When the Law Outlives the Body: The Adriana Smith Case and the Post-Roe Status of Medical Autonomy

Emory University Hospital Druid Hills. Courtesy of Wikimedia Commons.

Declared brain-dead at nine weeks pregnant, Adriana Smith’s body was kept alive for months, not for her, but for the fetus Georgia Lawmakers demanded she carry.

In February 2025, Adriana Smith, a 30 year old mother and nurse from Atlanta, Georgia experienced severe headaches. Smith was brought to Emory University Hospital where she was treated with pain medication and sent home without a CT scan. The following morning, her boyfriend found her in an incapacitated state and rushed her back to Emory University Hospital. CT imaging then revealed that she had brain clots. Due to the lack of urgency of her case and the complications she faced, Smith was declared brain dead. However, this case received national attention due to the procedures that followed. 

On May 7th 2019, Georgia's LIFE Act/Heartbeat Law was passed by the state legislature and signed into law by Governor Brian Kemp. In Section 3 of the Georgia House Bill 481, a “heartbeat” is listed as: “an embryonic or fetal cardiac activity or the steady and repetitive rhythmic contraction of the heart within the gestational sac.” The Act redefines an unborn child with a detectable heartbeat as a natural person and includes such a child in state population counts. It restricts abortions after a heartbeat is detected, with certain exceptions, and requires physicians to check for and report the presence of a fetal heartbeat before performing an abortion. Women must be informed if a heartbeat is detected and provided with specific notices. The Act allows for alimony and child support to begin at the point a fetal heartbeat is detected and permits parents to recover the full value of an unborn child’s life. It also classifies the unborn child as a dependent minor for income tax purposes. Additionally, the Act outlines legal rights, damages, and defenses related to abortion, providing for legislative intervention in constitutional challenges, and includes standard legal provisions such as a short title, severability, an effective date, and repeal of conflicting laws.

The lack of clarity surrounding this bill, specifically regarding the fact that a heartbeat was not detected, but that it could potentially be, ultimately led Emory University Hospital to decide that Smith had to be kept on life support until the fetus reaches viability at around 32 weeks. Georgia Attorney General Chris Carr's office clarified that the Georgia House Bill 481, also referred to as the Life Act, does not mandate life support after brain death, and withdrawing such support would not be considered an abortion, proving that in this case, Smith could have legally been taken off life support. Smith's mother, April Newkirk, shared that she was informed by the hospital that “while the law makes exceptions when the pregnant person’s life is in danger, Smith’s case falls in a legal gray area: she is brain-dead, which means her life is no longer considered at risk, and her doctors claim they are legally required to keep her body on life support until the fetus reaches viability.”  

When Smith entered the hospital at nearly nine weeks’ gestation, the pregnancy was months away from being viable. Doctors at the hospital had initially intended on keeping Smith's body alive until the fetus could survive outside of the womb which was estimated to be around 32 weeks, where Smith's pregnancy would then be medically induced. Doctors shared that at the time of nine weeks gestation, the embryo would not have been visible to the naked eye, and the tissue would have fit within the size of a petri dish. It was additionally noted that there were no public or confirmed reports indicating whether a heartbeat was detected in Ariana Smith's embryo. However, under Georgia law, the mere potential of that embryo to become a living, breathing child superseded the wishes of a family grieving their still breathing daughter. 

On June 17, 2025 Smith was removed from life support after receiving an emergency C-section surgery just four days prior. Smith remained on life-support within the hospital for over 90 days, at around 21 weeks of her gestational period. Smith's child was removed from her weighing 1 lb 13 ounces, showing severe health complications due to being premature. The case has sparked a debate across the country as it has yielded strong reactions and has broader implications in regards to women's health and bodily autonomy. Legal and ethical experts have voiced concerns over hospital driven decisions that prioritize state abortion law over end of life consent.

Specifically in regard to Smith's case, the family's goal was not to forcefully remove life support. In fact, they only requested the authority and respect to decide what Adriana would have wanted, never explicitly sharing what that decision would have been. Additionally, reproductive rights activists have taken upon this case to emphasize human rights violations, also noting the inclusion of racial injustice, drawing attention to the fact that Smith is Black. Experts share that in 2019, the maternal mortality rate for non-Hispanic Black women was 44.0 deaths per 100,000 live births, compared with 17.9 deaths among White women. These statistics continue to fuel advocacy of racial equity in health care. 

Following this case, Georgia lawmakers are split regarding their opinions on this matter. There have been lawmakers that have both defended and criticized the hospital's actions as policy arguably took precedence before health priority. Emory University Hospital, who was responsible for Smith's treatment, shared a statement that they used “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.” Smith's family is now responsible both emotionally and financially for raising a child that may face severe health complications going forward.  

Democratic lawmakers have called for federal resolutions to clarify fetal personhood and abortion laws in light of this case. Similar to Roe v. Wade, some feel that Smith's case will create pressure on federal legislation. Since the overturning of Roe v. Wade, an uproar of women's health advocacy has swept the nation. Yet, the same fundamental concerns continue to resurface. The troubling ambiguity in women’s health care legislation has created scenarios where medical providers and families have lost agency, and in Smith’s case, even in decisions of legally brain dead patients. Following legislative trends, until women’s health rights are returned, and a fetus no longer holds autonomy over the body it was grown in, issues like these may continue to arise.