Adriana Smith Deserved to Die With Dignity
By sTACY LEE KONG
Image: GoFundMe
Content warning: this newsletter contains disturbing details around anti-Blackness, medical racism, medical torture, reproductive injustice, slavery and death.
I’m honestly too horrified to come up with a clever way into this one, so I’m just going to say: I haven’t been able to stop thinking about Adriana Smith since I first learned her name last week.
In February, doctors declared Smith, a 30-year-old Black woman, brain dead. But Emory University Hospital in Atlanta has been keeping her body animated (I genuinely don’t think we can say ‘alive’) because she was nine weeks pregnant at the time, and Georgia’s abortion ban prohibits the termination of a pregnancy once cardiac activity is detected. Her family wasn’t given a choice in the matter. Her seven-year-old son thinks she’s sleeping. And the fetus the state of Georgia is trying so desperately to save? It’s not clear if he’ll even survive.
In every way that matters, she is gone, and the fact that the state has ordered her body to be used as a de facto incubator contravenes so many cultural norms (not to mention morals, bioethics, well-established protocols for end-of-life care and, you know, basic human decency) that I struggle to find the words to express how disturbing this all is. But I’m going to find them, because I think it’s important to explicitly state what this means beyond the tragedy her family is experiencing. And to be honest, I’d rather we didn’t do that through the lens of The Handmaid’s Tale.
“The decision should have been left to us—not the state.”
If you’re asking how this can even happen, the answer is racism. The data is very clear: America has the highest maternal death rate of any high-income nation, and Black women have the highest maternal death rate in America, by far. (A note: I’m using women here because that’s the language in the study I’m citing, but this data may also include trans and non-binary people who don’t identify as women, obviously.) In Switzerland, the maternal death rate, which is the number of people who die while pregnant or within 42 days of giving birth, is 1.2 per 100,000 live births. In the U.K., 5.5. In Canada, 8.4. And in America, it’s 22.3—except, among Black women, it’s 49.5. This is more than twice the rate for white women, and almost four times the rate for Asian-American women, who have the lowest maternal death rate in the country.
The reasons for this disparity are also clear: discrimination, bias and inattentive care. And it does seem like these things were factors for Adriana, who was a nurse herself. According to her family, she had been suffering with intense headaches for days, and eventually went to the hospital, where she was given medication and sent home without a CT scan or any other tests. The next day, her boyfriend woke up to the sound of her gasping for air and making gurgling noises. She was rushed to the hospital again, and this time “a CT scan showed blood clots in her brain,” according to MSNBC. Within hours, doctors declared her brain dead. At this point, medical ethics demand her family be consulted to determine what happens next. But in Adriana’s case, the hospital told her mother, April Newkirk, they had to keep her body alive (‘alive’) because of the state’s abortion ban, more formally known as the Living Infants Fairness and Equality (LIFE) Act, which prohibits the termination of a pregnancy once cardiac activity is detected, usually around the six-week mark.
“We didn’t have a choice or a say about it,” Newkirk told local news station 11Alive. “We want the baby. That’s a part of my daughter. But the decision should have been left to us—not the state.”
I should note here that so-called heartbeat laws like this one are misleading; as New York Times health reporter Roni Caryn Rabin explained in 2022, “the electric activity begins at around six weeks in a tube of cells that will become a heart, after multiple gyrations.” (Emphasis mine.) But regardless of the shaky science behind them, these laws do often contain a provision that allows abortion in cases where the mother’s life is at risk.
“After [six weeks], abortions can be performed in limited circumstances, such as if a ‘medical emergency’ exists or the pregnancy is ‘medically futile,’” a Ms. article notes. “However, because Adriana is already dead, her life is no longer at risk to qualify for the medical emergency exception.”
Just to be very clear: the argument is that she’s not eligible for an exception to the abortion ban… because she is dead.
Now, is it even true that Adriana’s case falls under the LIFE Act? Unclear! Georgia’s Attorney General Chris Carr says it doesn’t: “There is nothing in the LIFE Act that requires medical professionals to keep a woman on life support after brain death,” per his communications team. “Removing life support is not an action with the purpose to terminate a pregnancy.” Still, Emory’s administrators aren’t budging. The hospital’s plan is to keep her dead body on life support until early August, which would be about 32 weeks’ gestation, and the point they think the fetus will be able to survive outside of the womb. (Though even that is not guaranteed; in medical literature, there have been 30 cases of brain-dead people who were kept alive in order to bring a fetus to term, but only 12 “viable infants” were born and survived. Specific to this case, while Newkirk says his heartbeat is strong and he’s developing normally, tests do show the baby, who the family has named Chance, has fluid in his brain. “He may be blind, may not be able to walk, may not survive once he’s born,” she says.)
People are using the word necromancy to describe this situation and I get it
If, like me, you didn’t totally know what ‘brain death’ meant before this story went viral, it’s worth sitting with the definition, I think. Because Adriana is not in a coma. She is not in a vegetative state. She has experienced brain death, or death by neurologic criteria, which is defined as “the permanent and complete absence of human brain function.” This doesn’t just mean that there’s no function in the parts of her brain that control things like learning or morality or language; it means even her brain stem, which controls our most basic, vital functions, including breathing, heart rate, blood pressure, consciousness and sleep, has died. So, while interventions such as ventilators, medical treatments and constant supervision are keeping Adriana’s body artificially animated, she’s not alive—and there is zero chance she will recover.
That’s what I mean when I say she’s not there. And that’s why Emory’s decision to keep her body functioning feels like such a desecration.
It’s not just the consent piece, though it’s definitely jarring to see that we’re not just subject to broken consent in life, but can also be violated in death. It’s also, for me at least, the profound unfairness of it all. Adriana was denied equitable access to healthcare in life, which directly led to her death, and now that she’s legally no longer alive, she’s not eligible for any kind of protection—but what was literally still only a clump of cells at the time is? It’s tragically ironic that the attentiveness she needed in life is only being given to her after her death, and not even for her benefit.
Worse, this was always the plan.
“What is happening to Adriana and her family is not some anomaly,” Jessica Valenti argues in a recent edition of her abortion rights newsletter, Abortion, Every Day. “It’s not a case of the hospital misunderstanding the law, or an issue of Georgia lawmakers not fully thinking through what the state ban would mean for women like Adriana. (In fact, state Sen. Ed Setzler, who sponsored the state’s abortion ban, says the hospital is ‘acting appropriately.’) They planned for this. Anti-abortion legislators and activists knew this would happen—they knew their laws would devastate families and lives—and they passed them anyway.”
There is no way to separate Adriana Smith’s Blackness from what is being done to her body
It’s giving dystopia. And yes, I know The Handmaid’s Tale actually did feature a very similar storyline in season 3, so I understand why so many articles and pieces of political art about Adriana reference the show, and by extension Margaret Atwood’s novel of the same name. But there’s actually a more apt comparison: reproductive coercion throughout the transatlantic slave trade.
A 2021 blog post from the African American Intellectual History Society spells out how “enslavers enforced control over enslaved women’s reproduction through various means,” including slave breeding, the term for “forced relationships between enslaved men and women, and rape of enslaved women by white enslavers, overseers, and slave drivers.” If you know anything about the birth of modern gynecology, you know this also came about via slavery, since “white doctors… participated in the maintenance of the plantation regime and of labor [sic] increase by overseeing and interfering in the births of enslaved children. Their involvement in Black women’s childbirth and reproduction was exploitative as they violently experimented on Black women without anesthesia or consent.”
It is impossible to miss the parallels. Sure, the purpose here is not to maintain the plantation regime and to increase productivity, but it is to further a fascist worldview. And the tactics are very similar. I mean, are Republican lawmakers, medical institutions and individual healthcare practitioners enforcing control over a Black woman’s reproduction? Yes. Are they overseeing and interfering in the birth of a Black child? Yes. Are they doing so without Adriana Smith’s, or her family’s, consent? Yes. They have reduced this woman to an object, or perhaps more accurately, a vessel without needs, desires or autonomy of its own. It’s dehumanizing and extractive.
But here’s the thing: Atwood actually drew the same parallels when writing the novel. As a 2017 essay in The Verge pointed out, the author “openly acknowledges that Offred’s experiences of violence and sexual coercion are based on American slavery. The network that rescues handmaids is clumsily named the Underground Femaleroad, after the historic Underground Railroad. Atwood also mentions that the regime hates the song ‘Amazing Grace,’ which was originally written as a protest against the slave trade. Handmaids, like black slaves before them, are not allowed to read, need passes to go outside, and can be publicly lynched for perceived crimes against the regime.”
Both the book and the show are just very popular examples of a classic sci-fi writer strategy: take the horrors that oppressors actually inflicted on Black, Indigenous and racialized people and apply them to white people. Voila, instant horror! Even when done compellingly, this type of storytelling is frustrating because it centres white suffering. So, while I understand the impulse to reference a very popular show that has a seemingly perfect analogy for what we see unfolding now in Georgia, I’d just rather… not. Adriana Smith’s story is very real, and part of a very long legacy of exerting control over Black women’s reproduction. Let’s just say that.
✨ Out Now: Friday Talks Episodes 2 & 3 ✨
I’m really proud of this season of Friday Talks, and especially the way we’ve been able to have candid conversations that don’t necessarily get tied up in a neat bow at the end of each episode. For example: last week, I chatted with Toronto Metropolitan University professor Rupa Banerjee and policy analyst Chloe Brown about the ‘Canadian dream,’ and why it’s harder than ever to achieve for racialized second-generation Canadians. This week’s episode features Rechie Valdez, Member of Parliament and Minister for Women and Gender Equality and Youth of Canada, and Anar Ali, novelist, screenwriter and the creator and executive producer of the police drama Allegiance, for a wide-ranging convo on belonging, community and what ‘home’ even means.
P.S., Want more Friday Talks? Check out Friday Things on YouTube!
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