Brain Death in Pregnancy—Abortion, Advance-Directive, or End-of-Life Law?

( N Engl J Med . 2025;393(4):313-315. doi: 10.1056/NEJMp2507544) Katie Watson, JD, examines the legal and ethical complexities surrounding cases where pregnant individuals are declared brain-dead. The discussion is framed around the recent case of Adriana Smith in Georgia and the earlier case of Marlise Muñoz in Texas. Smith, who was 8 to 9 weeks pregnant, was declared brain-dead in February 2025. Her mother was reportedly told that Georgia’s 6-week abortion ban made it illegal to withdraw life support. Watson clarifies that this interpretation was incorrect, emphasizing that refusing or discontinuing medical treatment does not meet Georgia’s statutory definition of abortion. The removal of life support in such cases is an “act of omission,” distinct from the “act of commission” that characterizes abortion procedures. US Supreme Court precedents, Cruzan v. Director, Missouri Department of Health , Washington v. Glucksberg , and Vacco v. Quill, reinforce the legal distinction between withdrawing life-sustaining treatment and committing homicide or suicide.