Texas' highest court on Friday refused to ensure that doctors in the U.S. state are not prosecuted for abortions they believe are necessary in medically complicated pregnancies, rejecting a lawsuit by 22 patients and physicians.
The Texas Supreme Court's decision follows an earlier ruling from the court denying a woman's request for an emergency abortion of a non-viable pregnancy. In both cases, plaintiffs said the medical exception to the state's near-total abortion ban was unclear, and left doctors unwilling to perform medically necessary abortions in the face of severe penalties including potentially life in prison.
Texas law allows abortion when, in a doctor's "reasonable medical judgment," the mother has "a life-threatening physical condition that places her at risk of death or serious physical impairment." Justice Jane Bland wrote for the unanimous court that the state's constitution does not guarantee any broader right to abortion than that.
Bland also wrote that the law allows an abortion "before death or serious physical impairment are imminent," but did not offer any further detail about what circumstances would be covered by the exception.
The Center for Reproductive Rights, which represents the plaintiffs, did not immediately respond to a request for comment.
The decision comes as a judge in Indiana is expected to conclude a trial about a similar legal challenge over the scope of the medical emergency exception to that state's abortion ban.
Cases over when medical exemptions to abortion bans apply are pending in several other states, as well as before the U.S. Supreme Court, which is weighing whether a federal law governing emergency room treatment conflicts with Idaho's abortion ban.
The Texas lawsuit was filed in March 2023 by five Texas women who said they were denied medically necessary abortions despite the grave risk to their lives, as well as two doctors. Another 15 patients have since joined the case, bringing the total to 22.
The patients all said they had suffered pregnancy complications requiring abortions, or faced a risk of such complications in the future. Some said they had been forced to travel out of state to terminate a pregnancy.
It was one of the first cases in which pregnant women sued over curbs imposed after the U.S. Supreme Court in 2022 overturned its landmark Roe v. Wade decision, which had established a right to abortion nationwide.
Last August, the plaintiffs won an order from a trial court judge shielding doctors from prosecution for abortions they believed in "good faith" were necessary under a range of circumstances, including when a pregnancy poses a health risk, exacerbates a health condition or when the fetus is unlikely to survive after birth.
Bland wrote that the order went against the law by replacing the "objective" standard of "reasonable medical judgment" with a "subjective" one of "good faith." She also said it expanded the exception to include non-fatal health conditions and to consider the fetus's likelihood of survival, which are not part of the law as written.
Texas passed its abortion law in 2021, when the procedure was still legal nationwide. The law included so-called trigger language causing it to take effect automatically when the Supreme Court overturned Roe.
