Almerico v. Denney, 378 F. Supp. 3d 920

Background

Idaho statute (I.C. § 39-4510) requires the State's model health care directive to include a "Pregnancy Exclusion": if diagnosed as pregnant the directive "shall have no force during the course of my pregnancy."
The Model Form (incorporation clause) must be "substantially similar" to register a directive with the Idaho Secretary of State; unregistered directives remain, by statute, "valid," but the Court assumed for motion practice that noncompliant directives would not be followed.
The Secretary of State's guidance states life-sustaining measures will continue for incapacitated pregnant women despite contrary directives.
Plaintiffs brought a facial challenge to the Pregnancy Exclusion under the Due Process and Equal Protection Clauses.
Defendants moved to dismiss; the key legal question was whether the Supreme Court's Salerno "no set of circumstances" test governs facial challenges here or whether the Casey "large fraction"/abortion-specific exception applies.
The Court dismissed the facial challenge (granting Defendants' motion) but granted leave to amend to pursue an as-applied challenge, recognizing plausible as-applied injuries.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Which facial-review test applies (Salerno no-set-of-circumstances v. Casey large-fraction)?	Pregnancy Exclusion affects a woman’s bodily integrity akin to abortion regulation; Casey should apply.	Salerno governs facial challenges generally; Casey is limited to abortion undue-burden claims and precedent in the Ninth Circuit requires Salerno here.	Salerno applies; Court refuses to create a new exception to Salerno.
Is the Pregnancy Exclusion facially invalid under Salerno?	The statute always violates due process and equal protection by letting the state override directives of pregnant women.	The statute can be constitutional in some circumstances where the State's interest in protecting fetal life outweighs the woman's advance directive.	Plaintiffs failed the Salerno burden; facial invalidation denied because there are conceivable constitutional applications.
Can the State ever constitutionally limit a pregnant woman's advance directive?	Argued broadly that State may not prospectively dictate bodily integrity or end-of-life choices.	Cites precedents recognizing circumstances where State interest (protecting potential life) can justify limiting autonomy.	Court finds there exist plausible circumstances (even if rare) where the State may permissibly restrict a pregnant woman's advance directive.
Procedural disposition / relief	Plaintiffs sought a facial declaration and injunction.	Defendants sought dismissal.	Motion to dismiss granted with leave to amend to pursue as-applied claims; 30 days to amend.

Key Cases Cited

United States v. Salerno, 481 U.S. 739 (establishes the "no set of circumstances" standard for facial challenges)
Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833 (articulates undue-burden framework for abortion regulation and "large fraction" discussion)
Cruzan v. Director, Mo. Dep't of Health, 497 U.S. 261 (states may impose procedures for withholding life-sustaining treatment absent clear evidence of patient wishes)
Washington v. Glucksberg, 521 U.S. 702 (Due Process context: state may prohibit physician-assisted suicide)
Tucson Woman's Clinic v. Eden, 379 F.3d 531 (9th Cir.) (applies Salerno rather than Casey except for undue-burden abortion claims)
S.D. Myers, Inc. v. City & County of San Francisco, 253 F.3d 461 (9th Cir.) (discusses Casey's limited abrogation of Salerno)
Comfort v. Lynn School Committee, 418 F.3d 1 (1st Cir. en banc) (applies Salerno standard)
Pemberton v. Tallahassee Mem. Regional Med. Ctr., Inc., 66 F. Supp. 2d 1247 (N.D. Fla.) (balanced state's interest in protecting fetus against mother's autonomy in mandating C-section)