🟥 States That Invalidate or Override Advance Directives During Pregnancy
As of the most recent national review (based on statutes, not case law), the following 12 states have laws that explicitly void a pregnant person’s advance directive:
Alabama, Idaho, Indiana, Kansas, Michigan, Missouri, Oklahoma, South Carolina, Texas, Utah, Washington, Wisconsin.
⚖️ How These Laws Work
These laws generally fall into two categories:
1. Automatic Invalidation Laws
These states declare that a person’s advance directive is not valid if they are pregnant. Even if someone has stated they do not want life-sustaining treatment (e.g., ventilators, feeding tubes), that directive is ignored if they are carrying a fetus.
Example: In Texas, Section 166.049 of the Health and Safety Code states:
“A person may not withdraw or withhold life-sustaining treatment from a pregnant patient.”
2. Mandated Intervention Until Fetal Viability
Some states require that life-sustaining treatment be provided until the fetus is viable, which may be interpreted as 24–26 weeks or more. This often applies even if the person is brain-dead.
Example: In Missouri, the law states that no advance directive can be honored during pregnancy if it would result in withholding life-sustaining treatment from a pregnant person.
3. Hospital Discretion Laws (Gray Area)
A few states (not listed above) give hospitals or providers discretion about whether to honor an advance directive in pregnancy, which can still result in the family’s wishes being overridden.
🚨 Why This Matters
This is the legal backdrop behind cases like Adriana Smith in Georgia. Although Georgia does not currently appear on this list, ambiguities in state law and institutional fear of liability mean that hospitals may still err on the side of forced life support.
✅ What You Can Do
Check your state’s law on pregnancy restrictions in advance directives.
You can use resources like the Pregnancy Exclusions in State Living Will Laws – National Advocates for Pregnant Women (NAPW) or End of Life Rights Toolkit – Compassion & Choices.
Document your wishes clearly—in some states, adding explicit pregnancy-related clauses can help, even if not legally binding.
Have discussions with your family and care proxy so they know how to advocate for you.
Part 5 of our series “What Happened to Adriana” goes even deeper—following Baby Chance’s 25‑week fight for life after Georgia’s forced‑gestation law kept his brain‑dead mother on life support, and exposing the staggering medical, ethical, and financial costs of a birth that came far too soon.
