The List Comes Out: What Massachusetts Deleted From Its Abortion Law
On November 8, 2026, Massachusetts deletes the four statutory grounds for abortion after 24 weeks and replaces them with a physician's professional judgment. The 2024 vital-records report counted 99 such abortions out of 49,450, under the old list, and it does not record why.
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Listen free: The List Comes Out: What Massachusetts Deleted From Its Abortion Law
On August tenth, twenty twenty-six, in Boston, the governor of Massachusetts approved a three-section act. It does not open with a philosophy. Its first section names a block of statutory words and orders them struck. The list comes out. Our read is that both slogans now in circulation fail against that text. The claim that nothing changed is false, because four grounds for an abortion after twenty-four weeks are deleted and replaced with a physician's professional judgment. The claim that the Commonwealth has legalized elective abortion on demand until birth adds words the statute does not contain. We think the argument has been avoiding the sentence the legislature actually enacted.
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The act is chapter one hundred eighty-eight of the acts of twenty twenty-six. Its title is an act prioritizing patient access to care. The bill history of House bill five five nine five records the path in public: the House engrossed it one hundred nineteen yeas to thirty-three nays on July twenty-second, the House enacted it one hundred twenty-one yeas to thirty-five nays on July thirty-first, and the governor signed it on August tenth. The session law itself states no emergency preamble and no earlier effective date. The Trial Court Law Libraries annotate the amendment as effective November eighth, twenty twenty-six. Until that morning, the four grounds are still the law of the Commonwealth. After that morning, they are not. Ninety days. Three sections. Four deleted grounds. That is the scale of the paper, and it is enough to settle the cartoon that says the page did not move.
The words the act deletes
Read section one the way a statute asks to be read, which is as an instruction to a printer. It amends section twelve N of chapter one hundred twelve, as that section appears in the twenty twenty-four Official Edition, by striking lines one to nine. The words it orders struck are these: "no abortion may be performed except by a physician, and only if in the best medical judgement of the physician it is: (i) necessary to preserve the life of the patient; (ii) necessary to preserve the patient's physical or mental health; (iii) warranted because of a lethal fetal anomaly or diagnosis; or (iv) warranted because of a grave fetal diagnosis that indicates that the fetus is incompatible with sustained life outside of the uterus without extraordinary medical interventions." In their place the act inserts one clause: "an abortion may be performed by a physician based upon the professional judgment of the physician."
Count what left the page. Life of the patient. Physical health. Mental health. A lethal fetal anomaly, meaning a fetal condition the old text treated as a ground of its own. A grave fetal diagnosis incompatible with sustained life outside the uterus without extraordinary medical interventions. Five ideas, numbered as four grounds, because life and health were split and the two fetal grounds stood beside them. The replacement names none of them. Devastating diagnosis is absent. Serious complication is absent. Accepted standards of care is absent. The clause that remains says professional judgment. The struck text even spelled judgement with an e, the British form sitting in the Official Edition. The new text uses the American spelling, judgment, and then stops. A legislature that wanted the old limits to survive would have kept the list and added a fifth ground. This legislature struck the list.
The list is not ancient. The law libraries trace the current four-ground wording to chapter one hundred twenty-seven of the acts of twenty twenty-two, section twelve, effective July twenty-ninth, twenty twenty-two. Before that, chapter two hundred sixty-three of the acts of twenty twenty, effective December twenty-ninth, twenty twenty, had already rewritten the post-twenty-four-week rule into a physician's best medical judgment tied to life, physical or mental health, a lethal fetal anomaly, or a fetus incompatible with sustained life outside the uterus. Three rewrites in six years. Twenty twenty loosened an older criminal frame into a medical standard with named reasons. Twenty twenty-two numbered those reasons and added the phrase about extraordinary medical interventions. Twenty twenty-six deletes the reasons. Anyone still describing Massachusetts law as if the twenty twenty-two list were the permanent settlement is describing a statute that has an expiration date printed on the law library's own page.
What the week-line still does
The fight is about the line at twenty-four weeks, not about whether abortion exists in Massachusetts. Under section twelve M, a physician, physician assistant, nurse practitioner, or nurse midwife may perform an abortion, consistent with the scope of that license, if in their best medical judgment the pregnancy has existed for less than twenty-four weeks. Chapter one hundred eighty-eight does not amend section twelve M. People who talk as if the new act invented abortion before viability are six years late, and they are using a word the operative section does not use. Viability, meaning the point at which a particular fetus may survive outside the uterus, is a medical judgment about a body. Massachusetts wrote a week-count. Twenty-four weeks is a clock, not a synonym printed in section twelve N. The statute asks the physician to count.
Section twelve L, also left standing, says the Commonwealth shall not interfere with a person's personal decision to prevent, commence, terminate, or continue a pregnancy "consistent with this chapter." Those four words are the load-bearing ones. Non-interference runs with the rest of the chapter. When the post-twenty-four-week rule changes, the non-interference clause follows the new rule. It does not freeze the twenty twenty-two list, and it does not erase every other section.
What still binds a physician
Chapter one hundred eighty-eight has a second and a third section, and they are as plain as the first. Section three strikes the second paragraph of section twelve P. Until November eighth, that paragraph says that except in an emergency requiring immediate action, an abortion under section twelve N shall not be performed unless performed in a hospital duly authorized to provide facilities for obstetrical services. After November eighth, that sentence is gone. A post-twenty-four-week abortion is no longer tied by statute to a hospital with obstetrical facilities. The House press release of July twenty-second said the bill permits these procedures in health care treatment centers in addition to hospitals. The enacted text does the permitting by deletion. It does not write a new facility list. It removes the old one.
The first paragraph of section twelve P survives. Except in an emergency requiring immediate action, an abortion under section twelve M or section twelve N still requires the written informed consent set out in section twelve R. Section twelve R says the consent rule shall not impose any waiting period between the signing of the form and the abortion. So the Commonwealth does not have a twenty-four-hour or forty-eight-hour statutory wait. It does still have a signed form, a form the commissioner of public health prescribes, kept for seven years and then destroyed. Emergency is the exception, and the statute says immediate action. Consent is not the four-ground list. It is also not nothing. A description of the new law that skips the surviving consent sentence is as incomplete as a description that pretends the hospital sentence survived.
Two further limits are untouched because they are not in the three sections. Section twelve O still applies when an abortion is performed under section twelve N. The facility shall maintain life-supporting equipment, as defined by the department of public health, so the physician can take appropriate steps, in keeping with good medical practice and consistent with the procedure being used, "to preserve the life and health of a live birth and the patient." Chapter one hundred eighty-eight does not strike that sentence. A live birth during a post-twenty-four-week abortion is still a statutory event with an equipment duty attached. That is not a reason restriction. It is a survival rule. It answers the cartoon that says Massachusetts repealed every duty to a child who is born. It does not answer the cartoon that says any reason is now a statutory ground, because it never was a ground. It is what the facility must be able to do if the abortion produces a live birth.
Federal law is the other limit the state act cannot repeal. Title eighteen of the United States Code, section fifteen thirty-one, still prohibits a specifically defined method, the partial-birth procedure described in that section, with a life exception for a physical danger to the mother. It bans that method. It does not ban every abortion after twenty-four weeks, and it does not restore the four Massachusetts grounds. Title one, section eight, defines a born-alive infant as a person for purposes of federal statutes. We'd argue that treating either federal section as a reason list is the same error as treating the new state clause as a blank room.
Physician discipline remains, and it is the wrong kind of limit if what you wanted was a gate. Section five of chapter one hundred twelve still lets the board of registration in medicine act against gross misconduct in the practice of medicine, practice beyond authorized scope, gross incompetence, or gross negligence on a particular occasion or negligence on repeated occasions. That is an after-the-fact professional standard. It is not a list of permitted reasons printed in section twelve N. A patient cannot read the new section on the morning of a procedure and learn which reasons the Commonwealth has forbidden. The old section was that sentence. The new one is not.
Section twelve R's rule for a patient less than sixteen years of age is also untouched. If that patient has not married, an abortion shall not be performed unless the clinician first obtains both the patient's consent and the consent of one parent or guardian, unless a superior court judge authorizes it under the bypass the section describes. Chapter one hundred eighty-eight does not amend section twelve R. The late-abortion change is not a minor's-consent change. Anyone folding the two into one slogan is not reading the chapter.
Ninety-nine cases, and what they cannot prove
The number people will wave is in a different document, and it belongs to the old law. In December twenty twenty-five the Registry of Vital Records and Statistics, inside the Department of Public Health, issued Massachusetts Induced Termination of Pregnancy twenty twenty-four, pursuant to section twelve Q. The report counts forty-nine thousand four hundred fifty abortions. Table two sorts them by gestational age, meaning how many weeks the pregnancy had lasted. Forty-seven thousand seven hundred thirty-three were at zero to twelve weeks. One thousand eighteen were at thirteen to sixteen weeks. Three hundred sixty-four were at seventeen to twenty weeks. Two hundred thirty-six were at twenty-one to twenty-three weeks. Ninety-nine were at twenty-four weeks or more.
Do the division the table invites and the slogans avoid. Ninety-nine divided by forty-nine thousand four hundred fifty is about two tenths of one percent. About one in four hundred ninety-nine. Forty-seven thousand seven hundred thirty-three divided by the same total is about ninety-six point five percent in the first twelve weeks. The late cases are real. They are also a small share of a large total. A politics that describes Massachusetts abortion practice as a post-twenty-four-week practice is describing one case in five hundred and calling it the system.
The same report explains the total, which doubled, and the explanation is not the ninety-nine. Table four records thirty-one thousand six medical abortions by telehealth, out of forty-nine thousand four hundred fifty, about sixty-three percent. Table five records twenty-seven thousand eight hundred thirty-six patients who were not Massachusetts residents, against twenty-one thousand four hundred seven who were. Table six puts thirty thousand nine hundred two of the procedures in the telehealth row, against eighteen thousand four hundred one in the six health regions combined. The surge is pills, distance, and patients from other states. It is not a wave of abortions at twenty-four weeks. We don't buy a headline that staples the doubling to the late-abortion statute. The tables refuse the staple.
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And the ninety-nine cannot be drafted as evidence of chapter one hundred eighty-eight, because the chapter was not law in twenty twenty-four. The governor signed it on August tenth, twenty twenty-six. The libraries date its effect to November eighth, twenty twenty-six. Every one of those ninety-nine was performed while the four-ground text was the text. They are evidence of practice under the list, not practice after the list. If the objection is that late abortion is rare, the twenty twenty-four table supports the objection, under the old statute. If the claim is that the new statute has already produced a flood, the table is silent, because the new statute had not taken effect. Using twenty twenty-four to prosecute twenty twenty-six is a category error. Using twenty twenty-four to pretend twenty twenty-six changed nothing is the same error in the other direction.
Here is the limit that matters more than the arithmetic. Section twelve Q tells the commissioner to collect aggregate data, meaning totals with no names attached, including date and place, ages, method, and gestational age. It then forbids the other thing a public argument would need. The commissioner shall not collect, maintain, use, disclose, or disseminate disaggregated surveillance data or individually identifiable surveillance data on abortions performed in the Commonwealth. The law libraries date that prohibition to chapter sixteen of the acts of twenty twenty-five, section thirteen, effective November fifth, twenty twenty-five. The annual table can say ninety-nine. It cannot say why. It cannot say which of the four old grounds the physician marked. It cannot say whether a case was life, health, a fetal diagnosis, or something the list did not name, because the form the statute requires does not ask. There is no reason column. There has not been one in the table we have.
The method table has the same hole. Statewide, the twenty twenty-four report counts six thousand five hundred twenty-four dilation and evacuation procedures, evacuation meaning removal by surgery rather than by medication, twenty-one labor inductions, and thirty-one thousand six telehealth medical abortions. Those are methods, not weeks, and not reasons. The report does not cross-tabulate method by week. The number twenty-one is a method count. It is not a biography of the ninety-nine.
The objection, at full strength
The sponsors' case should be stated as they stated it, not as a straw. On July twenty-second, twenty twenty-six, the House press office said the bill "removes existing requirements that limit abortions at 24 weeks of pregnancy or later to specific medical circumstances," and that under current law those circumstances "must adhere to only four specific categories, which do not account for the full spectrum of medical conditions encountered by women and their doctors." The same release said dozens of patients annually are forced to travel out of state for later abortion care because of existing legal restrictions, according to Reproductive Equity Now. That dozens figure is an advocacy organization's account, cited by the House. It is not a line in the Department of Public Health report. We can quote it as what the House relied on. We cannot launder it into a vital-records statistic.
On July thirty-first the legislature's own release said the vote was about "removing restrictions on abortion after 24 weeks of pregnancy." On August tenth the governor's office said the law lets physicians rely on professional medical judgment, "consistent with accepted standards of care," and that under the previous law physicians had to determine whether a patient's circumstances met "a narrow list of statutory exceptions." The governor said the law continues an effort to have the strongest abortion protections in the country, and that health care decisions should be made between women and their doctors. Those are not sneering lines. They describe patients who wanted a pregnancy, received a devastating diagnosis or a serious complication, and were told the Massachusetts list did not fit, so they traveled. If that happened even dozens of times, it happened to people in the worst week of a wanted pregnancy. A commentary that treats those patients as a talking point has already failed, whatever the statute says.
The objection therefore has three strong points, and we concede them. First, the twenty twenty-four count is small: ninety-nine, not thousands, under a list that was still in force. Second, a four-ground list can miss a real medical disaster that does not fit the nouns the legislature chose in twenty twenty-two. Edge cases in pregnancy are not classroom hypotheticals. Third, professional judgment is a professional word. Hospitals, insurers, and the board of registration in medicine will still have standards, ethics rules, and malpractice law around it. That world does not vanish because a statutory list was deleted.
Why the objection still loses
It loses on the words the act used, and on the words it refused to use. The House called the bill a removal of the limit to specific medical circumstances, not a clarification of the four categories. The July thirty-first release described removing restrictions, not a professional restatement of the old ones. The enacted section one does what those releases describe. It strikes the circumstances. If the sponsors had wanted professional judgment to mean only the old four grounds plus unnamed cousins of those grounds, they had a sentence available. They could have kept the list and added, or other comparably serious complications, consistent with accepted standards of care. They did not. The phrase consistent with accepted standards of care appears in the governor's press release of August tenth. It does not appear in section twelve N as chapter one hundred eighty-eight rewrites it. A press release is not an amendment. When the administration's gloss is more limiting than the enacted clause, the clause governs. We'd argue that is the whole of statutory reading, and it is not a technicality. It is the difference between a law you can cite and a reassurance you were given.
The same act cuts the paper that would have let anyone test the reassurance. Until November eighth, section twelve N and one half says each circumstance permitting a post-twenty-four-week abortion shall be considered independently by the treating physician and the patient or the patient's health care proxy, and that no medical review process shall override a determination consistent with section twelve N. It also requires every facility authorized to perform those services to submit, annually, not later than September first, a written report of its procedures and processes for providing services consistent with those sections. Chapter one hundred eighty-eight, section two, strikes that whole section and inserts a shorter one: no medical review process shall override the professional judgment of a treating physician and a patient or proxy to provide an abortion consistent with section twelve N. The annual facility report is gone. The duty to consider each listed circumstance independently is gone, which follows, because the circumstances are gone. What remains is a prohibition on override. A prohibition on override, attached to a standard with no listed circumstances, is not a reporting system. It is a shield against one.
Put the two deletions next to section twelve Q and the shape is hard to miss. The vital-records statute collects gestational age and forbids named surveillance data. The twenty twenty-six act then deletes the facility process report. After November eighth, Massachusetts will know how many, at what weeks, by what method. It will not know, from any statute it left standing, why the post-twenty-four-week cases happened. Our verdict is that a legislature asking the public to trust professional judgment deleted the categories and the facility report that would have let the public test the trust. The bill is three sections long. Two of them remove a limit or a report. The third removes a hospital rule. No section adds a definition of professional judgment, a reason code on the twelve Q form, or the words accepted standards of care.
The price
The price has two sides, and only one of them is comfortable. If the House is right that the four categories were forcing patients with real complications out of Massachusetts, then November eighth removes a barrier those patients could feel in a car on the way to another state. That is a gain, and it is the gain the sponsors ran on. We do not owe them a sneer for naming it. We owe them the text they passed, which is wider than the stories they told. A standard that says professional judgment will cover the heartbreak cases. It will also cover any other case a physician is willing to call a professional judgment, until a board, a court, or a hospital rule says otherwise, after the fact, in a proceeding the annual table will never show. The statute does not sort those cases in advance. The public report cannot sort them after. That is the design.
What we will not say follows from the same pages. The ninety-nine are not labeled elective, because the form never asked. Future conduct by physicians is not in these documents, and section five is still on the books. Section twelve M and the rewritten section twelve N are permissions within their terms, not a ban. After twenty-four weeks the performer is still a physician, written consent is still required outside an emergency, and section twelve O still requires life-supporting equipment. The cartoons want sentences the documents do not contain.
What the documents do contain is a deletion. On November eighth, twenty twenty-six, the four grounds cease to be the gate. The list comes out. What replaces it is one clause of professional judgment, a deleted hospital requirement, a deleted facility report, a surviving consent form, a surviving equipment duty, and a vital-records table that can count to ninety-nine and cannot say why. Read the clause. Do not read the press release over it. Do not read the cartoon over either. The Commonwealth chose an open standard and a thinner record on the same day. That choice is the law, and it should be stated as plainly as the sentence that makes it.
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