Mathias, J.
Following the Supreme Court of the United States’s decision on abortion rights in Dobbs v. Jackson Women’s Health Organization, 597 U.S. 215 (2022), the Indiana General Assembly enacted a revised version of Indiana Code section 16-34-2-1 (2022), which is commonly referred to as Indiana’s abortion ban. [Footnote omitted.] According to that statute, performing an abortion in Indiana “shall in all instances be a criminal act,” except when performed in one of three circumstances: (1) when an abortion is necessary either to save the woman’s life or to prevent a serious health risk to her; (2) when there is a lethal fetal anomaly; or (3) when the pregnancy resulted from rape or incest. I.C. § 16-34-2- 1(a). [Footnote omitted.]
The first exception (the “statutory Life or Health Exception”) may apply at any time during the pregnancy so long as the decision is based on a “reasonable medical judgment” and certain procedural requirements are satisfied. I.C. § 16-34-2-1(a)(1)(A)(i) (“before the earlier of viability of the fetus or twenty (20) weeks of postfertilization age of the fetus”), (a)(3)(A) (“and any time after”). [Footnote omitted.] The Indiana Code further defines a “serious health risk” under the statutory Life or Health Exception to be “a condition . . . that has complicated the mother’s medical condition and necessitates an abortion to prevent death or a serious risk of substantial and irreversible physical impairment of a major bodily function.” I.C. § 16-18-2-327.9. That definition expressly excludes “psychological or emotional conditions” as well as “a claim or diagnosis that the woman will engage in conduct that she intends to result in her death or in physical harm.” Id.
Planned Parenthood and other medical-care providers challenged the facial validity of Indiana’s abortion ban under Article 1, Section 1 of the Indiana Constitution, which provides that “all people” are endowed “with certain inalienable rights,” including “life, liberty, and the pursuit of happiness.” The trial court entered a preliminary injunction on behalf of the medical-care providers. On the State’s appeal from that injunction, our Supreme Court held that Article 1, Section 1 of the Indiana Constitution affirmatively “protects a woman’s right to an abortion that is necessary to protect her life or to protect her from a serious health risk,” although the Court did not define “serious health risk” in the constitutional context. Members of the Med. Licensing Bd. of Ind. v. Planned Parenthood Great Nw., Haw., Alaska, Ind., Ky., Inc., 211 N.E.3d 957, 962 (Ind. 2023) (“Planned Parenthood I”). And, that baseline aside, our Supreme Court held that our General Assembly “otherwise retains broad legislative discretion for determining whether and the extent to which to prohibit abortions.” Id. Thus, in reviewing the trial court’s entry of the preliminary injunction, our Supreme Court concluded that a facial challenge to the statute could not succeed but as-applied relief might be justified. Id. at 976-77. The Court therefore vacated the preliminary injunction and remanded for further proceedings. Id. at 985.
On remand, the medical-care providers amended their complaint to request declaratory and injunctive relief on the theory that there are numerous, specific circumstances in which the life or health of a woman is at serious risk by a pregnancy, but the abortion ban would appear to prohibit a woman in those circumstances from obtaining an abortion to resolve those risks. The providers also challenged additional amendments to Indiana Code section 16-34-2-1 that now require all abortions to be performed in a licensed hospital or an ambulatory outpatient surgical center that is majority owned by a licensed hospital. See I.C. § 16-34-2-1(a)(1)(B), (a)(2)(C), (a)(3)(C) (“the Hospital Requirement”). The parties agreed to accelerate the proceedings on the amended complaint to a final hearing. After receiving significant amounts of evidence, the trial court entered a final judgment denying the medical-care providers their requested relief.
On appeal from that judgment, we hold as follows:
1. The constitutional right to an abortion under Article 1, Section 1 is limited to circumstances in which an abortion is the only reasonable medical option to protect a woman from a risk to her life or to protect her from a serious health risk. The circumstances argued by the medical-care providers here generally do not necessitate an abortion to treat those risks. Thus, the medical-care providers have not shown that their patients’ constitutional abortion rights are available in circumstances that would not qualify them for a legal abortion under the statutory Life or Health Exception.
2. The constitutional right to an abortion under Article 1, Section 1 requires the determination that an abortion is necessary to be a reasonable medical judgment, which is consistent with the statutory Life or Health Exception. There is therefore no material burden on the constitutional right to an abortion under that statutory language.
3. Because the constitutional right to an abortion requires an extreme medical scenario where the woman’s life or health is at serious risk, performing a constitutionally protected abortion in Indiana is a procedure that nearly always will be done in a hospital. Thus, the statutory Hospital Requirement is not a material burden on the constitutional right to an abortion.
We affirm the trial court’s judgment.
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1. The right to an abortion that is protected under Article 1, Section 1 requires the abortion to be a necessary procedure to protect the woman’s life or to protect her from a serious health risk.
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We acknowledge that the physical- and mental-health conditions identified by the medical-care providers all demonstrate some measure of a “serious health risk” as that phrase might be used colloquially, regardless of whether those risks are within our statutory or constitutional uses of the phrase. And we acknowledge the medical-care providers’ concerns that our Supreme Court’s articulation of the right to an abortion under Article 1, Section 1 might “compel[] physicians to wait until a patient’s condition is desperate before performing an abortion.” Appellants’ Br. at 37. But that is the balance struck between the unenumerated, reserved right to the people under Article 1, Section 1 and the State’s police power under the Indiana Constitution. See Planned Parenthood I, 211 N.E.3d at 970. Accordingly, the trial court did not err when it concluded that the physical- and mental-health conditions identified by the medical-care providers fail to show a scenario where the right to an abortion is available under Article 1, Section 1 but prohibited by the statutory abortion ban.
2. The constitutional right to an abortion under Article 1, Section 1 requires the determination that an abortion is necessary to be a reasonable medical judgment, which is consistent with the statutory Life or Health Exception.
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That said, we discern no impairment of the constitutional right to an abortion by the statutory “reasonable medical judgment” standard. As explained above, the constitutional right to an abortion is available only where that procedure is “necessary” to protect the life of the woman or to protect her from a serious health risk. Planned Parenthood I, 211 N.E.3d at 975-76. Those circumstances are medical circumstances and determining whether they exist requires a reasonable medical judgment. The statutory Life or Health Exception thus does not impose a material burden on the constitutional right to an abortion at all as both the constitutional right and the statutory exception require a reasonable medical judgment.
3. The statutory Hospital Requirement also does not impair the constitutional right to an abortion.
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We do not agree that the Hospital Requirement specifically, rather than the statutory ban itself, is to blame for the reduced access to abortion care in Indiana. And, the medical-care providers’ assertions aside, the Hospital Requirement does not impair the constitutional right to an abortion. A woman in need of exercising her constitutional right to an abortion is, by definition, facing a risk to her life or a serious health risk. Planned Parenthood I, 211 N.E.3d at 975-76. As the trial court expressly found, a woman facing such a substantial medical risk “will likely be receiving in-hospital care” with or without the Hospital Requirement. Appellants’ App. Vol. 2, p. 93. Thus, the medical-care providers cannot show that the Hospital Requirement imposes a material burden on the constitutional right to an abortion.
Conclusion
For all of these reasons, we affirm the trial court’s denial of the medical-care providers’ claims for declaratory and injunctive relief.
Affirmed.
Altice, C.J., and DeBoer, J., concur