Michigan Court Strikes Down ‘Pregnancy Exclusion’ in End-of-Life Care Law
A Michigan court has eliminated legal restrictions that prevented patient advocates from honoring end-of-life wishes of pregnant patients, ruling the ‘pregnancy exclusion’ violated reproductive rights.
LANSING, MICHIGAN — The Michigan Court of Claims has struck down provisions of the state’s Estates and Protected Individuals Code that limited end-of-life care decisions for pregnant patients, ruling the restrictions violated constitutional reproductive rights.
Michigan Court of Claims Judge Sima Patel issued the decision Thursday, declaring that the provisions collectively known as the “pregnancy exclusion” infringe upon fundamental reproductive freedom rights enshrined in the Michigan Constitution in 2022.
“These provisions do not protect the health of an individual seeking care,” the decision read. “Rather, they prevent individuals who are capable of becoming pregnant of making autonomous decisions about the type of healthcare they will receive in the event they are incapacitated.”
Patient Advocate Authority Restored
The struck-down provisions prevented patient advocates from making certain medical decisions on behalf of pregnant patients who were incapacitated. Under the previous statute, “A patient advocate cannot make a medical treatment decision under [state law] to withhold or withdraw treatment from a pregnant patient that would result in the pregnant patient’s death.”
Judge Patel ruled that these restrictions prevented patient advocates from making decisions aligned with the care and custody desired by patients, specifically targeting those who could become pregnant. The court found this differential treatment unconstitutional under the state’s reproductive freedom amendment.
Judge’s Previous Reproductive Rights Rulings
This marks the second major reproductive rights ruling by Judge Patel in recent years. In 2025, she struck down Michigan’s mandatory 24-hour waiting period for receiving abortions, also citing violations of the constitutional right to reproductive freedom.
The pregnancy exclusion challenge was brought by patients and doctors who argued the law created discriminatory barriers to end-of-life care based on pregnancy status. The lawsuit contended that the restrictions forced pregnant patients to receive unwanted medical treatment even when they had explicitly designated someone to make healthcare decisions on their behalf.
The ruling eliminates the distinction between pregnant and non-pregnant patients in end-of-life care decisions, allowing patient advocates to make treatment decisions based on the previously expressed wishes of incapacitated patients regardless of pregnancy status.
Constitutional Amendment Background
The decision relied heavily on the reproductive freedom amendment added to the Michigan Constitution in 2022. That amendment established broad protections for reproductive decision-making, including pregnancy, contraception, and related medical care.
According to the Michigan Advance, the court’s ruling emphasizes that reproductive autonomy extends beyond pregnancy termination to include decisions about medical care during pregnancy and end-of-life situations. The decision reinforces that patients retain the right to make advance healthcare decisions that patient advocates must honor, even during pregnancy.
The struck-down provisions had been part of Michigan’s broader estate and healthcare decision-making framework, but the court found they created an unconstitutional carve-out that denied pregnant individuals equal treatment in healthcare decision-making.
