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Texas will continue enforcing bans on performing abortions even when pregnancies develop serious complications, following a decision issued Friday by the state Supreme Court.

The ruling means physicians must wait until patients are dangerously ill before terminating their pregnancies — in some cases resulting in otherwise preventable health complications. Under the law, learning that a fetus is unlikely to survive does not allow doctors to perform an abortion. The court clarified abortions could be performed for patients experiencing preterm premature rupture of membranes, but did not offer specifics on other circumstances that could qualify for an exception. Texas passed a law last year also suggesting abortions could be performed for patients with that specific condition, though the law requires physicians prove in court they qualified for the exception, what is known as an affirmative defense.

Under this case, known as Zurawski v. Texas, 20 women and two doctors sued the state of Texas, with many arguing that the state’s abortion laws endangered their lives. Some left the state for care. Others, including lead plaintiff Amanda Zurawski, had to wait until they contracted sepsis, a life-threatening infection, before they could receive an abortion. Some have been told they may struggle to become pregnant again as a result of medical complications they developed while waiting for an abortion.

The lawsuit, filed by the Center for Reproductive Rights, did not seek to overturn Texas’ abortion bans; instead, plaintiffs wanted clarity from the state about when people facing dangerous pregnancy complications could receive abortions. Texas is the largest state in the country to have banned abortions. The Texas lawsuit also inspired comparable litigation in Tennessee and Idaho; both cases, also filed by the Center for Reproductive Rights, are still ongoing. 

The Texas court had previously ruled against Texas woman Kate Cox in a separate but similar case; by the time the court ruled in Cox’ case, she had already left the state to receive an abortion.

The Texas court’s decision means that the state’s heavily restrictive bans — which prohibit the procedure in almost all situations, without exceptions for rape or incest — will remain in effect, even in medically complex scenarios.

Doctors in Texas and across the country have said that even when states’ abortion bans offer exceptions to save the pregnant person’s life, the language on what qualifies is ambiguous at best. Without clear guidance, medical providers aren’t always able to provide abortions when they would normally be deemed medically appropriate — when, for instance, a pregnant patient has cancer and needs an abortion before commencing chemotherapy. 

In Texas, violating the state ban is a felony and can be punished by life in prison and at least $100,000 in fines. Abortion providers can also be sued by private citizens for at least $10,000 under the state’s six-week abortion ban, which went into place before Roe v. Wade was overturned. 

A state judge in Austin ruled last summer that while this case proceeded, the state could not deny patients access to abortions when their doctors deemed care appropriate to save their life or to prevent irreversible damage to their health. The judge also ruled that physicians could provide patients with abortions if they discovered fatal fetal anomalies. 

But that ruling, issued as a temporary injunction, had little impact. Almost immediately, the state attorney general appealed the decision, using a procedural mechanism that blocked the injunction from taking effect. The state’s Supreme Court then blocked the lower court ruling. 

The state has argued that the fault is not with Texas’ abortion laws. Rather, they argued, doctors have been given all the guidance they need under the state’s narrow exception language, and said that if patients feel they are not getting needed treatment, the fault is with physicians for being unwilling to make decisions about their health.