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The Florida Department of Health is making an unprecedented legal effort to stop a local TV station from airing an advertisement in support of an abortion rights ballot measure. The ad features a pregnant woman who was diagnosed with stage four brain cancer and says the law would have prevented her from having an abortion, even though the procedure was necessary for her to undergo chemotherapy.

State health departments typically do not weigh in on electoral issues. The move is part of a broader effort by the state’s Republican leaders, including Gov. Ron DeSantis, to leverage public resources to fight against the ballot measure,  which would protect the right to an abortion at least up until fetal viability. 

The campaign for the measure, known as Amendment 4, is pushing back. In a letter to the same TV station, its lawyers argued that the health department’s effort to block the advertisement constitutes a violation of the U.S. Constitution’s free speech protections. 

“The Department’s letter is a flagrant abuse of power and must be rejected. Moreover, there is no genuine dispute as to the accuracy of the statements in this Advertisement,” the lawyers wrote in the letter, shared with The 19th. 

The state government’s threats have drawn criticism from the Federal Communications Commission.

“Threats against broadcast stations for airing content that conflicts with the government’s views are dangerous and undermine the fundamental principle of free speech,” FCC Chair Jessica Rosenworcel said in a statement Tuesday.

The ad in question — which as of Tuesday has not been pulled by any TV stations — concerns a Tampa woman named Caroline, who was diagnosed with terminal cancer in 2022, months before Roe v. Wade was overturned. Caroline, who asked that her last name be withheld because she is worried about harassment directed at her young daughter, began developing symptoms when she was 17 weeks pregnant, struggling with speech and writing and eventually requiring a days-long stay in her hospital’s neuro-intensive care unit. At 18 weeks, she underwent surgery to determine what was wrong and what it might mean for her pregnancy. 

Two weeks later, she learned she had stage four glioblastoma. The typical prognosis is less than two years. Chemotherapy could extend her life, allowing her a bit more time with her daughter and husband. But as is true with many cancer treatments, the treatment would require her to terminate her pregnancy. 

“I had to choose between treatment or the pregnancy,” Caroline told The 19th. Still, it was a difficult decision — one she only made after she passed out while trying to get a second opinion and immediately had to travel back to the ICU. 

Caroline got an abortion that April, when abortion in Florida was still legal up to 24 weeks of pregnancy. She asked her husband a question that at the time felt hypothetical: “Could you imagine if we were in a state that didn’t allow this?”

Her story takes center stage in the TV ad, which is part of an effort by the Amendment 4 campaign to highlight how Florida’s six-week abortion ban has affected people with complex pregnancies. “The doctors knew if I did not end my pregnancy, I would lose my baby, I would lose my life, and my daughter would lose her mom. Florida has now banned abortion even in cases like mine,” she says in the 30-second spot. 

Florida’s law has some medical exceptions, including a provision that allows for termination after its six-week limit if staying pregnant poses a “serious risk of substantial and irreversible physical impairment of a major bodily function.” Two physicians must certify that the pregnancy qualifies. 

The state’s health department has argued that because the six-week ban has this medical exception, patients facing severe complications with pregnancy — including cancer — should be able to terminate their pregnancies without leaving the state and as a result, the advertisement sharing Caroline’s story is misleading. 

“Women faced with pregnancy complications posing a serious risk of death or substantial and irreversible physical impairment may and should seek medical treatment in Florida,” the health department’s letter reads. 

But doctors have repeatedly described a state of confusion over what kind of medical situation qualifies for that exception, which many say is ambiguous or not clearly worded. Providing an abortion that does not meet the state’s standards is a felony. In a sworn affidavit, Dr. Shelly Tien, a maternal-fetal medicine specialist who practices in Florida and Arizona, wrote that she did not believe a case like Caroline’s would have qualified under the state’s exception language.

“Under Florida’s current law, I would not have provided this abortion because it could be viewed as a crime to terminate Caroline’s pregnancy because the termination was not necessary to ‘save the pregnant woman’s life,’” Tien wrote. “While the termination was medically necessary because the cancer was terminal, the abortion would not have saved the patient’s life and therefore could be illegal under Florida’s law.”

Some physicians have used the state’s medical exceptional language to secure abortions for pregnant patients with cancer, who require chemotherapy that is incompatible with pregnancy. But the law has created substantial delays for patients, in part because different health systems and health providers vary in how they interpret the medical exception language. 

“Any time you have a condition that won’t lead to immediate death, you’ll have to make that case. In the case of the brain tumor, would the brain tumor kill her during her pregnancy? Probably not,” said Dr. Michele Heisler, the medical director at the advocacy group Physicians for Human Rights, who has interviewed numerous doctors in Florida about the state law’s impact. “I don’t think it would fall under the exceptions. It would be very tough.”

In one such case, Dr. Chelsea Daniels, an OB/GYN who practices at multiple Planned Parenthood affiliates across the state, saw a patient with stage four cancer who had discovered during a routine screening that she was about 20 weeks pregnant, requiring an abortion so that she could continue her cancer treatment. Daniels, who shared the story with The 19th earlier this summer, believed the case qualified as a medical exception, but she needed another physician to endorse that view — and attest to it in legal papers — so that she could find a hospital that would provide an abortion. 

“Finding a hospital in Florida that will do an abortion is really challenging because of this legal quagmire,” Daniels said in a July interview. The closest option she could find was in Tampa, a four-hour drive away, and navigating the referral process took a week, pushing her further into pregnancy and delaying her resumption of cancer treatment.

“This woman was dying of cancer and just had to go through a week of hell in order to have an abortion,” she said at the time. “Thank God, she got her care. But getting her up to Tampa was not easy.”

That type of workaround wouldn’t have been an option for Caroline and her family, she said. Two years ago, she could barely travel a few miles because she was so frequently in the intensive care unit. She couldn’t fly because of her recent brain surgery. And the doctor who cared for her at the time has since left Florida. 

If given the option, she said, she hopes to continue campaigning on behalf of the Florida abortion rights measure — at least as much as possible, depending on what her health will allow.

“This has shown me that it’s become political but it shouldn’t be,” she said. “I’m personally doing this for my daughter to have the same rights as me and my mom. The same rights as my mom had, and for all the women who are diagnosed with cancer.”

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