Episode 23: What Happens When a Pregnant Woman Is Declared Brain Dead?
Episode 23
Host: Jill Mastroianni
What Happens When a Pregnant Woman Is Declared Brain Dead?
When a woman is declared brain dead, but still pregnant, who decides what happens next? And what if she made her wishes clear, but the law says they don’t matter?
Jill explores the tragic case of Adriana Smith, a young nurse from Georgia whose body was kept on life support for four months after brain death because she was nine weeks pregnant.
This episode tackles uncomfortable questions about autonomy, abortion law, and what happens when healthcare decisions collide with unclear legal guidance.
What Jill covers in this episode:
The story of Adriana Smith, who was declared brain dead when she was 9 weeks pregnant
How Georgia's abortion and advance directive laws might have affected her care
The 2013 case of Marlise Munoz and Texas’s pregnancy restrictions on end-of-life care
The Dobbs United States Supreme Court decision: what it actually did, and what the dissent said
Georgia’s advance directive statute and its impact on end-of-life care for pregnant women
A 2019 JAMA study showing how 31 states restrict advance directives during pregnancy
Reflections on what it means to feel powerless and why kindness matters in hard conversations
Connect with Jill:
Website: DeathReadiness.com
Email: jill@deathreadiness.com
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Jill Mastroianni: (0:00)
What happens when a woman is declared brain dead… but she’s pregnant?
Who decides what happens next?
What if she had made her wishes clear—but the law, or the hospital, says those wishes don’t matter?
Today, we’re talking about a case that raises painful, complicated questions—about autonomy, abortion law, end-of-life care, and who gets to make the call when someone can’t speak for themselves.
Welcome to the Death Readiness Podcast. This is not your dad’s estate planning podcast. I’m Jill Mastroianni, former estate attorney, current realist, and your guide to wills, trusts, probate and the conversations no one wants to have. If your Google search history includes, “Do I need a trust?” “What exactly is probate?” and “Am I supposed to do something with mom’s Will?” you’re in the right place.
(01:03) Over the weekend, my daughter and I volunteered at a local event. She threw herself into the activities, collecting tickets and eventually using them to “buy” one of those old-school etch-a-sketches—the kind where you turn the little knobs to draw.
The next morning, I noticed it beside her bed. Etched into the screen were the words:“Word of the day: kind.”
It struck me—especially because something had happened at the event that hurt her feelings. I think that was her way of reminding herself to respond with kindness, even when things feel hard.
The following day, the etch-a-sketch was still there. This time, it simply said:“Happiness.”
I added a heart and our dog’s name, Hopper.
The next time I saw it, she’d drawn a picture of a dog with “Hopper” etched across the top.
I feel so lucky to have her in my life. And that kind of love—the big, overwhelming kind—comes with fear too. The kind that knows life is fragile, unpredictable.
(02:08) Today’s episode is about someone else’s daughter.
And while we’re going to talk about difficult—and yes, controversial—topics, I’m carrying my daughter’s reminder with me:Be kind.
Because that’s one of the most important things she’s taught me.
On last week’s Tuesday Triage, I talked about Nancy Cruzan and Terri Schiavo—and why advance healthcare directives matter so much.
After the episode aired, I received a thoughtful message from a listener named Pam, from Michigan. She asked why I hadn’t mentioned Adriana Smith.
The truth is, I had planned to include Adriana’s story in last week’s episode. But just before recording, I decided to hold off. It’s a tragic and complicated case—and one that deserves its own space.
(02:56) Because Adriana’s story doesn’t just raise questions about end-of-life decisions.It forces us to look at the gaps in our legal system—gaps that can silence a woman’s voice, even after she’s gone.
Gaps that leave families powerless. And make the rest of us wonder: if it were me, would my wishes matter?
I’m grateful to Pam for asking, because Adriana’s story does need to be told.
Adriana Smith was a young woman from Georgia who was declared brain dead in February 2025. Her body was laid to rest months later, at the end of June.
Today, I want to talk about Adriana. But first, I want to start with another story—one that raises many of the same questions.
(03:43) Two days before Thanksgiving in 2013, Marlise Munoz collapsed in her home in Fort Worth, Texas. She was 14 weeks pregnant and declared brain dead on Thanksgiving Day.
Brain death is defined as the irreversible loss of all brain function—and it’s considered legal death in all 50 states.
Marlise and her husband, Erick, were both paramedics. Because of their work, they’d had hard conversations about end-of-life care.
According to Erick and other family members, Marlise had made it very clear: she would never want to be kept alive by machines. She didn’t have a written advance directive.
When Erick asked the hospital to withdraw mechanical support, they refused, pointing to Section 166.049 of the Texas Health and Safety Code, which states:
“A person may not withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient.”
(04:44) Even though Marlise had been declared legally dead, the hospital interpreted the law to mean they were still required to keep her body functioning—because she was pregnant.
Erick filed suit, asking the court to stop further medical interventions and allow his wife’s body to be returned to the family.
The court agreed. It held that the law did not apply once a patient had been declared brain dead. On January 26, 2014, the hospital withdrew all mechanical support.
It’s worth noting that, during the case, ultrasound exams revealed significant fetal abnormalities, and the hospital ultimately acknowledged that the fetus was not viable.
The Munoz case revealed just how painful—and unclear—these legal gray areas can be.
(05:38) That brings us to Adriana Smith.
Adriana was a young nurse from Georgia who, like Marlise Munoz, was declared brain dead. This happened in February 2025—and like Marlise, Adriana was pregnant. But she was only nine weeks along.
Because of her pregnancy, Adriana’s body was kept on what I’ll refer to as “body support.” I use that term deliberately. As Professor Katie Watson of Northwestern University Feinberg School of Medicine has explained, “life support” isn’t technically accurate—because Adriana was already dead. What the machines were doing was preserving the functions of her body, not sustaining her life.
There’s very little public information about Adriana’s conversations or the specific decisions made in the hospital—and that’s as it should be. Her medical records are private. Presumably, the only people who fully understood her situation were her care team and her mother, April Newkirk, who has spoken briefly in a few media interviews.
(06:45) According to April, the hospital told her that because Adriana was pregnant, they could not legally remove body support. They believed doing so would violate Georgia’s abortion laws.
Emory Healthcare, which oversees the hospital, issued a carefully worded public statement. It said:
“It uses consensus from clinical experts, medical literature, and legal guidance to support our providers as they make individualized treatment recommendations in compliance with Georgia’s abortion laws and other applicable laws. Our top priorities continue to be the safety and well-being of the patients we serve.”
Because of patient privacy laws, the hospital has not commented on Adriana’s case directly.
So what did the hospital believe Georgia’s abortion law required? And does the law actually say what they thought it did?
Let’s take a closer look.
(07:42) You might have heard Georgia’s abortion laws described as the “Heartbeat law.”
That’s because Georgia Code Section 16-12-141 prohibits an abortion “if an unborn child has been determined […] to have a detectable human heartbeat,” except in limited circumstances.
This law was enacted in 2019 but was not enforceable until after the June 24, 2022 United States Supreme Court decision in Dobbs V. Jackson Women’s Health Organization.
I’m going to take a moment to talk about Dobbs. Because even though it’s often cited, I don’t think we always understand what it really means.
First, a quick aside: Dobbs refers to Dr. Thomas Dobbs, who was the Mississippi State Health Officer at the time. He now teaches epidemiology at the University of Mississippi Medical Center. And interestingly, he earned his undergraduate degree at Emory University—in Georgia, the very state at the center of Adriana Smith’s story.
(08:53) The Dobbs majority opinion overturned Roe v. Wade and Planned Parenthood v. Casey --two landmark cases that had protected a constitutional right to abortion, specifically before fetal viability. Viability, in this context, means the point at which a fetus could survive outside the womb.
The Mississippi law at issue in Dobbs banned most abortions after 15 weeks—well before viability. And the Court upheld that law.
The majority opinion stated that the Constitution does NOT contain a right to abortion, and therefore: “We now overrule those decisions and return that authority to the people and their elected representatives.”
(09:40) In other words, Dobbs didn’t ban abortion nationwide. Instead, it gave each state the power to make its own laws—whether that meant protecting access, restricting it, or banning it entirely.
The dissenting justices—Breyer, Sotomayor, and Kagan—warned of profound consequences:
They wrote: “Respecting a woman as an autonomous being… meant giving her substantial choice over this most personal and consequential of all life decisions.”
And in one of the most striking lines from the dissent, they said:
“From the very moment of fertilization, a woman has no rights to speak of.”
So, after Dobbs, Georgia’s “heartbeat law” —the one prohibiting abortion once fetal cardiac activity is detected—went into effect.
(10:35) Abortion is defined in Georgia as:
“The act of using, prescribing, or administering any instrument, substance, device, or other means with the purpose to terminate a pregnancy with knowledge that termination will, with reasonable likelihood, cause the death of an unborn child.”
That phrase—“with the purpose to terminate a pregnancy”—is key.
Georgia’s law doesn’t just focus on outcomes; it focuses on intent. In other words, for something to legally qualify as an abortion under this statute, it must be done with the specific purpose of terminating a pregnancy.
This nuance matters, especially when we consider what happened in Adriana Smith’s case.
(11:24) One of the original sponsors of Georgia’s “heartbeat law,” Republican Senator Ed Setzler, commented publicly on the situation. He said the hospital’s interpretation of the law was:
“Not inconsistent with the way the statute is crafted because of the direct foreseeability that ending the mother’s life ends the life of the child,”
Though he also acknowledged:
“You could argue that the removal of the life support of the mother is a separate act” from an abortion.
So there was tension—even among those who support the law—about how it should apply in a case like Adriana’s.
Meanwhile, Georgia’s Republican Attorney General, Chris Carr, offered a more definitive take. He stated that there is nothing in Georgia law that requires a woman to be kept on life support after brain death—because withdrawing support from someone who is already legally dead is not done with the purpose of terminating a pregnancy.
(12:26) Adriana Smith was a nurse. I don’t know whether she had an advance healthcare directive or a healthcare power of attorney. That information hasn’t been made public.
But even if she had completed an advance directive, it may not have changed what happened.
Under Georgia Code § 31-32-9(a), physicians are required to assess pregnancy status and fetal viability before following a patient’s end-of-life instructions. The law states:
“prior to effecting a withholding or withdrawal of life-sustaining procedures or the withholding or withdrawal of the provision of nourishment or hydration […] pursuant to a […] directions in an advance directive for health care, the attending physician:
Must determine that the individual is not pregnant.
or, if she is pregnant, that the fetus is NOT viable and that the individual has specifically indicated in the advance directive to withhold or withdraw life-sustaining procedures
(13:32) In plain terms? Even a legally valid advance directive can be overridden during pregnancy—unless it contains very specific language AND the fetus is determined to be nonviable.
That means even a valid advance directive can be ignored during pregnancy.
And Georgia is not alone.
A 2019 article in the Journal of the American Medical Association found that 31 states have laws that restrict or override end-of-life decisions for pregnant women. In 26 of those states, pregnancy can automatically invalidate a woman’s advance directive.
Adriana’s mother, April, later said she felt powerless—and unsure of what she would have done if given a choice. But she wanted to be able to make that decision. To be trusted with that responsibility.
And maybe, in the end, she did have that choice. There was no lawsuit. No public battle. Maybe April decided to keep Adriana on body support because she believed that’s what her daughter would have wanted. We don’t know—and that’s okay. That’s her story to hold.
(14:46) But here’s the part I haven’t told you yet.
On June 13, 2025, Adriana’s baby was delivered by cesarean section.
His name is Chance.
He was born at 25 weeks, weighing just 1 pound, 13 ounces.
I imagine there is a long road ahead for baby Chance, who joins his older brother.
Adriana was removed from body support four days later, on June 17.
Her mother, April Newkirk, said:
“Life has its ups and downs, but this hit us really, really hard. And we would just like for everyone to continue to pray for us and just to give us our privacy at this time.”
(15:31) In some ways, Adriana’s story raises more questions than it answers—and that’s okay. Her family deserves privacy. And her story deserves to be held with care.
But it also brings into sharp focus the gaps in our legal system—gaps that can silence a woman’s voice, even after she’s gone. Gaps that undermine the right to make deeply personal decisions about our own bodies.
Those gaps make me feel small. Powerless.
But then I think about my daughter.And her quiet reminder on an etch-a-sketch:Be kind.
Kindness doesn’t mean avoiding the hard conversations. It means showing up for them with compassion.
So that’s what I’ve tried to do here.Because we can do better.We have to do better.Women are not second-class citizens.
(16:32) Pam—thank you for asking me to talk about Adriana. Her story matters. And I’m grateful for the chance to share it—with honesty, with care, and yes—with kindness.
If you found this episode helpful, I’d love for you to share it with someone you think could benefit from it.
If you have a question you’d like me to answer on a future Tuesday Triage episode, whether related to today’s episode or something totally different, send me an email at jill@deathreadiness.com or visit deathreadiness.com/TuesdayTriage. I’d love to hear from you.
This is Death Readiness, real, messy and yours to own. I’m Jill Mastroianni and I’m here to help you sort through it, especially when you don’t know where to start.
(17:29) Hi, I'm April, Jill's daughter. Thanks for listening to The Death Readiness Podcast.
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The Death Readiness Podcast is for educational and entertainment purposes only.
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