Adriana Smith’s Case: A Stark Call for Clarity in End-of-Life Care and Reproductive Law

Adriana Smith, a registered nurse at Emory University Hospital in Atlanta and a mother of two, has become the centre of a deeply emotional and legally complicated matter. Doctors declared her brain dead (a condition when a person on artificial life support has no brain activity left and is a legal and medical confirmation of death). However, Adriana was kept on life support for over 90 days, not for her recovery, but to keep her pregnancy. At 32 weeks of gestation, she delivered a premature baby boy whom her family called Chance.

According to the family, at the beginning of February, at only nine weeks of pregnancy, Adriana complained of a severe headache. She appealed to Northside Hospital, but after receiving medication with no testing, she was discharged. Her boyfriend found her unable to breathe in sleep and brought her to the hospital. There, the scan showed the presence of blood clots in the brain. Shortly after that, she was declared brain-dead.

Afterwards, the hospital informed the family of the abortion law, the Living Infants Fairness and Equality (LIFE) Act, which is very restrictive for abortion in Georgia. As per this law, as soon as a fEtal heartbeat is detected, which generally happens around six weeks of pregnancy, abortion is forbidden. The law, however, allows only those cases of rape, incest, or if the mother’s life is endangered, to continue with the abortion. None of these cases correspond to Adriana’s situation.

The law is not clear about the procedures to be followed if a woman’s pregnancy has been declared dead, both legally and medically. This obscurity did no good to Adriana’s friends and family to the extent that they felt disarmed. The issue of whether or not to discontinue life support was, as claimed by her mother, April Newkirk, the decision of nobody else but Adriana’s partner or the immediate family. They were not only focused on the fate of the dignity of Adriana but also on that of the unborn child. Chance, who was born weighing only 1 pound and 13 ounces, is still struggling to live in the neonatal intensive care unit. His health forecast is still not clear.

This matter brings into the limelight the challenge that law places on the tonic of death and last care, fed from the core of the emotional community depth and the personal pain of the medical profession.

The LIFE Act and the Legal Grey Area

The LIFE Act (House Bill 481) has eradicated parental rights. It has legalized abortion to the ninth month of pregnancy in Georgia (United States), which was passed in 2019 and implemented fully in 2022 after the Dobbs v. Jackson Women’s Health Organization ruling. This decision prohibited the acceptance of the landmark decisions of Roe v. Wade and Planned Parenthood v. Casey. These decisions granted the woman a constitutional right to abortion in the absence of fetal viability. The point of fetal viability is the stage where the baby can survive outside the womb, usually with the help of technology, around 24 weeks.

Roe v. Wade introduced an abortion rule based on trimesters. It allowed the state not to have power over abortion in the first trimester and limited power in the second. It gave the state the right to restrict the abortion practice in the third trimester, except in the case of health emergencies. The minimal influence was to be replaced by the “undue burden” standard after the decision of Planned Parenthood v. Casey. If any law was considered to be placing a significant obstacle for a person who was on the way to abortion before viability and that law would be deemed constitutional, then it would be so according to the regulations.

On the other hand, the LIFE Act has a different approach in that it is now aimed at safeguarding the unborn child. It extends the unborn child’s legal rights as a natural person from when the heartbeat is detected. The law even talks about the fetus being included in some population counts and considered a dependent child for income tax purposes.

While the law permits abortion to prevent the death or severe physical impairment of the pregnant woman, it does not explicitly describe the procedure to be followed in the case of a pregnancy involving a brain-dead mother. Despite this legislative ambiguity, the hospital initially informed Smith’s family that because of the detectable fetal heartbeat and the LIFE Act, Adriana legally had to be kept on life support for fetal survival, thus effectively prohibiting abortion. Emory Healthcare has said that its staff made decisions based on experts’ opinions, medical literature, and legal advice. However, this situation for Adriana’s family meant having to accept that they were not even consulted, and thus, no one was there to represent their daughter’s care or her body.

Attorney General’s Clarification: A Step Towards (But Not Full) Resolution

As public outcry grew, fueled by Smith’s mother, April Newkirk, who defended her family’s right to choose, Democratic Senator Nabilah Islam Parkes formally requested clarification from Republican Attorney General Christopher Carr in late May. Carr’s office later released a statement that drove the point home: “The LIFE Act doesn’t in any way obligate healthcare workers who have a brain-dead woman to continue life support. Removing life support is no different than the process of ending a pregnancy.” A message of hospitals not being legally obligated by the LIFE Act to provide life support for a brain-dead pregnant woman went as far as the clarification. Emory Healthcare’s initial confusion and the lack of a quick public response to this legal opinion still demonstrate how such laws can scare healthcare workers if they misinterpret them. They might be afraid that they will be sued because of a lack of legislative guidance for their actions, and thus, they will be cautious and withdraw from their work.

What Adriana Smith’s Case Reveals

The story of Adriana cannot be summed up in abortion laws and political arguments. The story is really about human dignity, consent, the limitations of the law in dealing with real-life situations, and the never-ending fight of the pro-life versus pro-choice camp.

Keeping a brain-dead woman on life support to preserve a pregnancy without her prior consent or her family’s agreement forces us to ask difficult questions. Who decides when the patient cannot? Should a fetus’s right to life automatically override the dignity and autonomy of the mother’s body? How should hospitals respond when the law offers no guidance?

These are not hypothetical questions. They are authentic for families who must live through them, often in the most traumatic moments of their lives.

In the post-Dobbs era, many states have enacted strict abortion laws. But many of these laws, including Georgia’s LIFE Act, have not accounted for complex medical situations like Adriana’s. The fear is that these legal gaps and rigid interpretations may turn women into passive vessels, stripping them and their families of agency when they need it most.

Conclusion

Adriana Smith’s situation is a case that very painfully illustrates that laws are not just mere words written on paper. They impact people with families, which are cases of families positively dealing with grief and uncertainty. While the idea of protecting the life of the unborn is the principal value that is sincerely adhered to by many, it definitely should not come at the price of being blind to the human side of the mother, especially when no one can speak on her behalf.

In the situation when a woman is diagnosed as brain dead, the continuation of the pregnancy should not be considered as an automatic legal condition. This ought to be a decision made with advisement and sharing feelings. The decision should involve a team of healthcare providers and the family because it is only created thoughtfully and compassionately in this way. If not, we will go down the road of turning the place where we are supposed to get care, hospitals, into areas where policy reigns, empathy is nowhere to be found, and dignity is lost in silence.

The case highlighted the urgency of lawmakers revising and updating the laws regulating reproduction and death to make them more suitable for the current times. We want legal systems that are consistent and have an element of kindness. Until then, it is families like Adriana’s that will continue to be engulfed by grief and helplessness, being caught in the space between the silence of the law and the burden of conscience.

References:

• Brain dead pregnant women: Adriana Smith, brain-dead Georgian mother who gave birth to a son, to be taken off life support – The Economic Times
• brain dead: Miracle! 31-year-old brain dead woman delivers baby. Here’s what doctor is saying – The Economic Times
• Georgia mother says she is being forced to keep brain-dead pregnant daughter alive under abortion ban law
• Abortion by state: Tracking trigger laws, bans, or restrictions
• Family claims woman declared brain dead but pregnancy continues due to state law | 11alive.com
• LIFE Act: All about Georgia’s strange abortion law, which is not allowing a brain-dead pregnant woman to die | – Times of India
• https://www.legis.ga.gov/api/legislation/document/20192020/187013