Document ID: ./input/supremecourt_opinions/opinions/23pdf/23-726_6jgm.pdf
Page Number: 44.0

Cite as:  603 U. S. ____ (2024) 

21 

ALITO, J., dissenting 

PPROM occurs before the 34th week of pregnancy, there is 
a risk to the health of both the woman and her unborn child. 
In these situations, the Defense of Life Act requires doc-
tors  to  consider  whether  performing  an  abortion  is  neces-
sary to prevent the woman’s death.  Because this is a “sub-
jective” standard, Planned Parenthood, 171 Idaho, at 446, 
522  P. 3d,  at  1204,  different  doctors  may  reach  different 
conclusions  about  when  PPROM  endangers  the  woman’s
life.  At least some may conclude in some cases of PPROM
occurring  before  the  34th  week  of  pregnancy  that  the 
woman’s life is not endangered since she may never develop 
a serious infection, let alone life-threatening sepsis or any 
other  potentially  fatal  condition,  if  she  receives  proper 
treatment.  See 1 App. 306–307.  Rather, those doctors may 
believe that Idaho law requires them to try to delay delivery
long enough to save the child’s life, unless PPROM becomes 
sufficiently “severe” to cause “infection and serious risk of
sepsis.”  See, e.g., 2 id., at 547. 24
  According  to  the  Government’s  experts,  however, 
EMTALA requires a hospital to perform an abortion at the 
woman’s  request  whenever  PPROM  is  diagnosed,  even  if 
the woman has not yet developed an infection or any other 
health complications.  That is because, they assert, it can 
—————— 
P. Wagner et al., Outcome of Pregnancies With Spontaneous PPROM Be-
fore  24+0  Weeks’  Gestation  (2016)  (reporting  that  “[a]bout  half ”  of  fe-
tuses in PPROM pregnancies that make it to viability “will be discharged
alive without major complications”). 

24 It has been estimated that PPROM occurs in about 2% of all preg-
nancies involving a single fetus and in 7% of all pregnancies involving 
twins.  See PPROM Facts.  It is reported that in 2022, there were 22,391 
live births in Idaho.  March of Dimes, Fertility Rate: Idaho, 2012–2022, 
https://www.marchofdimes.org/peristats/data?reg=99&top=2&stop=1& 
lev=slev=4&obj=1&sreg=16  (Jan.  2024).    These  statistics  suggest  that 
PPROM may have occurred in as many as 500 cases.  In some of these 
cases,  the  fetus  may  not  have  been  viable,  and  in  some,  the  pregnant 
woman may not have chosen to have an abortion even if the law allowed.
Nevertheless, it would not be surprising if the Idaho law, if allowed to be
enforced, would result in fewer abortions and more live births.