The Texas Supreme Court said a medical exemption in the state’s abortion ban applies only when a person is at risk of death or serious physical impairment, ruling Friday against women who sued the state with claims that the ban had put their health at risk.
The state’s highest court, which is made up entirely of Republicans, reversed a lower court’s order that broadened the exception to circumstances in which a pregnancy is “unsafe” for the pregnant person or when there is a fetal condition making it unlikely the fetus will survive.
“Because the trial court’s order opens the door to permit abortion to address any pregnancy risk, it is not a faithful interpretation of the law,” the state Supreme Court said.
The ruling came in a lawsuit brought by several Texas women who suffered serious health complications in their desired pregnancies. They alleged the state’s strict abortion laws put their lives and health in danger when they were forced to wait until their health seriously deteriorated before receiving the procedure or were denied an abortion altogether until they traveled out of state.
The Texas Supreme Court said the challengers did not prove the abortion ban, with its narrow medical emergency exemption, violated the state constitution.
When the Supreme Court overturned federal abortion rights in June 2022, a Texas trigger law took effect, essentially blocking all abortions in the state other than those performed when the mother is “at risk of death or poses a serious risk of substantial impairment of a major bodily function unless the abortion is performed or induced.”
Texas Attorney General Ken Paxton, who was defending the abortion ban, praised the Friday ruling in a statement.
“Today, the Supreme Court of Texas unanimously upheld the Human Life Protection Act, one of our state’s pro-life laws,” said Paxton, a Republican. “I will continue to defend the laws enacted by the Legislature and uphold the values of the people of Texas by doing everything in my power to protect mothers and babies.”
The Center for Reproductive Rights, which filed the case on behalf of the women last year, said the ruling did not provide “meaningful clarity” for doctors. Nancy Northup, the center’s president and CEO, said in news conference that the group will “continue to pursue every available legal avenue to address the suffering that is happening in Texas.”
“Imagine the trauma of being forced to give birth to a baby who would live only hours. This is happening every day to women in Texas,” Northup said. “Today’s decision means the state of Texas thinks it is perfectly OK.”
The Texas justices took issue with the trial court’s order allowing for an abortion to be performed if a doctor had a “good faith” reason to believe the procedure was necessary. The high court ruled doctors must hew to the “reasonable medical judgment” standard in the law, which the ruling described as requiring doctors to “identify a life-threatening physical condition that places the mother at risk of death or serious physical impairment of a major bodily function unless an abortion is performed.”
The state Supreme Court said a fetal condition making a pregnancy unviable was not by itself a reason that an abortion could be performed.
“As painful as such circumstances are, that the law does not authorize abortions for diagnosed fetal conditions absent a life-threatening complication to the mother does not render it unconstitutional,” read the opinion, written by Justice Jane Bland.
Amanda Zurawski, a plaintiff in the case who nearly died after being denied an abortion, criticized the ruling Friday, saying it “feels like a gut punch.”
“Unfortunately, the Texas Supreme Court has showed us today that they don’t wish to help pregnant Texans access health care and they don’t want to help doctors practice medicine in the state of Texas,” she said. “The Supreme Court had the opportunity to provide clarity, but they didn’t – and we are right back where we started.”
Anti-abortion activists, meanwhile, praised the opinion and said the Texas abortion ban was clear in allowing exemptions for medical emergencies.
“The abortion lobby has created confusion on this fact to give the Democrats cover for their extremely unpopular all-trimester abortion agenda,” Marjorie Dannenfelser, president of anti-abortion group Susan B. Anthony Pro-Life America, said in a statement after the ruling.
How state abortion bans apply in medical emergencies has been flashpoint in the fallout from the US Supreme Court’s 2022 decision that ended the federal right to an abortion. The high court is now considering a Biden administration lawsuit challenging Idaho’s ban, which exempts abortions when a woman’s life is threatened but not when she is facing risks of bodily impairment that fall short of being potentially fatal.
In Texas, the state Supreme Court previously weighed in on the medical emergency exemption with a 2023 ruling that blocked a doctor from performing an abortion for a Texas woman whose pregnancy complications were putting her health and future fertility at risk. (The woman traveled out of state to receive the procedure.) The ruling called on the Texas Medical Board to issue more guidance to clear up confusion around when the exemption applies. The state board has proposed such guidance; however, critics say its draft rules have not clarified the question.
“The Texas Medical Board can and should issue guidance … that translates the way that the Texas Supreme Court has today interpreted the exception to Texas abortion bans and give guidance to physicians about how to apply those laws in specific medical circumstances,” said Marc Hearron, senior counsel at the Center for Reproductive Rights.
CNN has reached out to the board for comment.
This story has been updated with additional details.
CNN’s Elizabeth Cohen and John Bonifield contributed to this report.