海角大神

Doctors in Idaho can perform abortions in certain emergency situations without running afoul of the state鈥檚 strict abortion ban, at least for now, the U.S. Supreme Court ruled in a procedural but emotionally fractured decision.

The 6-3 dismissal of Moyle v. U.S. comes as the country continues to grapple with the legal and medical fallout from the court striking down a constitutional right to abortion two years ago. The majority's decision on Thursday to dismiss the case as improvidently granted surprised some court watchers expecting the justices to further restrict abortion access. However, that surprise mostly landed on Wednesday, when the decision was briefly available on the court鈥檚 website and was spotted by Bloomberg reporters.

The unsigned, one-sentence per curiam opinion does not resolve the central question in the case: Does a federal law requiring doctors to perform abortions in certain medical emergencies preempt Idaho鈥檚 law, which allows a doctor to perform the procedure only to save the life of the mother? All nine justices put their names to at least one of four separate opinions that accompanied the decision, making clear the sharp divisions on the court over that question.

And this issue, along with other abortion questions, is likely to return to the Supreme Court soon. A majority of the justices don鈥檛 appear keen to face them, however.

鈥淚t鈥檚 pretty clear that ... there are issues in the states, either between the states or between the states and the federal government, that will require Supreme Court intervention,鈥� says Naomi Cahn, a professor at the University of Virginia Law School.

鈥淭he court is splintered on this issue,鈥� she adds. And 鈥測ou just see [it] deferring any further consideration of abortion.鈥�

What constitutes a medical emergency?

The central question in Moyle is whether a provision of Idaho鈥檚 abortion ban is trumped by a conflicting federal law. The case dates from the immediate aftermath of the Supreme Court overturning the constitutional right to abortion in the 2022 case Dobbs v. Jackson Women鈥檚 Health.

In the ensuing months, Idaho passed a law prohibiting abortion in almost all circumstances. One exception held that a doctor could perform an abortion if it 鈥渨as necessary to prevent the death of the pregnant woman.鈥� Before that law could take effect, the Biden administration sued the state, claiming that Idaho鈥檚 law conflicted with the federal Emergency Medical Treatment and Labor Act (EMTALA). The government says the federal law requires a doctor to perform an abortion if they believe it鈥檚 necessary to 鈥渟tabiliz[e]鈥� a pregnant woman鈥檚 鈥渆mergency medical condition.鈥�

A district court judge ruled in favor of the Biden administration, and stayed that provision of the law pending further appeals. An appeals court declined to put that ruling on hold while appeals continued. Before the appeals court issued a ruling on the merits, as is customary, the Supreme Court granted an emergency appeal by Idaho and allowed the law to go into effect in full while it considered the case.

The high court鈥檚 maneuvers have caused significant confusion on the ground. For five months doctors in Idaho have not known if or when they can legally perform abortions. The state鈥檚 largest hospital system said that in the three months after the court let Idaho鈥檚 abortion ban take full, temporary effect, it had to airlift six patients to other states for emergency care. In the 12 months prior, they had only needed to airlift one patient.

鈥淲e don't do elective abortions. We treat women who are having pregnancy-related emergencies,鈥� says Jessica Kroll,聽an emergency medical doctor at St. Alphonse Health System in Boise.

It鈥檚 鈥渞eally strange,鈥� she adds. 鈥淓mergency [doctors] are now the center of the abortion battle.鈥�

On Thursday, the justices effectively let both laws temporarily take effect. They punted to the appeals court the preemption question, but not without writing over 40 pages of separate opinions displaying pointed disagreements that will likely need to be resolved in the coming years.

鈥淚t's not a win for abortion rights in any kind of meaningful sense,鈥� says Mary Ziegler, a professor at the University of California, Davis School of Law.

Abortion access in Idaho may change in the short term, but the case is effectively 鈥渟tarting all over at zero,鈥� she adds. 鈥淭here鈥檚 a lot of chaos that's been created in the aftermath of Dobbs. There's a lot of uncertainty about what physicians can and cannot do. And this isn't going to clarify anything.鈥�

So what, if anything, changed?

The clearest explanation for Thursday鈥檚 unsigned per curiam opinion can probably be found in a concurring opinion written by Justice Amy Coney Barrett and joined by Chief Justice John Roberts and Justice Brett Kavanaugh.

In her concurrence, Justice Barrett wrote that in the months after the Supreme Court agreed to hear the case, the facts changed to the point that there was no serious conflict left for the court to resolve.

鈥淭he parties鈥� [evolving] litigating positions have rendered the scope of the dispute unclear, at best,鈥� she wrote. 鈥淚 am now convinced that these cases are no longer appropriate for early resolution.鈥�

Specifically, she noted the government鈥檚 claims during oral argument that federal conscience protections allow hospitals and doctors to refuse to perform abortions, even in the EMTALA context. She pointed to another government concession that EMTALA doesn鈥檛 require abortions as a means to stabilize a pregnant woman鈥檚 mental health.

On the other side, she noted concessions made by Idaho during oral argument that its abortion ban does permit abortions for certain specific medical conditions, even if the threat to the woman鈥檚 life isn鈥檛 imminent.

鈥淚daho represents that its exception is broader than the United States fears, and the United States represents that EMTALA鈥檚 requirement is narrower than Idaho fears,鈥� wrote Justice Barrett.

鈥淭he dramatic narrowing of the dispute,鈥� she added, means that 鈥淚daho鈥檚 ability to enforce its law remains almost entirely intact.鈥�

Some of her colleagues disputed, in strong terms, the notion that the dispute has been narrowed.聽In a dissent, Justice Samuel Alito, joined by Justices Clarence Thomas and Neil Gorsuch, described the court鈥檚 鈥渁bout-face鈥� as 鈥渂affling.鈥�

鈥淣othing legally relevant has occurred鈥� since the court agreed to hear the case, he wrote, and the government鈥檚 preemption theory is 鈥減lainly unsound.鈥�

The preemption question 鈥渋s as ripe for decision as it ever will be,鈥� he added. 鈥淎pparently, the court has simply lost the will to decide the easy but emotional and highly politicized question that the case presents.鈥�

Meanwhile, writing separately, Justice Ketanji Brown Jackson agreed that resolving the EMTALA preemption question 鈥渞emains as imperative as ever.鈥�

鈥淭oday鈥檚 decision is not a victory for pregnant patients in Idaho. It is delay,鈥� she wrote. 鈥淭his court had a chance to bring clarity and certainty to this tragic situation, and we have squandered it.鈥�

Idaho 鈥渃hanged [its] tune about the exact types of medical care that fall in the gap between state and federal law,鈥� she added.

鈥淪ome of my colleagues appear to view this convenient rhetorical maneuver as a material change that (also conveniently) reduces the conflict between state and federal law to the point that a ruling from this Court is no longer warranted,鈥� she continued. 鈥淏ut the fundamentals of this dispute remain the same.鈥�

Are the justices ready for another Dobbs?

On the actual preemption question, the justices divided into a triad. While Justices Alito, Thomas, and Gorsuch agreed that the Idaho law isn鈥檛 preempted by EMTALA, Justice Jackson and Justices Elena Kagan and Sonia Sotomayor concluded the opposite. In her concurrence, Justice Barrett posited that the two laws can co-exist.

How courts will come down on the issue is unclear, but the division between the justices聽鈥� and some immediate reactions to the ruling聽鈥� suggest that complex, confusing debates lie ahead.聽

鈥淚t鈥檚 going to become continually clear that pro-life laws allow for women to get critical medical care,鈥� says Stephen Billy, vice president for state affairs at Susan B. Anthony Pro-Life America.

Meanwhile, in a statement, Idaho Attorney General Ra煤l Labrador said he 鈥渨ill continue my outreach to doctors and hospitals across Idaho to ensure that they understand what our law requires.鈥�

What does this mean for doctors? And for pregnant women with medical complications? In Idaho, Thursday鈥檚 ruling has brought a degree of clarity to emergency rooms that they have been sorely lacking in the past five months, says Dr. Kroll, who is also president of the Idaho College of Emergency Physicians.

鈥淲e [were] on the phone with risk [management] and lawyers, while our patient right there needs immediate medical care, not legal mediation,鈥� she recalls.

With the high court鈥檚 ruling 鈥渨e get to go back to just taking care of patients [and] getting people appropriate standard of care,鈥� she adds.

鈥淭he bad part of it is that it is like we're back in a waiting pattern again. ... It kind of puts me back on the edge of my seat.鈥�

A federal appeals court will now pick up the Moyle case. Whatever that court decides may be appealed back to the Supreme Court. In a separate case out of Texas, the Biden administration is challenging a Texas abortion ban it claims is preempted by EMTALA.

Whether the high court has the appetite for resolving these issues is unclear, however. The justices heard two abortion cases this term 鈥� the other concerned an effort to ban a widely used abortion pill 鈥� and both cases were resolved on procedural grounds without confronting the more contentious merits questions.

鈥淭he court is really struggling with this issue,鈥� says Professor Cahn. 鈥淒obbs was a major decision. It simply might not be ready to issue another major decision like that.鈥�