The Texas Supreme Court unanimously rejected a challenge to the state’s near-total abortion ban, ruling Friday that there is no need to clarify the law’s medical exceptions.
Texas bans abortion in almost all circumstances, but the court’s nine Republican justices ruled that a medical exception allows doctors to perform the procedure even if a woman is not in imminent danger of death.
“Texas law permits life-saving abortions,” the court wrote in an order signed by Judge Jane Bland. “The law also authorizes a physician, in the physician’s reasonable medical judgment, to intervene to address a woman’s life-threatening physical condition before death or serious disability is imminent.”
Zulawski v. Texas was filed in March 2023 by five women who sought abortions after Texas’ ban went into effect but were denied them despite the risks and harm their pregnancies posed to their health, their unborn children and their unborn children.
By the time the case reached the state Supreme Court in November of that year, there were 22 plaintiffs (20 women and 2 doctors).
The case was the first medically based challenge to a state abortion ban since the US Supreme Court overturned Roe v. Wade. The plaintiffs were not seeking to overturn the law, only to clarify under what circumstances abortion is justified.
The plaintiffs argued that the 2021 law goes against a long history of allowing doctors to determine whether an abortion is necessary to protect the mother’s health under state law.
They argued that while the bill contains language allowing abortion in cases where life is at risk, it is too vague and the penalties too severe, amounting to a blanket ban that would endanger the lives of mothers already carrying non-viable babies.
In August, a district court judge issued a preliminary injunction allowing Texans with complicated pregnancies to obtain abortions. The court replaced the law’s “reasonable medical judgment” with “good faith judgment.”
Texas Attorney General Ken Paxton (Republican) quickly appealed, staying the ruling and allowing the abortion ban to remain in effect as written.
On Friday, the Texas Supreme Court overturned the ruling, saying it “departed from the letter of the statute without constitutional justification.”
“A doctor who tells a patient that complications arising from your pregnancy are life-threatening and that you are at risk of death or serious disability if you do not have an abortion, and who then states, ‘However, the law does not allow us to perform an abortion in these circumstances,’ is simply making an incorrect legal judgment,” the court ruled.
The plaintiff in the lawsuit, Amanda Zulawski, experienced preterm rupture of membranes (PPROM) at 18 weeks into her pregnancy, a condition that is fatal to the fetus and poses significant risks to the mother, but doctors refused to abort the pregnancy because the fetus’s heart was still beating.
She spent nearly a week at home, slowly getting sicker, until her husband 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 made it difficult for her to have children in the future.
Since then, states have amended their laws to clarify that physicians who perform abortions in response to a diagnosis of PPROM are not liable under the Protection of Human Life Act.
“A physician may perform an abortion with the confidence that the law permits it in these circumstances, given a diagnosis based on reasonable medical judgment and the woman’s informed consent,” the court wrote. “Zulawski’s painful wait until she became ill enough to induce an abortion, her development of sepsis, and her permanent physical injury are not consequences mandated by the law.”
