The Texas Supreme Court unanimously denied a significant challenge to Texas’ near-total abortion ban, brought by 20 patients who were denied abortion care despite facing life-threatening pregnancy complications, as well as two doctors. In the decision, the judges refused to clarify exceptions to the state law’s abortion bans, ruling on Friday that the medical exceptions in the law would withstand constitutional challenge.
The case was brought by the Center for Reproductive Rights in March 2023 “on behalf of the women denied abortion care despite risks to their health, lives, and future fertility, and two Texas obstetrician-gynecologists,” the Center wrote about the case. The lawsuit did not seek to overturn the state’s abortion ban, but sought clarity from the state regarding when patients with pregnancy complications could receive abortions. Currently, abortion is banned in Texas unless the pregnant person faces life-threatening complications, or “substantial impairment of a major bodily function," a qualification which isn’t defined in the law.
The case, Zurawski v. Texas, was the first challenge to a state’s abortion ban on behalf of patients with pregnancy complications. According to the lawsuit, the lead plaintiff in the case, Amanda Zurawski, a citizen of Austin, Texas, was denied abortion care after she experienced preterm prelabor rupture of membranes (PPROM) at 18 weeks of pregnancy. Though her pregnancy was no longer viable, doctors reportedly would not provide her an abortion. Doctors have reported that they have withheld abortion care in some cases because they aren’t clear what would qualify as an exception to the state’s ban, and don’t want to risk legal trouble. After she developed sepsis as a result of her miscarriage, doctors induced an abortion and Zurawski “spent the next three days in the ICU fighting for her life. She ultimately survived, but the infection caused one of her fallopian tubes to become permanently closed, compromising her future ability to have children,” according to the Center.
“This outrageous ruling clearly demonstrates that Texas’s ‘medical exceptions’ to its extreme abortion bans just don’t work,” Molly Duane, senior staff attorney at the Center said in a statement. “This ruling means that pregnant Texans will continue to suffer because they can’t access the medical care they desperately need.”
The Texas court had previously ruled against Texas woman Kate Cox in a similar, separate case. But by the time the court ruled against Cox’ case, she had already left the state to receive an abortion. Friday’s ruling in the Zurawski case stated that only one of the 22 plaintiffs in the suit had standing to sue: Dr. Karsan, the Houston OB/GYN who had agreed to perform Cox’s abortion despite legal threat.
“We conclude that the Attorney General directly threatened enforcement against Dr. Karsan in response to her stated intent to engage in what she contends is constitutionally protected activity,” the justices wrote. “A state official’s letter threatening enforcement of a specific law against a plaintiff seeking relief from such enforcement is a sufficient showing of a threat of enforcement to establish standing to sue.”
The justices acknowledged the tragic outcomes of patients being denied this medical care, but seemingly placed blame back on the hands of doctors navigating the murky laws in the state. “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 ruling reads. “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.”
