I’ve felt an overwhelming need to write for about a month now. I struggled to find the right words as recent events in medicine and society have created a constant state of confusion and distress. Most notably, I have found it increasingly difficult to understand or process how some medical professionals can remain silent or indifferent in the face of ethical crises. At times, the anger this evokes leads me to say nothing out of the need for self-preservation.

Until the case of Adriana Smith came across my feed. To be clear, my foundational support of reproductive choice is a large part of both my medical practice and my political advocacy on both a state and federal level. As an anesthesiologist and a critical care physician who has previously worked with high-risk obstetrical patients while also simultaneously having the responsibility of declaring patients brain dead, my brain broke trying to understand this situation.

First and foremost, a brain-dead patient is dead. At the conclusion of the second brain death exam by a second provider, the time of death is called. The patient is dead. I truly do not know how to make it more clear for not only the lay person but other medical professionals. Unless there has been clear permission granted by the next of kin for organ donation, the patient is cared for by the ICU nurses in a respectful and nuanced manner to honor the dead and maintain autonomy and dignity to the deceased. Anything other than that is abuse of a corpse and illegal, immoral, and unethical.

The life of a 9-week embryo is fully dependent on the organ in which it is housed. An organ that belongs to an autonomous human who is now dead. Which means that the use of that organ (the uterus), whether by transplantation or preservation of existence for later harvesting of its contents, is akin to cutting out a kidney for money outside the rigorous system controlling legal and regulated organ donation. And if the argument is made that the potential for life in the uterus is why the patient must be kept artificially alive despite legal death, then the same argument could be made to force organ donation regardless of the opinion or comfort level of a patient or their family’s wishes. It would be state-mandated organ harvesting. Harvesting of a potential human from another human without permission. One must ask, what exactly are we doing?

We need to clarify why the hospital is interpreting the heartbeat bill of Georgia in such a way that it has created a generational moral failure. The lawyers can advise us, but it is still a medical decision. We are cowering behind HIPAA, but the precedent of this scenario is paramount. Within the details of this case, outside of the ethical disaster, there lies personhood language and the potential for the weaponization of pregnancy against the autonomy of pregnant individuals. And worse now, is that the state AG is insisting that the law does not apply in this situation, as the act of removing a person from life support is not intentionally terminating a pregnancy.

This is where the confusion lies and likely where the health care providers are hiding. Because this determination is at the level of the courts even if acting in the best interests of the patient and their family. If the bill allows for criminal prosecution for doing anything which could be deemed intentional resulting in the termination of the pregnancy, are we not prohibited from any medical care for a pregnant patient? Who determines what is necessary or not? Who determines intentionality or not? Who determines what is legal or not? Reasonable medical judgment becomes a criminal court decision vice a standard of care deliberation. Fear blankets the moral clarity of this patient’s providers.

Which then brings us to the rumors swirling about Adriana’s care prior to progressing to brain death. Though knowing the specifics or even the medical judgment that led to sending her home without imaging isn’t possible, one must wonder if her pregnancy status was a consideration in this decision. Additionally, one must question what procedure was considered upon her return to the hospital. Did that procedure not happen because it was deemed futile, or was there fear of contributing to a spontaneous abortion? Was she initially dismissed as an anxious Black pregnant woman without an appropriate workup, or was the consideration of the embryo of higher importance than the live patient in the stretcher, despite the pleas of her partner?

There have always been medical professionals who were hesitant to provide care to pregnant patients due to the fear of “litigation” in the event of a miscarriage or fetal anomaly. But with informed consent and management consistent with the standard of care, this fear was often more theoretical than reality. Underlying much of that fear was often personal bias that included their opinion that the fetus was worthy of equal consideration to the patient. Now that the law is here to encourage and validate their viewpoint, not only will the care available to pregnant patients be limited by those who already withheld needed care for these patients, but also by those practitioners who understood the necessity of procedures and other interventions on pregnant patients. Now all of us are forced to consider whether necessary actions could be interpreted as intentional and thus criminal if resulting in a spontaneous abortion.

The argument of many will be that this is hysterical or even fear-mongering, but my predictions in the wake of Dobbs have come to be reality in the time since then. There are bills being introduced across red states that would potentially charge women for doing any “dangerous activity” during pregnancy that could result in spontaneous abortion. I wondered at that time if the same pro-life forced birth female physicians who celebrated the overturning of Roe could be prosecuted for their pregnancy complications or losses due to work-related stress. I stated that our reproductive choice on when and how we procreate would be controlled by the government and our employer. Our womb was no longer ours. Our uterus is a prison of the government’s making. Now the truth lies dead in an ICU bed in Georgia. A uterus only. Controlled by the state.

Her name was Adriana Smith, and the advocate she needs is us. This is our fight. This is our lane. This is our responsibility. And someone must be willing to speak up, speak out, and fight against the hospital administration and the state and federal government. As someone who has quite literally imploded my career on principle at the dawn of the pandemic, I know how hard this may seem. But a dead Black woman is being used as an incubator in a state where her ancestors were once bought, sold, and bred. We owe her this much.

Nicole M. King is an anesthesiologist and intensivist.