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The case of a woman who had to flee Texas to get abortion care "has shown the world that abortion bans are dangerous for pregnant people," said one advocate.
The Texas Supreme Court's ruling late Monday, in which the all-Republican panel said Dallas resident Kate Cox could not obtain an abortion despite a lethal fetal diagnosis, did not stop the 31-year-old woman from getting care outside the state. But the ruling, said rights advocates on Tuesday, carries major implications for other Texans and people across the United States.
The state Supreme Court handed down a seven-page ruling saying that Travis County District Judge Maya Guerra Gamble was wrong to issue a temporary restraining order last week, which had barred the state from prosecuting Cox's physician for providing abortion care.
Cox learned earlier this month at about 20 weeks pregnant that her fetus had trisomy 18, a condition that results in miscarriage, stillbirth, or the death of a newborn in the days or weeks after birth.
Under Texas' near-total abortion ban, which ostensibly allows exceptions in cases in which an abortion is medically necessary to protect the pregnant person's life or to prevent unspecified "substantial impairment," Cox's physician said she would have to carry the pregnancy and have a Caesarean section, which could have resulted in uterine rupture and threatened her future fertility.
Republican Attorney General Ken Paxton appealed Gamble's ruling to the state Supreme Court, which said in its decision Monday: "A woman who meets the medical-necessity exception need not seek a court order to obtain an abortion. Under the law, it is a doctor who must decide that a woman is suffering from a life-threatening condition during a pregnancy, raising the necessity for an abortion to save her life or to prevent impairment of a major bodily function."
In other words, said Politico healthcare reporter Alice Miranda Ollstein, "the court views the lawsuit itself as evidence Cox does not qualify for relief from the state's ban."
The Republican justices, like the state abortion ban, did not provide guidance to help physicians determine situations in which they could provide abortion care without fearing prosecution and a potential life prison sentence.
Molly Duane, a senior staff attorney at the Center for Reproductive Rights (CRR) who has represented Cox in the case, said on Tuesday that Cox's ordeal offers the latest proof that so-called "exceptions" don't work, and it's dangerous to be pregnant in any state with an abortion ban."
"This ruling should enrage every Texan to their core. If Kate can't get an abortion in Texas, who can?" said Duane. "Doctors still don't know what the exception means, and the Texas Medical Board remains silent. If the highest court in Texas can't figure out what this law means, I'm not sure how a doctor could. Meanwhile, the lives of Texans hang in the balance.”
The court's ruling and its vague reasoning about co-called "exceptions" to abortion bans, said Mini Timmaraju, president and CEO of Reproductive Freedom for All, represents "the America the GOP wants."
For many Texans, said Nancy Northrup, president and CEO of CRR, a pregnancy complication like Cox's "could be a death sentence" under the state's laws.
"Kate's case has shown the world that abortion bans are dangerous for pregnant people," Northup said. "She desperately wanted to be able to get care where she lives and recover at home surrounded by family. While Kate had the ability to leave the state, most people do not."
Meanwhile, said author and advocate Jessica Valenti, Republicans are still pushing for a nationwide 15-week abortion ban. Susan B. Anthony Pro-Life America, a major group that supports forced pregnancy, has said it will not endorse a 2024 GOP candidate who doesn't back the proposal.
"What if there was no other state to go to? What if instead of being forced to travel to a neighboring state—an already-impossible hurdle for many Americans—Cox had to travel to a nearby country?" wrote Valenti on Monday. "That is not some hyperbolic hypothetical: It's exactly what life would look like under Republicans' 15-week national ban. And we can't let voters forget it."
"Courts are arguing with each other about whether a woman can have a medically necessary abortion," said one advocate. "This is not a hypothetical nightmare—it is a living one."
Reproductive justice groups on Friday night said the Texas Supreme Court and Republican Attorney General Ken Paxton were "directly endangering" a pregnant women who recently received news that her fetus has a life-threatening condition, after the high court halted a judge's order permitting the woman to obtain abortion care.
The state Supreme Court issued a stay temporarily blocking Travis County Judge Maya Guerra Gamble's Thursday ruling. Gamble had issued a temporary restraining order, allowing Dallas resident Kate Cox to obtain an abortion and protecting her physician, Dr. Damla Karsan, from civil or criminal liability under Texas' near-total ban on abortions.
Paxton quickly appealed Gamble's ruling, telling the court, "Nothing can restore the unborn child's life that will be lost as a result."
Molly Duane, senior staff attorney for the Center for Reproductive Rights (CRR), which is representing Cox, said Friday night that the group is holding out hope that "the [state Supreme Court] ultimately rejects the state's request and does so quickly."
"In this case we fear that justice delayed will be justice denied," said Duane. "We are talking about urgent medical care... This is why people should not need to beg for healthcare in a court of law."
Cox, who is about 20 weeks pregnant, discovered last week that her fetus has abnormalities including trisomy 18, a condition that would result in a miscarriage, stillbirth, or the death of her baby in the hours or days after birth.
Cox has sought emergency medical care several times since finding out the diagnosis, reporting symptoms such as cramping and fluid loss to emergency room doctors—but while Texas' abortion bans claim to allow exceptions in cases where a pregnant person's life or health are at risk, many health professionals are unwilling to risk potential life imprisonment by providing care.
Karsan has advised Cox that continuing the pregnancy could put her health and fertility at risk. Under Texas' abortion bans, Cox's only options are to have a Caesarean section after carrying the pregnancy to term—even as her health grows worse—or to have labor induced in the case of the fetal heartbeat stopping. Due to previous C-sections, doctors have told Cox that she could experience a uterine rupture if she is forced to give birth to the baby.
On PBS Newshour on Friday, Cox described how her baby "would need to be placed directly onto hospice" care if she is forced to go through childbirth.
Paxton and the state Supreme Court, which consists entirely of Republican judges, are "100% committed to torturing" Cox, said Slate journalist Mark Joseph Stern.
By challenging Gamble's ruling, CRR said in court filings that the state demonstrated "stunning... disregard for Ms. Cox's life, fertility, and the rule of law."
Before appealing Gamble's decision, Paxton wrote a letter to three hospitals where Karsan has admitting privileges, warning that if she provides abortion care to Cox there they could face civil or criminal penalties regardless of the lower court ruling. The attorney general said Gamble was "not medically qualified to make this determination."
The letter was the state's attempt to "intimidate [Karsan] to not act," Dr. Judy Levison, another obstetrician-gynecologist in Houston, toldThe New York Times.
"They named her and so, it's intimidating," Levison said.
On Thursday, Duane refused to comment in a news briefing about whether Cox and her doctors were planning to move forward with the abortion and when or where she might obtain care.
Cox is reportedly the first pregnant patient to request an emergency abortion from a court since the U.S. Supreme Court overturned Roe v. Wade last year.
On Friday, the day after Gamble ruled, a pregnant woman in Kentucky sued the state, saying its abortion ban violates residents' constitutional right to privacy and self-determination.
Mary Ziegler, a law professor at the University of California at Davis who specializes in abortion, told The Washington Post that Paxton likely "wants to stop Cox from being an example" for other pregnant people who need or want to terminate their pregnancies.
"Courts are arguing with each other about whether a woman can have a medically necessary abortion while she continues to remain pregnant with an unviable pregnancy," said activist Olivia Julianna. "This is not a hypothetical nightmare—it is a living one."
"The fight is far from over," said the groups that sued Texas over the ban.
The Texas Supreme Court, made up entirely of Republicans, decided Thursday to allow a ban on gender-affirming healthcare for trans youth to take effect on September 1, rejecting an emergency effort by advocacy groups to block the law.
The decision came a week after a Texas district judge temporarily halted the Republican-authored law, arguing that S.B. 14 infringes on the "fundamental right of parents to make decisions concerning the care, custody, and control of their children."
Texas officials swiftly appealed the district judge's decision, prompting the rights groups that sued over the law to file an emergency request urging the state's high court to prevent enforcement of the ban, which Texas Gov. Greg Abbott signed into law in June.
The Supreme Court's order allowing the law to take effect on Friday offered no explanation for the decision.
As The Associated Presssummarized, S.B. 14 "would prevent transgender minors from accessing hormone therapies, puberty blockers, and transition surgeries, even though medical experts say such surgical procedures are rarely performed on children."
"Children who already started the medications being banned are required to be weaned off in a 'medically appropriate' manner," the outlet added.
Lambda Legal, the American Civil Liberties Union, the ACLU of Texas, and the Transgender Law Center issued a joint statement on Thursday declaring that "the fight is far from over."
"Today's cruel ruling places Texas' transgender youth, and the families and medical professionals who love and care for them, directly in harm's way," the organizations said. "The district court heard two days of testimony, weighed the evidence, and made a reasoned and thoughtful determination that the ban likely violated the Texas Constitution, and thus should be delayed while the full case plays out in court."
"Inexplicably, the Texas Supreme Court disagreed, and transgender Texas youth and their families are forced to confront the start of the school year fearful of what awaits them," the coalition added. "The district court clearly articulated the ways in which S.B. 14 likely violates the Texas Constitution by infringing upon the fundamental right of parents to make decisions concerning the care, custody, and control of their children, infringing upon Texas physicians' right of occupational freedom, and discriminating against transgender adolescents with gender dysphoria because of their sex, sex stereotypes, and transgender status. We couldn't agree more and look forward to continuing this fight."
With the enactment of S.B. 14, Texas will become one of more than a dozen U.S. states that have imposed legal restrictions on gender-affirming care.
If it was left in place, the district court's injunction against the law "would have blocked the state attorney general's office, the Texas Medical Board, and the Texas Health and Human Services Commission from enforcing the law," The Texas Tribunereported Thursday.
The judge in the case "wrote that transgender youth and their families would 'suffer probable, imminent, and irreparable injury' if S.B. 14 went into effect while the legal battle ensues," the newspaper added. "A trial is set to begin May 6."
This story has been updated to clarify that the joint statement was issued by advocacy groups, not the law firms involved in the case.