Ending life support for two

The recent birth of a baby after doctors put his brain-dead mother on life support for nearly four months has reignited debate over end-of-life decisions for pregnant women. While abortion supporters claim pro-life laws ignore women’s healthcare decisions, pro-lifers say that medical advances give unborn babies a chance at life even in tragic circumstances.

Adriana Smith was nine weeks pregnant when she began experiencing severe headaches, later revealed to be a symptom of blood clots in her brain. On Feb. 19, physicians at Emory University Hospital in Atlanta placed the brain-dead Smith on a ventilator, hoping it would allow her baby to reach viability.

On June 13, doctors delivered Smith’s baby, whom her family named Chance, via cesarean section and rushed him to the neonatal intensive care unit. “He’s expected to be okay,” Smith’s mother, April Newkirk, told 11Alive News Atlanta about the 1 lb., 13 oz. baby. “He’s just fighting.”

Four days after Chance’s delivery, Emory physicians removed Smith’s ventilator. Her funeral is scheduled for Saturday.

According to a statement Newkirk gave to 11Alive News, doctors told Smith’s family earlier this year that they could not remove her from life support because of Georgia’s pro-life law. The state’s 2019 Living Infants Fairness and Equality (LIFE) Act protects babies from abortion once they have a detectable heartbeat, typically around six weeks of gestation. “I’m not saying we would have chosen to terminate her pregnancy,” said Newkirk. “But I’m saying we should have had a choice.”

Medical literature records at least 30 cases of brain death during pregnancy. In 2013, Marlise Munoz, 33, suffered blood clots in her lungs and was placed on life support on behalf of her 14-week-old fetus, despite her family’s wishes. Once she reached 22 weeks and physicians at a hospital in Fort Worth, Texas, said that the fetus likely had hydrocephalus and maybe a heart problem, a judge ordered doctors to remove life-sustaining treatment.

In Smith’s case, there’s disagreement about which laws prevented the hospital from removing the ventilator. Without providing patient-specific details, Emory Healthcare told several news outlets in May that it followed “individualized treatment recommendations in compliance with Georgia’s abortion laws and all other applicable laws.”

Abortion supporters responded by portraying Smith as a martyr of the state’s abortion ban. “The anti-abortion movement imbues every fetus with nearly messianic potential while discarding the pregnant person carrying it as a nonentity,” wrote Andrea González-Ramírez, a senior writer for New York Magazine’s The Cut. “In life and in death, we’re just human incubators to them.” Ms. Magazine titled a piece about the case, “Adriana Smith and the Legal Horror of Reproductive Servitude in the U.S.”

David Gibbs, president and general counsel of the National Center for Life and Liberty, noted that, while the hospital decided not to risk violating the state’s abortion ban, it likely misinterpreted the legislation. Still, the media took the opportunity to misrepresent the pro-life movement. “It is not like we have wards full of drugged or brain-dead women and we’re putting fetuses in them to take them to term,” said Gibbs. “That would be what they’re trying to paint it as, but that’s not the situation.”

Gibbs isn’t alone in this assessment. In an essay published in the The Atlantic, Elizabeth Bruenig opined about the moral dubiousness of using a legally dead person to treat a living one. But, she added, “it isn’t a case of a woman being forced to carry an unwanted pregnancy to term, as much of the coverage of Smith’s situation has suggested.”

On May 16, Georgia Sen. Nabilah Islam Parkes condemned the hospital’s decision as “the most extreme and stark example of a kind of pain and degradation inflicted on women and families every day under Georgia’s cruel abortion ban.”

The office of Georgia Attorney General Chris Carr clarified that the state’s abortion ban didn’t really apply to the complex scenario: “There is nothing in the LIFE Act that requires medical professionals to keep a woman on life support after brain death.” Removing life support, according to the attorney general, isn’t the same as purposefully aborting a pregnancy.

Even though the hospital may have hoped to avoid a lawsuit for possibly breaching the LIFE Act, Georgia’s abortion ban might not have been the only reason the doctors kept Smith on life support.

A very similar Georgia case predates the state’s 2019 pro-life law. In 1986, 25-year-old Donna Piazzi was declared brain dead because of a drug overdose. A judge ordered doctors to keep Piazzi on a respirator until her fetus, 21 weeks along at the time of her brain death, could reach viability.

Despite the fact that abortion in Georgia was legal under Roe v. Wade at the time, the judge nevertheless concluded that, “public policy requires the maintenance of life support systems for a brain-dead mother as long as there exists a reasonable possibility that the fetus may develop and survive.”

The Piazzi case may not have provided a clear precedent if Smith’s family had sued the hospital, but it demonstrates that Georgia’s abortion restriction might not have been the only law keeping Smith on life support.

In a social media post, the Secular Pro-Life advocacy group suggested that Emory’s physicians also had to consider Georgia’s Advance Directive for Health Care Act of 2007. According to the code, doctors may not remove life-sustaining care from a pregnant patient unless she made her wishes clear with a legal document, called an advance directive, and her fetus isn’t capable of viability.

Most states have similar rules about end-of-life decisions during pregnancy. Twenty-seven states require physicians to keep pregnant patients on life support, and some of those jurisdictions do not make exceptions even if a woman has stipulated that she doesn’t want to be kept on life support after brain death. When a pregnancy invalidates an advance directive, legal experts call it a “pregnancy exclusion.”

In 2015, the American College of Obstetricians and Gynecologists released a statement declaring that doctors ought to respect the woman’s end-of-life choices, regardless of pregnancy status.

Some state legislators agree. In 2021, Colorado authorized women to preemptively refuse life-sustaining care in the event of brain death during pregnancy. Beginning July 27, women in Washington state may also do so. Esther Ripplinger, president and CEO of Human Life Washington, told WORLD in an email that the updated law “reveals a blatant disregard for human dignity—going so far as to search under every rock to prevent unborn children from even having a chance at life.”

Kansas could soon follow Washington’s lead. On May 29, the pro-euthanasia nonprofit Compassion and Choices filed a lawsuit challenging the Sunflower State’s Natural Death Act, which invalidates the advance directives of pregnant women. “I shouldn’t have to fear that my pregnancy could cost me my dignity and autonomy,” wrote Emma Vernon, the eponymous plaintiff. “I am no less capable of planning my medical care simply because I am pregnant. I know what is best for me.”

Since only 1 in 3 adults have recorded their end-of-life wishes in a legal document, removing pregnancy exclusions might not honor the wishes of patients who wanted to give their infants the best shot at survival. That could give doctors, not loved ones, the final say.

“The more you put the physicians on autopilot, the greater their ability to direct your care,” said Heidi Klessig, a former anesthesiologist. She recommends that anyone over the age of 18 sign a “life-affirming” medical power of attorney document to clarify their wishes.

If patients don’t have their wishes in writing, physicians ought consider family members’ perspectives, according to John Mize, CEO of Americans United for Life.

In Adriana Smith’s case, “there wasn’t an advance directive that the child be terminated,” said Mize. “So who’s to say that the mom wouldn’t have wanted her child to be brought to term given her circumstances? And that’s the complexity in the gray area.”

Although Mize believes the hospital rightly erred on the side of life, he said it should have at least brought Smith’s family into the decision-making process. And they may not have opted for termination.

“I just want to be clear on something,” April Newkirk told 11Alive in late May. “We want her to have her baby, we want her life to continue through her children, but at the same time, to see her lay there like that, for that length of time, the grieving process for us can’t even start.”

In Mize’s opinion, focusing on the pro-life law misses the point. “The child’s worthy of a life, just like anyone else,” said Mize. “And they did the best that medicine can provide.”