Honoring a person’s wishes at the end of life is widely recognized as profoundly important to humane, ethical care.1 To that end, efforts to help individuals make their preferences about end-of-life care known have involved advance care planning, including the completion of advance directives and identification of a surrogate decision maker. Yet, in many jurisdictions in the United States, one condition invalidates a patient’s wishes or efforts on the part of surrogates to honor them: pregnancy.