1In 1990, the United States Congress passed the Patient Self-Determination Act which, among other things, requires medical providers to inform patients about their right to execute an advance directive. This landmark Act helped to ensure that a patient’s right to make an informed decision of their health care was protected, even in the event of incapacity.

However, nearly 30 years after the Patient Self-Determination Act was initially passed, to this day, in many states in the U.S., a woman’s advance directive is automatically invalidated if she is pregnant. This exemption is commonly referred to as a “Pregnancy Exclusion Clause.”

Compassion & Choices fully believes in the autonomy of all people, regardless of whether or not they are or are not pregnant, when making their health care decisions.

On May 31, 2018, in coordination with Legal Voice, a non-profit dedicated to advocating for women’s health care rights, we filed a Complaint in the U.S. District Court for Idaho arguing that the Pregnancy Exclusion Clause in Idaho’s advance directive law is unconstitutional. After the Attorney General of Idaho moved the court to dismiss the case, Compassion & Choices filed their Response to Motion to Dismiss.

On March 28, 2019, the U.S. District Court for Idaho filed their Memorandum Opinion and Order, dismissing the case. Compassion & Choices immediately began working on a Motion for Reconsideration, which was filed with the court on April 11, 2019.

On May 2, 2019, the defendants filed a Response to our Motion for Reconsideration, which Compassion & Choices replied to on May 16, 2019. Unfortunately, the court denied our Motion for Reconsideration on June 17, 2019. After that denial, on July 17, 2019, we filed an Amended Complaint. The Idaho Attorney General filed a Motion to Dismiss our Complaint on August 9th, which the court denied on November 8th, 

On December 15, 2020, Plaintiffs and Defendants filed cross-motions for summary judgment. In our brief, we argued,

“The Pregnancy Exclusion violates Plaintiffs’ constitutional rights. It does so now by compelling them to make statements contrary to their beliefs and desires for medical care in the event that they become pregnant, in violation of their right to free speech, and by making their medical decisions contingent, in violation of their Fourteenth Amendment rights to substantive and procedural due process. It does so in the future by potentially nullifying their directives and voiding their right to autonomously decide what medical procedures they will request or decline, in violation of the same Fourteenth Amendment rights.”

Oral argument was heard on these motions February, 26, 2021.

On April 6, 2021, the Federal District Court of Idaho issued a decision in the matter, granting our summary judgment motion in part. In its landmark ruling, the court held that the Pregnancy Exclusion was not a required element of a valid and enforceable directive, and further ruled that the defendants’ previous interpretation of the Act requiring the Pregnancy Exclusion violated the plaintiffs’ constitutional rights.

In its decision, the court held that Idaho’s law violated an individual’s constitutional right to refuse unwanted medical treatment, as the U.S. Supreme Court first recognized in Cruzan v. Director, Missouri Department of Health, stating: “Women do not lose these rights because they are pregnant when they fall into a coma…” The court further ruled that: “[t]he pregnancy exclusion also violates the First Amendment, which prevents the Government from compelling individuals to express certain views, just as it prohibits impermissible Government censorship of speech.”

“This decision is a victory for tens of thousands of women of child-bearing age in Idaho,” said plaintiff Hannah Sharp, who was pregnant when the lawsuit was filed in May 2018, but since has given birth and lives in Boise. “I am so thankful to now have the peace of mind that my directive will be valid and enforceable, despite lacking the pregnancy exclusion language.”

The ruling could have repercussions for pregnancy exclusions in over 30 states, including 10 states with severe restrictions: Alabama, Indiana, Kansas, Kentucky, Michigan, Missouri, South Carolina, Texas, Utah, and Wisconsin.

Compassion & Choices is closely monitoring and ready to defend any appeal of this decision. Compassion & Choices continues to work diligently to protect the health care decision-making rights of all people.


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