Koskenoja v. Whitmer

At a Glance:

On October 23, 2025, Compassion Legal: The End-of-Life Justice Center at Compassion & Choices, along with If/When/How: Lawyering for Reproductive Justice, Perkins Coie LLP, and Mogill & Lemanski, PLLC, filed a lawsuit on behalf of Michigan women, physicians and patient advocates who argue the state’s Pregnancy Exclusion violates their constitutional rights, including their right to make reproductive and end-of-life decisions.

In January 2026, the State of Michigan filed a brief informing the Court it agreed with Plaintiffs that the Pregnancy Exclusion is unconstitutional.

On April 16, 2026, the Michigan Court of Claims found that Michigan’s Pregnancy Exclusion was facially unconstitutional and unenforceable.

The Details: 

On October 23, 2025, we filed a lawsuit in coordination with If/When/How: Lawyering for Reproductive Justice, Perkins Coie LLP, and Mogill & Lemanski, PLLC in Michigan state court challenging the constitutionality of a Michigan law that limits the ability of pregnant people to refuse life-sustaining treatment.

Because Michigan has no living will statute, most individuals rely on a patient advocate appointed through a durable power of attorney for healthcare to make medical decisions on their behalf if they are incapacitated. Michigan’s Pregnancy Exclusion forbids patient advocates from refusing life-sustaining treatment for pregnant people.

Michigan’s Constitution recognizes the right to make deeply personal medical decisions, including during pregnancy and at the end of life. In 2022, Michigan voters amended the state constitution to include explicit protections for “the right to make and effectuate decisions about all matters relating to pregnancy.”

Michigan’s Pregnancy Exclusion denies these fundamental rights to pregnant people by limiting their right to refuse life-sustaining treatment through a trusted patient advocate and limiting the ability of physicians to respect their patients’ clearly-expressed decisions. Plaintiffs ask the court to affirm that the Michigan Constitution applies equally to them and ensures an individual’s most personal reproductive and end-of-life decisions are respected without discrimination.

Patient plaintiffs Dr. Viktoria Koskenoja of Skandia, Michigan; Jamie Aird of Rochester, Michigan; Nicole Sapiro Vinckier of Birmingham, Michigan; and Madalyn Knutson of Traverse City, Michigan have made advance directives appointing patient advocates, which detail the treatment they would consent to or refuse if they were incapacitated, including during pregnancy.

Plaintiff Dr. Koskenoja is an emergency medicine physician in Skandia, Michigan. She made her own advance directive in 2020 that designates her husband, plaintiff Sam Holcomb, as her patient advocate.

Dr. Koskenoja is joined by three other physician plaintiffs who regularly provide end-of-life treatment or treat pregnant individuals: Dr. Laura Lozier, a trauma surgeon in  Marquette, Michigan; Dr. Jerome Winegarden, an oncologist and hematologist in Ann Arbor, Michigan; and Dr. Lisa Harris, an obstetrician and gynecologist specializing in emergency obstetric services in Ann Arbor, Michigan. The law interferes with their responsibility to honor their patients’ medical decisions and respect their right to informed consent if they are pregnant.

In addition to Sam Holcomb, plaintiff Mark Vinckier is the designated patient advocate for his wife, plaintiff Nikki Sapiro Vinckier. Both patient advocate plaintiffs have accepted the profound responsibility of carrying out their loved ones’ medical decisions if they become incapacitated. Yet Michigan’s Pregnancy Exclusion denies them the ability to honor those decisions.

Under Michigan law, patient advocates must accept the Pregnancy Exclusion when accepting their designation. Mr. Holcomb refused to consent to the Pregnancy Exclusion when named as Dr. Koskenoja’s patient advocate because he fundamentally disagrees with the state’s limitation on honoring his wife’s end-of-life and reproductive choices. That refusal puts his designation at risk of being voided along with his wife’s clearly-expressed decisions.

The plaintiffs ask the court to declare the Pregnancy Exclusion as unconstitutional to ensure that all individuals can plan for and have control over their end-of-life care, regardless of pregnancy status.

In January 2026, the State of Michigan filed a brief informing the Court that they agreed with Plaintiffs that the Pregnancy Exclusion violated Plaintiffs’ constitutional rights. In February 2026, both parties filed a joint stipulation of facts and individual proposed conclusions of law with the Court. The Court will issue a decision based on those facts and proposed conclusions of law.

We are encouraged by the State of Michigan’s recognition that its Pregnancy Exclusion is unconstitutional and are hopeful more states will work to remove these dehumanizing limitations from their own laws.

On Thursday, April 16, Michigan Court of Claims Judge Sima Patel released a decision finding Michigan’s Pregnancy Exclusion facially unconstitutional. The Court held that there are no circumstances under which the pregnancy-related restrictions on patient advocate designations would be constitutionally permissible. In so reaching this conclusion, the Court found that the Pregnancy Exclusion (1) infringes an individual’s autonomous decisions about essential healthcare decisions, (2) does not promote or protect the health of the individual seeking care, (3) does not regulate by the least-restrictive means, (4) and is not consistent with accepted standards of care.

More than 30 states have advance directive laws containing a Pregnancy Exclusion, but in recent years, states like Colorado and Washington have taken action to repeal these laws. Compassion & Choices and If/When/How have previously successfully challenged Idaho’s Pregnancy Exclusions in Almerico v. Denney and are currently challenging Kansas’s Pregnancy Exclusion in Vernon v. Kobach.