The Texas Supreme Court ruled on Monday against a pregnant woman who challenged the state’s abortion restrictions. A lower court had previously granted the woman, Kate Cox, permission to receive an abortion due to pregnancy complications, despite the state’s strict abortion ban. Before Cox could safely obtain the abortion, however, Texas Attorney General Ken Paxton asked the Supreme Court to block it.

The brief opinion from the Texas Supreme Court recounted the trial court’s finding that Cox’s abortion would “fall within the medical-necessity exception to Texas’s abortion laws.” However, the Supreme Court found that “a woman who meets the medical-necessity exception need not seek a court order to obtain an abortion” but that “it is a doctor who must decide.” The Supreme Court said that only a doctor can exercise “reasonable medical judgement” and determine whether a pregnant woman “has a life-threatening physical condition” such that Texas law would permit the abortion.

The court clarified that their ruling was concerned more with the standard applied by the trial court for determining whether Cox met the exception, rather than a determination that Cox should not be entitled to an abortion. The Supreme Court said, “Nothing in this opinion prevents a physician from acting if, in that physician’s reasonable medical judgment, she determines that Ms. Cox has a ‘life-threatening physical condition’ that places her ‘at risk of death’ or ‘poses a serious risk of substantial impairment of a major bodily function unless the abortion is performed or induced.'”

In late November, Cox learned her pregnancy had full trisomy 18, meaning the baby would likely be miscarried before term. Even if the fetus did survive, it would likely be only for minutes after birth. According to Cox’s state district court petition, Cox wishes to have more children, and, if she were to continue her pregnancy, she would be put at risk of uterine rupture and hysterectomy—both of which threaten her life and future fertility.

Texas Health & Safety Code 170.002 states “a person may not knowingly perform, induce, or attempt an abortion.” The statute provides exceptions if:

[I]n the exercise of reasonable medical judgment, the pregnant female on whom the abortion is performed, induced, or attempted has a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy that places the female at risk of death or poses a serious risk of substantial impairment of a major bodily function unless the abortion is performed or induced; and the person performs, induces, or attempts the abortion in a manner that, in the exercise of reasonable medical judgment, provides the best opportunity for the unborn child to survive unless, in the reasonable medical judgment, that manner would create: a greater risk of the pregnant female’s death; or a serious risk of substantial impairment of a major bodily function of the pregnant female.

Shortly before the Supreme Court’s decision came down, lawyers representing Cox from the Center for Reproductive Rights announced that Cox had been forced to leave Texas to safely obtain an abortion. CEO of the Center for Reproductive Rights Nancy Northup stated, “This past week of legal limbo has been hellish for Kate. Her health is on the line. She’s been in and out of the emergency room and she couldn’t wait any longer.” Northup continued, “This is why judges and politicians should not be making healthcare decisions for pregnant people—they are not doctors….While Kate had the ability to leave the state, most people do not, and a situation like this could be a death sentence.”