AUSTIN, Texas (AP) — The Texas Supreme Court on Friday rejected a closely watched challenge to the state’s restrictive abortion ban, ruling against a group of women suffering severe pregnancy complications who became the first in the U.S. to testify that they had been denied an abortion since the Roe v. Wade ruling was overturned.
In a unanimous ruling, the all-Republican court upheld the Texas law, which opponents say is too vague about when medically necessary exemptions are allowed. The same issue was at the heart of another lawsuit filed last year by Kate Cox, a Dallas mother of two, who had asked the court for permission to have an abortion after her fetus developed a fatal condition during a pregnancy that resulted in multiple emergency room visits.
Abortion rights activists have struggled to stem the tide of restrictions that have gone into effect in most Republican-led states since the U.S. Supreme Court in 2022 overturned the Roe v. Wade decision that had upheld the constitutional right to abortion for nearly 50 years.
The court held that the law’s exceptions as currently written were broad enough and that doctors would misinterpret the law if they refused to perform an abortion when the mother’s life was in danger.
“Texas law permits life-saving abortion,” the court wrote in the order signed by Judge Jane Bland.
The decision appears to close another avenue, at least for now, for opponents seeking to force the state to provide more clarity about when exceptions are allowed. Last year, plaintiffs in an Austin courtroom gave emotional descriptions of carrying babies they knew wouldn’t survive and continuing pregnancies that increasingly put their health at risk.
“Now we know the court’s doors are closed to them,” said Molly Duane, an attorney with the Center for Reproductive Rights, which represented the Texas women. “It seems Texans have no choice but to go to the ballot box to decide what happens next.”
Under Texas law, doctors who perform abortions risk life in prison, fines of up to $100,000, and loss of their state license.
A lower court had issued a preliminary injunction in 2023 preventing Texas from enforcing the ban against doctors who, in their “good judgment,” terminated a pregnancy they deemed unsafe due to complications, but it was immediately blocked by an appeal from the Texas Attorney General’s Office to the state Supreme Court.
Amanda Zurawski, the lead plaintiff in the case, was told she had a medical condition that meant her baby would not survive. The Austin woman said she had to wait until she was diagnosed with life-threatening sepsis before she could have an abortion.
She spent three days in intensive care and suffered a enduring blockage of her fallopian tubes due to an infection, which narrow her ability to have more children.
The court ruled that state law does not require that the woman’s death or stern impairment be “imminent” for a doctor to review an abortion.
“Ms. Zurawski’s agonizing wait until she was ‘sick enough’ to have labor induced, the development of her sepsis, and her permanent physical impairment are not the consequences the law provides,” the court wrote.
Zurawski called the verdict “heartbreaking.”
“I am outraged on behalf of my fellow plaintiffs who the court found were not sick enough,” Zurawski said. “We all have a right to bodily autonomy. Every day, people in Texas are told they have no choice. This is disgusting and wrong.”
Texas Republican Attorney General Ken Paxton, whose office defended the law in the case, welcomed the ruling.
“I will continue to defend the laws passed by the Legislature and uphold the values of the people of Texas by doing everything in my power to protect mothers and babies,” Paxton posted on X.
Earlier this month, two University of Texas professors joined Paxton’s federal lawsuit against the Biden administration, which is challenging regulations that expand protections for pregnant students in federally funded education programs, including relief for students who have to miss classes because of an abortion.
Philosophy professor Daniel Bonevac and business professor John Hatfield said they would only accommodate students in cases of “medically necessary” abortion when the life or health of the mother was threatened.
The state’s lawsuit, decided Friday, argues that exceptions in Texas law allowing abortion to save the mother’s life or prevent impairment of a vital bodily function are causing confusion among doctors, who turn away some pregnant women with health complications for fear of reprisal.
The plaintiffs said the abortion ban raised concerns among medical professionals that they would be held liable if the state did not treat the situation as a medical emergency.
Last year, Cox left the state to have an abortion before the court ruled that she had not proven her life was in danger. In the ruling, the court also asked the state medical board to provide more guidance.
But up-to-date guidelines proposed by the medical board earlier this year contained little more than advice that doctors should carefully document their decisions. And the Republican-led Texas legislature is not expected to make any changes to the law’s language.
Plaintiff Kaitlyn Kash, whose fetus developed severe skeletal dysplasia, was told that even the simplest movements could break bones in the womb. Although her life was not threatened, she decided to leave Texas to have an abortion.
“I wanted to end my child’s suffering before it began,” Kash said. “The state simply told me that as a mother, I did not have the right to make those decisions for my child. … If you want to expand your family and have children, you should leave Texas.”
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Stengle reported from Dallas. Associated Press writer Paul J. Weber contributed from Austin, Texas.
