Over six days, a Dallas-area woman’s lawsuit over her ability to get an abortion moved from an Austin court to the state’s Supreme Court, ending in a ruling that puts the onus of deciding who is exempt from Texas’ abortion bans squarely on doctors.
Shortly before the Supreme Court issued its decision, Kate Cox left the state to terminate her pregnancy after a fatal fetal diagnosis. Her fight to get the procedure, and the court battle that ensued, captured the nation’s attention as an increasing number of states have instituted abortion bans or restrictions following the fall of Roe v. Wade.
Here’s what you need to know about Cox’s case and what it means for the future of abortion legislation in Texas.
What is the legal question at hand?
The lawsuit — the first filed by a pregnant woman since Texas enacted its abortion laws — doesn’t challenge those bans in their entirety.
Cox, 31, asked a Travis County judge only to permit her to get an abortion under the bans’ medical exemption clauses, which allow people to terminate their pregnancy if they have a “life-threatening physical condition,” or are at risk of “substantial impairment of a major bodily function.”
Before suing the state, Cox visited the emergency room multiple times for severe cramping and unidentifiable fluid leaks. Her baby was ultimately diagnosed with full trisomy 18, a condition that makes it highly unlikely the baby will survive after birth. The suit alleges that Cox is at risk for severe complications to her health and future fertility because of her two prior cesarean sections and elevated vital signs.
Where has the case been?
Cox’s lawsuit had a whirlwind week as it traversed multiple Texas courts. The case was first filed in Austin, where a judge granted Cox’s abortion request. State Attorney General Ken Paxton petitioned the state Supreme Court to block the decision late Thursday night.
The Supreme Court initially halted the decision Friday while it considered the case before striking down the lower court’s order Monday evening.
Why did the Texas Supreme Court rule against Cox?
In its opinion, the court said Cox’s doctor did not prove that Cox met the conditions required for a medical exemption.
The ruling also said doctors are the only ones who can decide whether a woman qualifies for an abortion because of a medical emergency.
“The law leaves to physicians — not judges — both the discretion and the responsibility to exercise their reasonable medical judgment, given the unique facts and circumstances of each patient,” the opinion said.
Is there a legal risk for Cox leaving the state for an abortion?
Cox left Texas Monday for her abortion. Abortion patients can’t be sued under the state’s abortion bans, but people who perform or aid with an abortion can be held civilly or criminally liable.
Many states where abortion is legal have enacted so-called shield laws meant to protect abortion providers who care for patients from states where the procedure is outlawed.
Under Senate Bill 8, one of Texas’ abortion bans, private citizens can sue people for helping someone get an abortion. The law, passed in 2021, has gone largely untested in court.
What does this mean for other abortion lawsuits?
Cox’s case isn’t the only abortion suit in Texas courts right now. Twenty women sued the state earlier this year over abortions they say were delayed or denied because of unclear wording in the laws’ medical exemptions.
The state Supreme Court heard oral arguments in the case, Zurawski v. Texas, which requests a temporary injunction that would exempt any Texan with a medically complicated pregnancy from the state’s bans, including those with fatal fetal diagnoses.
The court’s decision on the case could take months, although health law expert Seema Mohapatra said Monday’s ruling in the Cox lawsuit doesn’t bode well for the Zurawski case.
