When Policy Shapes a Birth Story
How one family’s tragedy exposes the systems that decide whose health, and whose life, is prioritized
Chance April Newkirk deserved a better birth story. One not written by the abortion law in Georgia, which determined that he would be born even though his mother was declared legally brain dead. This story has understandably received significant media attention. Adriana Smith was a 31-year-old mother and nurse who should have had a whole life ahead of her. After a medical emergency when she was nine weeks pregnant, she was declared dead and put on life support to give her unborn child a chance at life.
This decision was made by hospital staff without granting her family the option to give or withhold consent. This isn’t just a policy failure, but a violation of bodily autonomy. That decision has had serious personal and financial consequences for Adriana’s family. Due to Chance being born prematurely, he has had to stay in the NICU for the past six months. I don’t have to tell anyone who has ever given birth in a hospital in the U.S. that it costs a pretty penny. As a result, Adriana’s family has launched a GoFundMe that has raised over $500k to help cover medical expenses. While the generosity of strangers is commendable, none of that brings Adriana back, and none of it guarantees what Chances’ quality of life will be.
Despite the plethora of opinions that have been raised regarding abortion law in Georgia (and other states), what is rarely discussed is how systems, policies, and medical norms have shaped the care Black women receive. This isn’t just about a question of being pro-life or pro-choice, but how the decisions being made in medical settings impact the long-term quality of life of patients.
What Happens When Policies Forget to Do No Harm?
Even though Adriana’s case is often framed as an outlier, it truly should be reframed as a mirror to how policies can harm those they’re supposed to protect. During my graduate studies in Conflict Resolution and Coexistence, I remember taking a class where we extensively discussed the concept of “Do No Harm” and its practical implications. In medicine, it’s not about choosing what would be right for you, but what would be right for your patient. We’ve talked about this previously in the case of Dr. J. Marion Sims, whose experimental surgeries on Black women led to advances in gynecology but contributed to ethical discourse years later. That’s why we must keep in mind that just because an outcome is favorable, it doesn’t mean the means to achieve it didn’t cause unnecessary harm.
Firstly, abortion restrictions can force clinicians to act against medical ethics. In Adriana’s case, the decision to keep her alive long enough for Chance to develop presents an ethical dilemma. They were both patients, but it’s clear whose was valued over whose. That begs the question of whether she would have been given the chance to live as long as she did on life support if she had not been pregnant.
Secondly, the principle of “Do No Harm” is often overridden by legislation. Before the overturning of Roe v. Wade, people had a “right” to an abortion, but states could pass laws that made it difficult to get one. Following the repeal, abortion has become inaccessible in many states, which has disproportionately impacted Black, Indigenous, and People of Color (BIPOC) who face unique disparities in accessing healthcare, which puts their health and lives at stake.
Thirdly, Black women are often disproportionately harmed by these policies. Due to higher rates of pregnancy complications, bias, and inequitable access, Black women face unique challenges that other communities of color do not. We already know that Black women are three times more likely than White women to die of pregnancy-related complications, regardless of socioeconomic status.
For all these reasons, when harm is done in a clinical setting, we need to stop treating it as if it’s accidental. I’m not saying that it’s blatantly intentional either, but that policy decisions often drive it. While I can understand that many clinicians fear the legal risks they may face, I don’t understand allowing that fear to contribute to clinical harm. If clinicians are allowing fear to take the front seat in their medical decision-making, it will make it even more difficult for patients to trust that their provider has their best interests in mind.
What This Means And What Needs to Change
At the end of the day, what should be most important is what is best for the patient, not the government. I know that might be a bold statement in this era, but I’m tired of seeing Black women serving as case studies for the world to believe the system is broken. We shouldn’t have to die (or be kept alive) for needed change to come to our healthcare system.
I know I’m preaching to the choir. If you’re here, it’s because you care. You know as well as I do that the system won’t change unless we start naming the harm out loud.
This is how you can be part of the change:
If you’re a patient, you can ensure that if your state or country allows it, you have a Living Will and Health Care Proxy in place, even if you’re in “perfect” health. As Adriana’s case has shown, you can become incapacitated, which means someone else will be making medical decisions on your behalf. You want to ensure there is something in place to legally stop them from making decisions you wouldn’t make. Since I’m no lawyer, nor do I pretend to play one on the internet, it’s your responsibility to do your due diligence to see what your options are and take action accordingly
If you’re an advocate and happen to be a Health Care Proxy, depending on where you live, you may be responsible for making medical decisions as if you were that person. That is a responsibility not to take lightly, so ensure that you actually know what that person would want if they become incapacitated. I can tell you from personal experience that knowing (and having in writing) what that person wants can alleviate the drama that arises when medical decisions are made that others may not agree with.
If you’re a provider, you’re perhaps in one of the most challenging positions: making medical decisions when Living Wills and Health Care Proxies aren’t in place (or are prohibited by law). Something you can do that I can tell you from personal experience makes a difference is talking to family members before making a medical decision for your patient. I know there will be circumstances when this can’t practically be the case, but when possible, include families in the decision-making process. Even if you ultimately make a decision they disagree with, giving them space to speak matters.
Key Takeaways
Adriana’s story is truly devastating, but we must remember that what happened didn’t happen in a vacuum. The policies that govern our country also shape the healthcare that we receive. For that reason, we must confront the harm that is baked into our laws and healthcare systems. If we don’t, we will continue doing the harm that we are put here to eliminate.