The Texas Supreme Court on Friday rejected a challenge to the state's strict abortion ban — a response to a lawsuit filed last year by a group of women who had serious pregnancy complications.

The ruling from the nine justices, all of whom are Republicans, was unanimous.

Five women brought the lawsuit in March 2023, saying they were denied abortions even when issues arose during their pregnancies that endangered their lives. The case grew to include 20 women and two doctors. The plaintiffs had not sought to repeal the ban but rather to force clarification and transparency regarding the precise circumstances in which exceptions are allowed. They also wanted doctors to be allowed more discretion to intervene when medical complications arise in pregnancy.

The lead plaintiff, Amanda Zurawski, expressed outrage at Friday's ruling on behalf of all the plaintiffs, stating that the court had deemed them “not sick enough.” Zurawski emphasized the ongoing plight of Texans facing severe restrictions: “Every day, people in Texas are being told that they have no options,” Zurawski said in a statement. “It’s sickening and wrong. Our Courts should acknowledge all of our suffering and vindicate our fundamental rights to reproductive autonomy. We should not need to beg elected officials for our right to control our own bodies.”

Another plaintiff, Samantha Casiano, whose fetus was diagnosed with anencephaly, also expressed anger and disappointment. “I was told my baby would not survive, but I was forced to continue my pregnancy and give birth anyway, then watch her pass away hours later,” she said in a statement. “I don’t know how the court could hear what I went through and choose to do nothing. Texas lawmakers claim to care about protecting ‘the unborn’, but in reality they made my family suffer ... I am embarrassed to be a Texan because of these inhumane laws.”

Last summer, a district court judge who heard the case issued a temporary injunction, preventing Texas from enforcing the ban against doctors who terminated a pregnancy that they deemed unsafe due to complications. The ruling stated: “The Court finds that there is uncertainty regarding whether the medical exception to Texas’ abortion bans … permits a physician to provide abortion care where, in the physician’s good faith judgment and in consultation with the pregnant person, a pregnant person has a physical emergent medical condition.”

However, the Texas Supreme Court disagreed in its Friday decision.

Zurawski v. Texas was the first legal challenge to the state's bans that focused specifically on women with complicated pregnancies. Zurawski has said she nearly died in August 2022 after doctors delayed giving her a medically necessary abortion when she had catastrophic complications while 18 weeks pregnant. After her health deteriorated, her doctors eventually performed an abortion. She later developed sepsis and spent three days in the intensive care unit.

Zurawski's doctors later advised her not to try to carry a baby again. Consequently, she and her husband turned to in vitro fertilization and sought to have a baby through a surrogate.

At a hearing last summer, Casiano recounted her harrowing experience. At 20 weeks pregnant, she learned that her baby had anencephaly, a serious condition meaning the infant was missing parts of the brain and skull. This condition also posed a risk to her life. She sobbed and vomited on the stand as she described her baby’s fatal birth defect, prompting the judge to declare a recess. Casiano said she experienced emotional trauma during her pregnancy.

The Texas Supreme Court's Friday ruling aligns with a decision it issued in December, directing a lower court to vacate an order that had blocked the state's abortion ban in the case of Kate Cox. Cox sued the state after her developing fetus was diagnosed with trisomy 18, a rare chromosomal disorder that significantly increases the risk of stillbirth or infant death shortly after birth. She sought a court order to terminate the pregnancy. Cox’s lawyers argued that carrying the pregnancy posed risks to her health and future fertility. Shortly before the Texas Supreme Court ruled against her, Cox left the state to get an abortion. Her case was believed to be the first in which a person sought a court-ordered exception to an abortion ban following the Supreme Court’s decision to overturn Roe v. Wade in 2022.

Texas law prohibits all abortions except to save the life of the pregnant patient. Doctors who violate it can lose their medical licenses, face up to 99 years in prison, or incur fines of at least $100,000. Critics of the ban, which is among the most restrictive in the U.S., have said it does not provide enough clarity about which exceptions are allowed.

The plaintiffs and their supporters argue that the lack of clear guidelines leaves both patients and doctors in precarious positions, leading to delays in critical medical care and causing unnecessary suffering. The rejection of their challenge by the Texas Supreme Court underscores the ongoing legal and ethical battles surrounding reproductive rights in the United States. This decision further entrenches Texas' strict stance on abortion, highlighting the deep divisions over this issue at both state and national levels.

Moving forward, the plaintiffs and advocacy groups plan to continue their fight for clearer, more humane laws that respect the medical needs and personal autonomy of women facing severe pregnancy complications. The case has brought significant attention to the real-life consequences of restrictive abortion laws, potentially influencing future legal battles and legislative efforts across the country.

Zurawski’s experience is a stark reminder of the potential dangers of restrictive abortion laws. Her near-death experience and subsequent health complications highlight the critical need for medical professionals to have the discretion to make timely decisions in the best interest of their patients' health. As she and other plaintiffs continue their fight, they hope to pave the way for changes that will prevent others from experiencing similar ordeals.

The legal and ethical implications of this ruling are profound. The decision sets a precedent that may impact future cases and legislative decisions concerning reproductive rights and medical autonomy. It also raises questions about the role of the judiciary in interpreting and enforcing laws that have significant impacts on public health and individual freedoms. The plaintiffs’ determination to seek justice and clarity may inspire further advocacy and reform efforts, both within Texas and beyond, as the nation continues to grapple with the complexities of abortion legislation and women's rights.