An advance directive is a legal document where you can specify what medical care you would or would not like to receive in the event you are incapacitated and unable to make health care decisions for yourself. However, if you are pregnant your state may not follow your directives.
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Advance directives, also called living wills or medical directives, often include preferences on life-sustaining treatments, which are medical interventions designed to keep a patient alive. Examples include:
- Ventilation
- Artificial nutrition (tube feeding)
- Intravenous (IV) tubes
- Dialysis
Over half of states restrict whether an advance directive can be followed if the declarant is pregnant. These types of restrictions, commonly called “pregnancy exclusions,” can be divided into two categories: (1) those that invalidate all or part an advance directive, regardless of the pregnancy’s viability, and (2) those that invalidate all or part of a directive if the fetus or embryo could be brought to term.
State Law Chart
Details to each state’s law regarding advance directives and pregnancy can be found in the chart below.
States That Invalidate Regardless of Viability
Among the 10 states in this category, some invalidate a pregnant person’s entire directive, and others only affect preferences regarding life-sustaining treatment. These states are:
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States That Invalidate With Exceptions
Many states do not allow life-sustaining measures to be withheld or withdrawn from a pregnant person if the fetus could reach viability or live birth as a result of the life-sustaining measure. Of these 17 states, 5 (denoted by an asterisk) also make an exception for the patient’s well-being, such as if the treatment would be physically harmful to the pregnant person or cause unreasonably severe pain. Mental health concerns do not always count as potential pain in these circumstances.
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States Without Pregnancy Restrictions
There are 24 states that do not mention pregnancy restrictions. However, a few states have statutes that mandate life-sustaining treatment for pregnant people, unless they include specific pregnancy instructions in the advance directive document to do otherwise (denoted by an asterisk).
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What Does This Mean for My Advance Directive?
If you could at any point become pregnant, consider including pregnancy-specific treatment decisions in your advance directive. You can list other treatment preferences for different circumstances, such as the developmental level of your embryo or fetus.
If you would like your health care power of attorney (also called an “attorney in fact”) to have decision-making authority if you are pregnant, specifically include that as well. A few states, such as Florida, do not allow a surrogate decision maker to consent to withdrawing life support without specific authorization. Make sure you choose a health care proxy who will respect your decisions if you are pregnant.
The best way to ensure your wishes are followed is to have a living will already in place. Use FindLaw’s state-specific advance directive forms to express your medical treatment preferences quickly and easily.
Can Health Care Providers Ignore My Advance Directive?
Medical care providers have a duty to comply with your living will. However, there are several circumstances in which a provider may refuse to honor your wishes:
- If the decisions are contrary to the policy of the health care facility
- If the decisions would violate the provider’s health care standards
- If the decisions conflict with the provider’s conscience
There are several state and federal “conscience clause” laws that allow health care professionals to refuse to participate in health services to which they are morally or religiously opposed. In some cases, providers and facilities will only proceed with a treatment under a court order.
Advance directives are designed to you preserve your bodily autonomy and self-determination in medical decisions. As such, patients have a constitutional right to refuse life-sustaining treatments for themselves. Whether pregnancy exceptions to advance directives are constitutional is not a question that has come before the US Supreme Court.
State Law Guide to Advance Directive Pregnancy Restrictions With Links
| Alabama | Alabama Code § 22-8A-4(e)
Advance health care directives are invalid during a person’s pregnancy. |
| Alaska | Alaska Statutes § 13.52.055
An advance directive declining life-sustaining procedures will not be followed if the procedures would “likely result in the death of the patient” and if “the fetus could develop to the point of live birth” with life-sustaining treatment. |
| Arizona | No law
Arizona Revised Statutes § 36- 3262 provides a sample living will that includes an option to opt out of life-sustaining treatment if pregnant. |
| Arkansas | Arkansas Code § 20-17-206
An advance directive is not effective if “the fetus could develop to the point of live birth” with continued life-sustaining treatment. |
| California | No law |
| Colorado | No Law
In 2021, Colorado passed Senate Bill 21-193, which removed the pregnancy exclusion from its advance directive law (repealing Colorado Revised Statutes § 15-18-104). |
| Connecticut | No law
In 2018, Connecticut passed Public Act 18-11 (HB5148), which removed the pregnancy exclusion from its advance directive law (repealing Connecticut General Statutes §§ 19a-574, 19a-575). |
| District of Columbia | No law |
| Delaware | Delaware Code Title 16 § 2503(j)
“A life-sustaining procedure may not be withheld or withdrawn from” a pregnant patient if the fetus could be viable outside the uterus with continued life-saving treatment. |
| Florida | Florida Statutes § 765.113
Unless the pregnant person specifically authorizes their agent to do so in their advance directive, “withholding or withdrawing life-prolonging procedures” prior to fetal viability is not permissible. |
| Georgia | Georgia Code § 31-32-9
A pregnant person’s directions regarding life-sustaining procedures may only be followed if the fetus is unviable. |
| Hawaii | No law
In 2000, Hawaii passed House Bill 1836, which removed the pregnancy exclusion from its advance directive law (repealing Hawaii Revised Statutes § 327E-13(G)). |
| Idaho | No law
In 2021, Idaho’s law invalidating a pregnant person’s advance directives (Idaho Code § 39-4510) was declared unconstitutional. |
| Illinois | Illinois Statutes Chapter 755 § 35/3
An advance directive is ineffective if “the fetus could develop to the point of live birth” with continued life-saving treatment. |
| Indiana | Indiana Code § 16-36-4-8(d)
Advance directives are invalid during a person’s pregnancy. |
| Iowa | Iowa Code § 144A.6
An advance directive is ineffective if “the fetus could develop to the point of live birth” with continued life-saving treatment. |
| Kansas | Kansas Statutes § 65-28,103
Advance directives are invalid during a person’s pregnancy. |
| Kentucky | Kentucky Revised Statutes § 311.629
Advance directives are invalid during pregnancy unless the procedures will not maintain development and live birth, will be physically harmful to the pregnant person, or prolong severe pain. |
| Louisiana | Louisiana Revised Statutes § 40:1151.9(E)
Advance directives must be interpreted to “preserve human life, including the life of an unborn child if the qualified patient is pregnant and an obstetrician who examines the woman determines that the probable postfertilization age of the unborn child is twenty or more weeks and the pregnant patient’s life can be maintained” so they can give live birth. |
| Maine | No law |
| Maryland | No law
Maryland Code § 5-603 provides a sample living will that includes an option to opt out of life-sustaining treatment if pregnant. |
| Massachusetts | No law |
| Michigan | Michigan Compiled Laws § 700.5512
A health care agent cannot choose to withdraw or withhold treatment if it would result in the pregnant person’s death. |
| Minnesota | Minnesota Statutes § 145C.05, 145C.10
A person may include specific instructions regarding their pregnancy in their advance directive. Otherwise, life-sustaining treatment will be provided if there is a possibility of live birth. |
| Mississippi | No law |
| Missouri | Missouri Revised Statutes § 459.025
Provisions of an advance health care directive regarding withdrawal or withholding of treatment are ineffective during a person’s pregnancy. |
| Montana | Mont. Code Ann. § 50-9-106
“Life-sustaining treatment cannot be withheld or withdrawn” if “it is probable that the fetus will develop to the point of live birth.” |
| Nebraska | Nebraska Revised Statutes § 20-408
“Life-sustaining treatment cannot be withheld or withdrawn” if “it is probable that the fetus will develop to the point of live birth.” |
| Nevada | Nevada Revised Statutes § 449A.451
“Life-sustaining treatment cannot be withheld or withdrawn” if “it is probable that the fetus will develop to the point of live birth.” |
| New Hampshire | N.H. Revised Statutes § 137-J:5(V)
No agent or surrogate has the power to consent to the withholding of life-sustaining treatment during the principal’s pregnancy unless such treatment will not “maintain the principal in such a way as to permit the continuing development and live birth of the fetus” or will be physically harmful to the pregnant person or prolong severe pain. |
| New Jersey | No law
Nonetheless, New Jersey Statutes § 26:2H-56 permits inclusion of pregnancy-specific instructions in an advance directive, and § 26:2H-58 permits instruction limiting an agent’s authority if the declarant is pregnant. |
| New Mexico | No law |
| New York | No law |
| North Carolina | No law |
| North Dakota | North Dakota Century Code § 23-06.5-09
Health care must be provided during pregnancy unless the procedures will not maintain development and live birth, or will be physically harmful or unreasonably painful to the pregnant person. |
| Ohio | Ohio Rev. Code Ann. § 2133.06
Life-sustaining treatment cannot be withheld or withdrawn if it would terminate the pregnancy unless the fetus would not be born alive. |
| Oklahoma | Oklahoma Statutes § 63-3101.4
A person may include specific instructions regarding their pregnancy in their advance directive. Otherwise, life-sustaining treatment will be provided. |
| Oregon | No law |
| Pennsylvania | Pennsylvania Statutes § 20-5429
Regardless of the wishes stated in an advance directive, life-sustaining treatment, cardiopulmonary resuscitation, nutrition and hydration shall be provided to a pregnant woman unless such procedures will not maintain the pregnant patient in such a way as to permit the continuing development and live birth of the unborn child or will be physically harmful or painful to the pregnant person. |
| Rhode Island | Rhode Island General Laws § 23-4.11-6
Advance directives will be given no effect if “it is probable that the fetus will develop to the point of live birth” with continued life-sustaining procedures. |
| South Carolina | South Carolina Code § 62-5-507 (2021)
“Life-sustaining procedures may not be withheld or withdrawn pursuant to the health care power of attorney during the course of the principal’s pregnancy.” |
| South Dakota | South Dakota Codified Laws § 34-12D-10
“Notwithstanding a declaration made pursuant to this chapter, life-sustaining treatment and artificial nutrition and hydration shall be provided to a pregnant woman,” unless such procedures will not maintain development and live birth, will be physically harmful to the pregnant person, or prolong severe pain. |
| Tennessee | No law |
| Texas | Texas Health & Safety Code § 166.049
“A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient.” |
| Utah | Utah Code § 75-2a-123
“A health care directive that provides for the withholding or withdrawal of life sustaining procedures has no force during the course of a declarant’s pregnancy.” The appointment of a health care agent will be effective during the course of a declarant’s pregnancy. |
| Vermont | No law
Vermont Statutes § 18-9702(8) explicitly permits adults to include, in their advance directive, which life-sustaining treatments they prefer if they are pregnant. |
| Virginia | No law
Virginia Code § 54.1-2984 provides a sample advance directive that includes space to provide additional directions if pregnant. |
| Washington | Washington Revised Code §70.122.030
Advance health care directives are invalid during a person’s pregnancy. |
| West Virginia | No law |
| Wisconsin | Wisconsin Statutes § 154.03(2)
Advance health care directives are invalid during a person’s pregnancy. |
| Wyoming | No law |
What Else Goes in an Advance Directive?
Assigning a durable power of attorney and articulating your wishes will give your loved ones peace of mind in the event of an emergency. Living wills contain more than just your medical decisions—the terms can affect the future your caregivers and family members. In addition to the life support treatments listed at the beginning of this article, here are other common decisions to include:
- Do Not Resuscitate (DNR) order (declining cardiopulmonary resuscitation (CPR))
- Nursing home placement
- End-of-life care
- Organ donation
Consult your health care providers if you have questions about how to address a medical condition in your advance directive. (Note that Medicare covers advance care planning visits.) Your provider can also keep a copy of your treatment preferences in your medical record.
Check out other state advance directive laws to learn how to formalize your living will. Each state’s department of health usually has additional details about advance directives on its website.
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