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Every state has an advance directive statue that allows individuals to direct their health care in the event they become incompetent. Written into a majority of these statutes is a “pregnancy exclusion” that limits the effectiveness of the advance directive when the patient is a pregnant woman. The effect of the exclusion differs from state to state, and there is virtually no public awareness that pregnancy exclusions exist. This article analyzes the various pregnancy exclusions and explores whether a state's interest in the fetus should take precedence over a woman's right to refuse or terminate life support.