Texas Supreme Court Rejects Challenge on Exceptions to Abortion Ban

The Texas Supreme Court on Friday unanimously rejected a challenge to the state’s strict abortion ban, ruling against a group of 22 women and abortion providers who sought to expand the exceptions for medical emergencies under the law.

While the challenge will continue in trial court, the state’s attorney general, Ken Paxton, would almost certainly appeal any loss there, and the high court’s decision Friday made clear that he would ultimately prevail.

“I will continue to defend the laws enacted by the Legislature and uphold the values of the people of Texas by doing everything in my power to protect mothers and babies,” Mr. Paxton said in a statement.

The lawsuit, filed by the Center for Reproductive Rights, was the first on behalf of women denied abortions after the United States Supreme Court overturned Roe v. Wade two years ago. While the case revolves around the question of what counts as an exception — unlike other lawsuits, it did not seek to overturn a state ban — it has changed the political debate around abortion by underscoring the potentially devastating medical consequences of abortion bans even for women who were not seeking to end unwanted pregnancies.

The court’s 38-page decision on Friday agreed that the experiences the women had recounted in testimony — some so painful that a judge ordered the court into recess — were “filled with immense personal heartbreak.” But it said that Texas law allowed abortions for any woman who faces a life-threatening condition, “before death or serious physical impairment are imminent.”

Echoing arguments from the state and anti-abortion groups, the court blamed doctors for misinterpreting the law.

“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,” Justice Jane Bland — like all nine of the justices and the attorney general, an elected Republican — wrote in the unanimous opinion.

In a video conference Friday, 11 of the 20 plaintiffs who sought abortions warned, often tearfully, that it was not safe to be pregnant in Texas or any of the 14 states with near-total bans on abortion.

“This could be you, this could be someone you love,” said Ashley Brandt, who went to Colorado to abort one of her twin fetuses because it had no skull, after doctors in Texas said the condition, known as acrania, threatened the other twin’s life as well as hers, but that they could not give her an abortion. “Abortion is health care and exceptions do not work.”

The ruling on Friday reversed one last summer from a trial court judge, a Democrat, that had expanded the definition of exceptions allowed under Texas’ ban. That ruling said doctors could perform an abortion if in their “good faith judgment and in consultation with the pregnant person” it would be medically unsafe for a woman to continue a pregnancy, or if her fetus has a condition making it “unlikely to survive the pregnancy and sustain life after birth.”

The Supreme Court on Friday affirmed the narrower definition of exceptions in the Texas ban, which allows abortion if in the “reasonable medical judgment” of a doctor a woman faces “risk of death” or “substantial impairment of a major bodily function.” As in most states with bans, there is no exception for fatal fetal conditions.

The court noted that the Texas Legislature amended the ban last year to specify two medical conditions that qualify as exceptions, including one known as previable premature rupture of membranes, which the lead plaintiff in the case, Amanda Zurawski, faced at 18 weeks of pregnancy. Ms. Zurawski’s fetus was not viable, but doctors said they could not abort because it still had a heartbeat.

“The law can be — and has been — amended to reflect policy choices on abortion,” Justice Bland wrote.

Abortion rights groups and doctors argue that the language of the ban is too vague, and leaves doctors too afraid to even mention abortion to patients. Those who violate the ban face up to 99 years in prison, at least $100,000 in fines and the loss of their medical license.

The question of medical exceptions has emerged as one of the most potent and contested issues since Roe was overturned. The United States Supreme Court is expected to rule in the coming weeks on whether the Biden Administration can use federal law to allow abortion in states that ban it if the procedure is required to stabilize a patient in an emergency.

Ms. Zurawski, who has told of going into septic shock and being left infertile after being denied an abortion, has appeared in ads and on the campaign trail for Mr. Biden, as Democrats hope to turn anger about abortion bans to their advantage in elections this fall.

The Center for Reproductive Rights filed suit in three other states after filing the case in Texas in March 2023, and in December represented Kate Cox, a mother of two who unsuccessfully sought an abortion in Texas after her fetus was diagnosed with Trisomy 18, a genetic condition that almost always results in miscarriage or stillbirth, or death within the first year of life.

On Friday, Nancy Northup, the president of the center, said that given the court’s ruling, it was unclear whether the Texas case could continue in the trial court. She urged a federal law establishing abortion rights. “As we have seen in poll after poll, that is what the American people want,” she said.

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