The Texas Supreme Court on Friday rejected a challenge to the state’s abortion ban — a response to a lawsuit filed last year by a group of women who had serious pregnancy complications.
The ruling from the nine justices, who are all Republicans, was unanimous.
Five women brought the lawsuit in March 2023, saying they were denied abortions even when issues arose during their pregnancies that endangered their lives. The case grew to include 20 women and two doctors.
The plaintiffs had not sought to repeal the ban, but rather to force clarification and transparency as to the precise circumstances in which exceptions are allowed. They also wanted doctors to be allowed more discretion to intervene when medical complications arise in pregnancy.
The lead plaintiff, Amanda Zurawski, told NBC News she was infuriated by Friday’s ruling.
“It’s pretty heartbreaking that the Texas Supreme Court made it very clear today that they do not wish to help pregnant Texans. They don’t wish to clarify things for doctors in the state of Texas,” Zurawski said. “They had an opportunity to make things better, and they didn’t. So as a result, people are going to continue to suffer.”
Another plaintiff, Samantha Casiano, whose fetus was diagnosed with anencephaly, also expressed anger and disappointment.
“I was told my baby would not survive, but I was forced to continue my pregnancy and give birth anyway, then watch her pass away hours later,” she said in a statement. “I don’t know how the court could hear what I went through and choose to do nothing … I am embarrassed to be a Texan because of these inhumane laws.”
Texas law prohibits all abortions except to save the life of the mother. Doctors who violate it can lose their medical licenses, face up to 99 years in prison or incur fines of at least $100,000. Critics of the ban, which is among the most restrictive in the U.S., have said it does not provide enough guidance about which exceptions are allowed.
Friday’s decision did, however, offer a new sliver of clarity. The ruling affirms that a preterm premature rupture of membranes — when the amniotic sac breaks before 37 weeks of pregnancy — can warrant an abortion because it results in infection.
But, the decision says Texas law “plainly does not permit abortion based solely on a diagnosis that an unborn child has an abnormal condition, even a life-limiting one.”
The ruling also says Texas’ abortion ban does not mandate that a woman’s death be imminent for a doctor to perform an abortion due to a life-threatening complication, and that a doctor’s judgment can be reasonable even if not all physicians agree with it.
“For physicians who violate the abortion ban, the state would need to prove that no reasonable position would have concluded that the patient was eligible for the exception,” Molly Duane, the lead attorney for the plaintiffs, said on a call with reporters after the decision was issued. Duane is a senior staff attorney at the Center for Reproductive Rights, a legal advocacy organization representing the plaintiffs.
Last summer, a district court judge who heard the Zurawski case issued a temporary injunction, preventing Texas from enforcing the ban against doctors who terminated a pregnancy because of dangerous complications.
“The Court finds that there is uncertainty regarding whether the medical exception to Texas’ abortion bans … permits a physician to provide abortion care where, in the physician’s good faith judgment and in consultation with the pregnant person, a pregnant person has a physical emergent medical condition,” the ruling said.
However, the Texas Supreme Court disagreed. Duane said the Friday ruling effectively closes the door on many of the suit’s central claims.
“Our team will need time to determine what, if anything, remains of our original lawsuit,” she said.
Zurawski v. Texas was the first legal challenge to the state’s bans that focused specifically on women with complicated pregnancies.
Zurawski has said she nearly died in August 2022, after doctors delayed giving her a medically necessary abortion when she had catastrophic complications while 18 weeks pregnant. After her health deteriorated, her doctors eventually performed an abortion. She said she later went into sepsis and spent three days in the intensive care unit.
Zurawski’s doctors later advised her not to carry a baby again, she said. So she and her husband turned to in vitro fertilization and sought to have a baby through a surrogate.
Casiano recounted the details of her experience at a hearing last summer. At 20 weeks pregnant, she said, she learned that her baby had a serious condition in which parts of the brain and skull were missing. The issue also put her life at risk, Casiano said. She sobbed and vomited on the stand when describing the events, prompting the judge to declare a recess. Casiano said she had experienced emotional trauma during her pregnancy.
John Seago, president of the anti-abortion group Texas Right to Life, told NBC News that state law is clear about when an abortion is warranted, and confusion among doctors is “not a fault of the law.”
“It’s a fault of the implementation, of teaching doctors, making sure that lawyers in the hospitals and that the ethics committees in these hospitals know what the law is,” he said.
Seago said his group is working with the Texas Medical Board to educate doctors about what’s legal.
“Having this effect, that there are some women whose lives are being jeopardized, is the complete opposite of what the goal of these laws is,” he added.
The Texas Supreme Court’s Friday ruling is in line with a decision it issued in December, directing a lower court to vacate an order that had blocked the state’s abortion ban from applying in the case of Kate Cox.
Cox sued the state after her developing fetus was diagnosed with trisomy 18, a rare chromosomal disorder that significantly increases the risk of stillbirth or infant death shortly after birth. She sought a court order to allow her to terminate the pregnancy.
Cox’s lawyers said her doctor had determined that carrying the pregnancy put her health and future ability to have children at risk. Shortly before the Texas Supreme Court ruled against her, Cox left the state to get an abortion.
