Michigan Sued Over Pregnancy Exception In Patient Advocate Authority

One of the plaintiffs speaks out in a Detroit Free Press opinion piece:

https://www.freep.com/story/opinion/contributors/2025/10/28/lawsuit-gretchen-whitmer-michigan-pregnancy-exclusion-reproductive-rights/86879870007/

Why I'm suing Michigan over state's 'pregnancy exclusion' | Opinion
By Nikki Sapiro Vinckier - October 28, 2025

I’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.

The Michigan Court of Claims has struck down the "pregnancy exclusion" to end-of-life care decisions made by advocates of persons unable to communicate their treatment preferences.  Since the Whitmer Administration agrees with this decision (which they surreptitiously sought), there will not be any appeal to the Michigan Supreme Court.

This was "sue-and-settle" litigation removing an issue from the legislative process; another manifestation of the anti democratic practices developed by environmental groups over the past decades:

https://michiganadvance.com/briefs/court-of-claims-strikes-down-michigans-pregnancy-exclusion-in-end-of-life-care/

Court of Claims strikes down Michigan’s ‘pregnancy exclusion’ in end-of-life care
By Katherine Dailey - April 20, 2026

The Michigan Court of Claims struck down multiple provisions of the state’s Estates and Protected Individuals Code that were collectively considered the “pregnancy exclusion” — portions of the law that limited the decisions for end-of-life care that could be made on behalf of a pregnant individual.

Michigan Court of Claims Judge Sima Patel, who struck down Michigan’s mandatory 24-hour waiting period for receiving abortions in 2025, wrote in a judgment released on Thursday that the provisions in question “infringe the fundamental right to reproductive freedom,” as was enshrined in the Michigan Constitution in 2022.

“These provisions do not protect the health of an individual seeking care,” the decision read. “Rather, they prevent individuals who are capable of becoming pregnant of making autonomous decisions about the type of healthcare they will receive in the event they are incapacitated.”

Patel continued on to say that the provisions in question prevent a patient advocate — someone named by a patient to make medical decisions in the case that they are incapacitated — from making decisions in line with the care and custody desired by the patient, only if that patient is pregnant.

“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 read prior to the court’s decision.

During the lawsuit, the defendants — including Gov. Gretchen Whitmer, Attorney General Dana Nessel and Department of Health and Human Services Director Elizabeth Hertel — agreed with the facts brought by the group of patients, doctors and advocates, that the provisions in question were unconstitutional.

However, they argued that their respective departments would simply not enforce those provisions, not requiring the court to get involved. Patel, however, disagreed with this, as there would be no guarantee that those elected and appointed to relevant government positions in 2026 and beyond would share the same interpretation.

“There is no promise that the newly installed government officials will agree with the current defendants’ position and could insist on the enforcement of the challenged statutory provisions,” Patel wrote in her decision. “Further, as long as the challenged provisions remain within the statutes, hospitals are bound to follow them. These are real harms that will impact patients and their designated patient advocates.”