Position Statement on Life-Sustaining Care and Advance Directives for Pregnant Patients

Many states have laws that invalidate advance directives during pregnancy, limit decision-making regarding life-sustaining care, and grant personhood to fetuses. These laws adversely affect pregnant patients’ autonomous decision-making. By invalidating standard medical decision-making, legal documents, and agreements, these laws strip pregnant patients of their autonomy and may force them to receive care that violates their values. These laws also constrict obstetrician-gynecologists’ ability to practice evidence-based and ethical care, as they may require clinically futile interventions, impede professional autonomy, and interfere with the patient-physician relationship.

ACOG believes that patients are best suited to make pivotal decisions about their own lives and medical care, and that medical institutions and governments should not attempt to interfere with those decisions. Pregnancy is not an exception to the principle that a decisionally-capable patient has the right to refuse treatment, even treatment needed to maintain life. Therefore, a decisionally-capable pregnant person’s decision to refuse recommended medical or surgical interventions should be respected. The standard of medical care when a patient loses the capacity to make medical decisions is to rely on advance directives and proxy decision-makers to guide clinical care. Deviation from this standard for pregnant patients is not ethically justified. ACOG specifically calls for the repeal of all laws that interfere with the autonomous decision-making of pregnant people including laws that invalidate or limit advance directives or limit decision-making regarding life-sustaining care.

ACOG recommends that obstetrician-gynecologists support a pregnant patient’s autonomy and treatment decisions to the fullest extent permissible under the law. ACOG also recommends that obstetrician-gynecologists discuss and document patients’ values and wishes regarding future care and offer advance directives to ensure that clinicians and medical institutions have the information needed to support pregnant patients’ autonomy.

Additional Resources

ACOG Committee Opinion on End-of-Life Decision Making
Compassion & Choices resource on Pregnancy Exclusions

Approved by the Board of Directors: November 2025