Zurawski v. State of Texas was a lawsuit brought by twenty women and two physicians who said Texas’s abortion ban left doctors unable to tell when pregnancy complications were serious enough to justify treatment. On May 31, 2024, the Texas Supreme Court sided with the state, vacated a trial court injunction, and held that the statute’s “reasonable medical judgment” standard already gave physicians enough room to act before a patient’s condition became critical.1Supreme Court of Texas. Zurawski v. State of Texas The decision did not expand the law, but it prompted new Texas Medical Board rules within weeks and a 2025 legislative amendment that wrote much of the court’s reasoning into the statute itself.
Who Brought the Case
Amanda Zurawski, the lead plaintiff, was 18 weeks pregnant when her water broke. The fetus was not viable at that gestational age, and her risk of infection was serious, but her medical team waited until she developed septic shock before intervening. She spent three days in intensive care and later underwent procedures to repair scarring in her uterus and fallopian tubes. One tube remains permanently closed, and subsequent IVF treatments were unsuccessful.
The other plaintiffs told similar stories. Several had received diagnoses of fatal fetal conditions but were told their own health was not yet compromised enough for Texas doctors to act. Many traveled to Colorado, New Mexico, Maryland, Kansas, or Washington for care, sometimes waiting weeks for appointments at clinics already overwhelmed with out-of-state patients. Others waited at home in Texas until they got sick enough that their doctors felt safe treating them.
Two physicians joined the suit, arguing that the threat of prosecution made it impossible to practice obstetrics according to accepted clinical standards. The American College of Obstetricians and Gynecologists recommends counseling patients with previable membrane rupture on both expectant management and immediate delivery, including termination.2American College of Obstetricians and Gynecologists. Increased Risk of Maternal Morbidity Associated With Previable and Periviable Preterm Prelabor Rupture of Membranes The physician plaintiffs said Texas law blocked them from offering that full range of options.
The Law the Plaintiffs Challenged
Texas Health and Safety Code Chapter 170A, the Human Life Protection Act, bans abortion except when a licensed physician, exercising reasonable medical judgment, determines that the pregnant patient has a life-threatening physical condition placing her at risk of death or serious impairment of a major bodily function.3State of Texas. Texas Health and Safety Code 170A.002 – Prohibited Abortion; Exceptions The plaintiffs argued that the phrase gave doctors no workable way to know how close to death or organ failure a patient had to be.
The penalties behind that uncertainty are heavy. A physician who performs an abortion outside the exception faces a first-degree felony punishable by five years to life in prison, plus a civil penalty of at least $100,000 per violation.4State of Texas. Texas Health and Safety Code Chapter 170A Those stakes drove the chilling effect the plaintiffs described.
What the Texas Supreme Court Decided
The court vacated a trial court injunction that had tried to broaden the exception by substituting a “good faith” test for the statutory language.1Supreme Court of Texas. Zurawski v. State of Texas No justice dissented from the result, though two wrote separate concurrences.
On the central question, the court held that Chapter 170A already provides enough guidance. A patient does not have to be on the brink of death. A physician who concludes, using reasonable medical judgment, that a life-threatening condition poses a risk of death or serious impairment may perform an abortion without waiting for the situation to deteriorate further. The court treated this as an objective medical standard rather than a subjective one tied to a doctor’s personal view of the case.
The plaintiffs had asked the court to issue a list of specific conditions that would automatically qualify. It refused, saying medicine is too complex for a judicial checklist, and pointed the Texas Medical Board toward offering more detailed guidance through administrative rules.
Reasonable Medical Judgment, Not Good Faith
The distinction between the two standards did real work in the ruling. The statute defines reasonable medical judgment as the judgment a reasonably prudent physician would make given knowledge of the case and available treatments.5State of Texas. Texas Health and Safety Code 170A.001 – Definitions That is an objective test, measured against what a competent doctor in the same specialty would do under the same circumstances.
A good faith standard would be subjective, protecting a doctor who sincerely believed intervention was warranted even if peers disagreed. The court acknowledged that a physician exercising reasonable medical judgment is usually also acting in good faith, but it held that the legislature had chosen the objective standard deliberately and the courts could not swap it out.1Supreme Court of Texas. Zurawski v. State of Texas For doctors, that means their decisions can be second-guessed against what their peers would have done.
Fatal Fetal Diagnoses Alone Do Not Qualify
The court directly addressed whether a diagnosis of a fatal fetal condition triggers the exception on its own. It does not. Chapter 170A does not permit an abortion based solely on a diagnosis that the fetus has a condition incompatible with life after birth.1Supreme Court of Texas. Zurawski v. State of Texas The exception reaches only situations where the pregnant patient’s own health is at serious risk. If carrying a nonviable fetus creates such a condition for the patient, the exception can apply. The fetal diagnosis by itself is not enough.
Several Zurawski plaintiffs fell into exactly this gap. Women carrying fetuses with anencephaly or trisomy 18 could not get an abortion in Texas unless and until their own health deteriorated, and the ruling confirmed that out-of-state travel remained their only legal option absent a maternal crisis.
What Changed After the Ruling
Texas Medical Board Rules
The Texas Medical Board took up the court’s invitation and adopted new sections 165.7 through 165.9 of Title 22 of the Texas Administrative Code, effective June 21, 2024.6Texas Medical Board. TMB Provides Clarification on Rules Regarding Exceptions to the Ban on Abortions The rules require physicians to document their clinical reasoning when performing an abortion under the exception, but they allow that documentation to be completed after the fact in a genuine emergency so paperwork does not delay care. The board also stated that reasonable medical judgment depends on the specific patient, the clinical setting, and the treating physician’s training.
The board declined to publish a list of qualifying conditions, warning that any such list could be read to exclude anything not on it. It also acknowledged it had no authority to expand the statutory exception beyond what the legislature wrote.6Texas Medical Board. TMB Provides Clarification on Rules Regarding Exceptions to the Ban on Abortions The rules supply procedure, not a bright line on how sick a patient must be.
Senate Bill 31 and the 2025 Statutory Amendments
In 2025, the Texas Legislature passed Senate Bill 31, amending Section 170A.002 effective June 20, 2025. The amended statute now states expressly that a physician may act before a patient actually suffers any effects of the risk.3State of Texas. Texas Health and Safety Code 170A.002 – Prohibited Abortion; Exceptions It clarifies three points the Zurawski plaintiffs had argued were dangerously vague:
- The risk of death or impairment does not need to be imminent.
- The patient does not need to have already suffered physical harm.
- A life-threatening condition is one capable of causing death or potentially fatal; it does not need to be actively injuring the patient at the time of the procedure.
These amendments codify much of what the court said the statute already meant. Whether they change clinical behavior depends on how the law is enforced, not just how it reads.
Federal EMTALA Does Not Fill the Gap in Texas
The federal Emergency Medical Treatment and Labor Act requires hospitals that accept Medicare to stabilize patients with emergency medical conditions. Whether that duty requires an abortion when it is the medically necessary stabilizing treatment has been litigated separately, and in Texas it does not. In January 2024, the Fifth Circuit held in Texas v. Becerra that EMTALA does not require physicians to perform abortions and does not override Texas’s abortion restrictions.7Fifth Circuit Court of Appeals. Texas v. Becerra, No. 23-10246 The U.S. Supreme Court dismissed a parallel Idaho case, Moyle v. United States, in June 2024 without reaching the merits.8Supreme Court of the United States. Moyle v. United States, No. 23-726 In June 2025, HHS rescinded 2022 guidance that had told hospitals EMTALA required abortion care when necessary to stabilize a patient.9Centers for Medicare and Medicaid Services. CMS Statement on Emergency Medical Treatment and Labor Act (EMTALA) For Texas doctors, federal law offers no clear separate authority to perform an emergency abortion that state law would not already permit.