Last week, Michigan’s law that denied pregnant people the ability to make important decisions about their end-of-life care–commonly referred to as a Pregnancy Exclusion– was ruled unconstitutional under Michigan’s Reproductive Freedom Amendment.
The decision came after Michigan women, physicians, and patient advocates joined together to file a lawsuit challenging a Michigan law that denied pregnant people who are incapacitated the right to refuse life-sustaining treatment. The lawsuit, Koskenoja v. Whitmer, filed by Compassion Legal: The End-of-Life Justice Center at Compassion & Choices; If/When/How: Lawyering for Reproductive Justice; Perkins Coie LLP; and Mogill & Lemanski, PLLC, argued that the state’s Pregnancy Exclusion violates the plaintiffs’ constitutional rights, including their right to make reproductive and end-of-life decisions.
“This case is personal to people across Michigan—especially those who can become pregnant and the people who love them,” said Jess Pezley, Senior Staff Attorney at Compassion & Choices. “No one should feel disempowered in healthcare decisions as consequential as those surrounding birth and death. The Court’s decision is a win for patient-directed care, rightly recognizing that individuals and their loved ones hold the power to make these deeply personal end-of-life decisions.”
Because Michigan has no living will statute, most individuals rely on their chosen patient advocate (or health care proxy) to make medical decisions on their behalf if they are incapacitated. But Michigan’s Pregnancy Exclusion law prohibited patient advocates from refusing life-sustaining treatment for pregnant people. Because of this court’s ruling and the incredible advocacy of Michiganders, all people in Michigan will have their end-of-life medical decisions honored.
“I joined this lawsuit because, as a physician, I have seen firsthand how life can change in an instant. No one should have to worry that the choices they have made won’t be honored,” said patient and physician plaintiff Dr. Viktoria Koskenoja. “I am satisfied that patients in Michigan will now have full control over one of the most important and deeply personal decisions they can make. And as a physician, I am thrilled that I will never be forced to deliver care that overrides a patient’s autonomy. This decision is a win for women and their families across Michigan.”
In 2022, Michiganders voted to amend the state constitution to include explicit protections for “the right to make and effectuate decisions about all matters relating to pregnancy. ” With this ruling, the court has affirmed that Michigan’s Pregnancy Exclusion law denied these fundamental rights to pregnant people. Because of this win, Michiganders can make their most personal reproductive and end-of-life decisions free from discrimination and state intervention.
“This decision is the culmination of years of work by people across Michigan who refused to accept that their rights could be decided for them. It reflects organizing efforts, community conversations, and a commitment to making sure our state constitution actually protects the realities of people’s lives. This case is a powerful example of how individuals can shape their state constitutions and, in doing so, create the pathway for wins like this,” said patient plaintiff Nikki Sapiro Vinckier. “At a time when so much can feel uncertain or even overwhelming, it matters to see that kind of impact play out in real life. It’s a reminder that when people organize, speak up, and stay engaged, those actions can translate into tangible change. That’s what makes moments like this so powerful.”
Recognizing the inherent discriminatory nature of the Michigan Pregnancy Exclusion law, the court stated that the law created “…a blanket exception to an individual’s authority to make autonomous medical decisions on a single criterion: pregnancy.”
“This decision affirms a fundamental truth: that reproductive freedom means more than just a right to have an abortion,” said Farah Diaz-Tello, Senior Counsel and Legal Director for If/When/How. “It means that the most sacred decisions a person will make – about how they will birth and how they will die – belong to them and not the state or anyone else. These are rights that can’t be taken away because someone is pregnant; in fact, they should be even more closely guarded in these vulnerable moments.”
The issue of Pregnancy Exclusions in advance directive laws gained national attention in 2013 with the tragic case of Marlise Muñoz, a Texas woman who was approximately 14 weeks pregnant when she was declared brain dead. Even after her death, the hospital refused to cease medical interventions, citing Texas’s Advance Directive Act. Ms. Muñoz’s case stands as a stark and extreme example of how Pregnancy Exclusions can be used to override the decisions of individuals and their loved ones, stripping them of the right to make deeply personal end-of-life decisions.
Recognizing the horrible pain Texas and other Pregnancy Exclusion laws have caused pregnant patients and their loved ones, the court stated: “Similar statutory provisions have been used to prolong the suffering of patients and their families by requiring patients who have been pronounced brain dead by qualified medical professionals or who have been diagnosed as having no possibility of recovering with any quality of life to remain on invasive life support simply because they are pregnant.”
More than 30 states have advance directive laws containing a Pregnancy Exclusion, but in recent years, states like Colorado and Washington–and now Michigan–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.
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