What was Michigan's pregnancy exclusion in end-of-life care?

It was a provision in Michigan's Estates and Protected Individuals Code that prevented patient advocates from honoring a pregnant patient's medical wishes, including withholding or withdrawing treatment, even if the patient had clearly expressed those wishes.

Why did the Court of Claims strike down the pregnancy exclusion?

Judge Sima Patel ruled that the provisions infringed on the fundamental right to reproductive freedom protected by the Michigan Constitution, which voters enshrined in 2022.

Who is affected by this ruling?

Any Michigan resident who has named a patient advocate — someone legally authorized to make medical decisions when the patient is incapacitated — is directly affected, particularly those who could become pregnant.

Michigan Court Strikes Down Pregnancy Exclusion in End-of-Life Care

A Michigan Court of Claims judge struck down the state’s pregnancy exclusion in end-of-life care on Thursday, voiding language that had stripped incapacitated pregnant patients of their own documented medical wishes.

The struck-down provisions lived inside Michigan’s Estates and Protected Individuals Code. That’s the statute governing patient advocates, the legal designation for whoever steps in to make medical decisions when someone can’t speak for themselves. Under the old language, a patient advocate couldn’t withdraw or withhold treatment from a pregnant patient, no matter what that patient had explicitly put in writing beforehand. It didn’t matter what she wanted. The statute overrode her.

Claims Judge Sima Patel ruled that those provisions “infringe the fundamental right to reproductive freedom” enshrined in the Michigan Constitution. That right wasn’t always there. Voters put it there in 2022, amending the constitution directly after years of legislative standoff. Patel’s ruling is grounded in that amendment.

This isn’t Patel’s first run at laws that voters dismantled in 2022. She’s the same judge who struck down Michigan’s mandatory 24-hour abortion waiting period in 2025. The logic Thursday ran parallel: the challenged statutes don’t safeguard patients, they silence them.

The decision spelled it out plainly. “These provisions do not protect the health of an individual seeking care,” Patel wrote. “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.”

Think about what that means on the ground in Detroit, where hospital systems from Henry Ford to DMC operate under state statute, not press releases from Lansing. Say a woman drafts a patient advocate document clearly stating she doesn’t want life-sustaining intervention if she’s incapacitated and terminally ill. Under the old Estates and Protected Individuals Code, a pregnancy could freeze those instructions entirely. Her advocate’s authority vanished the moment she was pregnant and couldn’t speak. That’s the provision Patel wiped off the books Thursday.

The defendants in the case, Gov. Gretchen Whitmer, Attorney General Dana Nessel and Department of Health and Human Services Director Elizabeth Hertel, didn’t exactly fight hard for the law. They conceded the facts presented by the coalition of patients, doctors, and advocates who filed suit, and argued their agencies simply wouldn’t enforce the pregnancy exclusion. Their position: no enforcement means no live controversy, so no ruling needed.

Patel didn’t buy it. She said the argument “left a structural problem in place,” as Michigan Advance reported.

“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’s the crux of it. Hospital legal departments don’t govern themselves by what a governor says she’ll overlook. They govern themselves by what’s in Michigan Legislature’s codified law. The pregnancy exclusion was still in the Estates and Protected Individuals Code, on the books and technically enforceable, regardless of what any current administration promised to ignore. Any compliance officer at any Michigan hospital system had a defensible reason to follow the statutory language until a court said otherwise.

Now a court has said otherwise.

The 2022 constitutional amendment that locked reproductive freedom into the Michigan Constitution has been the legal foundation for a string of rulings that have redrawn what the state can and can’t mandate around pregnancy-related care. 3 distinct statutory provisions fell under Patel’s ruling Thursday, and the decision affects every Michigan resident who has ever signed a patient advocate document, not just those currently seeking abortion care.

It’s worth being specific about what the ruling doesn’t do. It doesn’t change criminal statutes. It doesn’t rewrite hospital policies overnight. What it does is remove the statutory cover that let institutions override a patient’s documented wishes whenever a pregnancy was involved. The law is off the books. The decision is binding.