Commonwealth v. Pugh, 462 Mass. 482

Question presented: whether a woman in unassisted childbirth may be criminally liable for the unintentional death of a viable fetus; defendant convicted of involuntary manslaughter based on (i) force during delivery and (ii) failure to summon medical help.
Trial judge found the defendant guilty of wanton or reckless acts by using significant force to deliver and by not seeking help when breech delivery was recognized; sentenced to 2.5 years with probation and stay of execution pending appeal.
Evidence included videotaped police interviews, the defendant’s statements, and three medical examiners with conflicting opinions on whether the baby was alive and which injuries caused death.
Judge found the baby viable through birth and that some ante-, peri-, and postnatal injuries occurred; he also found the baby could have lived with medical assistance, but the evidence did not prove what would have happened if help had been summoned.
Massachusetts Supreme Judicial Court reversed the conviction, holding there was insufficient evidence of recklessness/knowingly created risk during delivery and that there was no proven duty to summon medical assistance, raising due process concerns and rejecting criminal liability for unassisted childbirth.
Concluding judgment reversed; finding set aside; judgment for the defendant; amicus briefs acknowledged.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Was the evidence sufficient to convict for involuntary manslaughter on the theory of commission (actions during delivery)?	Commonwealth contends the defendant’s forceful delivery created a substantial risk of death.	Defendant argues no proven safe alternative and no causal link shown between forceful delivery and death.	No; evidence did not prove that force caused death or that a reasonable woman would have acted differently.
Does a criminal duty to summon medical assistance exist for a woman in labor under these circumstances?	Commonwealth asserts a duty to summon aid to protect the fetus.	Defendant argues no such duty should be imposed, given bodily autonomy and privacy concerns.	Declined to recognize a broad duty to summon medical help in unassisted childbirth.
If a duty to summon exists, was proximate cause proven for the omission?	Omission to summon help caused death as a likely outcome.	Absence of proof that assistance would have changed outcome defeats causation.	Insufficient evidence that omission proximately caused death; conviction reversed.

Commonwealth v. Catalina, 407 Mass. 779 (Mass. 1990) (reckless/wanton standard in involuntary manslaughter)
Cruzan v. Director, Mo. Dep’t of Health, 497 U.S. 261 (U.S. 1990) (right to refuse medical treatment; bodily integrity)
Roe v. Wade, 410 U.S. 113 (U.S. 1973) (reproductive rights and privacy considerations)
Remy v. MacDonald, 440 Mass. 675 (Mass. 2004) (bright-line tort duty distinctions for fetus vs. living child)
Commonwealth v. Levesque, 436 Mass. 443 (Mass. 2002) (duty where life-threatening risk to others; reckless failure to act)
Commonwealth v. Cass, 392 Mass. 799 (Mass. 1984) (infliction of prenatal injuries resulting in death of viable fetus as homicide)
Commonwealth v. Crawford, 430 Mass. 683 (Mass. 2000) (definition of viability and prenatal death standards)
Commonwealth v. Washington W., 457 Mass. 140 (Mass. 2010) (novel issues of duty in Massachusetts context)