By the time she ended up at a Georgia hospital with emergency complications, 30-year-old Atlanta nurse Adriana Smith was almost nine weeks pregnant.
Her condition, which included multiple blood clots, deteriorated as doctors tried to save her life, Smith's mother April Newkirk told Atlanta TV station WXIA.
"They did a CT scan and she had blood clots all in her head. So they had asked me if they could do a procedure to relieve them, and I said yes," Newkirk said. "And then they called me back and said that they couldn't do it."
She said doctors declared Smith 'brain dead' and put her on life support without consulting her.
"It's torture for me," Newkirk said. "I come here and I see my daughter breathing by the ventilator, but she's not there."
That was more than three months ago. Smith is still pregnant.
"And I'm not saying that we would have chose to terminate her pregnancy," Newkirk said, "but what I'm saying is we should have had a choice."
Except for an emailed statement, Emory Healthcare isn't commenting on the case.
"Emory Healthcare 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 all other applicable laws," the statement said. "Our top priorities continue to be the safety and wellbeing of the patients we serve."
Georgia's law H.B. 481, also known as the LIFE Act, passed in 2019. It went into effect shortly after the U.S. Supreme Court overturned Roe v. Wade with its Dobbs ruling on June 24, 2022.
The law bans abortion after the point at which an ultrasound can detect cardiac activity in an embryo. Typically this is about six weeks into pregnancy.
It also gives Smith's fetus the same rights as a person. The law says "unborn children are a class of living, distinct persons" and explains that the state of Georgia recognizes "the benefits of providing full legal recognition to an unborn child."
Did fetal 'personhood' mean life support was required?
Twenty states now ban abortion at or before 18 weeks' gestation; 13 of those have a near-total ban on all abortions with very limited exceptions, according to the Guttmacher Institute, a nonpartisan research group that supports abortion rights.
Like Georgia, some of these states built their abortion restrictions around the legal concept of 'personhood,' thus conferring legal rights and protections on an embryo or fetus during pregnancy.
Smith's case represents a major test of how this type of law will be applied in certain medical situations. Despite being unified in their opposition to abortion, conservatives and politicians do not always agree on the scope of the law in cases like Smith's.
For example, Georgia's Republican Attorney General Chris Carr doesn't think the law restricts the options in Smith's care, so removing her from life support wouldn't be equivalent to aborting the fetus.
"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,'" Carr said in a statement.
But Republican Georgia state Sen. Ed Setzler, who authored the LIFE Act, disagrees. Emory's doctors acted appropriately when they put Smith on life support, he toldthe Associated Press.
"I think it is completely appropriate that the hospital do what they can to save the life of the child," Setzler told the AP. "I think this is an unusual circumstance, but I think it highlights the value of innocent human life. I think the hospital is acting appropriately."
Personhood energizes anti-abortion movement
"The problem is that Georgia's law isn't just an abortion ban, it's a 'personhood' law declaring that a fetus or embryo is a person, that an 'unborn child,' as the law puts it, is a person," said Mary Ziegler, a law professor at the University of California-Davis and author of "Personhood: The New Civil War over Reproduction."
The legal concept of "personhood" has implications beyond abortion care, such as the regulation of fertility treatment, or the potential criminalization of pregnancy complications like stillbirth and miscarriage.
In Georgia's law, extending rights of personhood to a fetus changes how child support is calculated. It also allows an embryo or fetus to be claimed as a dependent on state taxes.
But the idea of personhood is not new, Ziegler said.
"It has been the goal for virtually everyone in the anti-abortion movement since the 1960s. That doesn't mean Republicans like that. It doesn't necessarily mean that that's what's going to happen. But there is no daylight between the anti-abortion movement and the personhood movement. They're the same," she said.
The personhood movement has gained more traction since the Supreme Court's Dobbs ruling in 2022.
In Alabama, after the state's Supreme Court ruled that frozen embryos are people, the state legislature had to step in to allow fertility clinics to continue their work.
"This is sort of the future we're looking at if we move further in the direction of fetal personhood," Ziegler said. "Any state Supreme Court, as we just saw in Alabama, can give them new life."
Georgia's law and pregnancy outcomes
In Georgia, dozens of OB-GYNs have warned the state law interferes with patient care -- a problem in a state with one of the worst maternal mortality ratesin the U.S., and where Black women are more than twice as likely to die from a pregnancy-related cause than white women.
Former members of Georgia's Maternal Mortality Review Committee have linked the state's abortion ban to delayed emergency care, and the deaths of at least two women in the state, as ProPublica recently reported.
The personhood provision is having a profound effect on medical care, said Atlanta OB-GYN Dr. Zoe Lucier-Julian.
"These laws create an environment of fear and attempt to coerce us as providers to align with the state, as opposed to aligning with our patients that we work so hard to serve," said Lucier-Julian.
Lucier-Julian said that's what happened to Emory Healthcare in the case of Adriana Smith.
But Cole Muzio, president of the conservative Christian Frontline Policy Council, says the state's abortion law shouldn't affect how Emory handles Smith's care.
"This is a pretty clear-cut case, in terms of how it's defined in the language of H.B. 481. What this bans is an abortion after a heartbeat is detected. That is the scope of our law," he said.
"Taking a woman off life support is not an abortion. It just isn't," he added. "Now, I am incredibly grateful that this child will be born even in the midst of tragic circumstances. That is a whole human life that will be able to be lived because of this beautiful mother's sacrifice."
A lawsuit challenging Georgia's law and its impact on public health is still working its way through the courts. It was filed by a coalition of physicians, the ACLU of Georgia, Planned Parenthood, the Center for Reproductive Rights, and other groups.
Smith's mother April Newkirk said her daughter had initially gone to a different Atlanta-area hospital for help with severe headaches and was sent home, where her symptoms quickly worsened.
"She was gasping for air in her sleep, gargling," she told the station. "More than likely it was blood."
Now, Newkirk said the family is not sure the fetus will even survive the stress involved in months of life support — or escape the risks of severe disability.
"My grandson may be blind, may not be able to walk, wheelchair-bound, we don't know if he'll live once she has him," she said.
But she added that the family will love him no matter what.
This story comes from NPR's health reporting partnership with WABE and KFF Health News.
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