Texas’ highest court on Friday refused to ensure that doctors are not prosecuted for abortions they believe are necessary in medically complicated pregnancies, rejecting a lawsuit by 22 patients and physicians.

The Texas Supreme Court’s decision follows an earlier ruling from the court denying a woman’s request for an emergency abortion of a non-viable pregnancy. In both cases, plaintiffs said the medical exception to the state’s near-total abortion ban was unclear, and left doctors unwilling to perform medically necessary abortions in the face of severe penalties including potentially life in prison.

The lawsuit was filed in March 2023 by five Texas women who said they were denied medically-necessary abortions despite the grave risk to their lives, as well as two doctors. An additional 15 patients have since joined the case, bringing the total to 22.

The patients all said they had suffered pregnancy complications requiring abortions, or faced a risk of such complications in the future. Some said they had been forced to travel out of state to terminate a pregnancy.

It was one of the first cases in which pregnant women sued over curbs imposed after the U.S. Supreme Court in 2022 overturned its landmark Roe v. Wade decision, which had established a right to abortion nationwide.

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