeks was not feasible (who would care for her children and how would she keep her job?) doctors refused to allow her to leave the hospital to get a second opinion.  Instead, they requested an emergency telephone hearing where a Leon County judge ordered Burton indefinitely confined to the Tallahassee Memorial Hospital.  The judge also ordered Burton to undergo any and all medical treatments doctors deemed necessary to save the life of Burton’s fetus.  

After three-days of state-ordered hospitalization and a state-ordered cesarean section, Ms. Burton suffered a stillbirth and was released.

The case illustrates the issue of compelled care and the ruling reinforces that women do not relinquish their right to determine their own medical care once they become pregnant.  The doctors and hospital argued that, under Florida’s child welfare statutes, their primary duty was to protect the fetus, even if that meant impinging on Burton’s rights and personal autonomy. 

Many in the medical profession have called for the physician responsible for Burton’s confinement to be disciplined for, ironically, putting both Burton’s health and the health of her fetus at risk.  The American College of Obstetricians and Gynecologists and the American Medical Association, which soundly rejected the actions in Tallahassee, worry that compelled hospitalizations of pregnant women will deter many from seeking care for fear that doing so will result in their involuntary confinement.

The decision-making process of the doctors, hospital, and lower court judge in this case smacks of a paternalism that unfortunately remains fundamental to the ideology of anti-reproductive rights activists everywhere.  Burton hadn’t even made a decision NOT to take doctor’s orders–she simply wanted the ability to be an informed and engaged advocate for her health and make sure the advice she was getting was the right advice.  Instead her life, the lives of her already-born children, and her personal integrity were utterly dismissed in the name of protecting a fetus that, if born at 25 weeks, would have required significant neo-natal care and, under the best case scenario, stood a fifty-fifty chance of surviving. 

That paternalism extended to the legal defense of the action where the state of Florida, in defending the actions, had argued that the power to indefinitely confine Burton stemmed from its parens patriae authority, that is, the power of the State to, in exceptional circumstances, override a parent’s refusal to allow their children to receive life-saving medical care.  The care in this case though invovled first care for Burton and not her fetus. 

As the appeals court correctly noted, there is no reason, nor should there be, to extend the parens patriae principles to potential fetal life.  Had the court done so it would have put Burton’s rights squarely at odds with the rights of this potential life–an unnecessary constitutional conflict that fundamentally ignores that a fetus is inextricably part of, and physiologically dependent on, the pregnant woman.  Therefore a state interest in fetal life does not and cannot ultimately “control” the privacy and autonomy rights of a pregnant woman.