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The Texas Supreme Court unanimously rejected the most significant challenge to Texas’ new abortion laws yet, ruling Friday that the medical exceptions in the law were broad enough to withstand a constitutional challenge.
The case, Zurawski v. Texas began with five women arguing that the state’s near-total abortion laws prevented them from receiving medical care for their complicated pregnancies. In the year it took to go through the court system, the case grew to include 20 women and two doctors.
In August, a Travis County judge issued a temporary injunction allowing Texans with complicated pregnancies to have an abortion if their doctor made a “good faith judgment” that it was necessary. The Texas Attorney General’s Office appealed.
The Texas Supreme Court overturned that ruling on Friday, saying it “departed from the law as written without constitutional justification.” While the opinion was unanimous, Justice Brett Busby issued a concurring opinion that left the door open to a broader challenge to the law.
Zurawski v. Texas was a pioneering case in post-Roe America, the first challenge to a state’s abortion bans on behalf of women with complicated pregnancies. At least three other states followed suit, and this led to a related case, in which Kate Cox, an actively pregnant woman in Dallas, sued to be allowed to terminate her pregnancy.
The Texas Supreme Court rejected Cox’s plea in December, which many saw as a likely harbinger of how the court could rule in Zurawski v. Texas. On Friday, those suspicions were confirmed when the court offered a ruling very similar in nature to the Cox case.
“A doctor who tells a patient: ‘Your life is threatened by a complication that arose during your pregnancy and you may die, or there is a serious risk that you will suffer substantial physical deterioration unless an abortion is performed,’ and in “The text itself says ‘but the law will not allow me to perform an abortion in these circumstances’ is simply incorrect in that legal assessment,” the court wrote.
How the case developed
The initial lawsuit was filed in March 2023, and unlike previous mass challenges leading up to the implementation of abortion bans, this case focused on a very narrow argument: women with complicated pregnancies were denied medically necessary abortions because Doctors were not clear how and when to do it. could act.
After the overturning of Roe v. Wade in the summer of 2022, Texas banned all abortions except to save the life of the pregnant patient. Almost immediately, women began telling stories of difficult pregnancies made worse by doctors’ doubts and uncertainty.
Amanda Zurawski, the plaintiff named in the lawsuit, was 18 weeks pregnant with a daughter they named Willow when she experienced premature rupture of membranes before giving birth. Even though the condition was fatal to the fetus and posed significant risks to the pregnant patient, her doctors refused to terminate the pregnancy because there was still fetal cardiac activity. Ultimately, Zurawski suffered sepsis and spent three days in the intensive care unit. Although she survived, the infection has made it difficult for her and her husband to conceive again.
At a news conference outside the state Capitol announcing the lawsuit, Zurawski said she was fighting for all Texans who are “scared and outraged at the thought of being pregnant.”
“The people in the building behind me have the power to fix this, but they haven’t done anything,” Zurawski said. “So it’s not just for me and our Willow that I’m here before you today; it’s for every pregnant person and everyone who knows and loves a pregnant person.”
Shortly after the laws went into effect, Lauren Hall, a 27-year-old woman from North Texas, told The Texas Tribune that she learned that her long-awaited first pregnancy was developing without a skull or brain and that she would survive after childbirth. Unlike other states, Texas law does not allow abortions in cases of lethal fetal abnormalities unless they threaten the mother’s life.
But when Hall considered taking this high-risk, no-reward pregnancy to the end, she felt like she was “losing her mind.” “I would consider what I experienced that weekend a medical emergency.”
Denied an abortion in Texas, Hall and her husband ended up struggling to travel to a clinic in Seattle that specializes in such cases, where she was met by angry protesters who had also traveled from Texas.
She returned home a few days later in a confusing mix of grief and anger, and a few months later, she signed the lawsuit in the hope that no one would have to go through that experience again.
“Providers are afraid to treat cases like ours without state guidelines, and more people will suffer (and lose their lives) if a change is not made,” Hall said at a news conference announcing the lawsuit. “I love Texas and it kills me that my own state doesn’t seem to care if I live or die.”
In July 2023, nearly a year after the laws went into effect, three of the plaintiffs testified at a landmark hearing, the first time individual women have testified about the impact of abortion laws on their pregnancies since it was decided. Roe v. Wade in 1973.
As they told their stories of long-wanted pregnancies gone wrong, and the way their doctors’ inability to act worsened their pain, the women felt overwhelmed: one sobbed, unable to get the words out; another fled the room immediately afterwards; another vomited in her hands.
An Austin judge sided with the plaintiffs and granted an injunction, ruling that the attorney general should not be able to prosecute doctors who, in their “good faith judgment,” terminate a pregnancy that poses a risk of infection; if the fetus will not survive after birth; or when the pregnant patient has a condition that requires regular invasive treatment.
Immediately, Texas Attorney General Ken Paxton appealed to the state Supreme Court, temporarily blocking the order from going into effect. The Supreme Court heard arguments in November.
At that hearing, Deputy Attorney General Beth Klusmann said the Texas Legislature had set a high bar for when a patient could qualify for an abortion, “but there is nothing unconstitutional in their decision to do so.” Judge Jimmy Blacklock, former general counsel to Gov. Greg Abbott, said he believed the injunction sought by the plaintiffs “could open the door much more widely” to people seeking abortions.
Molly Duane, senior attorney at the Center for Reproductive Rights, which represents the plaintiffs, acknowledged that the district court ruling “does more work than usual,” but said that was because “lawmakers typically don’t write laws that people who are regulated by those laws that I just don’t understand.”
The Cox case
At that hearing, Klusmann argued that the women who brought this lawsuit did not have the right to sue because they were not seeking abortions at the time. A week later, the Center for Reproductive Rights filed a lawsuit on behalf of Kate Cox, a 31-year-old Dallas mother who was actively pregnant and seeking an abortion.
Cox’s pregnancy was not viable and, her lawyers said, she had gone to the emergency room repeatedly for complications. Her case presented many of the same arguments as the Zurawski case, but she asked for an immediate decision.
For the first time since before Roe v. Wade, a judge intervened to allow a competent adult woman to terminate her pregnancy.
“The idea that Ms. Cox desperately wants to be a mother and that this law could cause her to lose that ability is shocking and would be a true miscarriage of justice,” said state District Judge Maya Guerra Gamble.
Paxton appealed that ruling to the Texas Supreme Court, which stayed it. As they deliberated, Cox’s condition deteriorated to the point that he had to travel out of state to have an abortion, his attorneys said.
The court ultimately rejected Cox’s abortion request, ruling that while “any parent would be devastated to learn” of a fetal diagnosis like this, “some difficulties in pregnancy…even serious ones, do not pose elevated risks to the child.” mother as an exception.” encompasses.”
The court asked the Texas Medical Board to issue guidelines to help doctors better understand when they can perform an abortion in the eyes of the law. Those guidelines, which have not yet been finalized, have been criticized for offering little reassurance and, in some cases, further confusing the issue.
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