In Georgia, a woman named Adriana Smith has been declared brain dead for more than three months. At nine weeks pregnant she suffered a catastrophic medical event involving a series of undiagnosed blood clots. Despite being declared brain dead, her body remains on life support. This is because Georgia law mandates the continuation of life-sustaining measures in an effort to preserve the pregnancy.
Adriana's family has been forced to witness her body maintained by machines as an incubator for the fetus. Smith's story lays bare how reproductive laws, when rigidly enforced without ethical nuance, can override medical judgment, strip families of agency, and compound psychological suffering. This is a case where autonomy and grief collide with legislation and where trauma flourishes in the absence of choice.
There is a unique kind of grief that haunts cases like this. Psychologist Pauline Boss named it ambiguous loss; a term that captures the pain of mourning someone who is physically present but psychologically gone (Boss, 1999). It's the kind of grief that offers no rituals and no closure.
Adriana's mother is not planning a funeral. Her son cannot say goodbye. Instead, they are caught in limbo, watching a body sustained by machines while knowing the person they love is no longer there. The illusion of life prolongs their agony. The rituals of mourning are delayed, and with them, the process of healing.
Research on ambiguous loss consistently shows that it can lead to complicated grief and trauma responses (Betz & Thorngren, 2006). For families like Adriana's, the inability to exercise agency around navigating their loss adds a layer of helplessness that is profoundly destabilizing.
The ethical tensions in these cases are tremendous: What does consent mean when a person is brain dead? Who does the body belong to?
Georgia's "heartbeat law" bans abortion once fetal cardiac activity is detected, usually around six weeks. In theory, exceptions exist for medical emergencies. In practice, those exceptions are vague and often do not account for cases like Smith's. This legal mandate strips clinicians of discretion. Medical teams are compelled to continue care that has no bearing on the patient's prognosis. Families are denied agency over a loved one's body. The ethical tensions in these cases are tremendous: What does consent mean when a person is brain dead? Who does the body belong to?
As noted in the AMA Journal of Ethics, the preservation of life in pregnant brain-dead patients is one of the most ethically complex scenarios in modern medicine. Yet when Georgia law dictates a one-size-fits-all response where nuance and critical thinking has become lost.
This is a case where autonomy and grief collide with legislation and where trauma flourishes in the absence of choice.
Adriana Smith was a Black woman. This matters.
Black women in the U.S. face disproportionately high maternal mortality rates, are more likely to have inadequate access to prenatal and emergency care, and are less likely to have their medical concerns taken seriously (Creanga et al., 2014). These disparities are structural.
In this context, reproductive legislation functions not only as a denial of bodily autonomy but as an extension of historical control over Black women's bodies. To ignore race in cases like Smith's is to erase a critical dimension of how reproductive trauma is experienced in the United States.
Adriana Smith’s story is not just about life support or legal definitions of death. It is about what happens when policy dehumanizes people in the name of ideological purity. It is about what grief looks like when it is legislated.
Her family will carry this trauma long after the machines are turned off. They will carry the memory of being sidelined and overruled. If we are to prevent this kind of harm in the future, we must craft reproductive policy that centers real lives and real families. That means grounding laws in empathy, clinical wisdom, and respect for the complexity of human grief.
Betz, G., & Thorngren, J. M. (2006). Ambiguous loss and the family grieving process. The Family Journal, 14(4), 359–365. https://doi.org/10.1177/1066480706290052
Boss, P. (1999). Ambiguous loss: Learning to live with unresolved grief. Harvard University Press.
Creanga, A. A., Berg, C. J., Syverson, C., Seed, K., Bruce, F. C., & Callaghan, W. M. (2014). Race, ethnicity, and nativity differentials in pregnancy-related mortality in the United States: 1993–2006. Obstetrics & Gynecology, 120(2, Part 1), 261–268. https://doi.org/10.1097/AOG.0b013e3182952f5e
