Nikki Sapiro Vinckier: What Writing My Advance Directive Taught Me About Sexism
By Nikki Sapiro Vinckier, PA-C
When I sat down to write my end-of-life wishes, I expected to confront mortality — not misogyny.
I was pregnant with my second child and had a toddler at home. As an OB/GYN PA, I knew everything that could go wrong — from postpartum hemorrhage to preeclampsia to the quiet emergencies no one talks about until it’s too late. I wanted to make sure that if something ever happened to me, my family would never have to guess what I wanted.
And I was giving birth in the deadliest country in the developed world to do it.
In the United States, maternal mortality rates are higher than in any other high-income nation — and they’re getting worse. We’re the only wealthy country where dying from pregnancy or childbirth is becoming more common, not less.
So my partner and I did what responsible parents are told to do. We sat down, had the hard conversations, filled out my advance directive, named him as my healthcare proxy, and moved on — believing we had done everything right.
What I didn’t realize was that simply living in Michigan had already stripped me of part of my autonomy.
Michigan’s Pregnancy Exclusion wasn’t something I debated or agreed to. It was buried in the state-mandated language — honestly, I hadn’t even noticed it. I only learned about it years later, after reading about Adriana Smith, a Georgia woman who was declared brain-dead while nine weeks pregnant and kept on life support for months without her family’s consent this past February.
When I looked back at my own paperwork, there it was: a single sentence that rendered my wishes meaningless if I happened to be pregnant.
That discovery stopped me cold. Even as a clinician, I’d missed the way the law quietly erased my rights.
The Pregnancy Exclusion is what happens when sexism becomes policy. It’s not loud or obvious; it hides in legal language and calls itself protection. Under this law, if I were pregnant and became incapacitated, my advance directive — the document outlining my medical decisions — would be automatically void. The state, not my chosen proxy, would decide what happens to my body.
It’s the kind of law you don’t notice until it’s too late. And it rests on the same old premise that women’s judgment cannot be trusted once pregnancy enters the picture and that my body serves one purpose only: reproductive.
That realization is what led both my partner and I to become plaintiffs in Koskenoja v. Whitmer, a lawsuit challenging Michigan’s Pregnancy Exclusion on constitutional grounds. It’s a case about consent, equality, and the right to self-determination — values Michiganders reaffirmed in 2022 when we enshrined the right to make and carry out decisions about pregnancy in our state constitution. The exclusion doesn’t just ignore that amendment; it defies it.
There’s no one-size-fits-all approach to end-of-life care. In my newly reissued advance directive, I’ve laid out explicit wishes for care before and after fetal viability. It doesn’t force one option over another — it simply affirms that the individual should decide, and that the capacity to become or be pregnant should never be a state-mandated factor in whether that decision is honored.
This lawsuit isn’t just about reproductive health or end-of-life care. It’s about refusing to accept that a pregnancy test can erase a person’s rights. It’s about the idea that equality must endure even when autonomy is hardest to protect.
Nikki Sapiro Vinckier, PA-C, is an OB/GYN Physician Assistant, reproductive health educator, and plaintiff in Koskenoja v. Whitmer, the lawsuit challenging Michigan’s Pregnancy Exclusion. She is also the founder of Take Back Trust, a digital platform made to educate and empower individuals with their reproductive healthcare.
