Michigan’s Court of Claims struck down the state’s “pregnancy exclusion” in end-of-life care Thursday, erasing provisions that blocked pregnant patients from having their own medical wishes honored if they became incapacitated.
The ruling directly affects any Michigan resident who has named a patient advocate, the legal term for someone authorized to make medical decisions when a patient can’t speak for themselves. Under the struck-down language in the state’s Estates and Protected Individuals Code, that advocate could not withhold or withdraw treatment from a pregnant patient even if doing so reflected what the patient had clearly asked for.
Court of Claims Judge Sima Patel wrote that the provisions “infringe the fundamental right to reproductive freedom” protected by the Michigan Constitution. Voters locked that right into the state constitution in 2022.
Patel’s ruling did not come in a vacuum. She was the same judge who struck down Michigan’s mandatory 24-hour abortion waiting period in 2025, and her reasoning Thursday followed a similar track: the challenged statutes don’t protect patients, they override them.
“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.”
The implications are concrete. Say a Detroit-area woman drafts a patient advocate document spelling out that she doesn’t want life-sustaining treatment if she’s terminally ill. Under the old law, if she became incapacitated while pregnant, her advocate’s hands were tied. The statute froze her prior wishes.
That’s done.
The state’s own top officials agreed the law was unconstitutional. Gov. Gretchen Whitmer, Attorney General Dana Nessel and Department of Health and Human Services Director Elizabeth Hertel, named as defendants, conceded the facts presented by the group of patients, doctors and advocates who brought the lawsuit. Their position was that their departments simply wouldn’t enforce the provisions, which they argued made a court ruling unnecessary.
Patel rejected that logic outright.
“There is no promise that the newly installed government officials will agree with the current defendants’ position and could insist on the enforcement of the challenged statutory provisions,” she wrote. “Further, as long as the challenged provisions remain within the statutes, hospitals are bound to follow them. These are real harms that will impact patients and their designated patient advocates.”
That last point carries weight for hospital systems across Michigan. Institutional compliance doesn’t hinge on what a governor or attorney general says they’ll ignore. It hinges on what’s written in statute. As long as those provisions sat in the Estates and Protected Individuals Code, hospital legal teams had every reason to follow them. The court’s ruling changes that calculation.
The plaintiffs in the case brought the challenge by arguing that the pregnancy exclusion created a two-tiered system for patient rights, where the ability to direct your own end-of-life care depended on whether you could become pregnant. Patel’s decision backed that view fully, finding no legitimate state interest in overriding a patient’s documented wishes on the basis of pregnancy alone.
This ruling connects to a broader pattern of Michigan courts applying the 2022 constitutional amendment to statutes that predate the Proposal 3 vote. Reproductive freedom protections in the state constitution don’t just cover abortion access. They extend to the full scope of decisions tied to pregnancy and reproductive capacity, and courts are still working out exactly how far that reaches.
As Michigan Advance reported, the defendants’ agreement with the plaintiffs on the underlying facts was notable. This wasn’t a case where the state fought the constitutional question. Whitmer’s office, Nessel’s office and Hertel’s department all effectively told the court these provisions can’t stand. The fight was over whether a formal ruling was needed to make that position stick, and the judge decided it was.
Patel’s ruling carries immediate practical force for patients, patient advocates and health systems statewide. Any Michigan resident who has filled out a patient advocate designation document should know their directives now can’t be set aside on the basis of pregnancy, and any advocate named in those documents has clearer legal footing to act on a patient’s stated wishes. The Michigan Legislature’s Estates and Protected Individuals Code will need to be reconciled with the ruling, either through a statutory cleanup or through continued reliance on the court’s judgment.
