Kate Cox, whose fetus had a fatal condition, did not qualify for an abortion in Texas: not after four emergency room visits, elevated vital signs, risks of a uterine rupture and with her ability to have more children in jeopardy.

The Texas Supreme Court’s rejection of the mother of two’s request for an exception under the state’s restrictive ban has laid bare the high threshold women in many states must meet to get the procedure: pregnancy complications that pose life-threatening danger to the mother.

“These laws reflect the policy choice that the Legislature has made, and the courts must respect that choice,” the court’s nine Republican justices said in their ruling late Monday.

The state’s Republican attorney general had for a week argued that Cox did not meet the standard for an exception, despite appeals from her attorneys that her health was deteriorating. Hours before the order came down, Cox’s attorney said she could no longer wait for the procedure and had already left Texas to get an abortion in another state.