Michigan’s “Pregnancy Exclusion” Law

November 12, 2025

Under the Michigan Estates and Protected Individuals Code, a person can designate a patient advocate to determine their medical care, should they be unable to make or communicate their own decisions. Michigan thus offers a critical protection of our rights to bodily autonomy and self-determination – unless you’re pregnant. Under the statute’s “pregnancy exclusion,” patient advocates are barred from acting on advance directives to make medical decisions to withhold or withdraw treatment, if doing so would result in the pregnant patient’s death.

Does the “pregnancy exclusion” sound unfair to you? The plaintiffs in Koskenoja v. Whitmer sure think so. In Koskenoja, Dr. Viktoria Koskenoja, an Emergency Medicine Physician, designated her husband, Sam Holcomb, as her patient advocate. Koskenoja created directions for end-of-life care, including directions for care should she be pregnant. Her lawyer, aware of the “pregnancy exception” advised against doing so. But Koskenoja was firm: “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 felt so strongly that she decided to sue, alongside other patients, doctors, and advocates, to argue that the “pregnancy exclusion” is unconstitutional.

In the words of another plaintiff, Nikki Sapiro Vinckier, an OB/GYN Physician Assistant and reproductive health educator, this is the implication of “pregnancy exclusion”: “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.” The horror that happened to Georgia woman Adriana Smith, who was declared brain-dead while nine weeks pregnant and kept on life support for months without her family’s consent, could happen in Michigan.

We at the Woodhull Freedom Foundation agree with the plaintiffs: the “pregnancy exclusion” is a way to exclude pregnant people from our constitutional rights to due process, equal protection, and freedom of speech.