Judicial Indecision: How SCOTUS Left Women’s Health in Jeopardy

 In June 2022, the United States Supreme Court decided on the case Dobbs v. Jackson Women’s Health Organization, ruling the United States Constitution does not guarantee women the right to an abortion. This landmark holding overturned decades worth of precedent set by Roe v. Wade (1973). [1] Citing the Due Process Clause of the 14th Amendment, the court in Roe recognized a woman’s right to terminate her pregnancy with different standards of availability depending on the trimester. [2] The Court decided Dobbs with a six-to-three vote, six conservative justices in the majority and the remaining three justices fervently dissenting. [3] The decision returned the question of abortion accessibility to the states. 

Following the ruling of Dobbs v. Jackson, women across the country lost the ability to make decisions regarding their own bodies. In 2023, nearly twenty-five million women lived in states where abortion access was either totally banned or heavily restricted. [4] As of July 2024, nearly 1 in 8 voters said abortion was the most important thing on the ballot. [5] As a result of the Dobbs ruling and the overturning of Roe, several state legislatures, including those in Idaho and Texas, immediately enacted total or near-total bans on abortion, allowing exceptions only when the life of the pregnant mother is at imminent risk. [6] These bans, most notably Idaho’s Defense of Life Act, have come into conflict with federal mandates for standardized patient care and is the discussion of the recent case Idaho v. United States. [7]

The Emergency Medical Treatment and Labor Act (EMTALA), passed in 1986, is a federal mandate that ensures access to medical care in the case of an emergency regardless of a patient’s ability to pay at that time. [8] EMTALA requires medical stabilization where treatment is necessary to avoid material deterioration of the condition. [9] Material deterioration, as defined by the National Institutes of Health, is a deviation from the defined normal range of vital signs (blood pressure, pulse rate, respiratory rate, etc.) 2-24 hours after the patient's arrival. [10] Necessary medical treatment refers to the common practice of medicine accepted by the American Medical Association and the US Department of Health and Human Services. [11] EMTALA and Idaho’s Defense of Life Act directly conflict in emergency cases: EMTALA calls for abortion when it is necessary to prevent harm to the health or life of the mother whereas the Defense of Life Act only authorizes abortion in cases where death is imminent. 

During the Supreme Court’s hearing of Idaho v. United States, the U.S. heavily relied on the theory of preemption, defined by the Legal Information Institute of Cornell Law School as the idea that “a higher authority of law will displace the law of a lower authority of law when the two authorities come into conflict.” [12] The U.S. claimed that the EMTALA mandate legally supersedes the Defense of Life Act, citing the Supremacy Clause of the Constitution, which establishes that federal laws take priority over state legislation. The state of Idaho countered that preemption of EMTALA is an overstep of federal power into areas traditionally regulated by states, potentially allowing doctors to ignore state-specific medical regulations on a broader scale. [13]

Ultimately, SCOTUS decided to dissolve the writ of certiorari in this case while vacating the stay of the injunction issued by the Idaho District Court. [14] The Court did not issue a formal decision, but rather, sent the case back to the Ninth Circuit Court of Appeals to be decided while maintaining the court order that prohibits Idaho’s Defense of Life Act from taking effect. [15] 

The strong precedent that both Justice Jackson and Justice Alito cite in their respective dissents shows that the Supreme Court had no legal foundation to dismiss this case. The Court refuses to acknowledge the arguments that warrant a decision in favor of the United States. 

Several justices from both the conservative and liberal blocs believe that a decision should have been made. Justice Alito, who stands directly opposite Justice Jackson on the outcome of the case, does not waver in his position that there should be a holding, firmly declaring in his dissent that this “[legal] question is as ripe for decision as it will ever be”. [16] Justice Alito cites Pennhurst State School and Hospital v. Halderman (1984) - a case in which the Court decided on federal powers over state mental health institutions. [17] In Pennhurst the central conflict lied between state and federal law in the same manner as Idaho v. US and in both cases there were conflicting interpretations of the Spending Clause, which is one of Congress’ enumerated legislative powers that authorizes federal programs such as Social Security and Medicaid which rely on government funding. [18] There was no reason that a decision couldn’t have been made in Penhurst, and in the same manner no reason a decision couldn’t have been made in Idaho.

In Justice Barrett’s concurring opinion, she said that both positions seem to be still evolving and several issues raised by the petitioners weren’t discussed in the lower court - specifically whether the federal government, under conditions of the Spending Clause, can require beneficiaries of government funds to infringe on state criminal law. [19] SCOTUS should have ruled in spite of the “evolving-nature” of the issues at hand and despite the fact that the lower court hadn’t raised the issue of the Spending Clause. The court might have considered citing Mapp v. Ohio (1961), which established that evidence obtained in an illegal search or seizure is inadmissible in court. [20] In Mapp v. Ohio, the language of the exclusionary rule, a key factor in the Court’s ultimate decision, was introduced despite the fact that this argument was not raised in the lower courts. [21] The precedent of Mapp v. Ohio clearly demonstrates an example where the Court made a decision, incorporating an argument which was not fully addressed in a lower court. SCOTUS should have followed the same procedure in Idaho.

 Justice Barrett concluded by saying that the writ of certiorari, the formal request for the Supreme Court to hear a case, was improvidently granted because the Court did not obey “normal appellate practice.” This argument heavily relied on the precedent of The Monrosa v. Carbon Black Export, Inc. (1959), - a case concerning a damages claim between an Italian shipping company and an American corporation - which was dismissed as improvidently granted due to improper jurisdiction of the Court. 

As Justice Jackson makes clear in her partial dissent, citing from the Monrosa decision, the Court typically dissolves cases as improvidently granted based on “circumstances … which were not fully apprehended at the time certiorari was granted.” In Monrosa, the Court stated that the case was dismissed due to the abstract nature of the constitutional question. [22] Justice Barrett herself concedes that the issue in Idaho v. US is apparent, writing “To be sure, the text of the two laws differs:” It is clear that in Monrosa, the Court did not come to a conclusion because the constitutional question was not within their jurisdiction and the question itself was too abstract. Neither of these conditions apply to Idaho, where the Court has full jurisdiction over the question and the central conflict, as acknowledged by Justice Barrett herself, is clear. 

Idaho v. US is not an isolated issue; Texas v. Becerra (2024) shows that the central constitutional question of whether federally mandated healthcare practice supplants state legislation has been asked in multiple courts and will continue to be asked throughout the country. The recent Fifth Circuit Court of Appeals’ decision in Texas upheld a Texas law prohibiting EMTALA’s use of abortions as stabilizing care and has already been appealed to the Supreme Court by the US. [23] Justice Jackson cites Texas v. Becerra (2024) to show the common nature of the constitutional question in this case necessitates “immediate determination”. [24] It is evident from the legal precedent cited by Justice Jackson and erroneously applied by Justice Barrett that the judgment to dismiss is unequivocally mistaken. 

Though a decision wasn’t made, the merits of the case - evident in Justice Jackson’s partial dissent - make it clear that the United States should have been the prevailing party. The central argument Justice Jackson uses in support of this holding is that under the Supremacy Clause of the United States Constitution, federal laws supplant state laws. [25] Cases like Mutual Pharmaceutical Co. v. Bartlett (2013) and Arizona v. US (2013) show federal preemption of state laws has found its way to the US Supreme Court before, grounding Justice Jackson’s argument in strong legal precedent. In Mutual Pharmaceutical Co. v. Bartlett, the Court held that federal law preempts state law design- defect claims concerning the sufficiency of a drug’s warning label. Justice Alito himself wrote for the majority in Mutual Pharmaceutical Co. v. Bartlett that “under the Supremacy Clause, state laws that require a private party to violate federal law are preempted…”. [26] This reaffirms that states do not have the power to implement laws which directly conflict with federal acts. 

Additionally, in Arizona v. United States, the Court found that three out of four of Arizona’s immigration laws were preempted by federal immigration law. Justice Anthony Kennedy employed the Supremacy clause claiming in his opinion that “state laws are preempted when they conflict with federal law… This includes cases where ‘compliance with both federal and state regulations is a physical impossibility.’” [27] Evidently, the Supremacy clause is an essential component that makes up the fabric of our system of government and is affirmed by centuries worth of precedent. 

Justice Jackson highlights the direct conflict between the guidelines of stabilizing care under EMTALA and the Idaho Life Act, which the other Justices fail to see or elect to ignore. [28] EMTALA’s preemption clause states that this act preempts any state law when there is a direct conflict between that state law and EMTALA’s requirements. [29]  The enforcement of EMTALA alongside the implementation of Idaho’s ban is, indeed, a “physical impossibility”. [30] 

This legal issue in states like Idaho will cause thousands of women to face severe damage to their health. Not only are the lives and health of pregnant women at stake, but so is the vital integrity of a physician’s ability to practice sound and evidence-based medicine. This conflict between federal mandates and state legislation will imminently return to the court, but in the meantime, women around the nation are unable to get the emergency medical care they need. By choosing to punt this question down the road, SCOTUS has ignored relevant precedent and instead relied on a weak legal foundation to avoid making a necessary decision. Not only does this indecision threaten the essential health care of women around the country, but also imperils judicial fidelity to the Constitutional text that governs us. It is now up to the Ninth Circuit Court to come to the decision which the Supreme Court could not, ensuring that pregnant women have the right to receive proper emergency medical care in the form of abortion. 

Edited by Love Patel

[1] Dobbs v. Jackson Women’s Health Organization, 597 U. S. 3 (2022).

[2] Roe v. Wade, 410 U.S. 64 (1973)

[3] Geoff Mulvihill, Kimberlee Kruesi, and Claire Savage. “A Year after Fall of Roe v. Wade, 25 Million Women Live in States with Abortion Bans or Restrictions.” PBS NewsHour, June 22, 2023. https://www.pbs.org/newshour/politics/a-year-after-fall-of-roe-v-wade-25-million-women-live-in-states-with-abortion-bans-or-restrictions.

[4] Geoff Mulvihill, Kimberlee Kruesi, and Claire Savage. “A Year after Fall of Roe v. Wade, 25 Million Women Live in States with Abortion Bans or Restrictions.” PBS NewsHour, June 22, 2023. https://www.pbs.org/newshour/politics/a-year-after-fall-of-roe-v-wade-25-million-women-live-in-states-with-abortion-bans-or-restrictions.

[5] KFF. “1 in 8 Voters Say Abortion Is Most Important to Their Vote: They Lean Democratic, Support Biden, and Want Abortion to Be Legal,” March 7, 2024. https://www.google.com/url?q=https://www.kff.org/womens-health-policy/press-release/1-in-8-voters-say-abortion-is-most-important-to-their-vote-they-lean-democratic-support-biden-and-want-abortion-to-be-legal/&sa=D&source=docs&ust=1722220024555975&usg=AOvVaw0iM6-Jq3v6JFmywjl_excp.

[6] Geoff Mulvihill, Kimberlee Kruesi, and Claire Savage. “A Year after Fall of Roe v. Wade, 25 Million Women Live in States with Abortion Bans or Restrictions.” PBS NewsHour, June 22, 2023. https://www.pbs.org/newshour/politics/a-year-after-fall-of-roe-v-wade-25-million-women-live-in-states-with-abortion-bans-or-restrictions.

[7] Idaho State Legislator. Defense of Life Act, 18-622 § (2022).

[8]  “Certification and Compliance for the Emergency Medical Treatment and Labor Act (EMTALA),” 1986. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/EMTALA.pdf.

[9] Idaho v. United States, 630 U. S. 5, 6 (2024).

[10] Daniel Pilsgaard Henriksen et al. “Prognosis and Risk Factors for Deterioration in Patients Admitted to a Medical Emergency Department.” PloS one vol. 9,4 e94649. 9 Apr. 2014, doi:10.1371/journal.pone.0094649

[11] American Medical Association. “Crisis Standards of Care: Guidance from the AMA Code of Medical Ethics,” April 2020. https://www.ama-assn.org/delivering-care/ethics/crisis-standards-care-guidance-ama-code-medical-ethics.

[12] Legal Information Institute. “Preemption.” Cornell Law School, 2024. https://www.law.cornell.edu/wex/preemption#:~:text=It%20refers%20to%20the%20idea; Idaho v. United States, 630 U. S. 25 (2024).

[13] Transcript of Oral Argument, Idaho v. United States (5).

[14] Legal Information Institute. “Injunction.” Cornell Law School, 2023. https://www.law.cornell.edu/wex/injunction#:~:text=An%20injunction%20is%20a%20court%20order%20requiring%20an%20individual%20to. 

[15] Idaho v. United States, 630 U. S. 1 (2024).

[16] Idaho v. United States, 630 U. S. 26 (2024).

[17] U.S. CONST. art. I, § 8, cl. 1

[18] Pennhurst State School and Hospital v. Halderman, 451 U. S. 15 (1981)

[19] Idaho v. United States, 630 U. S. 13 (2024).

[20] ​​Mapp v. Ohio, 367 U. S. 660 (1961)

[21] Encyclopedia of Cleveland History | Case Western Reserve University. “MAPP v. OHIO | Encyclopedia of Cleveland History | Case Western Reserve University.” Case Western University, May 12, 2018. https://case.edu/ech/articles/m/mapp-v-ohio.

[22] The Monrosa v. Carbon Black Export, Inc., 359 U. S. 184 (1959).

[23] Idaho v. United States, 630 U. S. 17, 18 (2024).

[24] Texas v. Becerra, 89 F. 4th 529, 533 (5th Cir 2024).

[25] Hashmall, Joe. “Supremacy Clause.” Legal Information Institute, June 5, 2017. https://www.law.cornell.edu/wex/supremacy_clause.

[26] Mutual Pharmaceutical Co. v. Bartlett, 570 U. S. 472, 2 (2013).

[27] Arizona v. United States, 567 U. S. 387, 8 (2012).

[28] Idaho v. United States, 630 U. S. 19 (2024).

[29] Rachel Carey . “Whiteford, Taylor & Preston LLP | New CMS EMTALA Portal Signals CMS Continued Focus on Enforcement Fight against State Abortion Bans.” www.whitefordlaw.com, 2024. https://www.whitefordlaw.com/news-events/new-cms-emtala-portal-signals-cms-continued-focus-on-enforcement-fight-against-state-abortion-bans#:~:text=EMTALA%20contains%20an%20expressed%20preemption.

[30] Arizona v. United States, 567 U. S. 387, 8 (2012).