Texas Judge Grants Woman’s Request for Abortion, in Rare Post-Roe Case

A Texas judge granted a request on Thursday to allow an abortion despite the state’s strict bans, ruling in the case of a pregnant woman whose fetus was diagnosed with a fatal condition.

The case is believed to be among the first attempts in the nation to seek a court-approved abortion since the U.S. Supreme Court overturned Roe v. Wade last year and allowed states to enact their own abortion restrictions.

The judge, Maya Guerra Gamble of Travis County district court, sided with the woman, Kate Cox, who is 20 weeks pregnant, and issued a temporary restraining order to permit her doctor to perform an abortion without facing civil or criminal penalties.

The judge, a Democrat, agreed with Ms. Cox’s lawyers that the procedure was necessary to protect Ms. Cox from a potentially dangerous birth, and to preserve her future fertility.

“The idea that Ms. Cox wants desperately to be pregnant, and this law might actually cause her to lose that ability, is shocking, and would be a genuine miscarriage of justice,” the judge said at the conclusion of a roughly 30-minute video hearing. “So I will be signing the order, and it will be processed and sent out today.”

The ruling applies only to Ms. Cox, though it represents another front in an effort to force Texas, which bans most abortions from conception, to allow abortions under the medical exceptions to its prohibitions. A separate lawsuit, brought by a group of Texas women who say they were denied abortions under state law, asks the state to clarify the conditions in which medical exceptions would apply.

Since the Supreme Court eliminated the federal right to abortion in 2022, more than a dozen conservative states have enacted abortion bans or severely restricted the procedure. The bans generally allow limited medical exceptions. In some of those states, women represented by abortion rights groups have sued to clarify when the procedure could be performed, or to have the bans overturned.

Those suits were filed after women were denied abortions. In some cases, the women claimed that they suffered harm to their health as a result, or were forced to leave the state, at significant cost, disruption or risk, to seek abortions elsewhere.

What made Ms. Cox’s case different was that she sought a court order while still pregnant.

Ms. Cox’s fetus was found to have trisomy 18, a genetic condition that in all but very rare cases leads to miscarriage or stillbirth, or to the infant’s death within the first year. Her lawyers said she had visited the emergency room four times because of pain and discharge — including once after her suit was filed on Tuesday — but that doctors had told her that under Texas law, she had to continue her pregnancy.

Ms. Cox, 31, could be seen wiping away tears from her eyes as she watched the judge issue the decision in the video proceeding with her husband, Justin. She said in an interview on Tuesday that she and her husband, who live in the Dallas area and have two young children, hoped for a big family and never planned on having an abortion.

The Texas attorney general’s office, which argued on Thursday against granting the order, could seek the intervention of a higher court.

After the ruling, Attorney General Ken Paxton sent a letter to top hospital officials in Houston, where Ms. Cox’s doctor practices, saying she and hospital staff could still face criminal and civil penalties, despite the judge’s order.

“The T.R.O. will not insulate you, or anyone else,” Mr. Paxton wrote, adding that it would expire “long before the statute of limitations for violating Texas’ abortion laws expires.”

Mr. Paxton’s letter contrasted with the order issued by the judge, which barred the state from enforcing its laws against Ms. Cox’s doctor, Damla Karsan, as well as anyone else involved in the procedure.

Marc Hearron of the Center for Reproductive Rights and one of Ms. Cox’s lawyers said that Mr. Paxton was misrepresenting the judge’s order. “He is trying to bulldoze the legal system to make sure Kate and pregnant women like her continue to suffer,” he said in a statement.

Since the overturning of Roe v. Wade, the issue of abortion has become a political liability for Republicans nationally. But Mr. Paxton was recently re-elected to a third term with the backing of hard right Republicans in Texas, where the Republican primary remains the critical election contest for statewide offices.

Texas is at the forefront of states that restrict abortion, and has three overlapping bans that outlaw abortions from the moment of fertilization, and allow private citizens to sue others who help a woman obtain an abortion.

The laws provide for some limited exceptions to save the health and life of a pregnant woman. Abortion rights advocates argue that those provisions are unclear and put women with pregnancy complications at risk.

The Texas Supreme Court, the state’s highest civil court, is currently weighing a broader effort by doctors, women and abortion advocates to clarify the medical exceptions under the law in a separate case, Zurawski v. State of Texas, brought by the Center for Reproductive Rights.

One of the lawyers in that case, Molly Duane, also represents Ms. Cox. In the court hearing on Thursday, Ms. Duane argued that her client qualified for an abortion under the state bans’ medical exceptions and asked the court to bar the state from enforcing the bans against Dr. Karsan, so that the doctor could proceed with the abortion without fear of punishment.

A doctor convicted of performing an illegal abortion in Texas can face a prison sentence of up to 99 years and fines of at least $100,000.

Johnathan Stone, a lawyer for the Texas attorney general’s office, argued that Ms. Cox’s pregnancy did not meet the “elements of the medical exception to Texas’s abortion laws,” citing a different doctor’s assessment of her condition.

Ms. Duane said that the state’s argument underscored the confusion over what standard would be used to assess a doctor’s determination that a patient meets the medical exception, leading many doctors to avoid performing abortions at all.

The issue, Ms. Duane said, is that while the law allows narrow medical exceptions, “no one knows what it means and the state won’t tell us.”

In her order, the judge found that Ms. Cox’s doctor “believes in good faith, exercising her medical judgment,” that an abortion is medically recommended and that the medical exception “permits an abortion in Ms. Cox’s circumstances.”

The judge said her order would protect Ms. Cox’s doctor and other workers at the hospital who would be involved in an abortion procedure, as well as Mr. Cox, all of whom might otherwise face legal liability under the Texas bans.

Before the ruling, those against abortion said they opposed the effort to interpret the law to permit an abortion in Ms. Cox’s case.

Amy O’Donnell, the communications director for Texas Alliance for Life, said that while it is “heartbreaking to hear of any family facing a tragic diagnosis for their unborn child” the group “does not support taking the life of an unborn child because of a life-limiting or fatal diagnosis.”