Update: Late Wednesday night, the Supreme Court refused to block the Texas law in a 5-4 vote.
Despite multiple legal challenges by abortion providers and an emergency petition to the Supreme Court, the new Texas law that bans most abortions at or around 6 weeks of pregnancy went into effect at midnight.
The bill, known as Senate Bill 8, also allows private citizens to sue healthcare workers, family members, or friends who help a patient get an abortion after the detection of fetal cardiac activity, which can occur as early as 6 weeks' gestation -- oftentimes before a patient is aware that they are pregnant. The new legislation makes an exception for medical emergencies, but not for cases of rape or incest.
"This is an all-out abortion ban, plain and simple," Amy Hagstrom Miller, CEO of Texas abortion provider Whole Woman's Health (which is one of the plaintiffs in a case against the bill), said during a media call.
In a statement, HHS Secretary Xavier Becerra called the law "dangerous and dubious."
"The burdens of this law descend disproportionately upon low-income families and communities of color," he said. "The 21st century must be about protecting and expanding Americans' health care, not illegally and discriminatorily denying it."
Daniel Grossman, MD, of the University of California San Francisco, wrote on Twitter that "this is anti-science, anti-evidence, anti-healthcare."
Medical societies, including the American College of Obstetricians and Gynecologists (ACOG), the American Medical Association, and the American College of Physicians (ACP), also criticized the new law, stating that this legislation is a clear violation of a patient's right to choose, as well as the patient-physician relationship.
"Patients and those they trust, including the clinicians who are dedicated to ensuring they can access respectful care, deserve better than this harmful law," the ACOG statement said.
The AMA said it was disappointed by the Supreme Court's inaction, noting that the law "interferes in the patient-physician relationship and places bounties on physicians and health care workers simply for delivering care. Opening the door to third-party litigation against physicians severely compromises patient access to safe clinical care."
Meanwhile, anti-abortion medical groups voiced their support of the new law taking effect. "Texas' recognition that the baby in the womb is in fact a real person is something to genuinely celebrate," Robin Pierucci, MD, chair of the American College of Pediatricians Pro-Life Committee, said in a press release.
Other states have proposed similar "heartbeat laws" that ban abortions at or around 6 weeks, though medical experts say this terminology is misleading because a fetus' heart is not yet developed at this stage of pregnancy.
But what makes the Texas law unique is that it deputizes private citizens to enforce it. Any individual -- whether they have a connection to the abortion or not -- can now sue those who assist a patient with getting an abortion after 6 weeks. This threatens not only abortion providers who perform the procedure, but also counselors, social workers, nurses, or even friends or family members who drive a patient to an abortion clinic.
If cases filed against anyone who "aids and abets" an abortion succeed, claimants are entitled to an award of statutory damages of at least $10,000, as well as recovered legal fees. Defendants in these suits, however, are not entitled to legal fee coverage.
Texas abortion providers filed a lawsuit in July to halt Senate Bill 8 from taking effect. A hearing on a preliminary injunction was scheduled for Monday, but the U.S. Court of Appeals for the Fifth Circuit canceled the hearing.
The abortion providers then filed an emergency application to the Supreme Court on Monday, urging justices to intervene. They stated in the filing that if the law took effect, it would "immediately and catastrophically reduce abortion access in Texas, barring care for at least 85% of Texas abortion patients (those who are 6 weeks pregnant or greater) and likely forcing many abortion clinics ultimately to close."
But 2 days later, the Supreme Court has yet to respond to the emergency application. The battle in Texas occurs in advance of the Court's upcoming hearing that will decide the future of Roe v. Wade.
"We are still hoping to hear from the Court today," said Marc Hearron, JD, senior counsel at the Center for Reproductive Rights and lead attorney on the case, who added that they could get a response in the next few days. "We will keep fighting."
In the meantime, providers must comply with the new regulations. Hagstrom-Miller said that in the hours leading up to Senate Bill 8 going into effect, the Whole Woman's Health clinics were packed. At the facility in Fort Worth, there were 27 patients in the waiting room around 10 p.m., she stated.
"Our waiting rooms were filled with patients and their loved ones in all four of our clinics yesterday," Hagstrom-Miller said. Providers at the Fort Worth clinic performed the last abortion at 11:56 p.m., minutes before many abortions would no longer be legal in the state.