The Texas Supreme Court on Friday rejected a petition by women who sought clarification of the state’s strict abortion ban. 

In the unanimous decision, the court said that the existing medical exceptions in the ban were broad enough to withstand a constitutional challenge. A group of women who were denied abortions under the state filed the lawsuit in March, and they had argued that because the ban’s language regarding medical exceptions is unclear, they were denied lifesaving care while they were pregnant. 

Texas bans abortions at about six weeks, with a limited medical exception for a pregnancy that threatens the life of the mother or risks impairing a major bodily function.

The state high court ruled that “the law does not require that a woman’s death be imminent or that she first suffer physical impairment” and said “Texas law permits a physician to address the risk that a life-threatening condition poses before a woman suffers the consequences of that risk.” 

The ruling said the plaintiffs are “simply wrong in that legal assessment” that a physician would then say “but the law won’t allow me to provide an abortion in these circumstances.”

Texas doctors face harsh penalties for performing an abortion that does not meet the criteria for a medical  exception — fines of at least $100,000 and up to 99 years in prison. Further, anyone who “aids and abets” an abortion is subject to a minimum $10,000 fine that can be levied by anyone under an unusual enforcement mechanism.

The lead plaintiff, Amanda Zurawski, who has since become a surrogate for the Biden campaign, said in a statement on Friday that she was “outraged” by the decision. “Every day, people in Texas are being told that they have no options,” she said. 

Texas Attorney General Ken Paxton, whosd challenged the lawsuit, said in a statement that he 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.”

Zurawski v. Texas 

The case, Zurawski v. Texas was brought by the Center for Reproductive Rights on behalf of at least 20 women who suffered medical emergencies and two doctors and was the most significant legal challenge to the state’s strict abortion ban. 

A Travis County judge ruled that women who experience pregnancy complications are exempt from the state’s abortion ban, which resulted in an injunction on the law. Paxton’s office appealed the ruling to the all-Republican state Supreme Court, which put the injunction on hold.

On Friday, the Texas Supreme Court overturned the lower court’s ruling, saying it “departed from the law as written without constitutional justification.” The decision was unanimous, but Justice Brett Busby issued a concurring opinion that left the door open to a broader challenge to the law.

The lawsuit was not filed to overturn Texas’ law, but instead sought clarification on what qualifies as a medical exemption. It was believed to be the first challenge of an abortion ban since the 2022 Dobbs decision by the U.S. Supreme Court, which overturned the landmark Roe v. Wade case that established the federal right to an abortion.

The court said Zurawski was incorrectly denied an abortion when her water broke when she was 17 weeks pregnant and the fetus still had a heartbeat. Zurawski was sent home, but doctors performed the abortion days later, after she went into septic shock. The infection caused one of her fallopian tubes to close, making it harder for her to conceive.

“Ms. Zurawski’s agonizing wait to be ill ‘enough’ for induction, her development of sepsis, and her permanent physical injury are not the results the law commands,” the ruling said. Further, the ruling said that “the law does not require a woman to surrender her life or to first suffer serious bodily injury before an abortion may be performed.” 

The ruling also noted that in the last legislative session, the Texas Legislature did amend the law to “plainly indicate that a physician who performs an abortion in response to such a diagnosis” as Zurawski suffered “is not liable.”

Though the Legislature amended the law and gave a legal defense to doctors, abortion rights advocats say it didn’t sufficiently clarify the law. 

Last year, Zurawski gave harrowing testimony with two other women who were denied abortions in Texas, along with a doctor and two medical experts. 

Other Texas abortion cases 

In November 2023, Kate Cox, filed an emergency lawsuit seeking an injunction to the law when she found out that her pregnancy was “unlikely to end with a healthy baby,” and due to two prior cesarean sections, continuing the pregnancy put her at risk of severe complications that threatened “her life and future fertility.” 

An Austin judge ruled Cox could terminate her pregnancy, but that ruling was stayed after Paxton appealed the decision to the state Supreme Court. Cox, who was 20 weeks pregnant at the time of the suit, ultimately left the state to have an abortion.

After a petition from Austin-area lobbyists, the Texas Medical Board is considering proposed guidelines on how it investigates complaints about prohibited abortions. The agency is currently considering public comment ahead of its planned June meeting, where the issue could be decided.