The Texas Supreme Court rejects a challenge to the abortion ban based on medical exceptions

The Texas Supreme Court unanimously rejected an 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 ruled that the medical exceptions allow doctors to treat women even if they are not at immediate risk of death.

“Texas law permits life-saving abortion,” the court wrote in the order signed by Judge Jane Bland. “The law permits a physician to intervene to address a woman's life-threatening physical condition before death or serious physical impairment is imminent” if the physician exercises reasonable medical judgment.

The case, Zurawski v. Texas, was filed in March 2023 by five women who sought abortions after the Texas ban went into effect and were denied despite the risk and harm their pregnancy posed to their health and that of their fetuses or future children.

By the time the case was argued in the state Supreme Court in November, there were 22 plaintiffs: 20 women and two doctors.

The lawsuit was the first medical challenge to a state's abortion ban since the U.S. Supreme Court overturned Roe v. Wade. The plaintiffs were not seeking to overturn the law, but only to clarify what circumstances justified an abortion.

The plaintiffs argued that the 2021 law violated a long history of allowing doctors to determine when abortion was necessary under state law to preserve the mother's health.

They argued that while the legislation contained language intended to allow abortions in life-threatening cases, it was so vaguely worded – and the penalties were so severe – that it amounted to a total ban that threatened the lives of mothers who were already carrying babies who would not survive. .

In August, a district court judge issued a temporary injunction allowing Texans with complicated pregnancies to obtain abortions. The court replaced the law's language of “reasonable medical judgment” with “good faith judgment.”

Texas Attorney General Ken Paxton (R) immediately appealed, suspending the ruling and allowing the abortion ban to remain as written.

On Friday, the Texas Supreme Court overturned that ruling, saying it “departs from the law as written without constitutional justification.”

“A doctor who says to a patient: 'Your life is threatened by a complication that arose during your pregnancy, and you may die, or there is a serious risk that you will suffer significant physical disability unless an abortion is performed performed', and in the Same breath statement 'but the law does not allow me to perform an abortion under these circumstances' is simply incorrect in that legal assessment,” the court ruled.

Amanda Zurawski, the named plaintiff in the lawsuit, was 18 weeks pregnant when she experienced premature pre-labor 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 heart activity.

She spent almost a week at home, gradually getting sicker, until her husband finally took her back to the emergency room, where she was diagnosed with sepsis and spent three days in intensive care. She survived, but the infection threatened her ability to have future children.

The state has since changed the law to clarify that a doctor who performs an abortion based on 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 perform an abortion with the confidence that the law allows it under these circumstances,” the court wrote. “Ms. Zurawski's agonizing wait until she was 'sick enough' for induction, her development of sepsis, and her permanent physical injury are not the outcomes the law requires.”

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