Government attorneys have asked the Ohio Supreme Court to uphold the state Health Department's order to shut down Toledo's last abortion clinic.
The case involves one of several restrictions Ohio lawmakers have placed on abortion clinics in recent years.
The court on Tuesday heard arguments over the Health Department's 2014 order to close Capital Care of Toledo.
The department says the clinic's lack of a patient-transfer agreement with a local hospital should force it to close.
Such agreements were mandated, and public hospitals barred from providing them, under restrictions passed in 2013.
Lower courts have ruled the restrictions unconstitutional.
The court's chief justice on Tuesday asked about an alternative for women in the city of 275,000 residents if the clinic closed. The closest clinic is an hour's drive away in Michigan.