Viktoria Koskenoja et al v. Gretchen Whitmer, Michigan CoC 25-000165-MM, challenges MCL 700.5509, Authority and responsibilities of patient advocate; suspension.
Sec. 5509(1)(d) reads: "The designation cannot be used to make a medical treatment decision to withhold or withdraw treatment from a patient who is pregnant that would result in the pregnant patient's death."
The lawsuit contends that MCL - Section 700.5509(1)(d) violates Article 1, Section 28 of the Michigan Constitution, Michigan's constitutional protection of abortion.
Patients, doctors challenge Michigan’s ‘pregnancy exclusion’ law in end-of-life care
By Katherine Dailey - October 24, 2025A group of patients, doctors and advocates are suing Gov. Gretchen Whitmer in the Michigan Court of Claims to argue for the unconstitutionality of a so-called “Pregnancy Exclusion” in state law that determines a person’s right to choose their end-of-life care.
The lawsuit specifically concerns the Michigan Estates and Protected Individuals Code, which dictates the process for designating a patient advocate, who can determine a person’s medical care if they are not able to do so themselves. However, pregnancy creates an exception to this.
“A patient advocate cannot make a medical treatment decision under [state law] to withhold or withdraw treatment from a pregnant patient that would result in the pregnant patient’s death,” the statute reads.
Filed on Thursday, the lawsuit alleges that the statute is a violation of due process rights and of equal protection for pregnant people, as well as freedom of speech rights.
The lawsuit, filed by Compassion Legal: The End-of-Life Justice Center at Compassion & Choices; If/When/How: Lawyering for Reproductive Justice; Perkins Coie LLP; and Mogill & Lemanski, PLLC, also argues that this goes against Michigan’s constitutional protections for reproductive freedom, which includes “the right to make and effectuate decisions about all matters relating to pregnancy.”
“Denying individuals the right to refuse treatment because they are pregnant is fundamentally at odds with the Michigan Constitution,” said Jess Pezley, senior staff attorney at Compassion Legal, in a press release.
Stacey LaRouche, a press secretary for Whitmer, wrote to the Advance in response to the suit, “Governor Whitmer has been a champion for reproductive freedom, and led the fight to protect and expand our rights following the repeal of Roe v. Wade, when other states did nothing. We cannot comment on pending litigation, but will be following this closely.”
Dr. Viktoria Koskenoja, an Emergency Medicine Physician in Skandia, Mich., and her husband, Sam Holcomb, are both plaintiffs in the case. Koskenoja designated Holcomb as her patient advocate, should she ever not be capable of making her own medical decisions — and included directions around potential pregnancy in her guidance to him.
“I made the decision to include them anyway because I felt so strongly that my ability to control my own medical care shouldn’t depend on my pregnancy status,” she said in the press release, despite her lawyer encouraging her not to.
“When I agreed to become my wife’s patient advocate, I made a commitment to speak for her if she could not speak for herself, and honor her most personal decisions,” Holcomb added.
The lawsuit has been assigned to Michigan Court of Claims Judge Sima Patel, who earlier this year struck down Michigan’s mandatory 24-hour waiting period for receiving abortions.
One of the plaintiffs speaks out in a Detroit Free Press opinion piece:
Why I'm suing Michigan over state's 'pregnancy exclusion' | Opinion
By Nikki Sapiro Vinckier - October 28, 2025I’ve spent my career helping people make deeply personal medical decisions about their bodies, their pregnancies, and their care. As an OB/GYN Physician Assistant and reproductive health educator, I’ve dedicated my work to helping patients and the public understand their rights and advocate for the care they deserve.
But I never expected that in my own state, I could lose the right to make those same decisions for myself simply because I could become pregnant.
That’s exactly what Michigan law says today. And it’s why I’m suing the state.
The lawsuit
I’m a plaintiff in Koskenoja v. Whitmer, a case challenging a dangerous provision called the "pregnancy exclusion," a law that automatically voids your end-of-life medical decisions the moment you’re pregnant.
Here’s what that means in real life: If you’re pregnant and become incapacitated — say, after a car accident or a brain injury — the loved one you’ve legally chosen to speak for you may be unable to follow your wishes to withdraw life support. The state steps in instead.
When I wrote my own advance directive with an estate planning attorney years ago, I thought I was doing everything right, making sure my loved ones would never have to guess about my care if the unimaginable happened. What I didn’t realize was that one mandated clause wouldn’t allow my loved ones to carry out my wishes if I were pregnant.
That hit home when I read about Adriana Smith earlier this year, a Georgia woman who was declared brain-dead while nine weeks pregnant and kept on life support for months without her family’s consent. As someone who knows exactly what prenatal care entails, the idea of my family having to witness that level of intervention on my incapacitated body, without consent, was beyond what I could ever feel comfortable with.
It’s unthinkable. And it could happen here.
What's at stake
Michigan is one of nine states that automatically invalidates advance directives during pregnancy. In these states, pregnancy becomes a condition that suspends your personhood.
But that’s not who we are. In 2022, Michigan voters made it loud and clear: decisions about pregnancy — whether to continue, end, or manage care — belong to the individual, not the government. Proposal 3 passed by overwhelming margins because Michiganders know this to be true. The pregnancy exclusion doesn’t just ignore that; it defies it.
What happened to Adriana Smith should never happen to anyone. Her story is a horrifying 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.
Michigan’s law even mandates its own words into your paperwork, a state-written sentence declaring that your advance directive cannot be used to withhold treatment if you’re pregnant. Before you’ve even signed your name, the state has already decided whose voice matters. It doesn’t just silence the patient; it forces loved ones to betray the person they promised to protect. And it leaves clinicians caught in the middle, ordered to provide care their patient refused and punished if they don’t.
What consent means
Consent isn’t just a medical formality. It’s the backbone of personal autonomy. It’s the right to say yes, the right to say no, and the assurance that your body is still your own even when you can’t speak for yourself. As both a clinician and a survivor, I know how sacred that is. Consent is what builds trust between a patient and their provider. And this law breaks that trust wide open. It forces clinicians to perform treatment on someone who cannot consent, someone whose documented wishes the law requires them to ignore.
It erodes the very core of ethical care. No clinician should have to carry out procedures their patient explicitly refused. And no patient should ever have to wonder whether pregnancy could strip them of the right to say no.
Why it matters
When people think about reproductive rights, they often think about abortion. But the same ideology that restricts abortion is behind these end-of-life exclusions. Both stem from the belief that the state has a right to control pregnant bodies. Both deny that pregnant people are capable of making moral, informed decisions about their own care.This lawsuit isn’t about special treatment for pregnant people. It’s about equal treatment.
And yes, these situations can be complicated. There are moments when families and clinicians face impossible choices — whether to continue life support, to deliver, or to let go. Those decisions are never simple, and they’re never the same for everyone. That’s exactly why they should belong to the person at the center of them. The point isn’t what choice is made; it’s who gets to make it.
We’re asking Michigan’s courts to enforce what voters already made clear: Your health care decisions belong to you. You shouldn’t have to give up your rights to plan for your future. You shouldn’t have to choose between becoming pregnant and keeping control over your care. And you shouldn’t have to fear that in a moment of crisis, your voice and your choices will be erased.
As both a health care provider and a patient, I refuse to accept that pregnancy is a condition that suspends your bodily autonomy. That’s why I joined this case: because autonomy shouldn’t end at conception, and dignity shouldn’t depend on politics.
Nikki Sapiro Vinckier is an OB/GYN Physician Assistant, reproductive health content creator, and plaintiff in Koskenoja v. Whitmer. She is the founder of Take Back Trust, a national platform helping people navigate reproductive health care in this changing landscape.
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