# Allegheny Reprod. Health v. PA DHS

> Supreme Court of Pennsylvania · January 29, 2024

URL: https://www.frixlaw.com/law-library/cases/9927557

## Case

- **Court:** Supreme Court of Pennsylvania
- **Decided:** January 29, 2024
- **Precedential status:** Published
- **Opinion:** Opinion
- **Judges:** Justice David Wecht
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/9927557

## How later opinions describe it (automated extraction)

- discussing the initial claims as including an allegation that the abortion prohibition discriminated against women on the basis of sex
- holding that the termination of a pregnant woman’s employment on the basis of a physical condition unique to her sex was “sex discrimination pure and simple”

## Opinion text

[J-65-2022] [MO: Donohue, J.]
IN THE SUPREME COURT OF PENNSYLVANIA
MIDDLE DISTRICT

ALLEGHENY REPRODUCTIVE HEALTH : No. 26 MAP 2021
CENTER, ALLENTOWN WOMEN'S :
CENTER, DELAWARE COUNTY : Appeal from the Orders of the
WOMEN'S CENTER, PHILADELPHIA : Commonwealth Court at No. 26 MD
WOMEN'S CENTER, PLANNED : 2019 dated January 28, 2020, and
PARENTHOOD KEYSTONE, PLANNED : March 26, 2021.
PARENTHOOD SOUTHEASTERN :
PENNSYLVANIA, AND PLANNED : ARGUED: October 26, 2022
PARENTHOOD OF WESTERN :
PENNSYLVANIA, :
:
Appellants :
:
:
v. :
:
:
PENNSYLVANIA DEPARTMENT OF :
HUMAN SERVICES, VALERIE A. :
ARKOOSH, IN HER OFFICIAL CAPACITY :
AS SECRETARY OF THE PENNSYLVANIA :
DEPARTMENT OF HUMAN SERVICES, :
ANDREW BARNES, IN HIS OFFICIAL :
CAPACITY AS EXECUTIVE DEPUTY :
SECRETARY FOR THE PENNSYLVANIA :
DEPARTMENT OF HUMAN SERVICES’ :
OFFICE OF MEDICAL ASSISTANCE :
PROGRAMS, AND SALLY KOZAK, IN HER :
OFFICIAL CAPACITY AS DEPUTY :
SECRETARY FOR THE PENNSYLVANIA :
DEPARTMENT OF HUMAN SERVICES’ :
OFFICE OF MEDICAL ASSISTANCE :
PROGRAMS, :
:
Appellees :

CONCURRING OPINION

JUSTICE WECHT DECIDED: January 29, 2024
Since 1776, the Constitution of the Commonwealth of Pennsylvania has opened

with a “Declaration of Rights,” a declaration that begins by identifying the “Inherent rights

of mankind.” 1 The “inherent and indefeasible rights” identified therein include the rights

to enjoy and defend life and liberty and to pursue happiness. Our Constitution further

states that “everything” contained in the Declaration of Rights “is excepted out of the

general powers of government and shall forever remain inviolate.”2 In 1971,

Pennsylvania became the first state in the nation to amend its constitution to add an

explicit guarantee of equality of the sexes. 3 With these founding enactments, our

Constitution places certain guarantees beyond the reach of the legislature and

establishes them as legal promises enforceable in Pennsylvania’s courts. “[T]he

talismanic words, I am a citizen of Pennsylvania, secures [sic] to the individual his [or her]

private rights” as guaranteed by our organic charter. 4

I join the Majority’s detailed articulation and application of these constitutional

promises in this case, which addresses a challenge involving Pennsylvania’s Medical

Assistance Program (“the Program”). This program provides payment directly to health

care providers for covered medical services available to enrollees. The Abortion Control

Act imposes a coverage exclusion under which the Program will not provide funds to

1 “All men are born equally free and independent, and have certain inherent and
indefeasible rights, among which are those of enjoying and defending life and liberty, of
acquiring, possessing and protecting property and reputation, and of pursuing their own
happiness.” PA. CONST. art. I, § 1.
2 “To guard against transgressions of the high powers which we have delegated, we
declare that everything in this article is excepted out of the general powers of government
and shall forever remain inviolate.” PA. CONST. art. 1, § 25.
3 “Equality of rights under the law shall not be denied or abridged in the
Commonwealth of Pennsylvania because of the sex of the individual.” PA. CONST. art. 1,
§ 28 (“ERA”).
4 Brown v. Hummel, 6 Pa. 86, 91 (1847) (emphasis in original).

[J-65-2022] [MO: Donohue, J.] - 2
cover abortions unless the pregnancy is the result of rape or incest, or unless an abortion

is necessary to avert the death of the pregnant woman (hereinafter, “Coverage

Exclusion”). 5 The Program covers all other costs associated with pregnancy and

childbirth, and it also covers all health care for men, including male reproductive health

services. No equivalent or comparable coverage exclusion applies to men.

Several abortion providers (“Providers”) filed a petition for review against the

Department of Human Services (“DHS”), which administers the Program, seeking

declaratory and injunctive relief from the Coverage Exclusion. Providers argued that the

Coverage Exclusion violates the ERA and the equal protection provisions6 of the

Pennsylvania Constitution. In support of these claims, Providers averred that the

Coverage Exclusion significantly harms women, as the Majority describes. 7 The

Commonwealth Court permitted several lawmakers from the Pennsylvania Senate

(“Senate Intervenors”) and House of Representatives (“House Intervenors”) to intervene

in the matter (collectively, “Intervenors”). 8 DHS and the Intervenors filed preliminary

objections, arguing that the petition for review raised claims that had been decided by this

Court in Fischer v. Department of Welfare. 9 DHS also asserted that Providers lack

5 18 Pa.C.S. §§ 3215(c), (j); see also 55 Pa. Code §§ 1141.57, 1163.62, 1221.57.
6 PA. CONST. art. I, §§ 1, 26 & art. III, § 32.
7 Maj. Op. at 7-9.
8 Allegheny Reprod. Health Ctr. v. Pa. Dep’t of Hum. Servs., 225 A.3d 902 (Pa.
Cmwlth. 2020).
9 502 A.2d 114 (Pa. 1985).

[J-65-2022] [MO: Donohue, J.] - 3
standing. The Commonwealth Court sustained the preliminary objections and dismissed

the petition for review. 10

The Majority reverses the Commonwealth Court’s orders permitting intervention,

sustaining the preliminary objections, and dismissing the petition for review. I fully join

the thorough and incisive Majority Opinion. I write separately to address several

important issues that this case implicates:

• the application of standing principles in light of Robinson Township v.

Commonwealth; 11

• the way in which courts frame the issues before them;

• judicial consideration of the state’s interest purportedly advanced by the Coverage

Exclusion;

• alternative arguments for recognizing a right to reproductive autonomy under both

the United States and Pennsylvania Constitutions in the wake of Dobbs v. Jackson

Women’s Health Organization; 12 and

• judicial consideration of history and tradition in constitutional analyses.

I. Provider Standing

Providers have standing in this case because they have plainly established that

they are aggrieved as medical organizations that provide abortion services. 13 To the

10 Allegheny Reprod. Health Ctr. v. Pa. Dep’t of Hum. Servs., 249 A.3d 598 (Pa.
Cmwlth. 2021).
11 83 A.3d 901 (Pa. 2013).
12 597 U.S. 215, 240 (2022).
13 Maj. Op. at 34.

[J-65-2022] [MO: Donohue, J.] - 4
extent that the Majority analyzes standing through the invocation of Robinson Township, 14

I note my ongoing disagreement with descriptors used throughout that 2013 opinion,

descriptors that tend to understate “the severity of the position in which a plaintiff must

find herself in order to establish standing.”15 In my view, it is not merely an undesirable

choice that confers standing, but rather the dilemma of “[b]eing forced to choose between

abdicating one’s rights or willfully violating the law and subjecting oneself to sanctions.”16

In Robinson Township, Dr. Khan was forced into such a position. 17 Notwithstanding my

disagreement with the adjectives upon which the Robinson Township Court relied to

identify the types of choices that will confer standing in pre-enforcement challenges, the

Court’s analysis in Robinson Township supports our finding of standing in this case.

II. Issue Framing

The Coverage Exclusion is a sex-based classification that applies only to health

care sought by women, apportioning access to health care depending upon one’s sex

and excluding funding for abortion, while simultaneously funding all reproductive health

care for men. 18 Any statute that singles out and targets the reproductive health choices

14 83 A.3d at 923-25; Maj. Op. at 29 (repeating Robinson Township’s application of
standing principles to pre-enforcement review of statutory provisions where the parties
“must choose between equally unappealing options and where the third option is equally
undesirable”).
15 Firearm Owners Against Crime v. Papenfuse, 261 A.3d 467, 495 (Pa. 2021)
(Wecht, J., concurring).
16 Id.
17 Robinson Township, 83 A.3d at 924.
18 See New Mexico Right to Choose/NARAL v. Johnson, 975 P.2d 841, 856 (N.M.
1998) (holding that a coverage exclusion that denied state funding for medically
necessary abortions singled out for unfavorable treatment a sex-linked condition that is
unique to women and is presumptively unconstitutional); Doe v. Maher, 515 A.2d 134
(Conn. Super. 1986) (“Since only women become pregnant, discrimination against
(continued…)

[J-65-2022] [MO: Donohue, J.] - 5
of women, that creates a sex-based classification, or that arises from and perpetuates

sex-based stereotypes, will trigger scrutiny under our ERA.

Intervenors characterize this case as having nothing to do with the right to an

abortion. Rather, Intervenors perceive the question implicated here as involving solely

the right to government funding. 19 In Fischer v. Department of Public Welfare, this Court

made the same mistake, identifying the right that it was confronting as “the purported right

to have the state subsidize the individual exercise of a constitutionally protected right,

when it chooses to subsidize alternative constitutional rights.” 20 The Court found this right

“nowhere in our state Constitution,” and indicated that such a right could not be

considered fundamental. 21

It is a familiar tactic of courts that are about to deny the existence of a civil right to

define the right so narrowly that the right, so defined, will not be found in the applicable

constitution. In Bowers v. Hardwick, for example, the Supreme Court of the United States

disparagingly and crassly characterized the issue as “whether the Federal Constitution

confers a fundamental right upon homosexuals to engage in sodomy.” 22 Unsurprisingly,

like this Court in Fischer, the Court did not discover this right on the face of the

Constitution. The Court corrected its mischaracterization in Lawrence v. Texas,

recognizing that such framing “disclose[d] the Court’s own failure to appreciate the extent

pregnancy by not funding abortion when it is medically necessary and when all other
medical expenses are paid by the state for both men and women is sex oriented
discrimination.”).
19 See Maj. Op. at 22.
20 502 A.2d at 121; Maj. Op. at 63.
21 Fischer, 502 A.2d at 121; Maj. Op. at 63.
22 478 U.S. 186, 190 (1986).

[J-65-2022] [MO: Donohue, J.] - 6
of the liberty at stake.”23 Explaining that the Bowers formulation of the issue demeaned

the claim that the individual put forward, “just as it would demean a married couple were

it to be said marriage is simply about the right to have sexual intercourse,” 24 the Lawrence

Court recognized that the laws involved in Bowers and in Lawrence touched upon nothing

less than the liberty of personal relationships. 25

In Dobbs, the Court likewise reduced the issue before it to the narrowest possible

articulation: the right to abortion, rather than the broader right to personal autonomy. 26

Such thin constructions of rights myopically disregard the broader guarantees within

which they sit. Framing the issue before us as implicating a right to abortion funding

instead of a right to equal health care would repeat the mistakes of Bowers and Fischer,

dishonoring the broader right at stake: the guarantee of equal treatment under the law.

This case is no more about a right to state funding of abortion, as Intervenors

declare, than our decision in Hartford Accident and Indemnity Company v. Insurance

Commissioner of the Commonwealth was about the right to insurance discounts, 27 or our

decision in Cerra v. East Stroudsburg Area School District was about the right to

23 539 U.S. 558, 567 (2003).
24 Id.
25 Id. (recognizing that the challenged statutes reached “the most private human
conduct” and “the most private of places,” seeking to control a personal relationship that,
“whether or not entitled to formal recognition in the law, is within the liberty of persons to
choose without being punished as criminals”).
26 597 U.S. at 216 (“[T]he Fourteenth Amendment does not protect the right to an
abortion.”).
27 482 A.2d 542, 548 (Pa. 1984) (holding that the ERA is violated by an insurance
company’s assessment of higher insurance rates for men than for women).

[J-65-2022] [MO: Donohue, J.] - 7
continued employment. 28 Unlike the Fischer Court, and contrary to Intervenors’ framing,

we will not minimize the claim for equal access to health care and the right to non-

discrimination in the exercise of civil rights as merely a right to state funding. If the ERA

is to have any meaning, it must guarantee equal treatment for women’s health care. The

state cannot restrict women’s access to health care in ways that the government does not

restrict men’s access. Referring to this case as involving merely a funding issue assumes

the premise that women are not entitled to all that the law provides to men, belittling the

lives of women and casting them as second-class participants in a state-funded health

care scheme.

III. State Interest

I agree with the Majority that, under the Equal Rights Amendment to the

Pennsylvania Constitution, a sex-based distinction is presumptively unconstitutional. 29

The right of citizens to be free from sex-based distinctions in the law, like many

constitutional individual rights, partially cabins the General Assembly’s authority, under

its police power, to enact laws to protect the public health, safety and welfare of

Pennsylvanians. 30 When individual rights conflict with the exercise of the government’s

police power, it falls to the courts to subject such legislative enactments to a constitutional

analysis. 31 Under the constitutional analysis mandated by the ERA, the government

28 299 A.2d 277, 280 (Pa. 1973) (holding that the termination of a pregnant woman’s
employment on the basis of a physical condition unique to her sex was “sex discrimination
pure and simple”).
29 Maj. Op. at 123.
30 Id. at 119-20.
31 Id. at 120 (citing Nixon v. Commonwealth, 839 A.2d 277, 286 (Pa. 2003)
(acknowledging that, although “the General Assembly may, under its police power, limit
those rights by enacting laws to protect the public health, safety, and welfare,” such laws
are “subject to judicial review and a constitutional analysis”)).

[J-65-2022] [MO: Donohue, J.] - 8
bears the burden of rebutting the presumption that a sex-based distinction is

unconstitutional with evidence of a compelling state interest and evidence that there are

no less intrusive means to support that expressed interest. 32

This presumption mirrors our treatment of the Non-Discrimination Provision of the

Pennsylvania Constitution, under which the Commonwealth is prohibited from

discriminating against any person in the exercise of a civil right. 33 When it seeks to

classify individuals for different treatment on the basis of their exercise of a civil right, the

Commonwealth is required to establish that those classifications are justified. 34 Because

the Coverage Exclusion discriminates against women on the basis of their exercise of a

fundamental right, it similarly can survive only if it can weather strict judicial scrutiny under

which the government establishes that the classification is necessary to achieve a

compelling state interest and that the classification is narrowly tailored to effectuate that

interest. 35

Because DHS and the Commonwealth Court relied exclusively upon Fischer to

support their preliminary objections and to dismiss the petition for review, the parties have

not yet had the opportunity either to support or to rebut the purported state interest behind

the Coverage Exclusion. They will have this opportunity on remand. An attentive reader

understandably might perceive and question the absence of any substantial discussion

of the state’s ostensible interests in the Majority Opinion in this case. This absence does

32 Maj. Op. at 123.
33 PA. CONST. art. I, § 26 (“Neither the Commonwealth nor any political subdivision
thereof shall deny to any person the enjoyment of any civil right, nor discriminate against
any person in the exercise of any civil right.”).

34 Maj. Op. at 211.
35 Id. at 217.

[J-65-2022] [MO: Donohue, J.] - 9
not presuppose or presume the lack of any state interest but instead simply reflects the

current procedural posture of this case. At this juncture, we are deciding only the nature

of the constitutional rights that are implicated by the Coverage Exclusion. It is for the

court on remand to hear in the first instance from the parties about the state interest

purportedly advanced by the Coverage Exclusion.

Candor compels acknowledgment of the strong and closely held beliefs of many

people in this Commonwealth and their representatives who view fetal life as fully vested

human life, and who place the state’s interest in preserving fetal life above all other

interests. For many people in this Commonwealth, the presence of a fetus renders the

evaluation of the state’s interest in the context of abortion restrictions such as the

Coverage Exclusion inherently different from the state’s interest in other contexts because

abortion restrictions uniquely involve destroying embryos or fetuses. I reserve judgment

regarding the nature and impact of the state’s interest vis-à-vis the constitutional rights

that we recognize today. Here, I offer a few observations.

At some basic level, the debate is irreducible, the competing perspectives

irreconcilable, partaking as they do of profound questions about the meaning of human

life and when it begins. Pennsylvania’s Constitution is invoked in this appeal, and so this

Court must interpret that charter as we weigh the challenge before us. Hence, while we

acknowledge the reality that profound moral claims cannot always be neatly resolved with

logical certainty, judgment must be had. This case having come before us, such judgment

is our role.

The parties agree that the state interest advanced by the Coverage Exclusion is

the preservation of the life and health of fetuses and women. 36 To this end, the House

36 Providers’ Brief at 73; Senate Intervenors’ Brief at 54; House Intervenors’ Brief at
51.

[J-65-2022] [MO: Donohue, J.] - 10
Intervenors add that the state interest also generally encompasses promoting childbirth. 37

We need look no further than the Coverage Exclusion itself, as the legislation articulates

the interest that it purportedly advances: to “protect hereby the life and health of the

woman subject to abortion and to protect the life and health of the child subject to

abortion.” 38

Presently, Intervenors rely upon Fischer’s characterization of this interest as

important and legitimate, 39 and further assert that this interest is compelling. The Fischer

Court relied upon the state’s interest as articulated in Roe v. Wade, 40 an interest in

“potential life which may be destroyed” that may justify certain restrictions upon the

performance of abortion. 41 The Senate Intervenors assert that the state’s interest bears

the approval of the Supreme Court of the United States, which recognized in Roe the

state’s efforts to further “its legitimate goal of protecting the life of the unborn [ ] even

when in so doing the State expresses a preference for childbirth over abortion.” 42

According to the Senate Intervenors, the Coverage Exclusion is narrowly tailored to serve

the government’s interest in protecting life because it withholds funds that would end the

life of the fetus while making an exception to this restriction to protect the life of the

mother. Intervenors and their amici attempt to demonstrate the consistency of the

37 House Intervenors’ Brief at 69.
38 18 Pa.C.S. § 3202(a).
39 Fischer, 502 A.2d at 122 (characterizing the governmental interests of preserving
life as important and legitimate); see also Dobbs, 597 U.S. at 301 (applying rational basis
review and holding that the state’s interest in protecting unborn life is legitimate).
40 410 U.S. 113 (1973), overruled by Dobbs, 597 U.S. at 231.
41 Fischer, 502 A.2d at 118 (citing Roe, 410 U.S. at 162).
42 Senate Intervenors’ Brief at 36.

[J-65-2022] [MO: Donohue, J.] - 11
government’s interest in protecting life by referring to various legislative initiatives

promoting childbirth and newborn care. For example, the House Intervenors rely upon

annual appropriations to fund Real Alternatives, a program to support alternatives to

abortion. 43 The House Intervenors further rely upon the following legislation effectuating

the state’s interest in protecting the life and health of unborn fetuses: the Newborn

Protection Act, otherwise known as the Safe Haven Law; 44 the Crimes Against the Unborn

Child Act; 45 the elimination of the cause of action for wrongful birth and wrongful life; 46

the prohibition of a defense against a cause of action for an injury sustained in utero;47

the Newborn Child Testing Act; 48 the Keystone Mothers’ Milk Bank Act; 49 the Freedom to

Breastfeed Act; 50 and the Maternal Mortality Review Act. 51

43 House Intervenors’ Brief at 52 (citing https://www.realalternatives.org/ (last viewed
June 21, 2023) (describing the Real Alternatives Program as “the non-profit, charitable
organization that administers the Pregnancy and Parenting Support Services for . . .
Pennsylvania . . . funded by the Commonwealth.”)).
44 23 Pa.C.S. §§ 6501-09.
45 18 Pa.C.S. § 2601-2609 (requiring the killing or injury of an unborn child to be
charged as homicide or aggravated assault).
46 42 Pa.C.S. § 8305.
47 42 Pa.C.S. § 8306 (“Where a person has, by reason of the wrongful act or
negligence of another, sustained injury while in utero, it shall not be a defense to any
action brought to recover damages for the injury, or a factor in mitigation of damages, that
the person could or should have been aborted.”).
48 35 P.S. §§ 621-625 (mandating newborn screening).
49 35 P.S. §§ 5011-5024.
50 35 P.S. §§ 636.1-636.4.
51 35 P.S. §§ 10241-10248.

[J-65-2022] [MO: Donohue, J.] - 12
The House Intervenors also highlight administrative programs that demonstrate

the state’s interest in favoring childbirth, including: infant and pre-natal health services

and programs administered by the Bureau of Family Health within the Department of

Health; programs directed at reducing infant mortality and improving birth outcomes

administered by the Division of Child and Adult Health Services, such as lead poisoning

prevention and SIDS education; the provision of baby formula, newborn services, and

breastfeeding support by the Division of Newborn Screening; and programs attending to

the special health care needs of children and youth by the Division of Community Systems

Development and Outreach. Amici support these arguments by referring to additional

state-level programs and initiatives. 52 House Intervenors and the Senate Intervenors

separately invoke the state’s interest in protecting women’s health, supported by their

amici. 53

By contrast, the petition for review presents the myriad ways in which the Coverage

Exclusion increases risks to women’s health, including the medical risks of delayed

52 See Amicus Curiae The Pennsylvania Pro-Life Federation at 3 (relying upon the
Probate, Estates and Fiduciaries Code, 20 Pa.C.S. § 5429, which bars the withholding of
life sustaining treatment for a pregnant patient pursuant to a living will or health care
directive); Amicus Curiae Members of the Republican Caucus of the Pennsylvania House
of Representatives at 16 (relying upon the Down Syndrome Prenatal and Postnatal
Education Act, 35 P.S. §§ 6241-6244 and the regulation of abortion clinics in the Health
Care Facilities Act, 35 P.S. §§ 448.101-448.904b).
53 See Amicus Curiae Guiding Stars Ministries Brief at 6 (speculating that the public
funding of abortions will lead to the coercion of women to obtain abortions and will subject
women who refuse to obtain an abortion to violence by the father); id. at 15 (asserting
that abortion has negative health consequences for women, including risk of death,
cancer, birth defects, and behavioral changes); Amicus Curiae Texas Right to Life Brief
at 6-8, 10-12 (including, among purported physical threats to women’s health posed by
abortion, a higher risk of breast cancer, organ damage, ectopic pregnancies, infections,
obstetric hemorrhage, placenta previa, low birth weight in future pregnancies, stillbirth or
preterm birth in future pregnancies, miscarriage in future pregnancies, and psychological
injuries).

[J-65-2022] [MO: Donohue, J.] - 13
abortion, 54 a fourteen-fold increase in maternal mortality associated with childbirth as

compared to abortion, 55 the aggravation of health problems caused by pregnancy, 56 and

the psychosocial harm associated with being forced to have a child that the woman does

not want. 57 Providers’ Amici also emphasize the increasing maternal mortality rates in

the Commonwealth of Pennsylvania. 58

Providers believe that the state could advance its interest in preserving the health

and life of fetuses in a more narrowly-tailored fashion that does not infringe upon a

constitutional right by, for example, addressing racial and ethnic inequities in pregnancy

outcomes and increasing early prenatal care. 59 The Senate Intervenors respond by

asserting that it is the role of government to strike “the appropriate balance between a

woman’s right to reproductive choice and the Commonwealth’s interest in preserving

life.” 60 In the Senate Intervenors’ view, addressing racial and ethnic inequities in

pregnancy outcomes or increasing early prenatal care would not prevent pregnancies

from being terminated and therefore would not be tailored to the government’s interest in

protecting life.

54 Providers’ Brief at 5.
55 Id. at 5-6, 75 (observing that the rate of maternal death has more than doubled
since 1994).

56 Id. at 6.
57 Id.
58 Amicus Curiae New Voices for Reproductive Justice and Pennsylvania and
National Organizations Advocating for Black Women and Girls Brief at 7 (observing that
although eleven percent of women in the Commonwealth are black, black women account
for thirty-one percent of pregnancy-related deaths).

59 Providers’ Brief at 76 n.34.
60 Senate Intervenors’ Brief at 55.

[J-65-2022] [MO: Donohue, J.] - 14
Although we are remanding for the development of the state’s interest, I observe

that, by design, the Coverage Exclusion coerces women who cannot afford private health

care into carrying pregnancies to term. Any interest advanced by the Coverage

Exclusion, therefore, can be understood only as an interest that is advanced at the cost

of forcing women to bear children against their will. It will be DHS’s unenviable burden

on remand to establish that a state interest that is advanced through the coercive use of

women’s bodies is constitutionally compelling and that the Coverage Exclusion is

narrowly tailored.

When it develops its interest, the state cannot rely upon any notion of enforcing

sex roles, as any interest that relies upon sex-based stereotypes will run afoul of the

ERA. 61 The provision of unequal health care and the coercion of women to give birth

against their will would seem to serve archaic and stereotypical notions about women,

rooted in beliefs about the primacy of childbearing and the disapproval of women who

feel compelled to discontinue their pregnancies. To manifest respect for a woman as a

mother while manifesting disrespect for a woman’s health care decisions is to perpetuate

a value-laden, sex-based stereotype. Women’s reproductive capacity and their ability to

become mothers traditionally has long been used as justification for perpetuating

distinctions between the sexes. 62 The state may not constitutionally advance its

purported interest in promoting motherhood by pre-ordaining that role for all women.

61 Hartford, 482 A.2d at 548 (“Gender-based rates such as Hartford’s rely on and
perpetuate stereotypes similar to those condemned in [prior] cases.”); Ex rel Spriggs v.
Carson, 368 A.2d 635, 639 (Pa. 1977) (“We also question the legitimacy of a doctrine that
is predicated upon traditional or stereotypic roles of men and women in a marital union.”).
62 Maj. Op. at 88-90; see also, e.,g., Muller v. Oregon, 208 U.S. 412, 421 (1908)
(upholding legislation that limited the number of hours a woman could work in a laundry
based upon a woman’s “physical structure and the performance of maternal functions,”
as well as her historical dependence upon a man, as essential to “vigorous offspring” and
“the strength and vigor of the race”).

[J-65-2022] [MO: Donohue, J.] - 15
A sex equality approach to reproductive rights under the ERA requires the court

below to probe the state’s purported interests rather than to accept them at face value.

Analyzing the state’s proffer could require an examination of whether the state’s purported

interest in women’s health and potential life is asserted only against women who do not

conform to legislators’ expected sexual and parenting roles or whether the state uses its

policy prerogative consistently to protect potential life in other contexts and supports

women who choose to give birth. 63 Where the legislature uses the law to coerce but not

to support women in bearing children, its purported interest in potential life rings hollow.

To assess whether the Coverage Exclusion in particular is narrowly tailored to

advance a compelling government interest in potential life, it may be helpful to analyze

the exclusion in the larger context in order to determine whether the state advances its

interest selectively in ways that depend upon controlling women. 64 A state concerned

with protecting potential life could show that it advances this interest in ways that support

women who choose to have children in their efforts to bear and raise a healthy child by,

for instance, providing effective sex education, ensuring access to contraception, offering

comprehensive health care aimed at reducing infant and maternal mortality, enacting

policies that seek to reduce the negative health consequences of pregnancy, addressing

the financial reasons that may cause women to choose to end a pregnancy, supporting

63 See Reva B. Siegel, Sex Equality Arguments for Reproductive Rights: Their
Critical Basis and Evolving Constitutional Expression, 56 EMORY L. J. 815, 821 (2007)
(suggesting that courts ought to evaluate the state’s interest by examining whether the
interest manifests only in ways that coerce women or if the state acts consistently to
protect potential life in other ways).
64 There is nothing novel in strictly scrutinizing legislation in context to ensure that it
is narrowly drawn to accomplish compelling governmental interests. In Church of Lukumi
Babalu Aye, Inc. v. City of Hialeah, 508 U.S. 520, 546 (1993), for example, the Court held
that challenged ordinances were “overbroad or underinclusive in substantial respects”
because the government failed to pursue its proffered objectives in alternative ways that
would not have burdened constitutional rights.

[J-65-2022] [MO: Donohue, J.] - 16
mothers in their education and continued employment, or directing resources at reducing

infant mortality. 65

Others have noted that the state’s interest in potential life rings hollow if the state

chooses to burden the rights of women while simultaneously refusing to protect actual life

once a fetus becomes a child. 66 As this argument goes, without committing to protecting

the welfare of human lives after they are born, the state cannot rely in good faith on the

narrow tailoring of its purported interest in protecting the lives that are forming inside of

human beings. If the state declines to abate the risks inherent to being born to mothers

who may struggle to support children financially, it may be unpersuasive for the state to

rest upon its purported interest in protecting fetal life.

The state will also bear the burden of demonstrating that the Coverage Exclusion

manifests the state’s purported interest in fetal health. The Coverage Exclusion contains

no exception for an abortion that the woman seeks because the fetus is not viable or

65 See, e.g., Reva Siegel, Prochoicelife: Asking Who Protects Life and How—and
Why it Matters in Law and Politics, 93 IND. L.J. 207, 210-11 (2018) (“As theorists of
reproductive justice emphasize, many kinds of laws shape the conditions in which women
conceive and bear children. Laws on sexual education, contraception, abortion, health
care, welfare, and employment all can play a role in protecting new life as they change
the contexts in which women make decisions about conception, abortion, and
childbearing, and as they alter the resources available to pregnant women and new
mothers. A government that wished to reduce the number of abortions would not rely on
abortion law alone, even in jurisdictions where it is permissible to criminalize the
practice.”) (citations omitted).
66 See Leah A. Plunkett & Michael S. Lewis, The Wages of Crying Life: What States
Must do to Protect Children After the Fall of Roe, 2022 PEPP. L. REV. 14, 17–18 (2022)
(asking that “those who say they are ‘Pro-life’ in politics and law demonstrate that they
protect vulnerable life beyond the abortion context, and they do so in the most minimal
and obvious fashion by committing, at least, to protecting the basic welfare of the most
vulnerable children”).

[J-65-2022] [MO: Donohue, J.] - 17
because it suffers from a fatal impairment. Thus, it will be incumbent upon the state to

explain how the Coverage Exclusion serves the state’s interest in fetal health. 67

To the extent that DHS relies upon the purported state interest in the health of the

woman seeking an abortion, it bears noting that the Coverage Ban contains no exception

for abortions that are medically necessary for the woman’s health. Providers and their

Amici have raised a plethora of evidence showing that the Coverage Exclusion operates

contrary to that interest by sacrificing women’s health in service of the interest in

protecting fetal life. A state interest that truly was concerned with protecting women’s

health would contain an exception to the Coverage Exclusion for the health of the woman

even when she does not face death, yet the Coverage Exclusion omits any such

exception. 68 As this case proceeds on remand, and as the lower court subjects the

purported government interest to a searching judicial inquiry, it will be incumbent upon

the state to demonstrate how the Coverage Exclusion’s denial of abortions that are

medically necessary for the woman’s health—which denial, according to Providers’

assertions, severely undermines women’s health—is somehow serving the state’s

interest in protecting women’s health.

In establishing its interest, the Commonwealth may not run afoul of other

constitutional provisions. For instance, the First Amendment provides that “Congress

shall make no law respecting an establishment of religion, or prohibiting the free exercise

67 See New Mexico Right to Choose, 975 P.2d at 857 (finding that a coverage
exclusion was not the least restrictive means of advancing the state’s interest in potential
life because it permitted the denial of an abortion that was necessary because of the
health of the fetus).
68 See Maher, 515 A.2d at 156-57 (rejecting as support for a coverage exclusion the
proffered state interest in protecting the health of pregnant women because this interest
had no application to funding restrictions for medically necessary abortions that are in
service of women’s health).

[J-65-2022] [MO: Donohue, J.] - 18
thereof. . . .” 69 Religiously inspired abortion restrictions may constitute the establishment

of religion and prohibit individuals in the exercise of their faith (or lack thereof). 70 In Harris

v. McRae, the challengers argued that the Hyde Amendment, a statute precluding the

use of public funds to fund abortions, contravened the Establishment Clause because it

incorporated religious doctrines regarding the sinfulness of abortion and the time at which

life begins. 71 The United States Supreme Court rejected this argument. 72 Although Harris

suggests that the Supreme Court is unlikely to invalidate abortion restrictions on

Establishment Clause grounds, the Establishment Clause could limit the range of

interests that the state is entitled to advance. The same limitation applies to the state’s

interest through the religious freedom guaranteed by the Pennsylvania Constitution. 73 As

suggested by the range of amicus briefs on both sides of this case, religious perspectives

69 U.S. CONST. amend. I. These provisions are applicable to the states via the
Fourteenth Amendment. See Everson v. Bd. of Educ., 330 U.S. 1 (1947); Cantwell v.
Connecticut, 310 U.S. 296 (1940); Hamilton v. Regents of the Univ. of California, 293
U.S. 245 (1934).
70 See Karen F. B. Gray, An Establishment Clause Analysis of Webster v.
Reproductive Health Services, 24 GA. L. REV. 399, 402 (1990) (“Under the establishment
clause . . . , the Court should have emphasized the importance of freedom from proscribed
religious beliefs: prohibiting the government from showing any favoritism to a religious
sect, or religion itself, and from taking any action that will be perceived as showing
favoritism.”).
71 448 U.S. 297, 319 (1980).
72 Id. at 320 (“The fact that the funding restrictions in the Hyde Amendment may
coincide with the religious tenets of the Roman Catholic Church does not, without more,
contravene [the Establishment] Clause.”).
73 PA. CONST. art. I, § 3 (“[N]o human authority can, in any case whatever, control or
interfere with the rights of conscience, and no preference shall ever be given by law to
any religious establishments or modes of worship.”).

[J-65-2022] [MO: Donohue, J.] - 19
often inform individual understandings of when life begins. 74 The state’s interest in

protecting fetal life cannot be based upon a religious view of morality or upon religious

notions of when life begins or ensoulment occurs. Such spiritual matters have no more

role in government policy than government has in religious doctrine.

Should the Commonwealth establish a compelling government interest that is

narrowly tailored, this interest will be balanced against a woman’s right to equality and

against her fundamental right to make decisions about her own life and well-being,

particularly in the context of the serious threats upon which Providers rely. Many courts

that have engaged in this kind of balancing under heightened scrutiny have held that

women’s decisional autonomy regarding their own well-being is primary. 75 In today’s

case, however, the Majority Opinion correctly leaves such matters to be decided at

another time. 76

74 Compare Amicus Curiae Jewish Pro-Life Foundation, Institute for Judaism and
Civilization, Inc., Beit Emunah, LLC, Rabbi Menashe Bovit and Rabbi Yakov David
Cohen, Brief at 8-10 (relying upon faith to advocate for the Coverage Exclusion) with
Amicus Curiae National Council of Jewish Women, Catholics for Choice, and Other Faith-
Based Organizations, Brief at 5 (asserting that “[r]eligious teachings on abortion make
clear that reproductive choice is fundamentally a matter of personal conscience that is
informed by faith-based beliefs”).
75 See, e.g., Department of Health v. Planned Parenthood of Alaska, 28 P.3d 904,
913 (Alaska 2001) (“[A]lthough the State has a legitimate interest in protecting a fetus, at
no point does that interest outweigh the State’s interest in the life and health of the
pregnant woman.”); Maher, 515 A.2d at 157 (concluding that under the federal and state
constitutions the government’s interest in protecting potential life “cannot outweigh the
health of the woman at any stage of the pregnancy”); Right to Choose v. Byrne, 450 A.2d
925, 937 (N.J. 1982) (“A woman’s right to choose to protect her health by terminating her
pregnancy outweighs the State’s interest in protecting a potential life at the expense of
her health.”); Comm. to Defend Reprod. Rights, 625 P.2d 779, 781 (Cal. 1981) (“[T]he
asserted state interest in protecting fetal life cannot constitutionally claim priority over the
woman’s fundamental right of procreative choice.”).
76 See Maj. Op. at 116 (recognizing that the question remains whether the legislative
determination trumps the constitutional guarantee expressed in the Equal Rights
Amendment).

[J-65-2022] [MO: Donohue, J.] - 20
IV. Federal Constitutional Law

The present opportunity to explore the demands of the ERA, the right to

reproductive autonomy, and Pennsylvania’s Non-Discrimination Provision arises in the

wake of the Supreme Court of the United States’ decision in Dobbs. 77 Although federal

law in general and Dobbs in particular do not govern claims brought under the

Pennsylvania Constitution, a discussion of the federal constitutional underpinnings of

reproductive freedom is instructive here.

Prior to Dobbs, Roe had been the law of the land for nearly fifty years. The federal

right to abortion announced in Roe 78 and reaffirmed in Planned Parenthood v. Casey 79

was predicated upon liberty and privacy interests ostensibly protected by the Due Process

Clause of the Fourteenth Amendment, which provides: “nor shall any State deprive any

person of life, liberty, or property, without due process of law.” 80 As a textual matter, the

Due Process Clause guarantees fair legal procedures, obligating the government to

engage in a fair process before depriving anyone of his or her right to life, liberty, or

property. Over time, the guarantee of procedural due process began to be understood

77 597 U.S. 215.
78 410 U.S. at 153 (holding that the right to privacy, “whether it be founded in the
Fourteenth Amendment’s concept of personal liberty and restrictions upon state action,
as we feel it, or, as the District Court determined, in the Ninth Amendment’s reservation
of rights to the people,” encompassed a woman’s right to terminate her pregnancy).
79 505 U.S. 833, 851 (1991) (“These matters, involving the most intimate and
personal choices a person may make in a lifetime, choices central to personal dignity and
autonomy, are central to the liberty protected by the Fourteenth Amendment.”), overruled
by Dobbs, 597 U.S. 215.
80 U.S. CONST. amend. XIV.

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also to include substantive limitations upon the sort of laws the government could

enforce. 81

I have recently explored the oxymoronic extension of the Due Process Clause from

procedural guarantees to substantive rights in the context of the limitations that federal

substantive due process imposes upon punitive damages. 82 Relying upon the Due

Process Clause as the textual basis for substantive federal constitutional rights has been

problematic from its inception, from the paradoxical framing of the concept of substantive

due process to its expansion to encompass an immense body of law. 83 The substantive

iterations of the Due Process Clause have never aligned with its procedural predicate. 84

Although I believe that the United States Constitution protects unenumerated rights, I

have expressed elsewhere my belief that the judicially-manufactured construction of

substantive due process as a home for those rights has proven inadequate. 85 My

disagreement with substantive due process is not a rejection of federal constitutional

recognition of unenumerated rights but is rather an objection to tasking the procedural

framework of the Due Process Clause to protect those substantive rights. As I explained

81 Casey, 505 U.S. at 846 (“Although a literal reading of the Clause might suggest
that it governs only the procedures by which a State may deprive persons of liberty, for
at least 105 years. . . the Clause has been understood to contain a substantive
component.”).
82 The Bert Co. v. Turk, 298 A.3d 44, 86-95 (Pa. 2023) (Wecht, J., concurring).
83 See Saenz v. Roe, 526 U.S. 489, 527 (1999) (Thomas, J., dissenting) (observing
that “the demise of the Privileges or Immunities Clause has contributed in no small part
to the current disarray of our Fourteenth Amendment jurisprudence”).
84 See, e.g., Akhil Reed Amar, The End of Roe v. Wade, WALL ST. J., (May 14, 2022)
(observing that the Due Process Clause of the Fourteenth Amendment guarantees fair
legal procedures, that the Texas abortion law at issue in Roe provided fair courtroom
procedures, and that Roe’s due process argument was “textual gibberish”).
85 The Bert Co., 298 A.3d at 86-95 (Wecht, J., concurring).

[J-65-2022] [MO: Donohue, J.] - 22
in The Bert Company, the fundamental rights that the Supreme Court has attached to the

Due Process Clause generally fall within the category of “none of the government’s damn

business,” and are so fundamental to the “realm of personal liberty” that they warrant

federal constitutional protection. 86

As the Supreme Court now conceives of the Fourteenth Amendment, that

provision protects only rights that are explicitly mentioned in the text of the Constitution

or those that are “deeply rooted in the nation’s history and tradition” and “implicit in the

concept of ordered liberty.” 87 After Dobbs, it is particularly important for advocates to

advance and develop new legal theories, and to seek the abrogation of precedent that

stands in the way. As the U.S. Supreme Court recently has demonstrated an eagerness

to reconsider established precedent—even in the face of decades of reliance—advocates

should not be dissuaded by the uphill battle that awaits those who might seek to enshrine

unenumerated fundamental rights somewhere other than the unduly elasticized Due

Process Clause.

Although the right to abortion as developed in Roe was held to derive from

substantive due process under the Fourteenth Amendment, abortion rights supporters

critical of Roe’s substantive due process analysis have long examined alternative federal

constitutional provisions upon which to ground such a right. In What Roe v. Wade Should

Have Said, eleven scholars wrote mock judicial opinions deciding Roe upon alternative

86 Id. at *34 (Wecht, J., concurring).
87 Dobbs, 597 U.S. at 231 (holding that the Due Process Clause of the Fourteenth
Amendment “has been held to guarantee some rights that are not mentioned in the
Constitution, but any such right must be ‘deeply rooted in this Nation’s history and
tradition’ and ‘implicit in the concept of ordered liberty’”).

[J-65-2022] [MO: Donohue, J.] - 23
grounds. 88 Of the eight scholars writing in support of abortion rights, four of them relied

in whole or in part upon theories of gender equality instead of or in addition to theories of

personal autonomy or privacy. 89

The Supreme Court’s decision to ground a right to abortion in substantive due

process was not inevitable. The litigants in Roe settled upon advocating for a right to

privacy in order to fit their case within the right to privacy that had been established in

Griswold v. Connecticut and defined as the right to control personal matters without

government interference. 90 Although Justice William O. Douglas’ majority opinion in

Griswold relied upon “penumbras” and “emanations” in the Bill of Rights, and ultimately

settled upon the logic of privacy to strike down restrictions on contraception, 91 earlier

88 See Jack Balkin, Roe v. Wade: An Engine of Controversy, in WHAT ROE V. WADE
SHOULD HAVE SAID: THE NATION’S TOP LEGAL EXPERTS REWRITE AMERICA’S MOST
CONTROVERSIAL DECISION 3, 17-18 (Jack M. Balkin ed., 2005); Scott A. Moss & Douglas
M. Raines, The Intriguing Federalist Future of Reproductive Rights, 88 B.U.L.REV. 175,
185 (2008) (“The extent to which abortion rights supporters are abandoning Roe for better
arguments is perhaps clearest in Jack Balkin’s bold and controversial book, What Roe v.
Wade Should Have Said, in which eleven scholars wrote mock judicial opinions for Roe.
Eight supported constitutional limits on abortion bans, but in a striking consensus none of
the opinions adopted Justice Blackmun’s original trimester framework.”).
89 Moss & Rains, supra note 88, at 188.
90 381 U.S. 479, 485-86 (1965); see also id. at 484 (holding that the “specific
guarantees in the Bill of Rights have penumbras, formed by emanations from those
guarantees that help give them life and substance,” and that “[v]arious guarantees create
zones of privacy”).
91 Id. at 485 (holding that the right to privacy permits married couples to obtain and
use contraceptives); see also Eisenstadt v. Baird, 405 U.S. 438, 453 (1972) (holding that
a Massachusetts statute permitting married persons to obtain contraceptives to prevent
pregnancy but prohibiting distribution of contraceptives to single persons for that purpose
violates the Equal Protection Clause).

[J-65-2022] [MO: Donohue, J.] - 24
challenges to these laws had been grounded on theories of sex equality. 92 Similarly, prior

to Roe, litigants brought challenges to abortion restrictions on a number of bases,

including sex inequality 93 as well as race and class inequality. 94 In Hall v. Lefkowitz, for

example, a group of women challenged an abortion ban as being void for vagueness, as

invading the right to privacy, as violating equal protection, and as denying due process. 95

Activism surrounding the Hall lawsuit prompted the legislature to legalize abortion until

the twenty-fourth week of pregnancy, effectively mooting the case. 96 In Abele v. Markle,

92 See Melissa Murray, Race-ing Roe: Reproductive Justice, Racial Justice, and the
Battle for Roe v. Wade, 134 HARV. L. REV. 2025, 2047-48 (2021) (“Early challenges to
contraceptive bans noted that such laws placed heavier burdens on women than men,
while other challenges emphasized privacy as a necessary precondition for structuring
intimate life along more gender-egalitarian lines”).
93 Id. at 2048 (“As feminists integrated abortion into their public discourse around sex
equality, calls for sex equality were central to feminist legal challenges to abortion bans.
In contrast to early abortion challenges, which were framed in terms of the professional
obligations and rights of physicians, feminists challenging nineteenth-century abortion
bans in the 1970s explicitly framed their claims in terms of liberty, women’s equality, and
sexual freedom.”); see also Linda Greenhouse & Reva Siegel, BEFORE ROE V. WADE:
VOICES THAT SHAPED THE ABORTION DEBATE BEFORE THE SUPREME COURT’S RULING 174 (2d
ed. 2012) (tracing how the “arguments for liberalizing abortion law in the name of public
health gave way over time to claims of the women’s movement seeking for women liberty,
equality, and dignity: women’s right to control their own bodies and lives; to have their
voices and decisions treated with respect; and to participate as equals in private and
public life”).
94 See Reva B. Siegel, Roe’s Roots: The Women’s Rights Claims that Engendered
Roe, 90 B. U. L. REV. 1875, 1889 (2010) (reviewing arguments that “emphasized the ways
in which the social organization of motherhood varied across lines of socioeconomic class
and race” and that asserted that “the criminalization of abortion specially harmed poor
and minority women).
95 305 F. Supp. 1030, 1031 (S.D.N.Y. 1969) (“These are four separate actions
challenging New York State’s abortion laws on various grounds of constitutional infirmity,
including but not limited to vagueness, invasion of right of privacy, denial of equal
protection of the laws and due process.”).
96 See Siegel, supra note 94, at 1886.

[J-65-2022] [MO: Donohue, J.] - 25
lawyers emphasized the gendered and racial impact of an abortion ban (at a time when

there was no heightened scrutiny for sex discrimination) under the Equal Protection

Clause. 97 The action proved successful, and the court invalidated Connecticut’s criminal

abortion statute. 98

Several similar lawsuits were filed around the same time, appealing for authority

to a range of constitutional sources. These included arguments that abortion restrictions

violated: a woman’s right to life and liberty under the Fourteenth Amendment; a woman’s

right to equal protection under the Fourteenth Amendment; the right of poor women to

equal protection under the Fourteenth Amendment; the right to privacy as protected by

the Ninth Amendment; the Eighth Amendment by imposing motherhood as a punishment

for engaging in sex, a form of cruel and unusual punishment; the Thirteenth Amendment

as a form of involuntary reproductive servitude; and the Nineteenth Amendment by forcing

women to become mothers while organizing the core activities of citizenship to exclude

caregivers. 99 Broader concerns about sexual freedom and government intrusion into

private, intimate life also contributed to efforts to repeal and liberalize abortion laws.100

All of this history indicates that, prior to Roe, litigants had advanced a number of theories

to support their arguments against abortion bans and restrictions that reflected concerns

independent of substantive due process.

97 452 F.2d 1121, 1123 (2d Cir. 1971) (discussing the initial claims as including an
allegation that the abortion prohibition discriminated against women on the basis of sex);
Abele v. Markle, 342 F. Supp. 800 (D. Conn. 1972) (on remand), vacated as moot, 410
U.S. 951 (1973).
98 Abele, 342 F.Supp. at 801-02.
99 See Siegel, supra note 94, at 1881-82 (collecting cases).
100 See Melissa Murray, Essay, Griswold’s Criminal Law, 47 CONN. L. REV. 1045, 1059
(2015) (discussing the concerns about selective enforcement of morals offenses).

[J-65-2022] [MO: Donohue, J.] - 26
Although amicus in Roe had advanced an argument premised upon equal

protection, 101 the parties’ advocates made a strategic decision to advance their claims

under substantive due process. 102 The equality challenges central to the earlier cases

did not make their way into the Court’s articulation of abortion rights in Roe.

Consequently, the Roe decision itself reflected a narrow understanding of the rights

involved, focusing upon the role of physicians (rather than women), the state’s police

power, and the right to privacy through the lens of substantive due process. 103 Roe

therefore said nothing about the relationship between the freedom to make one’s personal

decisions and equality for women. 104 In recognizing a woman’s right to choose abortion

in consultation with her physician as a matter of substantive due process, Roe effectively

precluded the development of the right to abortion on other constitutional grounds, or at

least rendered such development unnecessary. After Roe anchored the right to abortion

in substantive due process, sealing off other potential wellsprings of the right under the

federal Constitution, litigants and courts focused their arguments and resources upon the

right as narrowly recognized in Roe.

Meanwhile, nascent sex equality claims under the federal Equal Protection Clause

struggled to gain traction. Although the federal promise of equal protection applied to

101 See Amicus Curiae New Women Lawyers et al., at 26, Roe v. Wade, 410 U.S. 113
(1971).
102 Murray, supra note 92, at 2049 (“And critically, unlike the feminist lawyers who
litigated Abele and Lefkowitz, the Roe lawyers, Linda Coffee and Sarah Weddington, did
not frame their arguments in terms of sex equality or race and class inequality, choosing
instead to root their claims in the privacy logic that had undergirded the Court’s earlier
contraception decisions.”).

103 Roe, 410 U.S. at 153, overruled by Dobbs, 597 U.S. 215.
104 See Amar, supra note 84 (criticizing Roe for failing to discuss “the relationship of
abortion rights to women’s equality” and Dobbs for “saying little—too little—about sex and
gender equality”).

[J-65-2022] [MO: Donohue, J.] - 27
women as well as to men, for the first one hundred years after the ratification of the

Fourteenth Amendment, the Supreme Court did not find any law unconstitutional because

it discriminated on the basis of sex. It was not until 1971, the year that the ERA was

adopted in Pennsylvania, that the United States Supreme Court concluded that unequal

treatment of women on the face of the law could violate the federal constitutional

guarantee of equal protection. 105

Even then, the court declined to apply heightened scrutiny and instead applied a

rational basis standard of review. In the 1973 case of Frontiero v. Richardson, 106 Justice

William Brennan, writing for himself and three other Justices, called for the Court to

recognize classifications on the basis of sex as inherently suspect, warranting strict

judicial scrutiny. 107 In a concurring posture and writing for himself and two other Justices,

Justice Lewis Powell disagreed that sex discrimination warranted strict scrutiny, citing the

fact that the federal Equal Rights Amendment had been sent to the states for ratification

just months before; if ratified, the Amendment would elevate sex to a suspect

classification. 108 Justice Powell’s concurrence deprived the Court of the requisite votes

to subject sex discrimination to strict scrutiny under the Equal Protection Clause.

In 1974, the Supreme Court held that the Equal Protection Clause was not

offended by the exclusion of pregnancy-related disability from a state disability insurance

program because pregnancy “is an objectively identifiable physical condition with unique

105 Reed v. Reed, 404 U.S. 71 (1971) (applying rational basis review to hold that a
statute distinguishing between men and women in estate administration violated the
Equal Protection Clause of the Fourteenth Amendment).
106 411 U.S. 677, 682 (1973).
107 Id. As discussed, Justice Brennan’s position did not garner a majority.
108 Id. at 692 (Powell, J., concurring).

[J-65-2022] [MO: Donohue, J.] - 28
characteristics.”109 Accordingly, discrimination on the basis of pregnancy was not sex

discrimination under the federal Constitution. 110 In 1976, the Supreme Court adopted

heightened or “intermediate” scrutiny for sex-based classifications, requiring the

government to establish that the classification serves important governmental objectives

that are substantially advanced by the sex-based classification. 111 Shortly thereafter, the

Court resolved the abortion funding cases under the federal Constitution, holding that

109 Geduldig v. Aiello, 417 U.S. 484 (1974). This characterization of pregnancy was
part of the Majority’s defense of its analysis from criticism by the dissent. The Geduldig
Majority believed that pregnancy discrimination has nothing to do with gender
discrimination because it is a physical condition:

The dissenting opinion to the contrary, this case is thus a far cry from cases
like Reed v. Reed, 404 U.S. 71 (1971), and Frontiero v. Richardson, 411
U.S. 677 (1973), involving discrimination based upon gender as such. The
California insurance program does not exclude anyone from benefit
eligibility because of gender but merely removes one physical condition—
pregnancy—from the list of compensable disabilities. While it is true that
only women can become pregnant it does not follow that every legislative
classification concerning pregnancy is a sex-based classification like those
considered in Reed, supra, and Frontiero, supra. Normal pregnancy is an
objectively identifiable physical condition with unique characteristics. . .
[L]awmakers are constitutionally free to include or exclude pregnancy from
the coverage of legislation such as this on any reasonable basis, just as
with respect to any other physical condition.

The lack of identity between the excluded disability and gender as such
under this insurance program becomes clear upon the most cursory
analysis. The program divides potential recipients into two groups—
pregnant women and nonpregnant persons. While the first group is
exclusively female, the second includes members of both sexes. The fiscal
and actuarial benefits of the program thus accrue to members of both sexes.

Id. at 497 n.20.
110 Id. at 494-95.
111 See Craig v. Boren, 429 U.S. 190, 197 (1976) (“[C]lassifications by gender must
serve important governmental objectives and must be substantially related to
achievement of those objectives.”).

[J-65-2022] [MO: Donohue, J.] - 29
federal and state restrictions that barred Medicaid from funding abortions did not

discriminate against a suspect class 112 and did not warrant heightened scrutiny. 113

While gender equality as a matter of equal protection struggled to gain traction with

a majority of the United States Supreme Court, Justice Harry Blackmun cited feminist

views about the equality of women in his responsive opinion in Casey. 114 Similarly, in her

dissent in Gonzales v. Carhart, Justice Ruth Bader Ginsburg attempted to tie the right to

abortion to women’s equality rather than to privacy. 115 Although a majority of the

Supreme Court has never adopted the rationale that reproductive rights are derived from

equality principles, academics steadfastly have continued to advance that rationale for

recognizing the right to abortion in the federal Constitution. 116

Although the parties did not brief an equal protection argument in Dobbs, amicus

there offered an equal protection argument which asserted that laws regulating pregnancy

are sex discrimination and are subject to heightened scrutiny; that the purported state

interest reflected sex-role stereotypes; and that the state deliberately chose not to adopt

less discriminatory and less coercive (but more effective) means of achieving its

112 Maher v. Roe, 432 U.S. 464, 470 (1977).
113 Harris v. McRae, 448 U.S. 297, 322-23 (1980).
114 505 U.S. at 928 (Blackmun, J., concurring in part, concurring in the judgment in
part, and dissenting in part) (recognizing that abortion restrictions implicate “constitutional
guarantees of gender equality”).
115 550 U.S. 124, 171-72 (2007) (Ginsburg, J., dissenting) (recognizing that abortion
restrictions implicate a woman’s control over her own destiny and that women have the
“right to participate equally in the economic and social life of the Nation”).
116 See Siegel, supra note 63, at 829; Ruth Bader Ginsburg, Essay, Some Thoughts
on Autonomy and Equality in Relation to Roe v. Wade, 63 N.C. L. REV. 375 (1985); Sylvia
A. Law, Rethinking Sex and the Constitution, 132 U. PA. L. REV. 955, 962-63 (1984).

[J-65-2022] [MO: Donohue, J.] - 30
purported goal of protecting women’s health and fetal life. 117 Dobbs without equivocation

closed the door on federal equality arguments as a basis for the constitutional right,

rejecting the argument advanced by amici because that theory was “squarely foreclosed

by our precedents, which establish that a State’s regulation of abortion is not a sex-based

classification and is thus not subject to the ‘heightened scrutiny’ that applies to such

classifications.”118 Opening the door to arguments rooted in equal protection would

require the Court to abrogate substantial precedent within its equal protection

jurisprudence. The federal Equal Protection Clause presently is not primed to advance a

right to abortion in terms of women’s equality.

Nevertheless, litigants should develop and advance alternative arguments for

federal equal protection and for unenumerated rights under the federal Constitution.

Dobbs’ rejection of federal due process as the basis for a federal right to abortion opens

the door to arguments that the right to abortion is rooted elsewhere in the federal

Constitution. To highlight a few possibilities in addition to the Equal Protection Clause, I

discern intriguing arguments premised upon the Ninth Amendment, the Privileges or

Immunities Clause, the Thirteenth Amendment, the First Amendment’s Establishment

Clause, the Eighth Amendment, and the Fifth Amendment.

The text of the Ninth Amendment, which provides that “[t]he enumeration in the

Constitution, of certain rights, shall not be construed to deny or disparage others retained

by the people,” plainly provides that the rights enumerated in the Constitution are not an

117 See Amicus Curiae Equal Protection Constitutional Law Scholars Serena Mayeri,
Melissa Murray & Reva Siegel as Amicus Curiae Supporting Respondents at 1, Dobbs,
597 U.S. 215.
118 Dobbs, 597 U.S. at 236.

[J-65-2022] [MO: Donohue, J.] - 31
exhaustive list. 119 I have discussed elsewhere the viability of the Ninth Amendment as

“[t]he most obvious constitutional source for the recognition of unenumerated rights.”120

Addressing the concern that the enumeration of certain rights in the Bill of Rights may

imply the exclusion of others, the Ninth Amendment makes explicit the existence of those

unenumerated rights that are protected from government infringement. 121 These

unenumerated rights exist alongside—and in addition to—those rights enumerated in the

Bill of Rights.

Before Roe made its way to the Supreme Court, the lower court had anchored its

ruling in the Ninth Amendment, specifically holding that this Amendment rendered the

abortion regulation unconstitutional. 122 The Supreme Court did not analyze this

119 U.S. CONST. amend. IX.
120 The Bert Co., 298 A.3d at 95 (Wecht, J., concurring).
121 Id. at 20 (Wecht, J., concurring) (reviewing the debate at the nation’s founding
between the Anti-Federalists, who advocated for the inclusion of the Bill of Rights in the
federal Constitution, and the Federalists, who feared that enumerating the Bill of Rights
would suggest that other rights were not protected); see also Randy E. Barnett, The Ninth
Amendment: It Means What It Says, 85 TEX. L. REV. 1, 14 (2006) (concluding the Ninth
Amendment guarantees the protection of unenumerated “individual, natural, preexisting
rights”); James Wilson, Remarks in Pennsylvania Constitution Debates (Nov. 30, 1787),
reprinted in 2 THE DOCUMENTARY HISTORY OF THE RATIFICATION OF THE CONSTITUTION, 436
(Merrill Jensen ed., 1976) (“A bill of rights annexed to a constitution is an enumeration of
the powers reserved. If we attempt an enumeration, everything that is not enumerated is
presumed to be given. The consequence is, that an imperfect enumeration would throw
all implied power into the scale of the government, and the rights of the people would be
rendered incomplete.”).
122 Roe v. Wade, 314 F. Supp. 1217, 1221 (N.D. Tex. 1970) (holding “that the Texas
Abortion Laws must be declared unconstitutional because they deprive single women and
married couples of their right, secured by the Ninth Amendment, to choose whether to
have children”), aff’d in part, rev’d in part by Roe, 410 U.S. 113.

[J-65-2022] [MO: Donohue, J.] - 32
reasoning. 123 After the Supreme Court settled upon the Due Process Clause as the

source of the right to abortion, courts have not attempted to return to the Ninth

Amendment as the root of that right. Although largely ignored by the Supreme Court, 124

the Ninth Amendment may provide a solid foundation for reproductive autonomy. In a

concurring opinion in Griswold, for example, Justice Arthur Goldberg persuasively

developed his position that the Ninth Amendment’s protection of unenumerated rights

encompasses “the right of privacy in marriage,” including the right to contraception. 125

While this idea has yet to find traction in the Court, academics and scholars have

continued to afford the Ninth Amendment more careful and thorough consideration.126

With the overruling of Roe in Dobbs, the Ninth Amendment is ripe for reinvigoration.

123 Roe, 410 U.S. at 153 (“This right of privacy, whether it be founded in the Fourteenth
Amendment’s concept of personal liberty and restrictions upon state action, as we feel it
is, or, as the District Court determined, in the Ninth Amendment’s reservation of rights to
the people, is broad enough to encompass a woman’s decision whether or not to
terminate her pregnancy.”).
124 See Chase J. Sanders, Ninth Life: An Interpretive Theory of the Ninth Amendment,
69 IND. L. J. 759, 769-72 (1994) (observing that the Supreme Court has played a negligible
role in Ninth Amendment rights jurisprudence).
125 See Griswold, 381 U.S. at 495-96 (Goldberg, J., concurring) (“The fact that no
particular provision of the Constitution explicitly forbids the State from disrupting the
traditional relation of the family—a relation as old and as fundamental as our entire
civilization—surely does not show that the Government was meant to have the power to
do so. Rather, as the Ninth Amendment expressly recognizes, there are fundamental
personal rights such as this one, which are protected from abridgment by the Government
though not specifically mentioned in the Constitution.”).
126 See, e.g., Christopher J. Schmidt, Revitalizing the Quiet Ninth Amendment:
Determining Unenumerated Rights and Eliminating Substantive Due Process, 32 U. BALT.
L. REV. 169, 189-90 (2003); Sanders, supra note 124, at 764-69 (advocating that “[t]he
Ninth Amendment protects the right to engage in, and prevents governmental
encroachment into, any activity or practice which entails no possibility of harm to either
the actor or other people. Only the significant possibility of tangible physical or economic
harm, not ‘harm’ in the form of public disapproval or moral offense, can justify
governmental intrusion under the Ninth Amendment.”).

[J-65-2022] [MO: Donohue, J.] - 33
In addition to the Due Process Clause and the Equal Protection Clause, the

Fourteenth Amendment is home to the Privileges or Immunities Clause, which provides

that “[n]o state shall make or enforce any law which shall abridge the privileges or

immunities of citizens of the United States.” 127 The text of this provision is broad enough,

on its own or together with the Ninth Amendment, to anchor unenumerated rights in the

federal Constitution and to protect such rights against state infringement. 128 The United

State Supreme Court, however, long ago stymied the development of the Privileges or

Immunities Clause as a fount of unenumerated rights, holding in the Slaughter-House

Cases that the clause protects citizens only against state infringement of rights created

by the federal government, as opposed to rights that predated the creation of the federal

government. 129 Roundly criticized, 130 the Slaughter-House Cases “sapped the [Privileges

or Immunities] Clause of any meaning.” 131 Although the Court has never overturned the

Slaughter-House Cases, Justice Clarence Thomas has shown particular interest in

revisiting the Privileges or Immunities Clause as a constitutionally legitimate source or

127 U.S. CONST. amend. XIV.
128 See Adam Lamparello, Fundamental Unenumerated Rights Under the Ninth
Amendment and the Privileges or Immunities Clause, 49 AKRON L. REV. 179, 181 (2016)
(“The Ninth Amendment’s language means what it says: fundamental rights exist
independently of the Constitution’s text, and citizens are entitled to full enjoyment of those
rights. These fundamental rights are the Fourteenth Amendment’s Privileges or
Immunities.”) (emphasis in original).
129 Slaughter-House Cases, 83 U.S. 36, 79 (1872).
130 See The Bert Co., 298 A.3d at 98-101 (Wecht, J., concurring) (reviewing
scholarship critical of the Slaughter-House Cases).
131 Saenz, 526 U.S. at 527 (Thomas, J., dissenting).

[J-65-2022] [MO: Donohue, J.] - 34
protector of fundamental rights. 132 Should the Supreme Court show the same willingness

to revisit its precedent limiting the Privileges or Immunities Clause that it applied to

precedent expanding substantive due process, that clause may, on its own or together

with the Ninth Amendment, prove ripe for reconsideration as a source for protecting and

guaranteeing fundamental, unenumerated rights.

Several commentators have suggested that abortion restrictions may be

vulnerable under the Thirteenth Amendment, the first section of which prohibits “slavery”

and “involuntary servitude,” except as a punishment for a crime, “within the United States,

or any place subject to their jurisdiction.” 133 Involuntary servitude encompasses “the

control of the labor and services of one man for the benefit of another, and the absence

of a legal right to the disposal of his own person, property and services.” 134 The Thirteenth

Amendment argument suggests that forcing women to give birth, to endure the dangers

of pregnancy and childbirth, is tantamount to involuntary servitude, and a dystopian

attempt to turn back the clock to the days of coverture, before a woman could vote or own

her own property. As Professor Andrew Koppelman has argued, women who are forced

to carry a pregnancy to term and to give birth against their will arguably are placed in

involuntary reproductive servitude. 135

132 Id. at 521 (Thomas, J., dissenting) (explaining that “the terms ‘privileges’ and
‘immunities’ (and their counterparts) were understood to refer to those fundamental rights
and liberties specifically enjoyed by English citizens and, more broadly, by all persons”).
133 U.S. CONST. amend. XIII.
134 Plessy v. Ferguson, 163 U.S. 537, 542 (1896) (overruled on other grounds by
Brown v. Board of Ed. of Topeka, Shawnee Cnty., Kan., 347 U.S. 483, 492 (1954)).
135 Andrew Koppelman, Forced Labor: A Thirteenth Amendment Defense of Abortion,
84 NW. U. L. REV. 480, 484 (1990); see also Jamal Greene, Thirteenth Amendment
Optimism, 112 COLUM. L. REV. 1733, 1739 n.36 (2012) (citing Laurence H. Tribe,
American Constitutional Law § 15-10, at 1354 n.113 (2d ed. 1988) (contending that “[t]he
(continued…)

[J-65-2022] [MO: Donohue, J.] - 35
This argument builds upon other creative invocations of the Thirteenth Amendment

in academia. 136 According to Professor Koppelman, “abortion prohibitions violate the

amendment’s guarantee of personal liberty, because forced pregnancy and childbirth, by

compelling the woman to serve the fetus, creates ‘that control by which the personal

service of one man is disposed of or coerced for another’s benefit which is the essence

of involuntary servitude.’” 137 Because forcing women to continue pregnancies against

their will and to become mothers “makes them into a servant caste,” Professor

Koppelman argues, abortion prohibitions inflict “the same kind of injury that antebellum

slavery inflicted” upon the enslaved, contrary to the Thirteenth Amendment. 138 Professor

Laurence Tribe also believes that judicial recognition of the similarities between the

[T]hirteenth [A]mendment’s relevance [to laws requiring a woman to continue an
unwanted pregnancy] is underscored by the historical parallel between the subjugation of
women and the institution of slavery”)); id. (citing Donald H. Regan, Rewriting Roe v.
Wade, 77 MICH. L. REV. 1569, 1619-20 (1979) (suggesting that the constitutional
argument against abortion statutes could be based on nonsubordination and physical
integrity values of the Thirteenth Amendment); Siegel, supra note 94, at 1884 n.34, 1891,
1896 n.98.
136 See Greene, supra note 135, at 1739 (drawing upon prior examples of “Thirteenth
Amendment Optimism,” i.e., arguments regarding the application of the Thirteenth
Amendment that deserve to “be taken seriously”); Moss & Raines, supra note 88, at 189
n.79 (reviewing Thirteenth Amendment arguments against abortion restrictions); Akhil
Reed Amar, Comment, The Case of the Missing Amendments: R.A.V. v. City of St. Paul,
106 HARV. L. REV. 124, 126 (1992) (contending that hate speech may “constitute [a]
badge[] of servitude that may be prohibited under the Thirteenth and Fourteenth
Amendments”); Akhil Reed Amar & Daniel Widawsky, Commentary, Child Abuse as
Slavery: A Thirteenth Amendment Response to DeShaney, 105 HARV. L. REV. 1359
(1992).
137 Koppelman, supra note 135, at 484 (quoting Bailey v. Alabama, 219 U.S. 219, 241
(1911)); see also Michele Goodwin, Opinion, No, Justice Alito, Reproductive Justice Is in
the Constitution, N.Y. TIMES (Jun. 26, 2022), https://perma.cc/E2QX-GH6W (“This
Supreme Court . . . ignores the intent of the 13th and 14th Amendments, . . . which
extended . . . to shielding [black women] from rape and forced reproduction.”).
138 Id. at 485.

[J-65-2022] [MO: Donohue, J.] - 36
historical plight of women and the enslaved underscores the Thirteenth Amendment’s

relevance, and has asserted that a “woman forced by law to submit to . . . carrying,

delivering, and nurturing a child she does not wish to have is entitled to believe that more

than a play on words links her forced labor with the concept of involuntary servitude.”139

The Tenth Circuit recognized the logical force of this argument when it reversed the

imposition of attorneys’ fees for frivolous litigation, relying upon Professor Tribe’s

comments and the analogy between “restrictive state regulation of abortion and

involuntary servitude.” 140

Blending the Thirteenth and Fourteenth Amendments together, Professor Jed

Rubenfeld has argued that there is a freedom to choose one’s occupation that extends to

abortion rights. 141 Relying upon the Thirteenth Amendment’s prohibition of states

compelling individuals to fulfill employment contracts, and finding a right to privacy in the

Privileges or Immunities Clause of the Fourteenth Amendment that includes the right to

choose one’s calling in life, Professor Rubenfeld asserts that, “[i]f a state cannot force a

man to till a field, it cannot force a woman to mother a child.”142

139 See Moss & Raines, supra note 88, at 189 n.80 (quoting Lawrence H. Tribe,
American Constitutional Law § 15-10, at 1354 (2d. ed. 1988)).
140 Jane L. v. Bangerter, 61 F.3d 1505, 1515 (10th Cir. 1995); see also Casey, 505
U.S. at 928 (Blackmun, J., concurring in part, concurring in the judgment in part, and
dissenting in part) (“By restricting the right to terminate pregnancies, the State conscripts
women’s bodies into its service, forcing women to continue their pregnancies, suffer the
pains of childbirth, and in most instances, provide years of maternal care.”).
141 Jed Rubenfeld, Concurring in the Judgment Except as to Doe, in WHAT ROE V.
WADE SHOULD HAVE SAID: THE NATION’S TOP LEGAL EXPERTS REWRITE AMERICA’S MOST
CONTROVERSIAL DECISION, 109, 111 (Jack M. Balkin ed., 2005)); Moss & Raines, supra
note 88, at 189.
142 Id.

[J-65-2022] [MO: Donohue, J.] - 37
Before Dobbs, the Establishment Clause also had garnered interest as a potential

limitation upon abortion restrictions. 143 Under this theory, closely held beliefs about when

life begins and the relative value of potential life balanced against the health of the

pregnant woman are to a large extent informed by one’s religious views. 144 The

Establishment Clause argument suggests that the state’s interest in protecting fetal life

advanced by abortion restrictions is susceptible to being rejected as an endorsement of

a particular religious tenet or philosophy. 145 As I have noted elsewhere, under prevailing

Supreme Court jurisprudence, the Free Exercise Clause has in many ways swallowed

the Establishment Clause. 146 Nonetheless, considerable persuasive force remains in the

143 Gray, supra note 70, at 417 (“The establishment clause line of reasoning affords a
superior basis for allowing individual free choice in abortion decisions than the right to
privacy argument.”).
144 See supra, note 74.
145 Gray, supra note 70, at 417-18 (“Empirical proof establishes that: (1) the general
public views the issue as a religious one; (2) no consensus exists in other disciplines
supplying a nonreligious ground for the alleged religious endorsement; (3) the challenged
view is aligned with a particular religious belief; and (4) the government enacts abortion
statutes so based upon the legislators’ own religious beliefs or pressure from the groups
aligned with religiously motivated, anti-abortion beliefs.”) (footnotes omitted).
146 David N. Wecht, Majoritarianism Run Riot: Christian Supremacism and the
Religion Clauses, 58 GONZAGA L. REV. 93 (2023) (reviewing Am. Legion v. Am. Humanist
Ass’n, 139 S.Ct. 2067, 2089 (2019) (using history and tradition to insulate the
Bladensburg Cross from an Establishment Clause challenge); Shurtleff v. City of Boston,
142 S.Ct. 1583, 1593 (2002) (rejecting a challenge to a crucifix flag in front of city hall
under the Establishment Clause); Kennedy v. Bremerton Sch. Dist., 142 S.Ct. 2407, 2433
(2022) (approving of public prayer by a public school football coach on the public school
football field against an Establishment Clause challenge); and Town of Greece v.
Galloway, 572 U.S. 565, 591-92 (2014) (approving of sectarian Christian prayers at
government meetings)).

[J-65-2022] [MO: Donohue, J.] - 38
argument that religiously infused state interests supporting abortion restrictions are

“wholly illegitimate” as a violation of the Establishment Clause. 147

Prior to Roe, and in an amicus brief filed in Roe, advocates relied in part upon the

Eighth Amendment to inform their understanding of abortion restrictions that carry

criminal consequences and threaten cognizable harm to women or to physicians, arguing

that “abortion laws inflicted cruel and unusual punishment on women not imposed on men

for conduct no longer fairly understood as criminal.”148 Another argument views abortion

regulations as takings that demand just compensation under the Fifth Amendment.149

And yet another argument draws upon Griswold’s description of marriage as an

147 David R. Dow, The Establishment Clause Argument for Choice, 20 GOLDEN GATE
U. L. REV. 479, 488 (1990); see also id. at 494 (“interests rooted in orthodox religiosity are
not even legitimate, and certainly not compelling.”); Abigail Sellers, How the First
Amendment’s Commitment to Religious Freedom Could Ironically Save Roe v. Wade…If
We Let It, 94 S. CAL. L. REV. 691, 718 (2021) (observing that, despite the unsuccessful
Establishment Clause challenge in Harris, the “time has come for a potentially successful
Establishment Clause challenge to a restrictive abortion law”); John Morton Cummings,
Jr., The State, the Stork, and the Wall: The Establishment Clause and Statutory Abortion
Regulation, 39 CATH. U. L. REV. 1191, 1193 (1990) (suggesting that statutory abortion
restrictions “lack a secular purpose, benefit specific religious organizations, unnecessarily
entangle church and state, and place the state on one side of a political issue which is
divided along religious lines, thus violating the establishment clause”).
148 Siegel, supra note 63, at 824. The Amicus Curiae Brief in Roe asserted that “[s]uch
punishment involves not only an indeterminate sentence and a loss of citizenship rights
as an independent person . . . [and] great physical hardship and emotional damage
‘disproportionate’ to the ‘crime’ of participating equally in sexual activity with a man . . .
but is punishment for her ‘status’ as a woman and a potential child-bearer.” Brief of
Amicus Curiae on Behalf of New Women Lawyers et al. at 24, Roe, 410 U.S. 113.
149 See Nicole Knight, American Motherhood—A Taking, 43 MITCHELL HAMLINE L.J.
PUB. POL’Y & PRAC. 162 (2022); Rebecca L. Rausch, Reframing Roe: Property over
Privacy, 27 BERKELEY J. OF GENDER L. & JUST. 28 (2012); Susan E. Looper-Friedman,
“Keep Your Laws Off My Body”: Abortion Regulation and the Takings Clause, 29 NEW
ENG. L. REV. 253, 256 (1995); Jeffrey D. Goldberg, Comment, Involuntary Servitudes: A
Property-Based Notion of Abortion-Choice, 38 U.C.L.A. L. REV. 1597, 1609-12 (1991).

[J-65-2022] [MO: Donohue, J.] - 39
association to ground a right to reproductive privacy in the First Amendment’s freedom of

intimate association. 150

I offer no judgment on these arguments, some of which strike me as more

persuasive than others. Shifting the right to have an abortion from substantive due

process will require the advancement of novel legal theories and the abrogation of

substantial precedent. The Supreme Court that overturned Roe might not be open to

alternative arguments which maintain that the right that Roe protected is located

elsewhere in the Constitution. I merely observe that, in the wake of Dobbs, litigants have

the opportunity to craft what may prove to be better arguments than the rickety analysis

upon which Roe landed. This journey will be neither quick nor easy.

V. State Constitutional Law

Prior to Dobbs, the right to abortion articulated in Roe protected women from

unduly burdensome interference with the freedom to make their own decisions. Because

this right was established as a matter of federal law, there was no cause to resolve the

extent to which a state constitution independently protects reproductive autonomy. Now

that this federal floor has been demolished, states have a fresh opportunity to resolve

with renewed vigor claims of equality and reproductive autonomy that are untethered to

any possible limitations imposed by the federal constitution. 151 This court’s interpretation

of our organic charter does not rely in any respect upon the tenuous hook of federal

substantive due process in particular or upon the federal constitution more generally.

150 Kenneth L. Karst, The Freedom of Intimate Association, 89 YALE L.J. 624, 641
(1980) (“Coerced intimate association in the shape of forced childbearing or parenthood
is no less serious an invasion of the sense of self than is forced marriage or forced sexual
intimacy.”).
151 See Providers’ Supplemental Brief at 1-4 (arguing that, in the wake of Dobbs, “this
Court’s role in protecting the right to abortion under our state constitution takes on new
importance”).

[J-65-2022] [MO: Donohue, J.] - 40
As the Majority develops, Article I, Section 1’s broad protections for individual

rights protect a woman’s right to decide whether to continue a pregnancy. 152 Indeed,

bodily autonomy is so essential to the foundational concept of liberty that it is hard to

imagine any liberty that is more fundamental than the right to make decisions about one’s

own body. In this respect, the guarantee of reproductive autonomy is a safeguard against

tyranny. Without this guarantee,

the state would become omnipresent: It would be in its subjects’ values,
beliefs, opinion, worldviews, politics, and so forth. If the state is present in
its subjects’ minds and hearts—indeed, if the state forms its subjects’ minds
and hearts—the state, in very important ways, would form the institutions in
civil society that individuals create. . . . And if the state forms the institutions
of civil society, this is totalitarianism. 153
Although state control over the bodies of women and over the intimate decisions of

families may not strike one as problematic if one’s conscience aligns with the interests

advanced by the state, this discrete and momentary alignment is no protection against

the state shifting its target. Empowering the state to direct and occupy the lives of

individuals in ways that serve our personal interests also empowers the state to direct

and occupy our lives in ways that do not.

The right to reproductive autonomy anchored in Article I, Section 1 may also be

supported by other provisions in our Constitution, including the ERA itself and Article I,

Section 3. The Majority correctly foreshadows this possibility, linking the right to

reproductive autonomy in Article I, Section 1 to the ERA and observing that equality would

mean little if women did not possess autonomy over their own destinies. 154

152 Maj. Op. at 132-168.
153 Khiara M. Bridges, THE POVERTY OF PRIVACY RIGHTS 104 n.1 (Stanford Law Books,
1st ed. 2017).
154 Maj. Op. at 165.

[J-65-2022] [MO: Donohue, J.] - 41
As federal equal protection was sidelined as a basis of reproductive autonomy in

favor of substantive due process, equality began to emerge as the dominant rationale to

protect abortion access in the states. 155 The Majority’s overview of the history leading up

to the adoption of the ERA in the Commonwealth and the intent of its supporters

demonstrates that the ERA’s express guarantee provides fertile ground to recognize the

right to abortion as a matter of sex equality. Although Providers are not arguing that the

right to reproductive autonomy rests upon the ERA, focusing instead upon Article I,

Section 1, the ERA may provide independent authority requiring courts to strike down

abortion related restrictions that perpetuate gender-based inequality. 156

Under our ERA, legislative sex-based classifications presumptively are

unconstitutional. 157 As we stated unequivocally in Henderson v. Henderson,

[t]he sex of citizens of this Commonwealth is no longer a permissible factor
in the determination of their legal rights and legal responsibilities. The law
will not impose different benefits or different burdens upon the members of
a society based on the fact that they may be man or woman. 158

155 See, e.g., Maher, 515 A.2d at 159; New Mexico Right to Choose, 985 P.2d at 852-
55.
156 See, e.g., Grace Kavinsky, Comment, An Opportunity for Feminist
Constitutionalism, 75 STAN. L. REV. 1209, 1221 (2023) (advocating for states to adopt a
new abortion right, one based upon the express guarantees of sex equality that “lies
untapped in many state constitutions in the form of an equal rights amendment. . .”).
157 Maj. Op. at 123.
158 327 A.2d 60, 62 (Pa. 1974) (invalidating a statutory scheme awarding alimony
pendente lite and counsel fees only to wife and not husband); see also Spriggs, 368 A.2d
at 639-40 (plurality) (questioning the legitimacy of the tender years doctrine as predicated
upon “traditional or stereotypic roles of men and women in a marital union” and being
offensive to the equality of the sexes); Adoption of Walker, 360 A.2d 603, 605 (Pa. 1976)
(invalidating statutory distinction between unwed mothers and unwed fathers); Butler v.
Butler, 347 A.2d 477, 480 (Pa. 1975) (invalidating a presumption that, where a husband
obtains his wife’s property without adequate consideration, a trust is created in the wife’s
favor); Commonwealth v. Santiago, 340 A.2d 440, 445-46 (Pa. 1975) (invalidating the
(continued…)

[J-65-2022] [MO: Donohue, J.] - 42
The state may not rebut the presumption of unconstitutionality if the legislative enactment

perpetuates traditional gender stereotypes. 159

There is ample support in the ERA to go beyond invalidating explicit gender-based

distinctions to also invalidate laws and policies that operate to perpetuate sex-based

inequality. As we have recognized, “[t]he thrust of the Equal Rights Amendment is to

insure [sic] equality of rights under the law . . . .” 160 When we talk about reproductive

autonomy, what is really at stake is the prospect of equal citizenship. Although federal

jurisprudence has done little to recognize reproductive autonomy as an issue of equality,

it is apparent that equality is illusory without the ability to control one’s body, including

one’s reproductive decisions. As Justice Ginsburg tirelessly articulated, equality

demands “woman’s autonomy to determine her life’s course, and thus to enjoy equal

citizenship stature.” 161 Being empowered under the law to determine the timing of

presumption under the common law concept of coverture that presumed that a married
woman, committing a crime in her husband’s presence, was an unwilling participant);
DiFlorido v. DiFlorido, 331 A.2d 174, 180 (Pa. 1975) (holding that property acquired in
anticipation of or during marriage and which has been possessed and used by both
spouses will, in absence of contrary evidence, “be presumed to be held jointly by the
entireties.”); Commonwealth v. Butler, 328 A.2d 851, 85-57 (Pa. 1974) (invalidating
statutory parole eligibility for women but not men); Hopkins v. Blanco, 320 A.2d 139, 140
(Pa. 1974) (affording equal treatment of loss of consortium claims brought by husbands
and wives); Conway v. Dana, 318 A.2d 324, 326 (Pa. 1974) (refusing to follow the
presumption that the father must bear the principal burden of financial support for couple’s
children).
159 Hartford, 482 A.2d at 548 (“[W]e have not hesitated to effectuate the [ERA]’s
prohibition of sex discrimination by striking down statutes and common law doctrines
‘predicated upon traditional or stereotypic roles of men and women.’”) (quoting Spriggs,
368 A.2d at 639); DiFlorido, 331 A.2d at 180 (validating the equal financial contributions
of both spouses in a marriage).
160 Henderson, 327 A.2d at 62.
161 Gonzales, 550 U.S. at 172 (Ginsburg, J., dissenting); see also Ginsburg, supra
note 116 (arguing that grounding the right to abortion in equal protection, rather than
substantive due process, would not have prompted such social opposition and backlash);
(continued…)

[J-65-2022] [MO: Donohue, J.] - 43
motherhood protects a woman’s status as an equal citizen by affording her autonomy

over her sexuality, her relationships, her education, her career, her family, and her life. 162

This remedial purpose is served by invalidating legislative schemes that may appear

neutral on their face but operate in fact in a discriminatory manner. 163 In this respect, the

ERA can be read as barring the government from singling out and targeting the

reproductive health choices of women.

Ruth Bader Ginsburg, Speaking in a Judicial Voice, 67 N.Y.U. L. REV. 1185, 1200 (1992)
(opining that Roe should have focused “on the women’s equality dimension of the issue.
. . .”). Although Justice Ginsburg understood abortion rights as a matter of equality, the
Court majority continued to view challenges to abortion restrictions through the lens of
substantive due process.

162 As explained by Kathryn Kolbert and David H. Gans,

Singling out abortion services for proscription or special regulation violates
the core meaning of equality: it singles out women for adverse treatment.
Because only women obtain abortions, the direct impact of abortion
restrictions falls on a class composed only of women, while men are able to
protect their health and exercise their pro-creative choices free of
governmental interference. Restrictive legislation coerces only women to
continue their pregnancies to term. Only women bear the harmful
consequences of dangerous, illegal abortions, where the state has made
safe, legal abortions unavailable.

Responding to Planned Parenthood v. Casey: Establishing Neutrality Principles in State
Constitutional Law, 66 TEMP. L. REV. 1151, 1167 (1993).
163 See, e.g., DeFlorido 331 A.2d at 179 (invalidating a facially neutral policy in favor
of one that would “acknowledge the Equally important and often substantial nonmonetary
contributions made by either spouse”); Kemether v. Pa. Interscholastic Athletic Ass’n,
1999 WL 1012957, at *20 (E.D. Pa. 1999) (finding a violation of the ERA where a law
purported to treat men and women equally but had the effect of perpetuating
discriminatory practices and unfairly burdening women); see also Hon. Phyllis W. Beck &
Patricia Daly, Prohibition Against Denial or Abridgement of Equality of Rights Because of
Sex, THE PENNSYLVANIA CONSTITUTION: A TREATISE ON RIGHTS AND LIBERTIES, § 30.1, 708
(Ken Gormley & Joy G. McNally eds. 2nd ed. 2020) (observing that the courts of this
Commonwealth have recognized that the ERA triggers “a comprehensive eradication of
gender bias” and provides “protections far more extensive than afforded by the federal
law.”).

[J-65-2022] [MO: Donohue, J.] - 44
As the Majority observes, our own Pennsylvania Constitution was amended to

protect against sex discrimination at a time when the country as a whole was debating

the federal equal rights amendment. 164 Though ultimately unsuccessful, this federal effort

was the impetus for considering state equal rights amendments across the nation and for

the adoption of the ERA in Pennsylvania. 165 Federal proponents believed that women

were relegated to an inferior social position and were exploited or were prevented from

realizing their full potential. 166 These proponents sought an equal rights amendment at

the federal level because of dissatisfaction with the Supreme Court of the United States’

treatment of claims of sex-based discrimination under the federal Equal Protection

Clause. 167 Federal opponents, on the other hand, made the case that sex equality

implicated a right to abortion. 168 As the debates about the federal ERA evolved, reforming

criminal abortion laws became a central focus of the debate, driven by arguments of

equality. This constitutional dialogue led to the birth of Pennsylvania’s ERA in 1971.

At the time that our Constitution was amended to protect equality of the sexes in

1971, classifications that disadvantaged women on the basis of pregnancy were already

considered sex discrimination. The Pennsylvania Human Relations Commission

164 Maj. Op. at 87, 90-91.
165 Beck & Daly, supra note 163, at § 30.2, 709.
166 Id.
167 Maj. Op. at 90-91.
168 Siegel, supra note 63, at 828 (“Paradoxically, throughout the 1970s and into the
early 1980s, it was the ERA’s opponents rather than its proponents who were most likely
to assert that abortion was a sex equality right.”); Reva B. Siegel, Constitutional Culture,
Social Movement Conflict and the Constitutional Change: The Case of the De Facto ERA,
94 CALIF. L. REV. 1323, 1390 (2006) (“[Phyllis] Schlafly linked together the ERA, abortion,
and homosexuality in ways that changed the meaning of each, and mobilized a
grassroots, ‘profamily constituency’ to oppose this unholy trinity.”).

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disseminated Guidelines on Discrimination Because of Sex in 1970 and construed the

Human Relations Act’s bar on sex discrimination to include discrimination against

employees who took time away from work due to childbirth. 169 We validated those

guidelines in Cerra, holding that pregnancy discrimination is “sex discrimination pure and

simple.”170

In the aftermath of the adoption of the ERA, this Court immediately heeded its call

to enshrine equality of the sexes by equalizing the availability of loss of consortium claims

between husbands and wives based upon the understanding of marriage as an equal

partnership. 171 In DeFlorido, after eliminating the common law presumption that all

property acquired during a marriage is owned by the husband, the Court was faced with

the lower court’s adoption of an alternative method of determining ownership according

to who paid for the property. 172 Although that approach appeared facially neutral, the

Court looked deeper and determined that it was discriminatory as applied because it

“would fail to acknowledge the [e]qually important and often substantial nonmonetary

contributions made by either spouse.” 173 This jurisprudence recognizes that the ERA

may reach beyond legislation that explicitly treats men and women differently and require

judicial scrutiny of laws that perpetuate sex-based inequality while appearing neutral.

169 Pa. Human Relations Comm’n, Guidelines on Discrimination Because of Sex, 1
(24) Pa. Bull. 707-08 (Dec. 19, 1970); see also Maj. Op. at 75.
170 299 A.2d at 280.
171 Hopkins, 320 A.2d 139, 140 (rejecting the disparate treatment of loss of consortium
claims as having “no rational or proper foundation at law” because “husband and wife are
equal partners in the marital relationship, and, as such, should be treated equally under
the law with respect to that relationship”).

172 331 A.2d at 179-80.
173 Id. at 179.

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At the time that Pennsylvanians were considering the ERA, the Supreme Court of

the United States was interpreting the federal Constitution anemically, in a manner that

did not effectively rectify sex discrimination. In particular, the Supreme Court requires

state action, imposes a formal model of equality, applies intermediate rather than strict

scrutiny, and is unwilling to examine disparate impact. 174 In each respect, the ERA has

the capacity to provide broader protections than federal equal protection. Whatever

limitations the Supreme Court perceives in the federal Equal Protection Clause, those

have no bearing upon our interpretation of our own ERA.

Because the U.S. Supreme Court has limited the promise of equal protection by

requiring state action, it provides no protection against discrimination that occurs in the

private spheres of civil society and within the family. 175 There is no such requirement

under the ERA. “The rationale underlying the ‘state action’ doctrine is irrelevant to the

interpretation of the scope of the Pennsylvania Equal Rights Amendment, a state

constitutional amendment adopted by the Commonwealth as part of its own organic

174 Linda J. Wharton, State Equal Rights Amendments Revisited: Evaluating Their
Effectiveness in Advancing Protection Against Sex Discrimination, 36 RUTGERS L.J. 1201,
1205 (2005) (observing that several factors have limited the scope of protection available
under the Equal Protection Clause: “(1) the requirement of state action; (2) the failure of
the Supreme Court to subject claims of sex discrimination to the ‘strict scrutiny’ standard
of review applied to claims of race discrimination; (3) the Supreme Court’s application of
a formal equality model of analysis that further reduces the protection afforded claims of
sex discrimination when men and women are deemed not similarly situated; and (4) the
unwillingness of the Supreme Court, based proof of intentional discrimination, to closely
scrutinize facially neutral governmental regulations or policies that disparately impact
women”).
175 See, e.g., Shelly v. Kraemer, 334 U.S. 1, 13 (1948) (“Since the decision of the
Court in the Civil Rights Cases, the principle has become firmly embedded in our
constitutional law that the action inhibited by the first section of the Fourteenth
Amendment is only such action that may fairly because said to be that of the States. That
Amendment erects no shield against merely private conduct.”); Civil Rights Cases, 109
U.S. 3, 11 (1883).

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law.” 176 Rather than adhering to federal precepts, this Court looked to the language of

the ERA. Hartford suggests that “Pennsylvania ERA protections against gender

discrimination are greater than those protections typically provided in federal cases

requiring state action.” 177

In addition, the United States Supreme Court has developed an understanding

similar to Fischer’s conception of “physical characteristics unique to one sex”178 that was

grounded upon what Professor Reva Siegel has termed “physiological naturalism”: the

idea that reproduction is a physiological process divorced from judgments about social

roles and that it is therefore permissible to regulate reproduction through the female

body. 179 The requirement of formal equality premised upon physiological naturalism

176 Hartford, 482 A.2d at 586 (rejecting the argument that a claim under the ERA
requires state action); see also Welsch v. Aetna Insurance Co., 494 A.2d 409, 412 (Pa.
Super. 1985) (extending the rationale of Hartford to claims brought directly against
insurance companies).

177 Beck & Daly, supra note 163, at § 30.3, 715.
178 Fischer, 502 A.2d at 125.
179 See Reva Siegel, The Pregnant Citizen, from Suffrage to the Present, 19th Amend.
Ed.,108 GEO. L. J. 167, 189 n.127 (2020) (“[A]ccording to the logic of physiological
naturalism, because reproductive differences are objective, real, and categorically
distinguish the sexes, (1) judgments about pregnancy are free of stereotypes and
constitutionally suspect assumptions about social roles and (2) laws imposing unique
burdens on one sex are reasonable.”); Reva Siegel, Reasoning From the Body: A
Historical Perspective on Abortion Regulation and Questions of Equal Protection, 44
STAN. L. REV. 261, 265 (1992) (describing the tendency of the courts to address
“reproduction as if it were primarily a physiological process” and to evaluate “its regulation
in terms focused on the female body” as “physiological naturalism”); see also Michael M.
v. Superior Court, 450 U.S. 464, 469 (1981) (Stewart, J., concurring) (opining that,
although gender classifications may violate the federal constitution, “they do not always
do so, for the reason that there are differences between males and females that the
Constitution necessarily recognizes”); id. at 498 n.4 (Stevens, J., dissenting) (“In cases
involving discrimination between men and women, the natural differences between the
sexes are sometimes relevant. . . . [I]f, as in this case, there is an apparent connection
(continued…)

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under the Equal Protection Clause insulated from heightened scrutiny any legal burdens

imposed upon women as a result of biological differences between the sexes. This

framing, in turn, led to the Court’s failure to understand laws discriminating on the basis

of pregnancy as a form of sex discrimination. In Geduldig, the Court upheld an insurance

plan that provided benefits for all work-disabling conditions except pregnancy, refusing to

consider the classification as sex-discrimination because “[n]ormal pregnancy is an

objectively identifiable physical condition with unique characteristics.” 180 As Professor

Siegel has argued, “this mode of reasoning about reproductive regulations obscures the

possibility that such regulation may be animated by constitutionally illicit judgments about

women.” 181

Reviewing claims of sex discrimination through a lens of formal equality that

affords protection against sex discrimination only when men and women are similarly

situated sets men as the standard by which women (and equality) are measured, allowing

women to claim equality only to the extent that they are just like men. 182 By making men

the constitutional standard by which women are measured, this approach disavows

between the discrimination and the fact that only women can become pregnant, it may be
appropriate to presume that the classification is lawful.”).
180 417 U.S. at 496 n.20; see also Cleveland Bd. of Educ. v. LaFluer, 414 U.S. 632
(1974) (applying rational basis review to a mandatory maternity leave policy that forbade
teachers from working after their fourth or fifth month of pregnancy); see also Harris, 448
U.S. 297 (holding that the federal restriction contained in the Hyde Amendment was not
predicated upon a constitutionally suspect class); Maher, 432 U.S. 464 (state restrictions
on abortion funding involve no discrimination against a suspect class).

181 Siegel, supra note 182, at 264.
182 See Law, supra note 116, at 1007 (“But pregnancy, abortion, reproduction, and
creation of another human being are special—very special. Women have these
experiences. Men do not. An equality doctrine that ignores the unique quality of these
experiences implicitly says that women can claim equality only insofar as they are like
men. Such a doctrine demands that women deny an important aspect of who they are.
Such a doctrine is, to say the least, reified.”).

[J-65-2022] [MO: Donohue, J.] - 49
equality. Without an understanding of equality that includes, rather than excepts, physical

characteristics unique to one sex, reproductive capabilities would continue to justify

disparate treatment of men and women. In Geduldig and elsewhere, 183 the Supreme

Court’s focus upon formal equality has obscured and immunized the myriad ways in which

women are treated unequally precisely because of their unique physical

characteristics. 184 Contrary to federal equal protection jurisprudence, the ERA

recognizes that women’s reproductive capabilities inherently are sex-based

characteristics. 185

The Supreme Court also limits the reach of the federal guarantee of equal

protection through its standard of judicial review. Claims of racial classifications under

183 See Michael M., 450 U.S. at 468-69 (plurality) (extending Geduldig to uphold sex-
based classifications based upon the capacity to become pregnant).
184 As it evolved, the Supreme Court’s sex discrimination jurisprudence briefly began
to recognize that physical differences between the sexes may only justify discriminatory
laws that compensate one sex for the inequities that sex historically has suffered. In U.S.
v. Virginia, the Supreme Court declared that “inherent differences” between men and
women could not be used to denigrate either sex or “for artificial constraints on an
individual’s opportunity.” 518 U.S. 515, 533-34 (1996). Rather,

[s]ex classifications may be used to compensate women for particular
economic disabilities they have suffered, to promote equal employment
opportunity, to advance full development of the talent and capacities of our
Nation’s people. But such classifications may not be used, as they once
were, to create or perpetuate the legal, social, and economic inferiority of
women.

Id. This recognition that sex-based classifications based upon biological differences
deserved close scrutiny was short-lived. In Nguyen v. INS, 533 U.S. 53 (2001), the Court
upheld a law distinguishing between parents based on sex, and, according to Justice
Sandra Day O’Connor, further watered-down intermediate scrutiny by perpetuating
stereotypes masquerading as biological differences. Id. at 78-79 (O’Connor, J.,
dissenting).
185 See Maj. Op. at 88-89.

[J-65-2022] [MO: Donohue, J.] - 50
the Equal Protection Clause are reviewed through strict scrutiny, which requires the

government to establish that racial classifications are necessary to advance a compelling

governmental interest. 186 At the same time, the Court has turned down every invitation

to subject sex-based distinctions to strict scrutiny. 187 And it was not until 1976 that the

Supreme Court adopted intermediate scrutiny for sex-based classifications, requiring the

government to establish that the sex-based classification substantially advances

important governmental objectives. 188 Under this standard, the government does not

have to prove that it has compelling objectives or that less discriminatory alternatives are

unavailable. As it has developed, intermediate scrutiny has proven difficult to apply and

has done little to afford sufficient guidance in particular circumstances to connect a

purported important government interest to a challenged sex-based classification. 189

Rather than leading to the relatively more predictable outcomes of strict scrutiny and

rational basis review, intermediate scrutiny instead delivers malleable, unpredictable

186 See, e.g., Johnson v. California, 543 U.S. 499, 505 (2005).
187 See Frontiero, 411 U.S. at 682 (plurality) (opining that sex-based classifications
“are inherently suspect and must therefore be subjected to close judicial scrutiny”); id. at
691 (Powell, J., concurring in the judgment) (refusing to provide a fifth vote to apply strict
scrutiny to sex-based classifications).
188 See Craig, 429 U.S. at 197 (“classifications by gender must serve important
governmental objectives and must be substantially related to achievement of those
objectives”).
189 See, e.g., Craig, 429 U.S. at 221 (Rehnquist, J., dissenting) (opining that the test
of intermediate scrutiny is “so diaphanous and elastic as to invite subjective judicial
preferences or prejudices relating to particular types of legislation, masquerading as
judgments”); Contractors Ass’n of Eastern Pa., Inc. v. City of Phila., 735 F.Supp. 1274,
1303 (E.D.Pa. 1990) (observing that intermediate scrutiny provides “relatively little
guidance in individual cases,” and that the three-tiered scrutiny “provides the court with
‘buzz words’—i.e. ‘compelling state interest,’ ‘important governmental interest’ and
‘rational basis”—that in practice are at times both difficult to distinguish and to apply”)
(citations omitted); aff’d in part and vacated in part, 945 F.2d 1260 (3d Cir. 1991).

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results that have done little to root out and rectify sex-based classifications as highly

suspect under the law. 190

In the years after the adoption of the ERA, this Court interpreted the ERA

expansively, and we robustly extended its protection of sex equality beyond that afforded

at the federal level. 191 Before Fischer, the ERA had always been understood as

establishing an absolute ban on sex-based classifications, 192 and the Majority’s adoption

of strict scrutiny for sex-based distinctions returns our jurisprudence to that

understanding. 193 It is a reset, placing the development of the law back on the track it

was on before Fischer.

The federal equal protection argument against abortion restrictions is grounded

less upon asserting that restricting abortion intentionally discriminates against women and

more upon asserting that such laws negatively impact women. Under the federal

Constitution, laws that merely have a disparate impact on a particular group are

190 See Wharton, supra note 174, at 1213 (reviewing an argument by Professor
Deborah Brake that “the history of intermediate scrutiny in the lower courts demonstrates
widespread confusion and inconsistent results”).
191 See Maj. Op. at 120, 123.
192 Maj. Op. at 93-98; see also Hartford, 482 A.2d at 548; Spriggs, 368 A.2d at 639
(plurality); Walker, 360 A2d at 605; Butler, 347 A.2d at 480; Commonwealth v. Santiago,
340 A.2d 440, 445-46 (Pa. 1975); DiFlorido, 331 A.2d at 180; Henderson, 327 A.2d at 62;
Commonwealth v. Butler, 328 A.2d 851, 855-57 (Pa. 1974); Conway, 318 A.2d at 326;
Hopkins, 320 A.2d at 140.
193 Although the Majority does not designate its approach as strict scrutiny, I
understand the searching judicial inquiry that it articulates to be just that. As the Majority
describes it, “[i]t is the government’s burden to rebut the presumption [of
unconstitutionality] with evidence of a compelling state interest in creating the
classification and that no less intrusive methods are available to support that expressed
policy.” Maj. Op. at 123.

[J-65-2022] [MO: Donohue, J.] - 52
permissible and beyond the reach of the Equal Protection Clause. 194 In Personal

Administrator of Massachusetts v. Feeney, for example, the Court rejected a challenge

to a state policy that afforded lifetime hiring preferences in state civil service to veterans,

ninety-eight percent of whom were men. 195 Even though this policy overwhelmingly

operated to the advantage of men and to the disadvantage of women, the Court relied

upon its facial neutrality and the lack of any indication that the policy was the result of

intentional, invidious gender discrimination to uphold it against an equal protection

challenge. 196

In DiFlorido, this Court extended scrutiny under the ERA to laws and policies that

are facially neutral but that disproportionally impact men or women. 197 After we

invalidated the common-law rule that would have made household goods acquired during

a marriage presumptively the property of the husband, we invalidated the trial court’s

alternative sex-neutral presumption that the owner is the spouse that purchased the

property. Such a presumption “would fail to acknowledge the equally important and often

substantial non-monetary contributions made by either spouse.” 198 The Court chose

instead to presume that household goods acquired during the marriage are held jointly

194 See, e.g, Washington v. Davis, 426 U.S. 229, 239 (1976) (reviewing one hundred
years of precedent to conclude that “our cases have not embraced the proposition that a
law or other official act, without regard to whether it reflects a racially discriminatory
purpose, is unconstitutional [s]olely because it has a racially disproportionate impact”).
195 442 U.S. 256, 280-81 (1979).
196 Id. at 259, 274, 279 (holding that the requirement that the policy evince a
discriminatory purpose requires that the decisionmaker chose a course of action
“because of, not merely in spite of, its adverse effects upon an identifiable group”).

197 331 A.2d 174.
198 Id. at 179.

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by both spouses. 199 Applying Pennsylvania law, a federal court followed course and

sustained a jury verdict premised upon a disparate impact claim under the ERA. 200

Perhaps the reason that the federal Equal Protection Clause of the Fourteenth

Amendment has proven unable effectively to redress gender discrimination and inequality

is that it was never intended to do so. Before she became a Justice on the United States

Supreme Court, Ruth Bader Ginsburg opined that the Fourteenth Amendment was

necessary to redress racial discrimination apparent during Reconstruction and was

intended to enshrine constitutional protection for formerly enslaved men. 201 There is, of

course, a counterargument which posits that the framers of the Fourteenth Amendment

sought to ensure true freedom and to redress the subjugation of the formerly enslaved by

affording the basis for the right of bodily autonomy. 202 But without finding a historical

basis for gender equality in the Fourteenth Amendment, the Supreme Court has

demonstrated a reluctance to construe the Equal Protection Clause as promising gender

equality. This is particularly so following the reasoning of Geduldig, which divorced claims

199 Id. at 179-80.
200 Kemether, 1999 WL 1012957 at *20 (expressly rejecting the defendant’s claim that
the ERA did not extend to facially neutral policies: “While a practice may purport to treat
men and women equally, if it has the effect of perpetuating discriminatory practices, thus
placing an unfair burden on women, it may violate the ERA”).
201 See Ruth Bader Ginsburg, Sexual Equality Under the Fourteenth and Equal Rights
Amendments, 1979 WASH. U. L. Q. 161, 161 (1979) (recognizing that “the framers of the
fourteenth amendment did not contemplate sex equality”).
202 David H. Gans, No, Really, the Right to an Abortion Is Supported by the Text and
History of the Constitution, THE ATLANTIC (Nov. 4, 2021),
https://www.theatlantic.com/ideas/archive/2021/11/roe-was-originalist-reading-
constitution/620600 (last viewed July 17, 2023) (“The right of ‘having a family, a wife,
children, home,’ as Senator Jacob Howard, who played a central role in drafting the
Fourteenth Amendment, put it, guarantees to the individual free choice in matters of family
and childbirth, in the same way that the freedom of speech also includes the right to not
speak.”).

[J-65-2022] [MO: Donohue, J.] - 54
of discrimination on the basis of pregnancy from claims of discrimination on the basis of

sex.

Against this historical backdrop, the ERA can be understood as a mandate from

Pennsylvania voters to do better. Rather than waiting for federal judicial opinions to catch

up to popular will or for the states to ratify the federal Equal Rights Amendment, the

people of this Commonwealth elevated to constitutional magnitude the guarantee of

equality on the basis of sex that depends in no respect upon federal precedent. 203

I therefore agree that a presumption of unconstitutionality for laws based upon

distinctions between sexes is the appropriate starting point to analyze the Coverage

Exclusion, for the reasons set out by the Majority. My agreement in this respect does not

foreclose my openness to considering other ways to effectuate the promise of the ERA.

Scholars have long proposed various approaches under state equal rights amendments,

some of which may warrant consideration by this Court in future cases. 204 For example,

Professor Reva Siegel has argued that “courts can enforce equal citizenship values by

evaluating restrictions on reproductive decision making to ensure that such restrictions

do not reflect or enforce gender stereotypes about women’s agency and their sexual and

203 Other states have recognized the same effect of their own equal rights
amendment. For example, the Washington Supreme Court has said of its state’s ERA:

Presumably the people in adopting [the ERA] intended to do more than
repeat what was already contained in the otherwise governing constitutional
pro

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/9927557. Public record. Not legal advice.