A conflict in Texas regarding a woman’s ability to end a non-viable pregnancy may result in abortion remaining a key issue in the 2024 election and potentially alter the course of lawsuits against state restrictions.

This situation highlights the uncertain legal and ethical boundaries that have arisen for doctors since the Supreme Court’s decision to overturn Roe v. Wade. It has also sparked a discussion about who is exempt from strict abortion laws, who is allowed to challenge these laws, and the potential consequences doctors face when trying to interpret unclear laws with severe punishments while assisting patients in urgent medical situations.

According to legal professionals, the ramifications of the Texas case extend beyond the state’s boundaries and expose flaws in the legal system following the Roe v. Wade decision. The current system relies on a mix of state laws that can lead to conflicting interpretations. Many states have ambiguous exemptions for abortion bans, leaving it up to doctors to determine who qualifies based on their medical judgment. However, this puts doctors at risk of losing their license and facing severe consequences, such as hefty fines or even imprisonment, if a jury disagrees with their decision.

Greer Donley, a law professor at the University of Pittsburgh, stated that the current confusion surrounding the Dobbs case demonstrates its impracticality. She noted that the case’s foundation is based on the idea that elective and therapeutic abortions can be differentiated and one can be banned while the other is protected. However, recent events have shown that this distinction is not feasible.

Kate Cox, a 31-year-old mother of two from the Dallas area, is currently 20 weeks pregnant. Her medical team has informed her that her fetus has Trisomy 18, a life-threatening condition. Continuing the pregnancy could increase her risk of hypertension, gestational diabetes, and infection. However, her doctors are hesitant to provide an abortion due to the state’s strict laws and fear of legal consequences or losing their medical licenses. They have stated that they will not perform the procedure until the fetus has passed away.

Cox brought the case to court and on Thursday, a judge in the state ruled that she has the right to get an abortion and that the doctor who will perform it cannot face criminal charges. Shortly after, Texas Attorney General Ken Paxton cautioned Cox’s doctor and the hospitals where she works that they may still face legal action if they proceed with the abortion. Paxton argued that the court’s order only prevents his office from pressing criminal charges, but does not stop local prosecutors from doing so or prevent state residents from filing civil charges.

Paxton stated that if the state appeals the ruling, the doctors will not have legal protection against criminal charges even if the lower court’s decision is reversed.

He cautioned that the temporary restraining order will end well before the statute of limitations for breaking Texas’ abortion laws expires.

The Democrats have taken advantage of the situation and criticized Paxton’s involvement and appeal to the state’s supreme court. They believe this demonstrates two key points: that the rights of women are at risk with a Republican-led government and that there is a threat to the checks and balances system.

The Biden administration, specifically those in charge of reproductive rights, have been closely following Cox’s case. However, the recent threat from Paxton has brought the issue to the forefront for President Joe Biden and his team, causing concern for supporters who see it as a direct attack against Cox and her doctors, despite a court ruling. This action has also sparked worries that it may complicate matters for the medical community as they continue to navigate the repercussions of the Dobbs decision from last year.

The Biden campaign for reelection intends to present this case as a clear illustration of the dangerous threat to women’s reproductive rights if Republicans regain control in 2024.

“Ken Paxton is doing a great job of expressing for thousands of women in Texas the horror of having the state in charge of your pregnancy,” said Cecile Richards, the former CEO of Planned Parenthood and current co-chair of Democratic Super PAC American Bridge 21st Century. “These are people’s lives that are at stake, and it’s only going to get worse.”

On Friday, the campaign emphasized the media coverage of Paxton’s statement multiple times. They also attempted to leverage the legal dispute to criticize Republican presidential frontrunner Donald Trump, framing the situation as a consequence of his actions – such as appointing three Supreme Court justices and supporting initiatives that restrict reproductive rights.

“This story is shocking, it’s horrifying, and it’s heartbreaking — it’s also becoming all too commonplace in America because of Donald Trump,” Rep. Veronica Escobar

Representative (D-Texas), who is also a co-chair for the Biden campaign, stated that the public should be aware that Donald Trump and the Republicans who support Make America Great Again will not end their efforts here.

The Trump campaign did not promptly reply to a comment request.

Physicians have expressed concerns since the overturning of the Roe v. Wade decision last year, stating that the ambiguous and unscientific terminology used in state laws restricting abortion has left them uncertain about when they can intervene, even in cases where patients are experiencing life-threatening complications.

The ban in Texas does not have any exceptions for rape, incest, or severe fetal abnormalities. However, it does permit abortions in cases where the patient’s life is in danger or there is a serious risk of significant harm to a major bodily function.

Donley stated that the ambiguity surrounding the implications of this, along with the possibility of imprisonment, financial ruin, and the termination of their professions, is causing a restraining influence on physicians.

“Consider all the terms used: How do you define ‘serious’? What qualifies as a ‘substantial impairment’? What constitutes a ‘major bodily function’? Each of these phrases is open to interpretation and can be a source of controversy,” she explained. “It’s logical for hospitals to interpret these exemptions in the strictest manner to safeguard themselves.”

Anti-abortion groups in Texas are rallying behind Paxton and characterizing Cox’s lawsuit as an attempt to undermine and ultimately get rid of the state’s ban. Both Texas Alliance for Life and Texas Right to Life told POLITICO they are unconvinced that Cox qualifies for a medical exemption and said she should carry the pregnancy to term even if the baby does not survive.

According to Amy O’Donnell, spokesperson for Texas Alliance for Life, aborting a child not only deprives them of a potential lifespan, but also denies their family the opportunity to mourn and honor their lost child. This is not a compassionate choice for either the family or the child.

The president of Texas Right to Life, John Seago, stated that he shares the same viewpoint as those who criticize the ban and its exemptions, stating that they do not align with the terminology used by doctors. However, he believes that it is the duty of the state’s medical board and private medical associations to educate doctors on how to properly utilize these exemptions.

According to him, they have not successfully fulfilled their role in informing doctors, hospital ethics committees, and attorneys about the legalities. He believes that medical associations should take responsibility and properly educate physicians who are directly involved.

Both Cox’s case and another filed Friday in Kentucky by an anonymous pregnant woman represent a new chapter in the legal battles over abortion post-Roe. Until now, most cases have been brought by doctors and advocacy groups challenging bans on behalf of their pregnant patients, because pregnancy and abortion are so medically precarious and time-sensitive compared to the slow pace of court proceedings.

Republican representatives have presented their case in the courts of Texas, Kentucky, and other states, claiming that the doctors and organizations involved do not have the right to bring a lawsuit as they are not directly affected by the outcome of a pregnancy. They also argue that the interests of doctors and patients do not always align. With the recent involvement of pregnant individuals in legal challenges, it will be a test to see if conservative judges will permit them to bring a lawsuit.

Brigitte Amiri, the deputy director of the ACLU Reproductive Freedom Project, who is involved in the Kentucky case, stated that there must be a means of accessing the courthouse doors. She argued that it is contradictory for the state to deny third-party standing for doctors and then prevent a pregnant individual from bringing the case for alternate reasons. She emphasized the importance of allowing citizens to challenge laws.

Cox’s lawyers emphasized that the majority of individuals in her circumstances, or those seeking an abortion in general, do not have the necessary time, bravery, and means to pursue legal action.

Molly Duane, a senior staff attorney at the Center for Reproductive Rights, expressed that the healthcare system should not operate in this manner. She stated that she would not feel comfortable with her doctors waiting for a court decision on whether or not they could save her life.