The case of Adriana Smith, a pregnant patient being kept on life support at Atlanta\u2019s Emory University Hospital, is raising ethical questions nationwide about whether autonomy is guaranteed under legislation that limits legal abortions. <\/p>\n\n\n\n
It also resulted in a political firestorm. <\/p>\n\n\n\n
On one side of the aisle, Smith\u2019s case is being raised as an argument against Georgia\u2019s abortion law, House Bill 481, also known as the LIFE Act. <\/p>\n\n\n\n
\u201cI believe that, absent further clarity and reform to the law, cruelty like this will continue to be inflicted upon my constituents,\u201d Democratic U.S. Rep. Nikema Williams wrote in a statement put out this week<\/a>.<\/p>\n\n\n\n Another statement<\/a> from Democratic state Rep. Kim Schofield, released in partnership with Reps. Viola Davis and Sandra Scott, blames the state for turning Smith into \u201can incubator against her will.\u201d <\/p>\n\n\n\n Meanwhile, state Republicans have been largely silent. There has been no comment from Gov. Brian Kemp\u2019s office. <\/p>\n\n\n\n State Sen. Ed Setzler, who sponsored Georgia\u2019s abortion law in the House in 2019, told The Associated Press<\/a> that he agrees with how Smith\u2019s case has been managed. <\/p>\n\n\n\n \u201cI think this is an unusual circumstance, but I think it highlights the value of innocent human life,\u201d he said. \u201cI think the hospital is acting appropriately.\u201d <\/p>\n\n\n\n Left largely in the middle is Smith\u2019s family, which has made little public comment. <\/p>\n\n\n\n On a webpage seeking donations<\/a> \u2014 which has garnered almost $97,000 at the time of publishing \u2014 Smith\u2019s mother April Newkirk writes the family was \u201cgiven no choice\u201d regarding the hospital\u2019s decision keep Smith on life support around two months into her pregnancy, after clots in her brain caused irreparable damage.Newkirk expressed frustration over that lack of choice in an interview with an Atlanta TV station a week ago<\/a>.<\/p>\n\n\n\n She recently told reporters<\/a> that they\u2019re hoping the baby can be delivered safely in August. Smith is now about 22 weeks pregnant. <\/p>\n\n\n\n Newkirk has not responded to GPB\u2019s requests to get in touch. A statement attributed to Emory University Hospital said<\/a> treatment at the hospital is based on “consensus from clinical experts, medical literature, and legal guidance in compliance with Georgia’s abortion laws and all other applicable laws.” <\/p>\n\n\n\n Georgia\u2019s abortion law makes it illegal to terminate a pregnancy after about six weeks of gestation, or when an ultrasound can detect fetal cardiac activity. <\/p>\n\n\n\n The law does that in part by including a fetus in the definition of a \u201cnatural person\u201d starting at around six weeks of pregnancy. Past that point, the law makes certain exceptions for abortions, including if a physician determines there\u2019s a \u201cmedical emergency,\u201d or that a pregnancy is \u201cmedically futile.\u201d <\/p>\n\n\n\n Questions over those exceptions have been raised<\/a> since the law’s passage. <\/p>\n\n\n\n This week, in response to Smith\u2019s case, Georgia Attorney General Chris Carr said in a statement that nothing in HB 481 says that removing a patient from life support counts as an action \u201cwith the purpose to terminate a pregnancy.\u201d <\/p>\n\n\n\n “Our prayers go out to the family of Adriana Smith during this difficult time,” Carr\u2019s statement reads. “There is nothing in the LIFE Act that requires medical professionals to keep a woman on life support after brain death. Removing life support is not an action ‘with the purpose to terminate a pregnancy.’\u201d<\/p>\n\n\n\n But Dana Sussman, senior vice president at the nonprofit coalition Pregnancy Justice, said it\u2019s not enough for this legislative language to be defined sporadically. <\/p>\n\n\n\n \u201cThere’s confusion in these laws and women will suffer,\u201d Sussman said. \u201cWe’re not able to get a clarifying statement from an attorney general every time, and we shouldn’t have to rely on a clarifying statement from an attorney general to have bodily autonomy.\u201d <\/p>\n\n\n\n Another snag in maintaining autonomy, Sussman said, can come in the form of a piece of paperwork signed by people in health care facilities, called an advance directive, that is supposed to clearly define the medical decisions of a patient should they become incapacitated. <\/p>\n\n\n\n Under Georgia\u2019s version, unless the patient provides written permission against it, doctors are supposed to provide \u201clife-sustaining procedures\u201d if a fetus is determined to be viable, even if the pregnant person is no longer able to birth them. <\/p>\n\n\n\n Ten states consider pregnancy a condition that overrides advance directives completely<\/a>, including Texas, where in 2013, the family of a brain-dead woman who was kept alive because of her pregnancy entered into a legal battle<\/a> over her treatment, and won. <\/p>\n\n\n\n Sussman notes it\u2019s not clear what Adriana Smith would have wanted. <\/p>\n\n\n\n \u201cBut I think we have to confront this,\u201d she said. \u201cBecause this is yet another iteration of the harms and the damage when we give more rights to embryos and fetuses than we do to women and pregnant people.” <\/p>\n\n\n\n Policy like Georgia\u2019s law that includes so-called fetal personhood language, she said, is also what results in situations of pregnancy criminalization,<\/a> such as in the arrest of a woman from Tift County<\/a> after she experienced a miscarriage, a case where the charges were ultimately dropped. <\/p>\n\n\n\n Martha Zoller, founding member and current board member of the Georgia Life Alliance, an organization that opposes abortion, argues Smith\u2019s case should be kept separate from the LIFE Act and agrees with the attorney general\u2019s take. <\/p>\n\n\n\n \u201cWe don’t see this as a heartbeat bill case,\u201d Zoller said. \u201cIt’s a tragedy no matter how you slice it. But it sounds to me like the family was left out of the decision-making, and that was wrong.\u201d <\/p>\n\n\n\n Yet, Zoller said, she thinks that as result of increased legal interference, \u201cdoctors are not being allowed to figure out what to do\u201d in many cases. She said the GLA stands in their support of the LIFE Act. <\/p>\n\n\n\n Since Roe v. Wade<\/em> was overturned by the U.S. Supreme Court, medical providers in Georgia have reported delaying care in cases where emergency abortions would have normally been given to address pregnancy-related complications. <\/p>\n\n\n\n According to a survey<\/a> of 38 Georgia-based OB-GYNs published by Georgia U.S. Sen. Jon Ossoff\u2019s office, the majority said that the state\u2019s abortion law puts women\u2019s health \u201cat greater risk,\u201d with just over a dozen sharing specific examples of where confusion over the law contributed to medical emergencies. <\/p>\n\n\n\n Those examples include cases where women experienced excessive bleeding from miscarriages past six weeks of pregnancy, or had risk factors like hypertension, heart conditions or autoimmune disorders that made pregnancy dangerous, but not enough to be considered an exception under the law by providers. <\/p>\n\n\n\n \u201cWith this law now in effect, when it comes to things like high-risk pregnancies and medical emergencies, we’re often trying to figure out, ‘OK, how sick is sick enough?’\u201d said Dr. Nisha Verma, a practicing physician and abortion provider who contributed to the survey. <\/p>\n\n\n\n Verma, who also serves as a policy and advocacy advisor at the national American College of Obstetricians and Gynecologists (ACOG), said the report is just a snippet of what she believes is a \u201cwidespread\u201d sentiment \u2014 that strict abortion legislation in Georgia and more than a dozen other states limits doctor\u2019s ability to make \u201cevidence-based\u201d decisions about their patient\u2019s care, because there\u2019s a fear of legal consequences if they get it wrong. <\/p>\n\n\n\n An ongoing national study<\/a> out of the University of California San Francisco aims to document clinician experiences has found similar evidence of \u201cdistress<\/a>.”<\/p>\n\n\n\n A spokesperson for ACOG said it does not comment on specific cases in response to questions about Adriana Smith. Verma said regarding Ossoff\u2019s report, it\u2019s not surprising that we\u2019re seeing a \u201cvariation in practice\u201d different than before Georgia\u2019s law was in effect. <\/p>\n\n\n\n \u201cClinicians are confused and scared,\u201d said Sara Redd, assistant professor at Emory University\u2019s Rollins School of Public Health. <\/p>\n\n\n\n And already, patients are affected disproportionately, she said. <\/p>\n\n\n\n \u201cPeople who are already experiencing structural barriers to accessing healthcare or are experiencing oppression,\u201d Redd said. Georgia has one of the highest maternal mortality rates in the country, with Black women experiencing pregnant-related deaths at double the rate<\/a> compared to White women. <\/p>\n\n\n\nSo what does the law say, and is it clear? <\/h3>\n\n\n\n
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Smith\u2019s case is not a one-off <\/h3>\n\n\n\n
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