A Brain-Dead Pregnant Woman Was Kept Alive in Georgia. It’s Unclear if State Law Required It.

A Georgia woman declared brain-dead and kept on life support for more than three months because she was pregnant was removed from a ventilator in June and died, days after doctors delivered her 1-pound, 13-ounce baby by emergency cesarean section. The baby is in the neonatal intensive care unit.

The case has drawn national attention to Georgia’s six-week abortion ban and its impacts on pregnancy care.

Adriana Smith was put on life support at Emory University Hospital in Atlanta in February. The then-30-year-old Atlanta nurse was more than eight weeks pregnant and suffering dangerous complications.

Her condition deteriorated as doctors tried to save her life, Smith’s mother told Atlanta TV station WXIA.

“They did a CT scan, and she had blood clots all in her head,” April Newkirk said. “So they had asked me if they could do a procedure to relieve them, and I said yes. And then they called me back and they said that they couldn’t do it.”

She said doctors declared Smith brain-dead and put her on life support without consulting her.

“And I’m not saying that we would have chose to terminate her pregnancy,” Newkirk said, “but what I’m saying is, we should have had a choice.”

Emory Healthcare declined to comment on the specifics of Smith’s case. After doctors removed Smith from life support, Emory issued a statement.

“The top priorities at Emory Healthcare continue to be the safety and wellbeing of the patients and families we serve,” the health system said. “Emory Healthcare uses consensus from clinical experts, medical literature and legal guidance to support our providers as they make medical recommendations. Emory Healthcare is legally required to maintain the confidentiality of the protected health information of our patients, which is why we are unable to comment on individual matters and circumstances.”

In a previous statement, Emory Healthcare said it complies “with Georgia’s abortion laws and all other applicable laws.”

Abortion Laws and Fetal Personhood

Georgia’s HB 481 — the Living Infants Fairness and Equality, or LIFE, Act — passed in 2019. It took effect shortly after the U.S. Supreme Court overturned Roe v. Wade with its ruling in Dobbs v. Jackson Women’s Health Organization on June 24, 2022.

The law bans abortion after the point at which an ultrasound can detect cardiac activity in an embryo. Typically, this occurs about six weeks into pregnancy, often before women know they’re pregnant.

The law also gave fetuses the same rights as people.

It says that “unborn children are a class of living, distinct persons” and that the state of Georgia “recognizes the benefits of providing full legal recognition to an unborn child.”

Nineteen states now ban abortion at or before 19 weeks of gestation; 13 of those have a near-total ban on all abortions with very limited exceptions, according to the Guttmacher Institute, a nonpartisan research group that supports abortion rights.

Like Georgia, some of these states built their abortion restrictions around the legal concept of “personhood,” thus conferring legal rights and protections on an embryo or fetus during pregnancy.

Smith’s case has represented a major test of how this type of law will be applied in certain medical situations.

Despite mainly being unified in their opposition to abortion, conservatives and politicians in Georgia do not publicly agree on the scope of the law in cases like Smith’s.

For example, Georgia Attorney General Chris Carr, a Republican, said that the law should not restrict the options for care in a case like Smith’s and that removing life support wouldn’t be equivalent to aborting a fetus.

“There is nothing in the LIFE Act that requires medical professionals to keep a woman on life support after brain death,” Carr said in a statement. “Removing life support is not an action ‘with the purpose to terminate a pregnancy.’”

But Republican state Sen. Ed Setzler, who authored the LIFE Act, disagreed. Emory’s doctors acted appropriately when they put Smith on life support, he told The Associated Press.

“I think it is completely appropriate that the hospital do what they can to save the life of the child,” Setzler said. “I think this is an unusual circumstance, but I think it highlights the value of innocent human life. I think the hospital is acting appropriately.”

Mary Ziegler, a law professor at the University of California-Davis and author of “Personhood: The New Civil War Over Reproduction,” said the problem is that Georgia’s law “isn’t just an abortion ban. It’s a ‘personhood’ law declaring that a fetus or embryo is a person, that an ‘unborn child,’ as the law puts it, is a person.”

The legal concept of “personhood” has implications beyond abortion care, such as with the regulation of fertility treatment, or the potential criminalization of pregnancy complications such as stillbirth and miscarriage.

Under Georgia’s law, extending rights of personhood to a fetus changes how child support is calculated. It also allows an embryo or fetus to be claimed as a dependent on state taxes.

But the idea of personhood is not new, Ziegler said.

“It has been the goal for virtually everyone in the anti-abortion movement since the 1960s,” she said. “That doesn’t mean Republicans like that. It doesn’t necessarily mean that that’s what’s going to happen. But there is no daylight between the anti-abortion movement and the personhood movement. They’re the same.”

The personhood movement has gained more traction since the Dobbs ruling in 2022.

In Alabama, after the state’s Supreme Court ruled that frozen embryos are people, the state legislature had to step in to allow fertility clinics to continue their work.

“This is sort of the future we’re looking at if we move further in the direction of fetal personhood,” Ziegler said. “Any state Supreme Court, as we just saw in Alabama, can give them new life,” she said referring to personhood laws elsewhere.

Fetal Personhood Laws Can Delay Care

In Georgia, dozens of OB-GYNs have said that the law interferes with patient care — in a state where the maternal mortality rate is one of the worst in the U.S. and where Black women are more than twice as likely to die from a pregnancy-related cause than white women.

Members of Georgia’s Maternal Mortality Review Committee — who were later dismissed from the panel — linked the state’s abortion ban to delayed emergency care and the deaths of at least two women in the state, as ProPublica reported.

The personhood provision is having a profound effect on medical care, said Atlanta OB-GYN Zoë Lucier-Julian.

“These laws create an environment of fear and attempt to coerce us as providers to align with the state, as opposed to aligning with our patients that we work so hard to serve,” Lucier-Julian said.

Lucier-Julian said that’s what happened to Emory Healthcare in Smith’s case.

Cole Muzio, president of the Frontline Policy Council, a conservative Christian group, said the state’s abortion law shouldn’t have affected how Emory handled Smith’s care.

“This is a pretty clear-cut case, in terms of how it’s defined in the language of HB 481,” he said. “What this bans is an abortion after a heartbeat is detected. That is the scope of our law.”

“Taking a woman off life support is not an abortion. It just isn’t,” Muzio said.“Now, I am incredibly grateful that this child will be born even in the midst of tragic circumstances. That is a whole human life that will be able to be lived because of this beautiful mother’s sacrifice.”

A suit challenging Georgia’s law and its impact on public health is working its way through the courts. A coalition of physicians, the American Civil Liberties Union of Georgia, Planned Parenthood, the Center for Reproductive Rights, and other groups filed the suit.

Newkirk said her daughter had initially gone to a different Atlanta-area hospital for help with severe headaches, was given some medicine, and was sent home, where her symptoms quickly worsened.

“She was gasping for air in her sleep, gargling,” she told WXIA in May. “More than likely, it was blood.”

Now, Newkirk said, the family is praying for her grandson to make it after the stress from months of life support.

He is fighting, she said.

“My grandson may be blind, may not be able to walk, wheelchair-bound,” she said. “We don’t know if he’ll live.”

She added that the family will love him no matter what.

This article is from a partnership with WABE and NPR.