To the Editor The Research Letter1 on state regulations regarding pregnant women who lack decisional capacity demonstrated variation of health legislation across states. Unfortunately, the analysis incorrectly characterized the state laws in Arkansas.
The Arkansas Rights of the Terminally Ill and Permanently Unconscious Act of 1987 (ARTIPUA)2 contains the following language: “The declaration [a verbal or written advance directive] of a qualified patient [one who is terminally ill or permanently unconscious] known to the attending physician to be pregnant must not be given effect as long as it is possible that the fetus could develop to the point of live birth with continued application of life-sustaining treatment.” Part of the confusion that both the authors and Arkansas clinicians encounter is that the state has a separate Health Care Decisions Act3 that does not address pregnancy issues and is often (and mistakenly) presumed to be the only relevant statute in these matters. While both statutes address making decisions and even developing and implementing advance directives, the Health Care Decisions Act did not make adequate provisions to repeal ARTIPUA when it was enacted, leaving practitioners to navigate multiple statutes rather than just one.
Hester DM, Eisenberg L, Guidry-Grimes L. Regulating Decisions for Incapacitated Pregnant Women. JAMA. 2019;322(9):894–895. doi:10.1001/jama.2019.10183
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