"I have decided to override her refusal to have a C-section," wrote the doctor...

... on the hospital record of the woman who is suing.

Dr. Howard Minkoff, chairman of obstetrics at Maimonides Medical Center in Brooklyn, whose articles on the subject of patient autonomy have been published in medical journals, said he believed that women had an absolute right to refuse treatment even if it meant the death of an unborn child. “In my worldview, the right to refuse is uncircumscribed,” Dr. Minkoff said, cautioning that he was not commenting on the particular facts of Mrs. Dray’s case. “I don’t have a right to put a knife in your belly ever.”

Such a person might be accused of being immoral or a terrible mother, he said, “but we won’t tie you down.”

Doctors perform too many C-sections because they're too afraid of malpractice lawsuits. That risk-aversion could be balanced by liability when the doctor does perform the C-section.

In this case, the doctor allowed the woman (who had had 2 previous C-sections) to attempt to go through labor:

At first, she said, Dr. [Leonid] Gorelik appeared to relent, saying he would give her an epidural for the pain and then reconsider. “I was begging, give me another hour, give me another two hours,” Mrs. Dray said. Her mother, who was there, supported her, and the doctor said, “I’m not bargaining here,” Mrs. Dray said.

Mrs. Dray said she kept begging on the operating table. His answer, she recalled, was, “Don’t speak.”

The linked article, in the NYT, seems quite supportive of the mother's control over the medical decisionmaking process. Other than the material I boldfaced in Minkoff's strong position in favor of the woman's autonomy, there's nothing at all sympathetic to the doctor's calling to save the life of the child. The comments, however, go very strongly in that direction. Here are some of the comments readers have rated most highly. I've added some boldface, and each paragraph is a different commenter:

I am speechless. The doctors are supposed to allow pregnant women to do anything they would like even if it means the death of the unborn fetus?... I am sorry but I really don't have much sympathy for this woman. If she would really like a natural birth, why not just stay at home or go to a birth center/ simply hire a midwife at home that does not perform C-section? Why bother to go to a hospital and refuse the professional advice of the doctor?

I have absolutely no sympathy for this woman at all. Her sense of entitlement is simply galling. She's having a baby. The most important thing here is to ensure the delivery of a healthy baby, not to satisfy some preconceived notion that she should have a vaginal delivery. The doctors who performed the C-sections have two patients to care for: the mother and the child. This is not a case of an abortion where the child was unwanted, in which case the pregnant woman is the only patient. She clearly wanted her baby, which means in this case, the doctors had every obligation to ensure that the baby would come out as healthy as possible. It's not as though she arrived at the hospital and was immediately strapped down and forced to have surgery. She was given hours to try a vaginal delivery and it didn't work. Perhaps she had a pelvis that was too narrow, or perhaps the fetal monitor was beginning to show signs of distress, or perhaps the baby's position was off. No matter the reason the doctors decided to perform the C-section, they were doing their job to ensure that a healthy baby was born. I agree that patients should have a say in how they get care, but she seems to forget that she wasn't the only patient in the room. Let's not kid ourselves and think that if the baby was born vaginally but brain damaged...you think she wouldn't be suing in that case, too?

As an anesthesiologist, I am biased. But after 2 C-sections, the risks of a vaginal birth increase dramatically. I do not blame the doctors for protecting themselves by enforcing another C-section... let them err on the side of preserving life and function, and pray they are not sued. That will mean less OBs out there for the rational souls that understand the risks and don't want their kids to be another notch on the statistics pro/con ladder.

If this woman had 2 prior C-sections then the doctors are absolutely right that vaginal delivery was exceedingly risky. I almost laughed when I read that the woman is charging the doctors and hospital for “improperly substituting their judgment for that of the mother." What?? That's what they are supposed to do. They are doctors, she is not.... I am a woman and as pro-choice (in all areas) as anyone can be, but this is nonsense.

I think there is more to this story. If Mrs. Dray was determined to have a vaginal birth this time, that is something she and her OB should have discussed in great detail, during her pregnancy. Did she not reveal her desire for a vaginal birth until she was in labor? That would be odd and certainly a surprise for her OB. What was the medical reason given for the necessity of the c-section? Surely the physician documented why he thought the fetus was in danger during a vaginal birth.

While I agree that patient autonomy is paramount, was Mrs. Dray willing to sign away her right to sue if anything happened to the fetus during a vaginal birth? And even if she was, would that have held up in court (I doubt it)?

I agree with Dr. Minkoff's "worldview", where he says, "I don't have a right to put a knife in your belly, ever." I have been a surgical nurse for 25 years and I can honestly say I have NEVER experienced a patient being forced into an OR. Where was the surgical consent in this case? Was one signed? Who signed it? Because if it wasn't the patient or her legal representative with documented medical power of attorney who signed, I don't think the surgeon had any right to perform a section. Yes, she has a healthy baby. But her rights were trampled (while her bladder was perforated). This must have been a nightmare for the surgical & obstetrical teams--I sympathize.

And that last comment reveals a second issue that the article completely omitted. What consent form did the woman sign? I'm going to guess that the woman agreed, in writing, that the doctors could override her preference and force the surgery on her. I suspect this case is about the right to withdraw consent in the middle of treatment, after the doctors are committed to providing care. With the baby's life at stake, how can the woman win this lawsuit?

And what does this have to do with ideas about abortion? Here's a hypothetical. The doctor says (honestly and correctly): "I have to do a C-section or your baby will die." The woman says: "I still don't want a C-section, it's my right to choose, and if that means the baby will die, I'm calling this an abortion." Is the doctor supposed to step back and say "Okay, your choice"?