Invalidation of US Advanced Directives for Pregnant Persons: Loss of End-of-Life Autonomy (V)
Hannah Carpenter1, Georgia Loutrianakis The University Of Texas Medical Branch Galveston2, Galveston Texas 1The University Of Texas Medical Branch, Galveston, Texas, United States2The University Of Texas Medical Branch, Galveston, Texas, United States
Abstract
All individuals, regardless of their pregnancy status, should be able to direct their end-of-life care. However, over half of the states in the US endorse pregnancy clauses within their advanced directive regulations, invalidating the end-of-life decision-making of pregnant persons. Whilst pregnancy exclusion laws already impose several ethical implications on pregnant persons, anti-abortion legislation will place further constraints on autonomy, injustice, and dignity of pregnant or potentially pregnant persons. “Dobbs v. Jackson Women’s Health Organization” carries further implications for pregnant persons and physicians in states where abortion is now criminalized. This legislation has exacerbated the need for advanced directives for pregnant persons following a growth in pregnancies, which has resulted in increased pregnancy mortality rates, unsafe pregnancies, and a lack of access to safe abortions.
“Dobbs” may result in further states adopting similar pregnancy exclusion laws, making it even harder for pregnant persons and their families to challenge restrictive advanced directive statutes. Pregnant persons have become increasingly more vulnerable because they experience an increased risk of mortality, health complications, and reduced access to needed care. These provide a need for end-of-life planning. To protect this vulnerable population, we suggest: (1) increasing awareness of exclusion laws; (2) encouraging persons to discuss their end-of-life preferences and complete advanced directives; (3) increasing research on how pregnant persons are affected by exclusions clauses; and (4) supporting legislation that allows pregnant persons’ advanced directives to remain legitimate, regardless of their pregnancy status. In the shadow of “Dobbs,” we need to protect pregnant persons’ autonomy wherever possible.
Biography
Hannah Carpenter is a second-year PhD student in bioethics and health humanities at the University of Texas Medical Branch in Galveston, Texas, United States. She has a background in law and healthcare policy. Her research focus is reproductive healthcare justice and ethics, public health policy, and clinical ethics.
Georgia Loutrianakis is a third-year PhD candidate in bioethics and health humanities at the University of Texas Medical Branch in Galveston, Texas, United States. Her dissertation is focused on the intersection of ethical conceptions of trust and reproductive healthcare access. Research interests include clinical ethics, reproductive healthcare justice and ethics, and feminist trust theories.