Emergency room doctors in Texas are not required to perform emergency abortions despite federal guidance that requires hospitals to offer stabilizing care, a federal appeals court ruled on Tuesday.

The U.S. Court of Appeals for the Fifth Circuit affirmed a ruling that sided with the state of Texas, which had sued the Biden administration, arguing that the federal guidance issued in 2022 was an overstep that would “force abortions.”

The appeal was heard by Judge Leslie H. Southwick, who was appointed by President George W. Bush, and judges Kurt Engelhardt and Cory Wilson, who were appointed by President Donald Trump.

Judge Engelhardt wrote that the federal guidance does not mandate physicians to provide emergency abortions, adding that the guidance “does not mandate any specific type of medical treatment, let alone abortion.”

The Department of Justice and the Texas attorney general’s office did not immediately respond to requests for comment on Tuesday night.

The ruling on Tuesday is the latest development in a lengthy legal battle between the Biden administration and the state of Texas after the Supreme Court’s decision in 2022 to overturn Roe v. Wade, and it comes amid a slew of other lawsuits over whether exceptions can be made for abortions in states, like Texas, where it is banned.

The ruling also came less than a month after the Texas Supreme Court ruled against a woman who had sought a court-approved abortion because her fetus was diagnosed with a fatal condition. The woman, Kate Cox, eventually left Texas to have an abortion, and the ruling against her left many doctors across the state unclear on which cases would legally qualify for an abortion.

After the Supreme Court overturned Roe v. Wade, the U.S. Department of Health and Human Services issued guidance in July 2022 that instructed hospitals that federal law requires doctors to perform abortions, even in states where it is banned, if they believe it is “the stabilizing treatment necessary” to protect the health of the mother in an emergency medical situation.

The federal guidance reinforced the Emergency Medical Treatment and Labor Act of 1986, or EMTALA, which requires emergency rooms to provide stabilizing care regardless of a patient’s ability to pay.

Attorney General Ken Paxton of Texas responded by suing the Biden administration over the guidance. Mr. Paxton wrote in a complaint filed in July 2022 that President Biden was “flagrantly disregarding the legislative and democratic process — and flouting the Supreme Court’s ruling before the ink is dry — by having his appointed bureaucrats mandate that hospitals and emergency medicine physicians must perform abortions.”

Judge Engelhardt wrote in the ruling on Tuesday that “EMTALA does not provide an unqualified right for the pregnant mother to abort her child especially when EMTALA imposes equal stabilization obligations.”

“We therefore decline to expand the scope of EMTALA,” Judge Engelhardt wrote.

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