The Texas Supreme Court ruled against a 31-year-old woman carrying a fetus with a fatal health condition, saying that her court-approved request for an abortion does not qualify as a medical exemption under state law. 

The ruling, which came Monday after Kate Cox left the state to obtain the procedure elsewhere, leaves physicians in the dark about how to provide emergency care to people whose pregnancies pose serious or life-threatening health risks, says Wendy Parmet, a professor at Northeastern University School of Law.

“There’s something so incredibly disturbingly problematic about how, on the one hand, the court talks about how doctors can do what’s within their ‘reasonable medical judgment,’ and yet on the other, slams the door on doctors receiving any assurance that they can go forward safely,” she says.

Cox requested an emergency abortion this month after her fetus was diagnosed with a fatal genetic condition called Trisomy 18. On Thursday, a lower court judge granted a temporary restraining order permitting the procedure and shielding the physician from prosecution.

Texas Attorney General Ken Paxton appealed the district judge’s ruling to the high court, arguing that Cox did not demonstrate that the fetal diagnosis — while lethal to the unborn child — was a “life-threatening” medical condition.

In Monday’s ruling, the court did not include an order protecting Cox’s physician, Damla Karsan, from prosecution. 

“What [the ruling] doesn’t say is that if you get it wrong, you could lose your license, you could go to jail,” Parmet says. 

“What the court has refused to do is provide doctors with any safe resting place,” she adds. “They’re saying physicians can rest on their medical judgment, but have to gamble with their own lives and careers.”

The Texas state court, which is composed entirely of Republicans, is also hearing a separate case brought by 20 Texas women who were denied abortions that could help clarify what constitutes a “medical exemption” under the current laws, says Martha F. Davis, university distinguished professor of law at Northeastern, who teaches constitutional law and human-rights advocacy.

Underlying both Zurawski v. State of Texas and Cox’s case is whether Texas’ six-week ban and other abortion restrictions are constitutional despite there not being adequate guidance for doctors, who paradoxically the high court gives discretion to (“reasonable medical judgment”) in cases involving potentially life-threatening pregnancies, Parmet says.

“The complicating factor from the court’s perspective is that [Zurawski v. State of Texas] was just argued a week or so ago, and that case presents the question of how the Texas ban should be interpreted in these kinds of circumstances — in other words, what kind of breadth is given to the bans,” Davis says. 

Davis submitted an amicus brief in the Zurawski case.

“If a doctor determines that a woman’s life or health is in jeopardy, can they confidently perform the abortion without worrying about criminal consequences for themselves? That is what is at stake in the Zurawski case,” Davis says. 

Davis says the position taken by Paxton and other anti-abortion advocates in Texas endangers the lives of women and pregnant people. 

“The idea that the life of a living person who has hopes, dreams and aspirations would be sacrificed for a fetus that does not have that promise makes no moral sense,” Davis says. 

“What’s being lost, of course, is her future fertility,” she says.

Tanner Stening is a Northeastern Global News reporter. Email him at t.stening@northeastern.edu. Follow him on X/Twitter @tstening90.