When the story of Adriana Smith broke earlier this year, people across the country were horrified. Declared brain-dead at just nine weeks pregnant, Adriana was kept on life support for months against her family’s wishes. Her body became the site of a state-mandated experiment in control — one that forced treatment on a woman who could no longer consent.
For many of us, Adriana’s story didn’t reveal something new. We already knew how fragile bodily autonomy had become in this country. But it was an exceptionally horrific display of just how little some lawmakers think of women, and how far they’ll go to control our bodies. Forcing care on someone who can no longer consent and treating a person as a vessel rather than a human being is not medicine. It is subjugation.
I’ve written my own advance directive in Michigan. I’m an OB-GYN physician assistant. And even knowing what I know, I was stunned to realize that under my state’s law, those protections can be erased the moment pregnancy is detected.
That realization is what led me to join a lawsuit against my own state. I’m a plaintiff in Koskenoja v. Whitmer, a case challenging Michigan’s pregnancy exclusion — a statute that nullifies a person’s end-of-life medical decisions if they are pregnant.
Under this law, if someone capable of becoming pregnant is in a car accident and becomes incapacitated, their advance directive — the document naming who should make decisions for them — would no longer apply. The state would decide instead. Their autonomy ends where pregnancy begins.
“As both a health care provider and a patient, I refuse to accept that pregnancy is a condition that suspends your personhood.”
This isn’t hypothetical for people like me. I’m someone who could become pregnant, and that means the rights I’ve carefully outlined for myself could disappear the moment a pregnancy is detected. Michigan is one of at least nine states — including Texas, Alabama, Missouri, Utah and Wisconsin — that automatically invalidate advance directives during pregnancy. These laws send the same chilling message: Once you’re pregnant, decision-making no longer belongs to you.
The pregnancy exclusion has existed for decades with little to no public attention, quietly stripping pregnant people of the right to make their own medical choices. But in 2022, Michigan voters made it clear that we reject that logic. Through the first-ever citizen-led ballot initiative of its kind, we amended our state constitution to protect the right to make and carry out decisions about all matters relating to pregnancy: abortion, birth, miscarriage care, contraception, infertility treatment and postpartum recovery. The pregnancy exclusion directly contradicts that promise.
What happened to Adriana Smith should never have happened to anyone. Her story is a heartbreaking reminder of what’s at stake when the state takes control of a person’s body, even after they can no longer speak for themselves. The same ideology that justifies forced birth also justifies forced treatment. Both rest on the belief that pregnant people are exceptions to the rules of bodily autonomy.
As both a clinician and a survivor of sexual assault, I know how sacred the principle of consent truly is. This law forces providers to break that trust — to perform treatment on a patient who cannot consent, and whose prior decisions we’re legally required to ignore. It replaces the will of the patient with the will of the state. That’s not medicine. That’s control.
It erodes the very foundation of ethical care. No doctor should be compelled to carry out procedures their patient has explicitly refused. And no patient should ever have to wonder whether pregnancy could strip them of the right to say no.
If a government can override a pregnant person’s decisions when they’re incapacitated, it can override anyone’s. That’s why this case matters — not just in Michigan, but everywhere. As both a health care provider and a patient, I refuse to accept that pregnancy is a condition that suspends your personhood. That’s why I joined this case — because autonomy shouldn’t end at conception, and dignity shouldn’t depend on politics.
Nikki Sapiro Vinckier, PA-C, is an OB-GYN physician assistant, reproductive health content creator and founder of Take Back Trust, a platform equipping patients to navigate and protect their reproductive health care. She blends over a decade of clinical experience with digital advocacy to make reproductive education accessible and empowering. Follow her on social media at @nikkivinck.
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