In
many states, pregnancy invalidates a woman's DNR
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[April 24, 2019]
By Linda Carroll
(Reuters Health) - Most states have
statutes that invalidate a woman's advance directive if she is pregnant,
a U.S. study finds. And because those statutes are often not clearly
outlined in the DNR form, women filling out an advance directive most
likely would not know that it wouldn't apply if they were pregnant,
researchers reported in JAMA.
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"Two-thirds of states that had restrictions didn't disclose that in
the advance directive document," said study leader Dr. Erin
DeMartino of the Mayo Clinic in Rochester, Minnesota. "So a person
could in good faith fill out a DNR and assume that unless she
decides to annul it herself it would be a valid document moving
forward."
DeMartino and her colleagues were surprised at how common the
pregnancy exceptions were.
"One of the purposes of our study is to shine a light on where we
are in 2019 and to show the American public and medical
professionals the prevalence of these laws and how they could apply
in the rare medical circumstances where they come up," she said.
The situation may be rare, but it's certainly not unheard of for a
young woman to end up incapacitated and tethered to life support
machines because of a pregnancy statute. In 2014, 33-year-old
Marlise Munoz suffered a pulmonary embolism and was pronounced
brain-dead upon arrival at the hospital. She was 14 weeks pregnant
at the time.
Although Munoz had told her husband and family that she wouldn't
want to be kept alive by machines if she were fatally injured,
doctors said they could not disconnect her from life-support. The
family was told that even if Munoz had a DNR, a Texas statute
forbade them from taking a pregnant woman off life-support. It took
a lawsuit by her husband to get permission two months later to
remove life-support from Munoz.
To take a closer at the issue, DeMartino and her colleagues used the
Nexis Uni and Fastcase databases to search for laws effective in
February 2019 that governed treatment decisions for incapacitated
pregnant women. They also scrutinized advance directive documents
from each state.
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The researchers found that 28 states had statutes restricting a
woman's choice to withhold or withdraw life-sustaining therapies
because of pregnancy - and 68 percent of the official advance
directive forms in those states did not disclose the pregnancy
restrictions. Of the 28, 25 had statutes that invalidated a woman's
DNR if she turned out to be pregnant. And three states - Alaska,
Georgia and Oklahoma - required that physicians test a woman for
pregnancy before withholding or removing life-support.
Two states - Washington and Idaho - did not have a specific statute
barring the removal of life-support from pregnant women but did
state in their DNR forms that it was not allowed. Eight states'
advance directive documents asked for the woman's pregnancy-specific
care preferences.
While 18 states banned withdrawal of life-sustaining therapy when
the treating physician determined the fetus could survive if the
mother was kept on life-support, 12 required the woman be kept on
life-support regardless of the fetus's status. In 19 states,
surrogates' decisions were restricted because of pregnancy.
The new findings are "chilling," said Dr. Albert Wu, an internist
and professor of health policy and management at the Johns Hopkins
Bloomberg School of Public Health. "It's shocking that the vast
majority of U.S. states actually restrict the rights of women who
happen to be incapacitated in this unfortunate situation. I'm
disappointed and disturbed by this."
The statutes described in the new study "are a violation of the
rights of women," said Wu, who was not involved in the new research.
"It adds insult to injury that in the majority of cases these
restrictions are not disclosed to people when they are expressing
their choices in their advance directives."
SOURCE: http://bit.ly/2ZsD9RI JAMA, online April 23, 2019.
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