A Texas judge ruled on Friday that the state must allow doctors to provide abortions to pregnant women whose health or lives are in danger, or whose fetuses have little likelihood of survival.
The ruling broadens and clarifies the limited exceptions granted in the state’s bans, among the strictest in the country. And it temporarily bars state officials — until the full case is decided — from prosecuting doctors who, in their “good faith judgment and in consultation with the pregnant person,” determine that an abortion is medically necessary.
In her ruling, Judge Jessica Mangrum, elected as a Democrat in 2020, wrote that “the uncertainty regarding the scope of the medical exception and the related threat of enforcement of Texas’ abortion bans has created an imminent risk” for doctors who “will have no choice but to bar or delay the provision of abortion care” to women who require the procedure to prevent death or serious health risks.
The ruling was in response to a lawsuit from 13 women who had been denied abortions despite pregnancy complications that they said caused grave and potentially fatal risks to their health.
The Center for Reproductive Rights filed the case in March on behalf of the 13 women and two OB-GYNs, citing their stories as examples of what the complaint called the “catastrophic harms” to women since the United States Supreme Court overturned Roe v. Wade, which for five decades protected a constitutional right to abortion.
“Today’s ruling should prevent other Texans from suffering the unthinkable trauma our plaintiffs endured,” said Nancy Northup, president and chief executive of the Center for Reproductive Rights.
Texas’ attorney general, Ken Paxton, did not immediately respond to a request for comment on Friday.
In the past, he has noted that the law allows for abortions if there is “a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy” that places the pregnant woman “at risk of death or poses a serious risk of substantial impairment of a major bodily function unless the abortion is performed or induced.”
While abortion rights groups and providers had filed many other lawsuits since Roe was overturned in June 2022, this was the first suit brought by women denied abortions under state bans.
That same month, Gov. Greg Abbott of Texas signed a law seeking to clarify exceptions for some specific medical conditions.
During two days of court hearings in July, the lead plaintiff, Amanda Zurawski, described how she went into septic shock and nearly died when her water broke at 18 weeks, after doctors told her they could not abort the fetus because it still had a heartbeat.
Another plaintiff, Samantha Casiano, began to cough and gag on the stand as she recalled having to carry and ultimately deliver a fetus that had no skull — and no chance of survival — because doctors could not perform an abortion. The judge called a recess after Ms. Casiano became physically ill.
Lawyers for the state had described the women as publicity seekers, saying that while their stories were “indisputably tragic,” the women were on an “ideological crusade.”
In cross-examinations, the state tried to shift blame to doctors and the women themselves, suggesting that Ms. Zurawski should have known her pregnancy was high-risk because she was 35, and that the plaintiffs should have filed malpractice suits or complaints against their health care providers.
The state’s lawyers repeatedly pressed the women to say that no state official had directly told them they could not have an abortion.
Unlike other lawsuits from abortion rights groups, this one had not sought to overturn the state’s three separate bans on abortion. Instead, the suit asked the court to expand and elaborate on the exceptions allowed under the bans.
Like most states with bans, Texas allows exceptions when a physician determines that there is risk of “substantial” harm to a pregnant woman. But the plaintiffs in the case said that the severe penalties — including potential for prison sentences of up to 99 years, $100,000 fines and the loss of medical licenses — had scared doctors into not providing abortions even where the law would seem to allow them.
The case asked the court to establish that doctors could perform abortions if, in their good-faith judgment, continuing the pregnancy would be unsafe for the woman’s health, or the fetus had a condition “where the pregnancy is unlikely to result in the birth of a living child with sustained life.”
Anti-abortion groups argue that even the strictest state bans do not harm women’s health, that no law prevents doctors from providing lifesaving care and that the laws prevent only what they and the lawyers for Texas call “elective” abortions, or those that are intended to end an unwanted pregnancy.