A couple of interesting articles to read to enhance our understanding of the lawsuit filed by five women who claim that Texas’ anti-abortion laws have harmed them.
In theory, even after the Supreme Court’s anti-abortion decision in Dobbs v. Jackson Women’s Health Organization (2022), medically necessary abortions remain legal in all 50 states. Texas law, for example, is supposed to permit abortions when a patient is “at risk of death” or if they face “a serious risk of substantial impairment of a major bodily function.”
There’s also a federal law, the Emergency Medical Treatment and Labor Act (EMTALA), which requires most hospitals to perform emergency abortions to prevent “serious impairment to bodily functions” or “serious dysfunction of any bodily organ or part.” (Though, notably, Texas’s GOP attorney general, Ken Paxton, convinced a Trump-appointed judge to issue an opinion claiming that this federal abortion protection does not exist.)
But in practice, the new lawsuit claims, Texas physicians are often too terrified to perform likely legal abortions because the consequences of performing an abortion that the courts later deem to be illegal are catastrophic. The maximum penalty for performing an illegal abortion in Texas is life in prison.
This lawsuit, known as Zurawski v. Texas, asks the state courts to clarify when medically necessary abortions are legal within the state so that doctors can know when they can treat their patients without risking a prison sentence or a lawsuit.
These plaintiffs argue in their complaint that one reason why Texas doctors are unwilling to perform abortions, even when delaying an abortion risks a patient’s life, is that Texas law is a hodgepodge of multiple abortion bans, each with inconsistent provisions permitting abortions when a patient’s life or health is in danger, and none of which use medical terminology that doctors can rely upon to know exactly what they are and are not permitted to do.
Texas’s primary criminal ban on abortions, for example, provides that abortions are permitted when “in the exercise of reasonable medical judgment” a physician determines that their patient “has a life-threatening physical condition” or faces a “serious risk of substantial impairment of a major bodily function” that relates to their pregnancy.
Meanwhile, a separate statute, enacted before Roe v. Wade was decided in 1973, also bans abortions. And it does so with a much narrower exception for abortions performed “for the purpose of saving the life of the mother.” But it’s unclear whether, now that the Supreme Court has overturned Roe, this law remains in effect or not. While a federal appeals court determined in 2004 that this pre-Roe ban on abortions was “repealed by implication,” Attorney General Paxton claimed that the law is still enforceable after Roe was overruled.
And then there’s SB 8, the state’s bounty hunter law, which permits private citizens to sue doctors who perform abortions after the sixth week of pregnancy. That statute uses completely different language to describe when an abortion is allowed, permitting abortions “if a physician believes a medical emergency exists that prevents compliance” with SB 8.
Most of these statutes, moreover, were enacted when Roe was still good law. So there are few, if any, court decisions interpreting them, explaining how the multiple conflicting exceptions to the multiple different abortion bans interact with each other, or resolving disputes about which laws are actually in effect.
Typically, lawyers rely on past court decisions to predict how courts are likely to apply a statute to their clients. But, without many (or any) such decisions to rely upon, lawyers advising doctors and hospitals cannot provide reliable advice to those clients. And, again, if a doctor and their attorneys guess wrong about whether a particular abortion is legal, that doctor could wind up spending the rest of their life behind bars.
See here, here, and here for more on EMTALA, which is likely to end up before SCOTUS eventually. Author Ian Millhiser speculates about the possibility that the Zurawski case could clarify state law, but he has his doubts. Which leads us to this Slate story.
Make no mistake about it: Texas’ law has unique problems. The state’s conservative lawmakers kept the pre-Roe criminal ban passed in 1925; to circumvent Roe v. Wade, they passed S.B. 8. In 2021, after Donald Trump reshaped the Supreme Court, they passed a trigger law. Inconsistencies crept in, and the result is a mess that frightens doctors away from addressing real emergencies.
But the problems with Texas’ exceptions are broader, and they tell a story about why abortion exceptions as a general matter fail to protect patients. From the time of previous eras’ abortion bans, exceptions were tailored more to prevent free access to the procedure than to address real problems in pregnancy, and state abortion laws today are no exception.
When abortion reform efforts got underway in the 1960s, the American Law Institute proposed what amounted to a menu of exceptions to criminal abortion bans for patients seen to be innocent enough to deserve abortion (the ALI included exceptions for rape and incest, fetal abnormality, and certain health threats). Pushback from anti-abortion lawyers was immediate. They argued not just that abortion was immoral and unconstitutional, but also that the exceptions were an open invitation for fraud. Decades before Todd Akin’s comments about “legitimate rape,” they argued that pregnancy after sexual assault was all but impossible—and that rape exceptions were an excuse for promiscuous women. They framed health exceptions as universally unnecessary, arguing that virtually no pregnancies were life-threatening.
After Roe, anti-abortion suspicion of patients invoking exceptions only deepened. They pointed to Roe’s companion case, Doe v. Bolton, that defined health to include physical and mental well-being. For abortion opponents, that looked like an exception that could swallow the rule: wouldn’t anyone forced to remain pregnant suffer mental distress?
So after Congress passed the Hyde Amendment, a ban on Medicaid reimbursement for abortion in 1976, anti-abortion legislators worked to make it harder for patients to invoke exceptions or to eliminate them altogether. Sexual assault victims, for example, had to report to law enforcement within a certain time frame, and some Hyde proponents voted to eliminate all rape and incest exceptions.
Anti-abortion activists began using a similar strategy in model laws designed to chip away at Roe. For example, in the Pennsylvania law considered by the Supreme Court in Planned Parenthood of Pennsylvania v. Casey, anti-abortion groups proposed a medical emergency exception only to save a patient’s life or “create serious risk of substantial and irreversible impairment of major bodily function.”
The similarity to Texas’ law is no accident. For the anti-abortion movement, the narrow and ambiguous language adopted by Pennsylvania in the 1980s, and by Texas more recently, reflects the same beliefs: The most important issue is preventing abortion, and exceptions serve primarily to discourage what Republicans see as unjustified procedures. But the justifications of many plaintiffs are all too obvious. One patient diagnosed with “preterm prelabor rupture of membranes” was denied care, developed sepsis, nearly died, and suffered lasting impacts to her future fertility; another, pregnant with twins, was forced to travel out of state to maximize the chances of survival for herself and one of the twins when the second received a devastating diagnosis. These stories will almost certainly continue in Texas and states like it.
In other words, to borrow from a bit of wisdom that has been applied to the Trump regime, the lack of clarity is the point. We don’t know what the courts will make of this, but we can expect that Ken Paxton and the rest of the forced birth machinery will do everything in their power to keep threatening everyone who might try to get an abortion for any reason. You know what I’m going to say here, so say it with me: Nothing will change until we start winning more elections.