Although polygamy (marriage to two or more spouses at the same time) is illegal in the United States, it sometimes occurs by default, when the individual neglects to get a legal divorce and then takes on a common law spouse. This can create confusion and legal difficulties in the absence of a signed Durable Power of Attorney for Health Care. 

This is a case of a 49-year-old Hispanic male who was involved in a motor vehicular accident while not wearing a seat belt. He suffered multiple chest injuries, fractured ribs and humerus and sustained severe subdural bleeding. He was unconscious when brought to the Emergency Department, where a trauma work-up was done. His CT scan of the head revealed severe bleeding and was inoperable. His pupils were fixed and dilated. His EEG showed minimal brain activity. In short, there was no hope of survival. 

He had been married and had one daughter, however, the marriage did not work out and he left them both. Several months later, he moved in with another woman whom he lived with up to the time of the accident. Although they never married, they had three children together. He never divorced his first wife because of the fact that his parents were very religious Catholics who did not believe in divorce. 

A decision had to be made as to whether or not to remove him from life support. His first (legal) wife said she wanted everything done to keep him alive. His second (common law) wife wanted to remove him from life support and donate his organs. She claimed that he always told her that in the event of serious accident to donate his organs. 

Since the wishes of the legal wife and the common law wife were at odds, the Bio-ethics committee became involved. The case was brought to court, and the decision was made in favor of the common law wife. He was on life support for fifteen days, at which point he was taken off and his organs donated. 

In countries where polygamy is legal, it is usually the first wife who takes precedence; in this country, where simultaneous multiple marriages are outlawed, it is the most recent wife.