Advance directives––legal instruments that allow individuals to document their medical decision preferences in the event of later incapacitation––are a tool for safeguarding patient autonomy. Every state in the United States recognizes the validity of some form of advance directive. Yet more than half of states have laws that potentially invalidate a person’s advance directive solely because a patient is pregnant. These “pregnancy exclusions” are embedded in state statutory schemes and can serve to automatically revoke or suspend a pregnant woman’s previously documented end-of-life decisions, including decisions about whether and when life-sustaining care should cease. Such exclusions may lead medical providers to administer life-sustaining treatment against the patient’s stated wishes for the sole purpose of preserving the pregnancy. Plainly stated: these exclusions may potentially compel providers to use an incapacitated pregnant patient’s body as an incubator.

It is difficult to imagine a more devastating situation than that of an incapacitated patient’s family who has lost a loved one and still faces decisions about whether to continue life support for the purpose of sustaining the pregnancy. In February 2025, Adriana Smith, a 30-year-old Georgia resident, sought medical attention at Northside Hospital after experiencing a series of headaches. Clinicians administered medication to Ms. Smith and she was released. The following day, Ms. Smith was found unresponsive and was subsequently declared brain dead. At the time of Ms. Smith’s death, she was approximately nine weeks pregnant. Medical personnel kept Ms. Smith on life support for 16 weeks to sustain her pregnancy. In June 2025, clinicians terminated Ms. Smith’s life support after delivering Ms. Smith’s baby via caesarean section, at approximately 25 weeks gestation.

There are conflicting and unclear reports about Ms. Smith’s family’s wishes regarding her medical care, as well as the basis for the hospital’s decision to continue life support. It was initially reported that the hospital told Ms. Smith’s family that Georgia’s anti-abortion laws demanded that life-sustaining care for Ms. Smith continue. A later statement from the Georgia Attorney General indicated, however, that the Georgia law did not require sustaining care because “removing life support is not an action with the purpose to terminate a pregnancy.”

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