Document ID: ./input/supremecourt_opinions/opinions/23pdf/23-726_6jgm.pdf
Page Number: 9.0

2 

MOYLE v. UNITED STATES 

BARRETT, J., concurring 

they believe that “abortion is the stabilizing treatment nec-
essary to resolve” a pregnant woman’s emergency medical 
condition,  they  “must  provide  that  treatment.”  Id.,  at  1 
(italics and emphasis deleted).  Any contrary state law, the 
guidance continues, is “preempted.”  Ibid. (italics and em-
phasis deleted). 

Idaho’s Defense of Life Act criminalizes the performance
of most abortions.  Idaho Code Ann. §18–622 (Supp. 2023).
As  originally  enacted,  the  Act  allowed  accused  physicians
to raise an affirmative defense that “the abortion was nec-
essary to prevent the death of the pregnant woman.”  §18–
622(2)(a)(i).  Soon before the Act was set to take effect, the 
United States sued Idaho, seeking to enjoin Idaho’s law “to 
the extent it conflicts with EMTALA.”  1 App. 5.  EMTALA, 
the  United  States  argued,  requires  physicians  to  perform 
abortions  under  certain  circumstances  that  Idaho’s  Act 
would forbid. 

After holding an evidentiary hearing, the District Court
identified a conflict and granted a preliminary injunction.
623 F. Supp. 3d 1096 (Idaho 2022).  The court based its con-
clusion on three key assumptions: (1) The Act prohibits the 
termination  of  ectopic  pregnancies;  (2)  the  pregnant 
woman’s death must be objectively “imminent” or “certain”
before  a  physician  can  perform  an  abortion;  and  (3)  the 
“necessary to prevent death” exception is only an affirma-
tive  defense.  Id.,  at  1109–1114.    The  Government’s  wit-
nesses,  whose  testimony  the  court  credited,  made  similar 
assumptions.  Id., at 1104–1105.  They claimed that the Act
might prohibit abortions as treatment for conditions includ-
ing severe heart failure, pre-eclampsia, preterm premature
rupture of the membranes (PPROM), sepsis, and placental 
abruption, because a physician could not know, “with cer-
tainty,” that an abortion is necessary to save the mother’s
life in those circumstances.  See, e.g., 1 App. 30–38.  They
also assumed that the Act only permitted abortions where 
death was “imminent.”  See, e.g., 2 id., at 608.