By Mary Anne Franks for Ms. Magazine.
Broadcast version by Alex Gonzalez for Northern Rockies News Service reporting for the Ms. Magazine-Public News Service Collaboration

People end up in emergency rooms for a variety of reasons. They’re having trouble breathing. They’ve suddenly developed chest pains. They’re bleeding uncontrollably. They’ve fallen off a roof, they’ve crashed their car, they’ve overdosed, they’re suicidal, they got stabbed in a fight, they got shot by police.

Some people who need emergency services are poor, or have no insurance, or are in the country illegally, or have committed a crime. Under the federal Emergency Medical Treatment and Labor Act (EMTALA), they are all entitled to receive emergency care. This law is based on a simple principle: Hospitals shouldn’t be allowed to let people die based on who they are, how much they can pay, or what they have done.

On April 24, the Supreme Court will hear oral arguments in Moyle v. U.S., a case that will determine whether individual states are allowed to exclude a single group from this basic protection: pregnant women. The state of Idaho claims that it has the right to forbid pregnant women and girls—and only pregnant women and girls—from receiving emergency care that could save their lives.

How, and why, would a state want to do this?

First, the how: In 2022, the Supreme Court ruled in Dobbs that forced childbirth does not violate the Constitution. This allowed Idaho’s 2020 “Defense of Life Act,” a draconian anti-abortion law, to go into effect. According to the law, anyone who performs an abortion faces imprisonment of up to five years in prison. Healthcare professionals who perform abortions will also have their professional licenses suspended or revoked permanently.

This puts the state law directly in conflict with federal emergency care law. EMTALA requires Medicare-funded hospitals (which most hospitals are) to provide medically necessary stabilizing treatment to any patient with an “emergency medical condition.” An emergency medical condition is one that, in the absence of immediate medical attention, is likely to cause “serious impairment to bodily functions,” “serious dysfunction of any bodily organ,” or otherwise puts the health of the patient “in serious jeopardy.”

Pregnancy complications are a common reason for emergency care visits, and the medically necessary stabilizing treatment necessary to prevent serious injury or death to women and girls experiencing those complications sometimes includes the termination of the pregnancy.

Given that an abortion is sometimes the only medical treatment that will prevent death or serious bodily injury to women, a more accurate title for Idaho’s abortion law would be the “Let Women Die Act.” But as seen in the majority decision in Dobbs and the arguments propounded recently by the Alliance Defending Freedom in the mifepristone access case, forced birth proponents are rarely candid about their necropolitical agenda. Defenders of Idaho’s law instead feign outrage at the suggestion that the law will kill women, pointing to the law’s exception for abortions performed by a physician who “determined, in his good faith medical judgment and based on the facts known to the physician at the time, that the abortion was necessary to prevent the death of the pregnant woman.”

Idaho insists that the law’s exception for abortions necessary to save the life of the mother means that there is no conflict between it and federal law. But as the Department of Justice pointed out when it sued to stop the Idaho law from being enforced with regard to EMTALA’s requirements, federal law requires emergency medical care necessary to prevent serious injury, not just death. The federal law does not authorize the withholding of essential medical treatment to patients who are only close to, but have not yet arrived, at death’s door.

What is more, as countless medical professionals have attested, the line between serious bodily injury or death is rarely precise. It is often difficult, if not impossible, to predict the exact moment that a serious medical condition becomes a life-threatening one.

As the National Women’s Law Center detailed in its amicus brief in the case, “No clinical bright line defines when a patient’s condition crosses the lines of this continuum. At what point does the condition of a pregnant woman with a uterine hemorrhage deteriorate from health-threatening to the point that an abortion is ‘necessary’ to prevent death? When is it certain she will die but for medical intervention? How many blood units does she have to lose? One? Two? Five? How fast does she have to be bleeding?”

The recognition that serious bodily injury and death are so closely related as to be nearly indistinguishable has long been reflected in U.S. law. At common law, a person could be convicted of murder not only if he intended to kill but also if he intended to inflict “grievous bodily injury.” The law of self-defense generally allows a person to use deadly force when facing an imminent threat of death or serious bodily harm, not only to herself but to others.

Significantly, Idaho’s self-defense law specifies that a person is not required to wait for the danger to become fully apparent before acting: “The defense of self or of another does not require a person to wait until he or she ascertains whether the danger is apparent or real. A person confronted with such danger has a clear right to act upon appearances such as would influence the action of a reasonable person.”

Unless, of course, the person in danger is a pregnant woman.


Mary Anne Franks wrote this article for Ms. Magazine.

Vice President Kamala Harris focused on reproductive rights at a campaign event in Michigan Wednesday.

Her remarks come as President Joe Biden has fallen behind former President Donald Trump in the state, according to the latest polls. In front of a crowd of hundreds, Harris stressed abortion rights are at risk if Republicans win in November. She said Biden has vowed to veto any attempts to ban abortion nationwide.

"We believe in freedom. Freedom from the government telling us what to do about matters of heart and home," Harris explained. "We believe in the right of people to make basic decisions, like when and if they will start a family and how."

Meanwhile, Trump's pick for vice president, Sen. JD Vance, R-Ohio, has supported national abortion bans and opposed exceptions for rape and incest. Democrats are hoping the distinction will lead them to a victory this year in the key battleground state of Michigan. It was a critical issue for voters in 2022, when Gov. Gretchen Whitmer won her reelection race easily and both chambers of the state legislature flipped to Democrats for the first time in decades.

In her speech, Harris condemned political violence following the recent attempted shooting of Donald Trump at a Pennsylvania political rally. She also praised the gun safety measures Michigan lawmakers passed in recent years, including universal background checks and safe storage requirements. She added politicians in Washington, D.C., should favor similar laws.

"The solutions don't really require that much creativity," Harris asserted. "What they do require is people in the United States Congress to have courage to act and do what we know is the right thing to do and not cower, based on special interests and powerful lobbyists."

One Michigan Democrat in Congress, Rep. Hillary Scholten, D-Grand Rapids, has called on Biden to drop out of the presidential race over concerns about his age and cognitive ability. Harris would likely be a top replacement choice in the race against Trump.


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Abortion bans and restrictions limit women's participation in the workforce, according to a new analysis that quantifies the negative impacts on state economies.

South Dakota saw an average loss in GDP of nearly 1% per year between 2021 and 2023, due to a drop in labor force participation by people who became pregnant and didn't have access to abortion care, according to data from the Institute for Women's Policy Research. That adds up to nearly $641 million in economic losses to the state.

Jamila Taylor, president and CEO of the Institute for Women's Policy Research, said the 16 states with abortion bans or extreme restrictions, including South Dakota, are costing the national economy $68 billion annually.

"Not only do these restrictions and bans have a clear impact on the health and well being of people with the ability to get pregnant, they also have an impact on their productivity and their economic position in life," Taylor said.

Taylor added abortion access not only helps family finances, but also allows women ages 15 to 44 to engage more broadly in society -- in local communities or politics, for example.

Despite restrictions, abortion numbers are rising. The first full calendar year after the Dobbs decision overturned Roe v. Wade saw an 11% increase in abortions since 2020 - or over one million abortions in the formal health care system in 2023, according to The Guttmacher Institute.

If voters pass South Dakota's constitutional Amendment G in November, it will enshrine protections to abortion.

Hannah Haksgaard, University of South Dakota law professor, said even if it passes, people seeking an in-state abortion would likely see a lag time before services become available.

"There would still likely be state legislation that would try to restrict abortion in certain ways, and then the question would become whether those restrictions violated the new constitutional amendment," she said.

Haksgaard added that could make providers move slowly on offering abortion services in the state, until the legal issues are settled.


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A ruling from the U.S. Supreme Court Thursday will allow for abortions in emergency situations in Idaho - for now.

The justices said they were dismissing an appeal, reestablishing a lower court decision allowing hospitals to perform abortions in emergency cases, despite the state's restrictive abortion laws.

Molly Meegan, chief legal officer for the American College of Obstetricians and Gynecologists, said the organization is glad to see temporary relief in this case but added it is far from a complete solution.

"The way these laws are set up in Idaho and elsewhere are that there are limits on what care can be provided," Meegan explained. "Those limits are not clearly defined, and they're not committed to the discretion, the judgment, the expertise and the training of the physician that's facing a particular patient."

The protection for emergency abortions stems from a federal law known as the Emergency Medical Treatment and Labor Act. The law requires Medicare-funded hospitals to perform abortions in emergency situations. The three dissenting justices in Thursday's case called the Act's ability to preempt Idaho's restrictive abortion laws "plainly unsound."

Dr. Stella Dentas, president of the American College of Obstetricians and Gynecologists, said there is still a lack of clarity around the law in Idaho and OB/GYNs are leaving the state as a result. She noted when doctors face the prospect of jail over restrictive laws like Idaho's, it makes their job more difficult in emergency situations.

"It's already hard enough to make these critical decisions in the moment," Dentas emphasized. "If you're stuck on, 'OK, I can go down path A, but I'm not allowed to go down path B,' that is very confusing for both clinicians and the patients and the shared decision-making that we do."

Meegan added legislators should not be determining what care is available to patients.

"These questions need to be decided by science, by evidence, by the individual case in front of you," Meegan contended. "The idea that you can have black and white worlds being created by people without the expertise, training or experiencing the emergencies is really fundamentally dangerous."


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