Boston ? Melissa Ann Rowland’s life is not a pretty picture. Even her supporters will tell you that.

“She’s not the vision of a soccer mom,” says one, with classic understatement. Even the photo that went around the world on the March day the Utah woman was formally accused of murdering her twin son by refusing a Caesarean section gave new meaning to the phrase “mug shot.”

Rowland was born to a retarded mother, adopted as a baby, admitted to a mental hospital at 12 with “oppositional defiance disorder.” She has a history of mental illness, illegal drug use and accusations of child abuse and … well, you get the picture. Not a pretty one.

Indeed, the first reports claimed that she had resisted the C-section out of vanity, telling a nurse she did not want to be cut “from breast bone to pubic bone.” The prosecutor accused her of “depraved indifference to human life.”

But sometimes you have to step back from the single portrait to see the entire legal landscape. You see, if Melissa Ann Rowland can be prosecuted for murder, it’s not just a tale of her own troubled life. It presents all of us with a sober question: Must every pregnant woman follow her doctor’s orders?

Rowland denies that it was vanity that kept her from the knife. She denies “indifference,” depraved or not. Nevertheless, in the days since this story came onto the national radar screen, it’s been cast in the fixed-in-cement language of the abortion debate. As sides line up, this case has become another example of the rights of the woman versus the rights of a fetus.

But widen the lens and consider Amber Marlowe, for example. In January, this mother also refused to have a C-section. A Pennsylvania hospital got a court order to perform the operation. But after she and her husband fled to another hospital, she delivered the baby normally.

Or widen it to include Angela Carder. In 1987, when Carder was pregnant and critically ill with cancer, the doctors in her Washington hospital got a court order to try and save her fetus. Mother and fetus died in surgery.

The landscape is dotted with such attempts by the state to overrule the power of the mother to make health decisions for herself and her fetus.

I know that pregnancy comes these days with an expanding list of dos and don’ts. No to liquor and smoking. Yes to vitamins and folic acid. Good cheese and bad cheese. It’s what women expect when they’re expecting. Those who are careful look angrily at those they regard as careless.

But in a country where one in four births are by C-section, do we want a doctor’s opinion to carry the force of law? What if a doctor decided on fetal heart surgery? Would it be murder if a pregnant woman said no?

As Lynn Paltrow of National Advocates for Pregnant Women sees it, the real conflict is not between mother and fetus but “between the pregnant woman on behalf of herself and the fetus and the raw power of the state to tie her down and force her to go under the knife.” Indeed, Rowland didn’t refuse a C-section; she delayed it. She had the C-section 11 days later in another hospital. One twin was born alive and one was stillborn.

We don’t know why, or indeed whether, the delay caused one twin to die. Rowland may or may not have made a bad decision. But there’s a difference between a bad decision and murder.

Those of us who have chronicled the ups and downs of everything from thalidomide to hormones know that medicine is not infallible. We are even wary of ordering parents to follow the doctor’s prescription for, say, chemotherapy for their children.

At the same time, no court has ever ruled that one person can be forcibly operated on for the benefit of another. The law cannot demand that you give up your kidney or bone marrow or even blood to save another life. Even your toddler’s. Nor does it charge you with murder if you refuse.

So, does only a pregnant woman lose the right to refuse treatment? Is she the only one who loses the guarantee to make medical decisions for herself and her fetus?

The abortion debate has discolored every argument. But this is not about abortion. As Paltrow asks, “What value is there in making every pregnancy a crime waiting to happen based on every post-birth analysis by doctors?”

Melissa Ann Rowland is no poster child for maternity. But if she can be charged with murder, then any other pregnant woman can be watched, monitored, doctored by the police. That’s not a very pretty picture.

Ellen Goodman is a columnist for Washington Post Writers Group.