On Tuesday, the Texas Supreme Court considered this question: Are the state's abortion laws harming women when they face pregnancy complications?

The case, brought by the Center for Reproductive Rights, has grown to include 22 plaintiffs, including 20 patients and two physicians. They are suing Texas, arguing that the medical exceptions in the state's abortion bans are too narrow to protect patients with complicated pregnancies. Texas Attorney General Ken Paxton is fiercely defending the state's current abortion laws and arguing that the case should be dismissed.

At a lively hearing in Austin on Tuesday, the full panel of Texas Supreme Court justices considered whether to apply a temporary injunction that a lower court judge ruled should be in place. That injunction would give doctors greater discretion to perform abortions when a doctor determines that a woman's health is threatened or that a fetus has a condition that could be fatal. It would make more people eligible for exceptions to Texas's abortion bans, but it would not overturn those laws.

Liz Sepper, a professor at Texas Law, says during the hour-long hearing, the justices seemed convinced that the plaintiffs had standing to sue, but not particularly eager to take on the substantive questions in the case. "I also got a sense that some of the justices were convinced that the Texas bans are contradictory and lack the kind of clarity that allow doctors to apply them in emergency situations," Sepper says.

She says a decision could come in the next few weeks or months, as soon the justices can come to an agreement. "This case, I think, became more tangled the more that the justices pulled the thread," she says. "And so they have to find a way out of the tangle."

Throughout the hearing, several of the justices seemed sympathetic to the stories of patients who faced difficult medical circumstances because of their pregnancies.

Dr. Dani Mathisen, 28, is one of seven new plaintiffs who joined the case earlier this month. She is in her medical residency as an OB-GYN and comes from a family of physicians, so when she was pregnant in 2021 and getting a detailed ultrasound test at 18 weeks gestation, she knew something was very wrong.

Mathisen was watching the monitor as the sonogram technician did the anatomy scan. She saw something was wrong with the spine of the fetus, then the heart, then kidneys. She asked, "Can you show me that again?" But the sonographer said she would have to wait to talk to the doctor, who was actually Mathisen's aunt.

When she and her doctor spoke after the scan, "I think I asked one question," Mathisen recalls. "I said, 'Is it lethal?' And she said yes."

Mathisen and her husband had been looking forward to becoming parents, but now she knew she wanted an abortion and would have to travel outside of Texas to get it.

This was in September 2021 before the federal high court overturned the constitutional right to an abortion for the whole country, but after the Texas law known as SB 8 went into effect. SB 8 banned most abortions after six weeks of pregnancy and says anyone helping someone get an abortion can be sued. Doctors can lose their medical licenses.

Mathisen says she didn't know where to start with calling clinics out of state and figuring out flights, rental cars and hotels. Her mother is also a doctor, and she took charge.

"My mom was just like, 'Take a Xanax, I will have it figured out when you wake up,'" Mathisen says.

Mathisen's mother made arrangements for her to have the procedure in New Mexico. That is not technically illegal under Texas law (although some counties are trying to ban traveling through them for abortions.) But Mathisen remained worried, knowing that SB 8 aims at people who help patients get abortions. It's sometimes called "the bounty hunter law."

"There was this tiny goblin in the back of my head going, 'Your mom's going to go to jail for this,'" Mathisen says.

Mathisen was able to go to New Mexico for an abortion. Some of the other plaintiffs were not able to travel. Two developed sepsis while waiting for Texas hospitals to approve abortion procedures. One had such severe blood clotting, her limbs began to turn purple, then black.

Texas Attorney General Ken Paxton's office has not responded to multiple requests from NPR for comment on the new plaintiffs, but in filings, lawyers for the state argue that these women were not harmed by the state's abortion laws. They say the law is clear, the exception is sufficient as is, and suggest that doctors were responsible for any harms the patients claim.

On Tuesday, Beth Klusmann of the Texas attorney general's office and Molly Duane of the Center for Reproductive Rights presented their cases and were peppered with questions from the justices. The body is made up of nine elected judges who serve staggered six-year terms; they are all Republicans. Some have been on the state's highest court for more than a decade; some are recently elected. There are a few possible ways they could rule, court watchers say.

  • They could uphold the lower court's injunction until the case can be fully heard in April. This would broaden the medical exception to abortion bans in Texas at least until the spring.
  • They could leave the status quo in place – with a narrow medical exception – and say the case should be heard in full in April.
  • They could leave the status quo in place, letting the narrow exceptions to the laws stand, and signal that they believe Texas will win on the merits, likely prompting a motion to dismiss the case in the lower court.

This case has grown over the course of 2023. In March, there were five patients and two OB-GYNs who were the plaintiffs in this case; in May, there were 13 patients, and now, in November, there are 20 patients suing Texas over its abortion exception.

Mathisen says joining the lawsuit is important to her: "I don't just have a sad story, but I'm doing something with that sad story."

And there is also a happy coda for Dr. Dani Mathisen: She is about 30 weeks into a healthy pregnancy.

Copyright 2023 NPR. To see more, visit https://www.npr.org.



The Texas Supreme Court will hear arguments today in a case challenging its abortion laws. Twenty patients and two OB-GYNs have sued the state, arguing the medical exception that allows legal abortions during pregnancy complications is too narrow and putting patients' lives in jeopardy. NPR's Selena Simmons-Duffin has this preview.

SELENA SIMMONS-DUFFIN, BYLINE: Dani Mathisen is an OB-GYN by profession, but she joined the lawsuit challenging Texas' abortion laws as a patient. When she was 18 weeks into her first pregnancy, she could tell that something was wrong right away at a prenatal appointment with a sonographer.

DANI MATHISEN: As she scanned through my abdomen, I saw, like, oh, there's something wrong with her spine. And then, oh, there's something wrong with her heart, oh, her kidneys. And I kept asking the sonographer to show me again because I could read the scan myself.

SIMMONS-DUFFIN: She could also see the fetus had no brain structures. Mathisen comes from a family of physicians. Her OB-GYN was actually her aunt. After the scan, they talked.

MATHISEN: I think I asked one question. I said, is it lethal? And she said yes.

SIMMONS-DUFFIN: Mathisen knew she wanted an abortion, but she knew that wasn't possible in Texas. Texas has three overlapping abortion bans. There is a medical exception for when a patient's life or, quote, "major bodily function" is in jeopardy. But the lawsuit brought by the Center for Reproductive Rights argues that language isn't enough and puts patients with pregnancy complications in difficult and sometimes dangerous situations. Dani Mathisen was able to go to New Mexico for an abortion. Some of the other plaintiffs were not able to travel, two developed sepsis, which can be deadly.

Texas Attorney General Ken Paxton is fiercely defending the current abortion laws. His office has not responded to multiple requests for comment from NPR. In filings, lawyers for Texas argue the abortion law is clear, the medical exception is sufficient, and that doctors are responsible for any harms the patients claim. There are nine justices on the Texas Supreme Court, all are Republicans. Today, they consider whether there should be a temporary hold while the legal process continues, which would allow doctors more discretion to perform abortions in Texas when pregnancy complications arise.

Selena Simmons-Duffin, NPR News.


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