Supreme Court weighs whether hospitals obligated to provide emergency abortions

The Supreme Court will hear arguments on Wednesday in a case that will ultimately decide whether hospitals have an obligation, under federal law, to provide emergency abortions to women in medical emergencies even in states with abortion bans.

The justices are weighing a case from Idaho, where a strict abortion ban was enacted in 2022, a year after the court overturned Roe v Wade.

It is the latest abortion case to end up in the hands of the court after justices heard arguments in another seeking to restrict abortion medication last month. A decision in both cases is not expected sometime in or before June.

The case arguments arrive after several high-profile incidents where pregnant women have detailed physically and emotionally traumatizing medical situations in which they were denied abortions due to state laws but faced sepsis, severe bleeding, pain and more.

Emergency room doctors in Idaho face an impossible choice when a pregnant patient arrives with a medical condition that may require them to perform an abortion due to a strict, yet vague, anti-abortion law that directly conflicts with their role as medical professionals and federal statute.

They can treat the patient who needs an abortion to prevent serious bodily dysfunction or jeopardize their health – as required under the federal Emergency Medical Treatment and Active Labor Act (EMTALA) – but potentially face jail time or medical license suspension due to the state law, Idaho Defense of Life Act.

Alternatively, they can decline to treat the patient to protect their medical license and prevent criminal prosecution, putting the health of the pregnant person in jeopardy and violating EMTALA.

It’s the same conflict that emergency room doctors in Texas are facing and one that could extend across the US, putting pregnant people at risk of severe bodily harm or death in the event of a life-threatening emergency.

In August 2022, Idaho passed an anti-abortion law that imposes penalties on doctors who perform abortions unless the physician uses “good faith medical judgment” deeming it necessary to protect the life of the mother.

Those penalties can include revoke of medical license, for at least six months, and jail time of two to five years.

The vague language, similar to the kind used in Texas law, makes it difficult for doctors to determine what “good faith medical judgment” means to avoid penalties.

Pro-abortion activist rally for
Pro-abortion activist rally for "reproductive rights and emergency abortion care," outside the US Supreme Court as it hears arguments in the Moyle v. United States case, in Washington, DC, on April 24, 2024. (AFP via Getty Images)

Additionally, the state’s law directly conflicts with guidance from the Biden administration that said hospitals must provide abortions to patients in emergency situations, under EMTALA, in order to receive federal funding.

The US law requires that hospitals that get federal funding to treat or stabilise a patient regardless of their ability to pay or insurance status. It was passed to prevent hospitals from “patient dumping”.

However, the law does not explicitly mandate which medical treatments, like abortions, are necessary.

The Biden administration argues the federal statute should override any state abortion restrictions. Idaho officials say the administration misused the law to impose a federal mandate on states.

“EMTALA’s protection for the uninsured into a federal super-statute on the issue of abortion, one that strips Idaho of its sovereign interest in protecting innocent human life and turns emergency rooms into a federal enclave where state standards of care do not apply,” Idaho officials said in their appeal to the court.

In the US government response, Solicitor General Elizabeth Preloger said that abortions are necessary when “medical conditions that threaten their lives or risk severe and lasting harms, including sepsis, uncontrollable bleeding, kidney failure, and loss of fertility” occur.

Doctors in Idaho have warned that not explicitly allowing abortions in life-saving situations will cause extreme harm to pregnant people.

“This conflict is not hypothetical: It is very real, and the consequences of [the law] will be grave,” doctors from St Luke’s Health System in Idaho wrote in a brief.