Document ID: ./input/supremecourt_opinions/opinions/23pdf/23-726_6jgm.pdf
Page Number: 20

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

5 

Opinion of JACKSON, J. 

(PPROM), sepsis, and placental abruption, to name just a 
few examples.  Having now been sued over its interference 
with  EMTALA’s  protections  for  people  experiencing  these
conditions, Idaho has shifted its position, both here and be-
fore the District Court, recharacterizing abortions in these 
scenarios as life-saving care permitted under Idaho law. 

Some  of  my  colleagues  appear  to  view  this  convenient 
rhetorical  maneuver  as  a  material  change  that  (also  con-
veniently)  reduces  the  conflict  between  state  and  federal
law to the point that a ruling from this Court is no longer
warranted.  See ante, at 6–7 (BARRETT, J., concurring).  But 
it  is  both  legally  and  factually  implausible  to  say  that 
Idaho’s  current  litigating  position  actually  mitigates  the 
conflict between that State’s law and EMTALA. 

The conflict between state and federal law still exists—in 
real  life.  Idaho  cannot  credibly  maintain  that  its  law  al-
ways permits abortions in cases of PPROM or pre-eclamp-
sia such that its mandate never conflicts with federal law. 
The same medical condition can present with different risks 
in different patients.  See, e.g., Brief for Physicians for Re-
productive Health as Amicus Curiae 10–11; Brief for Physi-
cians for Human Rights as Amicus Curiae 11–19.  And, of-
ten,  a  doctor  simply  does  not  know  what  the  risks  are  or
whether a patient might face death.  See Tr. of Oral Arg. 
103–104; 2 App. 615–617.  Such a doctor, observing the dif-
ferent  legal  thresholds  for  action  under  state  and  federal 
law—not to mention the severe criminal penalties for a mis-
calculation—would surely be cowed into not providing abor-
tion care that medical standards warrant and federal law 
requires.  Do not take my word for this; it is already hap-
pening.*  So it is strange, to say the least, that this Court 

—————— 

*See Brief for Idaho Coalition for Safe Healthcare, Inc., as Amicus Cu-
riae 7–13 (providing examples in Idaho where doctors’ lack of certainty
prevented them from providing medically necessary abortions); see also
Brief for St. Luke’s Health System as Amicus Curiae 14–16 (same); Brief