The Texas Supreme Court on Monday issued its ruling on the case of Kate Cox. The high court tossed the decision back to doctors, saying it would be an overreach for the court to rule on one specific case.

The ruling stated that doctors must use their “reasonable medical judgment” to decide if a patient qualifies for an abortion. It called for the state’s medical board to issue more guidance.

The ruling came hours after Cox’s lawyers announced she would leave the state for an abortion. Cox, a 31-year-old Dallas resident and a mother of two learned that her baby was diagnosed with a fatal disorder. She and her husband have decided to abort the baby. Texas has a near-total ban on abortion except in cases to save the life of the mother or to prevent “substantial impairment of a major bodily function.”

“A woman who meets the medical-necessity exception need not seek a court order to obtain an abortion,” the ruling reads. “The law leaves to physicians—not judges—both the discretion and the responsibility to exercise their reasonable medical judgment, given the unique facts and circumstances of each patient.”

The high court added that the Texas Medical Board, which oversees physicians, “can do more to provide guidance in response to any confusion that currently prevails.”

“The Board could assess various hypothetical circumstances, provide best practices, identify red lines, and the like,” the ruling said, referencing similar guidelines the agency has issued in the past on COVID-19.

The justices stated that they shared the state’s concern that delivering opinions on individual cases, as Cox’s lawyers requested, would open the door to allowing abortion in situations that go beyond the emergency exception. Cox is believed to be the first woman to sue for permission to get an abortion since the Supreme Court’s decision on Dobbs v. Jackson Women’s Health Organization.

The Center for Reproductive Rights represents Cox in court. It said late Monday it was reviewing the ruling.

This case started last week when Cox petitioned the court for access to an abortion. Her baby was diagnosed with a fatal condition and her doctor told Cox that carrying the baby to term could put her health at risk, as well as future fertility. She has made four trips to the emergency room in the past month with complications from the pregnancy.

The Texas attorney general’s office argued that Cox shouldn’t be allowed to have an abortion, claiming her condition didn’t qualify and that the risk to her health was not imminent.

A Travis County judge ruled in Cox’s favor, which allowed her to get an emergency abortion from her Houston physician. On Friday, the Texas Supreme Court temporarily blocked the ruling.

I think the Texas Supreme Court’s ruling is a good one. It should be left to the doctors to counsel their patients. Frankly, I was a bit confused over the whole case because I thought that since an exception for the mother’s health was in place, Cox was within the legal parameters. The baby is expected to be stillborn. Cox and her husband want more children. A pregnancy that endangers her health and her future fertility is a double whammy.

The Texas Supreme Court ruled that the abortion ban does not require the patient to be facing imminent death before a doctor can use the exception. If her doctor attested to her “reasonable medical judgment,” then she would have been free to legally perform the abortion. However, the doctor did not do that in the court filing.

“Our ruling today does not block a life-saving abortion in this very case if a physician determines that one is needed under the appropriate legal standard, using reasonable medical judgment,” the ruling reads. “If Ms. Cox’s circumstances are, or have become, those that satisfy the statutory exception, no court order is needed.”

Lawyers for Cox released a statement that she is leaving the state for an abortion. That was hours before the court’s ruling was announced. Her lawyers said the legal limbo is “hellish.”

“Her health is on the line. She’s been in and out of the emergency room, and she couldn’t wait any longer,” said Nancy Northup, president and CEO of the Center for Reproductive Rights, which represented Cox.

Cox’s lawyers said in court filings Monday that they still want the high court to rule on her case because there’s a high likelihood she could face the same situation again. In a recent op-ed for the Dallas Morning News, Cox wrote that she and her husband are trying to “do what is best” for their baby daughter and family but “are suffering because of the laws in Texas.”

“I need to end my pregnancy now so that I have the best chance for my health, for parenting my children, and for a future pregnancy,” she wrote.

It’s a sad case all around. There is no word yet if she has left the state or remains in Texas now that the Supreme Court has ruled.