The 5th U.S. Circuit Court of Appeals ruled Tuesday against the “requirement that physicians must provide an abortion when that care is the necessary stabilizing treatment for an emergency medical condition,” siding with Texas in its lawsuit accusing the Biden administration of overstepping its authority.
Under Tuesday’s decision, Texas’ abortion ban is allowed to stand, despite the federal government’s guidance on abortion care which says, “hospitals receiving Medicare must provide abortions if they were a necessary medically stabilizing treatment,” Time reported.
The ruling directly challenges the Emergency Medical Treatment and Labor Act (EMTALA), which states that hospitals must “provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility.”
In 2023, a court in Idaho found that the state’s near absolute abortion bans were in violation of EMTALA and, in an opposite ruling, upheld EMTALA guidance in the state.
Texas has passed the most stringent abortion restrictions in the nation. The ruling comes mere weeks after Kate Cox’s headline-making request for an abortion was denied by the Texas Supreme Court. Cox had requested the abortion because doctors had determined her fetus would not live. After her request’s denial, she traveled elsewhere for the abortion.
How did the decision come to be?
The ruling did not come about in a vacuum.
Here’s how we got to this point:
- June 2022: Roe v. Wade was overturned, sending abortion laws nationwide into a tailspin.
- July 2022: The U.S. Department of Health renewed its guidance on the provision of care to hospitals regarding EMTALA. The Texas Tribune reported this guidance to include, “When a state law prohibits abortion and does not include an exception for the life of the pregnant person — or draws the exception more narrowly than EMTALA’s emergency medical condition definition — that state law is preempted.”
The State of Texas, the American Association of Pro-Life Obstetricians & Gynecologists and the Christian Medical & Dental Associations sued the Department of Health and Human Services over the guidance, arguing that it prevented the state from restricting abortion, per Reuters.
- August 2022: A lower court agreed with the plaintiffs, and said that EMTALA does not provide guidance on what doctors should do when balancing the life of the mother and the fetus, but that Texas’ ban on abortions “includes narrow exceptions to save the mother’s life or prevent serious bodily injury in some cases,” per Reuters. A temporary injunction was then issued and extended.
- November 2023: Judges in the 5th Circuit Court of Appeals “seemed prepared to uphold the injunction” after hearing arguments in the case, per the Texas Tribune. Judge Leslie Southwick expressed concern that the HHS was trying to expand abortion access through the creation of “broader categories of things, mental health or whatever else HHS would say an abortion is required for.”
A justice department attorney argued for the defendants that restricting hospitals’ use of EMTALA guidance would have “potentially devastating consequences for pregnant women within the state of Texas,” reported PBS News Hour.
- January 2024: Judges agreed with the plaintiffs. Judge Kurt D. Engelhardt authored the ruling. “We agree with the district court that EMTALA does not provide an unqualified right for the pregnant mother to abort her child,” the Engelhardt wrote, per the Texas Tribune. “EMTALA does not mandate medical treatments, let alone abortion care, nor does it preempt Texas law.”
How does this ruling impact women in Texas?
While the exact repercussions from this ruling remain to be seen, the decision doesn’t exactly expand abortion access. EMTALA guidelines require care that ensures patients are stable before any sort of transfer of care, whether that be to a different department or different facility entirely. Abortion can’t be considered stabilizing treatment outside of a few dire circumstances.
The Texas Supreme Court is currently evaluating the scope of these dire circumstances, Reuters reported. A group of 22 patients and doctors in Texas are fighting to ensure that “doctors cannot be prosecuted if they perform abortions that, in their good faith medical judgment, are necessary to safeguard the mother’s life or health.”
Trigger laws in Texas that went into effect after Roe. v Wade was overturned left some doctors scared to provide life-saving abortions to pregnant women in their care, the plaintiffs argued. This caused some women to seek care out-of-state and others to develop complications during their pregnancies, per Reuters.