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Looking East and West on Advance Decision-Making in Pregnancy: The Looking East and West on Advance Decision-Making in Pregnancy: The Pregnant Advance Directive Holder in Irish, English and New York State Law Aoife Marie Finnerty LLB, MA Doctor of Philosophy in Law University of Limerick Supervisor: Eoin Quill Submitted to the University of Limerick, May 2021 Abstract In Western society, the point in a woman’s life when she routinely ceases having control over her person in a treatment context – if such a point in time arises – is pregnancy. The Assisted Decision-Making (Capacity) Act 2015 typifies this, providing that advance directives intended to apply in pregnancy be referred for High Court adjudication. The singling out of pregnant women for special treatment where their bodily integrity and self-determination are concerned did not suddenly start with this Act. Instead, impingement on the interests of pregnant women has existed in many domestic legal frameworks for decades. This research discusses the development of such laws and the underpinning moral issues to explain why the Irish legislature drafted the Act in this manner. In doing so, it highlights the many and varied issues – ethical and legal – with the position adopted. Perhaps obvious, but it is only by describing the law applicable to non-pregnant individuals that the extent of these ‘pregnancy exceptions’ are fully articulated. Aiding this exposition, is a discussion of the law in other jurisdictions, namely England and Wales and New York State (and the greater United States). The Irish legislature was undoubtedly guided by the now-repealed 8th Amendment to the Irish Constitution, which protected the right to life of the unborn, however, there is a wealth of international law demonstrating that in pregnancy, exceptions have always been made to the usual rules governing medical treatment. These exceptions can be explicit in laws prohibiting life- sustaining treatment from being withdrawn from pregnant women, despite their wishes. Or, they can be more subtle in laws that allow, however inadvertently, for consent to treatment to be coerced. Spanning seven chapters, this thesis comprehensively discusses informed consent, end-of-life decision-making, advance directives and critically, how the law operates in these areas when the individual is pregnant. Acknowledgements First and foremost, sincere thanks to my supervisor Eoin Quill for his advice and guidance over the past 4 years. I am sure it is rare to find a supervisor whose style of mentoring so suits his supervisee and for that I am eternally grateful. Thanks also to the School of Law at the University of Limerick, which was ‘home’ for the past four years. I wish to express my sincere and heartfelt thanks to Professor Mary Donnelly in University College Cork her generosity of time; without her invaluable, well-timed and considered advice my journey would have been so much tougher. Thanks also to Dr Oliver Feeney in UCC for his advice. Sincere thanks also to Professor Irene Lynch Fannon of UCC for her support and flexibility during my time in UCC and to my colleagues Molly and Jen for their good humour and advice. On a personal level, there are so very many people who provided support, help and friendship along the journey towards PhD. Although it is difficult to understand what is required to complete a PhD thesis unless you have completed one yourself, that has never stopped my closest friends from trying. To my dear friends Dee, Jen, Triona and Niamh, a much-needed listening ear was always there when I needed it and for that, I thank you from the bottom of my heart. In particular, thank you Niamh for your willingness to be where I needed you to be, when I needed you to be there. Without my family, I could not have managed to complete this PhD. To my parents Pat and Maggie, thank you for all the support you have provided over the past four years and throughout my education. Mam, I remember you saying quite some time ago that you thought I would end up going back to do a PhD, so you can definitely claim some of the credit for the idea. To both of you: I am pretty sure this will be my last graduation, so enjoy it! To my brothers, Seán and Brian, thanks for the laughs. Lastly, to my husband John, thank you for everything. Without your support and patience, this would not have been possible. Although these past few years have not been the easiest of times for us, we can look forward now knowing that the best is yet to come. To Annalise and Lila Table of Cases England and Wales AA Re, [2012] EWHC 4378 Re A (A Minor) [1993] 1 Med. L. 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