The Texas Supreme Court unanimously rejected a challenge to the state’s near-total abortion ban, ruling Friday that the law’s medical exceptions do not need to be clarified.
Texas bans abortions in almost all circumstances, but the nine Republican justices on the court found that the medical exceptions allow doctors to treat women even if they are not at imminent risk of death.
“Texas law permits a life-saving abortion,” the court wrote in the order signed by Justice Jane Bland. “The law permits a physician to intervene to address a woman’s life-threatening physical condition before death or serious physical impairment are imminent” if the physician exercises reasonable medical judgment.
The case, Zurawski v. Texas, was initiated in March 2023 by five women who sought abortions after the Texas ban went into effect and were denied despite the risk and harm that their pregnancies posed to their health and that of their fetuses or future children.
By the time the case was argued in the state Supreme Court that November, there were 22 plaintiffs: 20 women and two doctors.
The lawsuit was the first medical-based challenge to a state’s abortion ban since the U.S. Supreme Court overturned Roe v. Wade. The plaintiffs weren’t seeking to overturn the law, only to clarify what circumstances warranted an abortion.
The plaintiffs argued that the 2021 law flew in the face of a long history of doctors being allowed to determine when abortion was necessary to preserve the health of the mother under state law.
They contended that while the legislation included language intended to allow abortions in life-threatening cases, it was so vaguely worded — and its penalties so harsh — that it amounted to a total ban that threatened the lives of mothers already carrying babies who would not survive. Physicians face up to 99 years in prison, at least $100,000 in fines, and the loss of their medical license for violating the law.
In August, a district court judge issued a temporary injunction that allowed Texans with complicated pregnancies to get an abortion. The court replaced the law’s language of “reasonable medical judgment” with “good faith judgment.”
Texas Attorney General Ken Paxton (R) immediately appealed, putting the ruling on hold and allowing the abortion ban to continue being enforced as written.
On Friday, the Texas Supreme Court overturned that ruling, saying it “departed from the law as written without constitutional justification.”
“A physician who tells a patient, ’Your life is threatened by a complication that has arisen during your pregnancy, and you may die, or there is a serious risk you will suffer substantial physical impairment unless an abortion is performed,’ and in the same breath states ‘but the law won’t allow me to provide an abortion in these circumstances’ is simply wrong in that legal assessment,” the court found.
The Center for Reproductive Rights, which filed the lawsuit, said in a statement the ruling “fails to provide any meaningful clarity on when doctors can perform abortions for dire medical reasons” and “largely ignores the women who filed the case.”
Amanda Zurawski, the named plaintiff in the suit, was 18 weeks pregnant when she experienced preterm prelabor rupture of membranes (PPROM). The condition is fatal to the fetus and poses a serious risk to the mother, but doctors refused to perform an abortion because there was still fetal cardiac activity.
She spent nearly a week at home, growing gradually sicker, until her husband finally brought her back to the emergency room, where she was diagnosed with sepsis and spent three days in the intensive care unit. She survived, but the infection threatened her ability to have future children.
“We all deserve bodily autonomy. Every day, people in Texas are being told that they have no options. It’s sickening and wrong,” Zurawski said in a statement. “Our Courts should acknowledge all of our suffering and vindicate our fundamental rights to reproductive autonomy. We should not need to beg elected officials for our right to control our own bodies.”
Since then, the state amended the law to make it clear a physician who performs an abortion in response to a PPROM diagnosis is not liable under the Human Life Protection Act
“With a diagnosis based on reasonable medical judgment and the woman’s informed consent, a physician can provide an abortion confident that the law permits it in these circumstances,” the court wrote. “Ms. Zurawski’s agonizing wait to be ill ‘enough’ for induction, her development of sepsis, and her permanent physical injury are not the results the law commands.”
Updated at 1:17 p.m.