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Comment & Response
September 3, 2019

Regulating Decisions for Incapacitated Pregnant Women—Reply

Author Affiliations
  • 1Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
  • 2Neiswanger Institute for Bioethics, Loyola Stritch School of Medicine, Maywood, Illinois
  • 3General Internal Medicine, Mayo Clinic Health System, La Crosse, Wisconsin
JAMA. 2019;322(9):895. doi:10.1001/jama.2019.10187

In Reply Our analysis sought to characterize the prevalence and contents of statutes and official advance directive documents pertaining to decision-making for incapacitated pregnant women.1 The Arkansas Health Care Decisions Act,2 passed in 2013, was included in our analysis and made no mention of pregnancy. However, Dr Hester and colleagues describe an earlier Arkansas statute, ARTIPUA,3 which restricts end-of-life decision-making for pregnant women. This earlier statute, enacted in 1987, requires ongoing application of life-sustaining technologies to a pregnant woman in a permanently unconscious or terminally ill state so long as “it is possible that the fetus could develop to the point of live birth,” notwithstanding any instruction she has recorded in her advance directive. While the more recent Arkansas Health Care Decisions Act is silent on decision-making for pregnant women, it did not repeal the pregnancy restrictions of the 1987 act. In essence, this burdens front-line clinicians with the challenge of caring for terminally ill pregnant patients within the confines of relevant Arkansas statutes with competing formulations of end-of-life decision-making.