During Wednesday’s Supreme Court arguments over life-saving abortions in emergency rooms, a few things became clear: The male justices are unconcerned by women’s suffering, and Justice Samuel Alito thinks there aren’t enough abortion restrictions across the U.S.—but if you press him on that point, you’re the ridiculous one.

The case, United States v. Idaho, is about whether emergency rooms in Idaho—a state that bans all abortions except those done to prevent death, not to preserve health—are in violation of a federal law that requires E.R. patients to be stabilized. The Emergency Medical Treatment and Labor Act, or EMTALA, says hospitals that accept Medicare funding have to stabilize patients facing threats to their health, and for pregnant patients facing complications, the treatment is sometimes abortion.

But this is not a normal case: Idaho is represented in part by Alliance Defending Freedom, or ADF, a far-right legal activist group that is pushing for nationwide restrictions, including a national abortion ban. Idaho and ADF argued in case briefs and before the court that a fetus is a separate patient under EMTALA and deserves equal treatment in E.R.s. This is a fetal personhood argument, and if it’s taken to its logical endpoint, it would lead to a ban on all abortions nationwide, the end of IVF as we know it (see: Alabama), and restrictions on certain forms of birth control. In practice, women whose water breaks too early could be forced on bed rest to try to save the fetus, or given C-sections against their will. The latter is already happening, and in fact, happened even before Dobbs.

During arguments, some of the male justices seemed content to talk about whether EMTALA’s funding conditions are an appropriate use of the Constitution’s spending clause, while the women were focusing on the medical harm Idaho’s law has caused to living, breathing women. Late in the argument, Alito—who wrote the majority opinion in Dobbs that allows laws like Idaho’s to be enforced—was upset that not enough time had been devoted to the existence of the words “unborn child” in the law about emergency room care.