Establishing Objective Cardiac Activity as the Definitive “Fetal Heartbeat” Under the 2023 South Carolina Fetal Heartbeat Act

Introduction

This commentary examines the Supreme Court of South Carolina’s decision in Planned Parenthood South Atlantic et al. v. State of South Carolina (Appellate Case No. 2024-000997, filed May 14, 2025). The case arose from a challenge to the 2023 South Carolina Fetal Heartbeat and Protection from Abortion Act (“2023 Act”), which generally prohibits abortions once a “fetal heartbeat” is detected, subject to limited exceptions. The key issue before the Court was the statutory meaning of “fetal heartbeat”—in particular, at what biologically identifiable moment in pregnancy does the term occur? Appellants (Planned Parenthood and affiliated providers) contended it does not arise until formation of a four-chambered heart (approximately nine weeks’ gestation), whereas the State argued it occurs when cardiac electrical activity first becomes detectable (approximately six weeks). The Court’s unanimous opinion, authored by Justice Few, anchors the definition in observable medical technology—namely, cardiac electrical impulses detected by ultrasound.

Summary of the Judgment

The Supreme Court of South Carolina affirmed the circuit court’s ruling in favor of the State. It held:

The statutory definition of “fetal heartbeat”—“cardiac activity, or the steady and repetitive rhythmic contraction of the fetal heart, within the gestational sac”—is ambiguous on its face.
Applying established rules of statutory construction and examining legislative history and findings, the Court concluded the General Assembly intended “fetal heartbeat” to mean the first detectable cardiac electrical activity observable as a sound or trace on diagnostic ultrasound, generally at around six weeks’ gestational age.
Contrary interpretations focusing on chamber formation at nine weeks, or on fetal versus embryonic terminology, were rejected as inconsistent with the legislature’s consistent six-week framing, its express finding that a “fetal heartbeat is a key medical predictor that an unborn child will reach live birth,” and prevailing practice in other “heartbeat laws.”

Consequently, the 2023 Act’s prohibition on abortion once a “fetal heartbeat has been detected” applies the moment a medical professional observes steady, repetitive cardiac activity in the gestational sac via ultrasound.

Analysis

Precedents Cited

Planned Parenthood South Atl. v. State (“Planned Parenthood I”), 438 S.C. 188, 882 S.E.2d 770 (2023): Held the 2021 heartbeat ban unconstitutional under the South Carolina Constitution; characterized the ban repeatedly as a “six-week” prohibition.
Planned Parenthood South Atl. v. State (“Planned Parenthood II”), 440 S.C. 465, 892 S.E.2d 121 (2023): Upheld the 2023 Act’s constitutionality, but expressly reserved definition of “fetal heartbeat” for another day.
Hodges v. Rainey, 341 S.C. 79, 533 S.E.2d 578 (2000): Confirms the singular task of courts is to discern and effectuate legislative intent in statutory interpretation.
Creswick v. Univ. of S.C., 434 S.C. 77, 862 S.E.2d 706 (2021) and Kennedy v. S.C. Ret. Sys., 345 S.C. 339, 549 S.E.2d 243 (2001): Reaffirm principles that courts apply plain meaning when a statute is clear, and resort to legislative history when it is not.
Texas “Heartbeat” Law & Whole Woman’s Health Org. v. Jackson, 595 U.S. 30 (2021): Federal opinions describing six-week bans as tied to detectability of cardiac activity, shaping contemporaneous legislative practice elsewhere.
Dobbs v. Jackson Women’s Health Org., 597 U.S. 215 (2022): Overruled Roe and Casey, returning abortion regulation to the states and precipitating re-enactment of heartbeat bans.

Legal Reasoning

The Court’s approach unfolded in four main steps:

Textual Ambiguity: The Court found terms like “cardiac activity,” “steady,” “repetitive,” “rhythmic contraction,” and “gestational sac” lack uniform, precise medical definitions. An interpretation strictly by textual meaning alone could point to different gestational landmarks (six weeks vs. nine weeks vs. ten weeks).
Legislative History & Silence: The Court gave decisive weight to the legislature’s exclusive and consistent references to both the 2021 and 2023 Acts as “six-week” bans. In light of the repeated shorthand in filings, opinions, floor debates, and rejected amendments, nothing in the record suggests lawmakers intended to expand or shift the threshold from the six-week point understood by the Court and the parties.
Legislative Findings: The 2023 Act’s express finding that a “fetal heartbeat is a key medical predictor that an unborn child will reach live birth” aligns with medical data showing >95% live-birth rates once early cardiac electrical activity is detected at around six weeks. The General Assembly reaffirmed the same correlation it made in the 2021 Act.
Medical Objectivity & Statistical Consistency: By focusing on the detectability of cardiac electrical impulses via transvaginal ultrasound (observable as sound and trace), the Court’s interpretation grounds the statutory term in an objective, repeatable medical event rather than an estimated number of weeks, or on later chamber development.

Impact

This decision clarifies the operative threshold for abortion restrictions under South Carolina’s heartbeat law and potentially under similar statutes in other jurisdictions. By defining “fetal heartbeat” as the first detectable cardiac electrical activity (approximately six weeks’ gestation), the Court provides medical professionals and abortion providers with an objective standard for compliance. Future litigation will likely cite this ruling when construing “heartbeat” bans or analogous gestational cutoffs. Legislatures elsewhere may look to this decision’s use of legislative findings and objective markers in drafting or defending early-pregnancy restrictions.

Complex Concepts Simplified

Statutory Ambiguity: A statute is “ambiguous” when its terms are open to more than one reasonable interpretation.
Rules of Statutory Construction: Principles courts use—first, apply plain meaning when clear; second, look to legislative intent, history, and context when unclear.
Legislative Silence: The absence of contrary debate or amendment in the legislative record can indicate what lawmakers did not intend.
Fetal vs. Embryonic Terminology: “Fetal” is an imprecise adjective in these Acts, used interchangeably with “embryonic” in related statutes; the statute does not limit its terms to fully chambered hearts.
Transvaginal Ultrasound: A diagnostic tool inserted into the vagina to provide high-resolution imaging and audible detection of early cardiac electrical impulses in the gestational sac.
Rule of Lenity & Constitutional Doubt Canon: Canons that—when criminal penalties or constitutional rights are at stake—favor the interpretation least likely to impose punishment or infringe rights; here they were unnecessary once the Court resolved ambiguity.

Conclusion

The Supreme Court of South Carolina’s ruling in Planned Parenthood v. South Carolina establishes a clear, medically verifiable, and legislatively consistent definition of “fetal heartbeat.” By anchoring the statutory term to the first detectable cardiac electrical activity—observable and audible via transvaginal ultrasound—the Court upholds the legislature’s intent to prohibit most abortions at a point generally around six weeks’ gestational age. This decision not only resolves longstanding uncertainty in South Carolina’s heartbeat law but also guides future statutory drafting and judicial interpretation of early-pregnancy regulations both within and beyond the state.