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When the Supreme Court overturned Roe v. Wade, it claimed to be removing the judiciary from the abortion debate. In reality, it simply gave the courts a macabre new task: deciding how far states can push a patient toward death before allowing her to undergo an emergency abortion. On Tuesday, the U.S. Court of Appeals for the 5th Circuit offered its own answer, declaring that Texas may prohibit hospitals from providing “stabilizing treatment” to pregnant patients by performing an abortion—withholding the procedure until their condition deteriorates to the point of grievous injury or near-certain death. The ruling proves what we already know: Roe’s demise has transformed the judiciary into a kind of death panel that holds the power to elevate the potential life of a fetus over the actual life of a patient.

If that description seems hyperbolic, consider the facts of Tuesday’s decision, Texas v. Becerra. It involves a clash between a federal law and Texas’ stringent abortion ban. Texas law reflects the anti-abortion movement’s fundamental hostility toward any health exceptions; it permits emergency abortions only when a patient is “at risk of death” or “substantial impairment of a major bodily function.” Any doctor who terminates a pregnancy before this point is subject to a 99-year prison term. The Texas Supreme Court affirmed the narrow scope of this exception last month when it forbade Kate Cox from terminating her pregnancy. Cox suffered “severe cramps, leaking fluid and elevated vital signs” due to an abnormality that rendered the fetus incompatible with life. Yet the court unanimously decreed that, until her symptoms grew considerably more dire, Cox was legally obligated to continue the failing pregnancy.

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This draconian ban, and others like it, conflicts with a federal statute, the Emergency Medical Treatment and Active Labor Act, or EMTALA. That law compels federally funded hospitals to provide “necessary stabilizing treatment” to any patient experiencing an “emergency medical condition.” It defines the term as any condition that “could reasonably be expected” to seriously jeopardize a patient’s health, bodily functions, or organs. In July 2022, President Joe Biden’s Department of Health and Human Services issued guidance noting that EMTALA applies when a pregnant patient requires an abortion for “stabilizing” care. It clarified that any stricter abortion laws must yield to EMTALA, granting red-state doctors permission to terminate a pregnancy well before a patient is dying.

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Texas promptly attacked the Biden administration’s guidance, filing a lawsuit in a division that ensured the case would land in front of one of conservatives’ favorite judges: James Wesley Hendrix, a far-right Trump appointee. The state argued that it has the right to force patients into more extreme medical distress before allowing them to terminate a pregnancy, and that EMTALA’s “stabilizing” standard does not apply to abortion. Predictably, Hendrix agreed, blocking the federal government from “enforcing the guidance” in Texas, or against a group of anti-abortion doctors who joined the lawsuit. Biden’s Department of Justice appealed, but now the 5th Circuit has sided with Hendrix.

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The decision was authored by Kurt Engelhardt, a Trump appointee, and joined by Cory Wilson (another Trump pick) and Leslie Southwick (a George W. Bush appointee). Engelhardt asserted that EMTALA “does not govern the practice of medicine,” which is “historically subject to police power of the states,” not the federal government. Instead, he wrote, the law merely bars hospitals from “dumping” poor patients who need emergency treatment. If Congress had intended it to apply to abortion, he concluded, it would have said so more explicitly. (Of course, “stabilizing treatment” encompasses a vast range of medical procedures that Congress did not identify by name, and Engelhardt did not explain why he singled out abortion for disfavor.) The judge also latched onto EMTALA’s reference to an “unborn child,” claiming the law creates a “dual requirement” that hospitals owe “equal stabilizing obligations” to patients and their fetuses, and may not terminate the latter to save the former. This proposition is flatly false, a willful misreading of a provision designed to give patients the right to insist on emergency fetal intervention if they so choose.

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Consider, for a moment, the implications of the 5th Circuit’s decision. The court acknowledged a fact that the anti-abortion movement has strived mightily to conceal: Abortion bans like Texas’ imperil the health of pregnant patients, denying them the medical standards of care that doctors have applied in these tragic scenarios. In their place, doctors must apply a state-mandated fixation on preserving the fetus’s heartbeat for as long as possible—even if the pregnancy is guaranteed to end in miscarriage, even if the fetus is incompatible with life, and even if the patient is at risk of organ damage or other serious bodily impairment. Kate Cox learned this lesson the hard way when state officials, backed by the Texas Supreme Court, blocked her access to a desperately needed abortion. So did Amanda Zurawski, who nearly died after Texas denied her emergency abortion care—despite premature dilation, prolapsed membranes, and rapidly advancing sepsis—and now faces infertility due to delayed treatment. So have countless other patients denied access to emergency abortions by red-state bans.

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These states consistently attempt to blame patients, doctors, and even the media for these horrific, agonizing episodes. But as the 5th Circuit confirmed, the blame falls on the laws themselves. The Biden administration tried to carve out a humane exception for “stabilizing” care when a patient’s health “could reasonably be expected” to suffer severely. Republican lawmakers vehemently rejected this trade-off, doubling down on an exception so narrow and ambiguous that, in practice, a doctor cannot act until their patient reaches death’s door.

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The U.S. Supreme Court will ultimately have to address this dispute. A federal judge in Idaho embraced the Biden administration’s interpretation of EMTALA in 2022, and the U.S. Court of Appeals for the 9th Circuit looks poised to side with him soon. Idaho has already asked SCOTUS for an emergency order giving the state permission to prosecute doctors who provide “stabilizing” abortions before a patient is sufficiently close to dying. Meanwhile, the administration has penalized hospitals in Missouri and Kansas for violating EMTALA by refusing to terminate a patient’s nonviable pregnancy until she began hemorrhaging (or worse). There’s now a deep split among the lower courts about executive branch authority to regulate in this area that only the Supreme Court can resolve.

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These cases give SCOTUS an opportunity to limit the damage of its cavalier eradication of reproductive rights. The conservative justices could use EMTALA to draw a line in the sand, creating a nationwide guarantee of abortion access when a patient’s health is at risk. But doing so would mean admitting that, last time around, the court got it wrong—that overturning Roe did not remove the judiciary from the abortion debate, but shifted life-or-death decisions about pregnancy into the hands of judges who know nothing about the practice of medicine. There is little reason to believe that this Supreme Court will own up to its mistakes. The justices can, after all, close their eyes to the suffering they have unleashed, a luxury that red-state doctors do not have.

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QOSHE - The Supreme Court Is Teed Up to Decide Its Biggest Abortion Case Since Dobbs - Mark Joseph Stern
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The Supreme Court Is Teed Up to Decide Its Biggest Abortion Case Since Dobbs

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04.01.2024
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When the Supreme Court overturned Roe v. Wade, it claimed to be removing the judiciary from the abortion debate. In reality, it simply gave the courts a macabre new task: deciding how far states can push a patient toward death before allowing her to undergo an emergency abortion. On Tuesday, the U.S. Court of Appeals for the 5th Circuit offered its own answer, declaring that Texas may prohibit hospitals from providing “stabilizing treatment” to pregnant patients by performing an abortion—withholding the procedure until their condition deteriorates to the point of grievous injury or near-certain death. The ruling proves what we already know: Roe’s demise has transformed the judiciary into a kind of death panel that holds the power to elevate the potential life of a fetus over the actual life of a patient.

If that description seems hyperbolic, consider the facts of Tuesday’s decision, Texas v. Becerra. It involves a clash between a federal law and Texas’ stringent abortion ban. Texas law reflects the anti-abortion movement’s fundamental hostility toward any health exceptions; it permits emergency abortions only when a patient is “at risk of death” or “substantial impairment of a major bodily function.” Any doctor who terminates a pregnancy before this point is subject to a 99-year prison term. The Texas Supreme Court affirmed the narrow scope of this exception last month when it forbade Kate Cox from terminating her pregnancy. Cox suffered “severe cramps, leaking fluid and elevated vital signs” due to an abnormality that rendered the fetus incompatible with life. Yet the court unanimously decreed that, until her symptoms grew considerably more dire, Cox was legally obligated to continue the failing pregnancy.

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This draconian ban, and others like it, conflicts with a federal statute, the Emergency Medical Treatment and Active Labor Act, or EMTALA. That law compels federally funded hospitals to provide “necessary stabilizing treatment” to any patient experiencing an “emergency medical condition.” It defines the term as any condition that........

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