Abortion: Judicial Control

CONTENTS

SUMMARY

ISSUE DEFINITION

BACKGROUND AND ANALYSIS

Judicial History

Development and Status of the Law Prior to 1973

The Supreme Court's 1973 Abortion Rulings

The Public Funding of Abortions

The 1977 Trilogy -- Restrictions on Public Funding of

Nontherapeutic or Elective Abortions

The Public Funding of Therapeutic or Medically Necessary

Abortions -- The Supreme Court's Decisions in McRae

and Zbaraz

U.S.

Supreme Court Decisions Subsequent to Roe and Doe Involving the

Substantive Right to Abortion

Informed Consent, Spousal Consent, Parental Consent, and

Reporting Requirements

Parental Notice

Advertising of Abortion Services

Abortions by Non-Physicians

The Definition of Viability

U.S. Supreme Court Decisions -- 1983-1987

FOK ADD1 TIONAL KEADI NC

ABORTION:

JUDICIAL CONTROL

SUMMARY

I n 1973 t h e U.S. Supreme C o u r t h e l d t h a t t h e C o n s t i t u t i o n p r o t e c t s a

woman's d e c i s i o n w h e t h e r o r n o t t o t e r m i n a t e h e r p r e g n a n c y , R z v . ,-W

410 U.S. 1 1 3 , and t h a t a S t a t e may n o t u n d u l y burden t h e e x e r c i s e o f t h a t

f u n d a m e n t a l r i g h t by r e g u l a t i o n s t h a t p r o h i b i t o r s u b s t a n t i a l l y l i m i t

a c c e s s t o t h e means of e f f e c t u a t i n g t h a t d e c i s i o n , D o e v . B o l t o n , 410 U.S.

179. But r a t h e r t h a n s e t t l i n g t h e i s s u e , t h e c o u r t ' s r u l i n g s h a v e k i n d l e d

h e a t e d d e b a t e a n d p r e c i p i t a t e d a v a r i e t y of g o v e r n m e n t a l a c t i o n s a t t h e

n a t i o n a l , S t a t e and l o c a l l e v e l s d e s i g n e d e i t h e r t o n u l l i f y t h e r u l i n g s o r

hinder t h e i r effectuation.

These g o v e r n m e n t a l r e g u l a t i o n s h a v e , i n t u r n ,

spawned f u r t h e r l i t i g a t i o n i n which r e s u l t i n g j u d i c i a l r e f i n e m e n t s i n t h e

law h a v e been no more s u c c e s s f u l i n dampening t h e c o n t r o v e r s y .

Thus, a s

t h e p r e v i o u s C o n g r e s s e s h a v e been, t h e 1 0 0 t h c o n t i n u e s t o be a forum f o r

p r o p o s e d l e g i s l a t i o n and c o n s t i t u t i o n a l amendments aimed a t l i m i t i n g o r

p r o h i b i t i n g t h e p r a c t i c e of a b o r t i o n .

The law w i t h r e s p e c t t o a b o r t i o n i n mid-19th

c e n t u r y America

f o l l o w e d t h e p r e - e x i s t i n g common law of England i n a l l b u t a few S t a t e s .

By t h e t i m e of t h e C i v i l War a number o f S t a t e s had begun t o add t o o r

r e v i s e t h e i r s t a t u t e s i n o r d e r t o p r o h i b i t a b o r t i o n a t a l l l e v e l s of

gestation.

The S t a t e s v a r i e d i n t h e i r e x c e p t i o n s f o r t h e r a p e u t i c

abortions.

1967 saw t h e f i r s t v i c t o r y of an a b o r t i o n r e f o r m movement w i t h t h e

passage of l i b e r a l i z i n g l e g i s l a t i o n i n Colorado.

The l e g i s l a t i o n was

b a s e d on t h e Model P e n a l Code.

Between 1967 and 1973, a p p r o x i m a t e l y onet h i r d of t h e S t a t e s had a d o p t e d , e i t h e r i n whole o r i n p a r t , t h e Model

P e n a l C o d e ' s p r o v i s i o n s a l l o w i n g a b o r t i o n i n i n s t a n c e s o t h e r t h a n where

o n l y t h e m o t h e r ' s l i f e was i n d a n g e r .

Between 1968 and 1972 t h e c o n s t i t u t i o n a l i t y o f r e s t r i c t i v e a b o r t i o n

s t a t u t e s o f many S t a t e s was c h a l l e n g e d on t h e g r o u n d s o f v a g u e n e s s ,

v i o l a t i o n of t h e f u n d a m e n t a l r i g h t o f p r i v a c y , and d e n i a l of e q u a l

p r o t e c t i o n under t h e s e laws.

I n 1973, t h e Supreme C o u r t r u l e d , i n Roe v.

W a d e , 410 U.S. 113, and D o e v. B o l t o n , 410 U.S. 1 7 9 , t h a t T e x a s and

G e o r g i a s t a t u t e s r e g u l a t i n g a b o r t i o n i n t e r f e r e d t o an u n c o n s t i t u t i o n a l

e x t e n t w i t h a woman's r i g h t t o d e c i d e w h e t h e r t o t e r m i n a t e h e r p r e g n a n c y .

The c o n s t i t u t i o n a l b a s i s f o r t h e d e c i s i o n s r e s t e d upon t h e c o n c l u s i o n t h a t

t h e F o u r t e e n t h Amendment r i g h t o f p e r s o n a l p r i v a c y embraced a woman's

d e c i s i o n whether t o c a r r y a pregnancy t o term.

v. B o l t o n d i d

The Supreme C o u r t ' s d e c i s i o n s i n R z v. W a d e and

n o t a d d r e s s a number o f i m p o r t a n t a b o r t i o n - r e l a t e d i s s u e s which h a v e

s u b s e q u e n t l y been r a i s e d by S t a t e a c t i o n s s e e k i n g t o r e s t r i c t t h e s c o p e of

the court's rulings.

These i n c l u d e t h e i s s u e s o f i n f o r m e d c o n s e n t ,

s p o u s a l c o n s e n t , p a r e n t a l c o n s e n t , and r e p o r t i n g r e q u i r e m e n t s .

In

a d d i t i o n , R o e and D o e n e v e r r e s o l v e d t h e q u e s t i o n o f w h a t , i f a n y t y p e , of

a b o r t i o n p r o c e d u r e s may b e r e q u i r e d o r p r o h i b i t e d by s t a t u t e .

The C o u r t

h a s h e a r d a number o f a b o r t i o n - r e l a t e d c a s e s s i n c e 1 9 7 3 a s a t t e m p t s a r e

made t o c l a r i f y t h e s e i s s u e s .

ISSUE DEFINITION

I n 1973 t h e U.S. Supreme C o u r t h e l d t h a t t h e C o n s t i t u t i o n p r o t e c t s a

woman's d e c i s i o n w h e t h e r o r n o t t o t e r m i n a t e h e r p r e g n a n c y , R o e v . W s ,

and t h a t a S t a t e may n o t unduly burden t h e e x e r c i s e o f t h a t f u n d a m e n t a l

r i g h t by r e g u l a t i o n s t h a t p r o h i b i t o r s u b s t a n t i a l l y l i m i t a c c e s s t o t h e

The i s s u e o f a

means o f e f f e c t u a t i n g t h a t d e c i s i o n , Doe v. B o l t o n .

S i n c e 1973,

woman's r i g h t t o an a b o r t i o n , however, i s f a r from s e t t l e d .

t h e r e h a v e been F e d e r a l and S t a t e l e g i s l a t i v e e f f o r t s d e s i g n e d e i t h e r t o

n u l l i f y t h e rulings or hinder t h e i r effectuation.

Subsequent l i t i g a t i o n

challenging t h i s l e g i s l a t i o n has led t o f u r t h e r j u d i c i a l refinements.

BACKGROUND AND ANALYSIS

Judicial History

Development and S t a t u s O E the Law P r i o r t o 1973

The law w i t h r e s p e c t t o a b o r t i o n i n mid-19th c e n t u r y America f o l l o w e d

t h e p r e - e x i s t i n g common law of England i n a l l b u t a few S t a t e s .

Thus, no

i n d i c t m e n t would o c c u r f o r a b o r t i n g a f e t u s f o r a c o n s e n t i n g f e m a l e p r i o r

t o "quickening."

But by t h e t i m e o f t h e C i v i l War, a n i n f l u e n t i a l a n t i a b o r t i o n movement began t o a f f e c t l e g i s l a t i o n by i n d u c i n g S t a t e s t o a d d t o

o r r e v i s e t h e i r s t a t u t e s i n o r d e r t o p r o h i b i t a b o r t i o n a t a11 s t a g e s of

gestation.

By 1910 e v e r y S t a t e had a n t i - a b o r t i o n l a w s , e x c e p t Kentucky

whose c o u r t s j u d i c i a l l y d e c l a r e d a b o r t i o n s t o b e i l l e g a l .

I n 1 9 6 7 , 49 o f

t h e S t a t e s and t h e D i s t r i c t o f Columbia c l a s s i f i e d t h e c r i m e of a b o r t i o n

a s a felony.

The c o n c e p t of q u i c k e n i n g was no l o n g e r u s e d t o d e t e r m i n e

c r i m i n a l l i a b i l i t y b u t was r e t a i n e d i n some S t a t e s t o s e t p u n i s h m e n t .

N o n - t h e r a p e u t i c a b o r t i o n s were e s s e n t i a l l y u n l a w f u l .

The S t a t e s v a r i e d i n

t h e i r exceptions f o r therapeutic abortions.

Forty-two S t a t e s p e r m i t t e d

a b o r t i o n s o n l y i f n e c e s s a r y t o save t h e l i f e of t h e mother. Other S t a t e s

a l l o w e d a b o r t i o n t o s a v e a woman from " s e r i o u s and permanent b o d i l y

i n j u r y t ' o r h e r " l i f e and h e a l t h , "

Three S t a t e s allowed a b o r t i o n s t h a t

were n o t "unlawfully

~ e r f o r r n e d " o r t h a t were n o t "without

lawful

j u s t i f i c a t i o n " , l e a v i n g i n t e r p r e t a t i o n of t h o s e s t a n d a r d s t o t h e c o u r t s .

T h i s , however, r e p r e s e n t e d t h e h i g h w a t e r mark i n r e s t r i c t i v e a b o r t i o n

laws i n t h e U n i t e d S t a t e s , f o r 1967 saw t h e f i r s t v i c t o r y o f a n a b o r t i o n

r e f o r m movement w i t h t h e p a s s a g e of l i b e r a l i z i n g l e g i s l a t i o n i n C o l o r a d o .

The l e g i s l a t i o n was b a s e d upon t h e Model P e n a l Code.

The movement had

s t a r t e d i n t h e e a r l y 1950s and c e n t e r e d i t s e f f o r t s on a p r o p o s e d c r i m i n a l

a b o r t i o n s t a t u t e d e v e l o p e d by t h e American Law I n s t i t u t e t h a t would a l l o w

a b o r t i o n s when c h i l d b i r t h posed g r a v e d a n g e r t o t h e p h y s i c a l o r m e n t a l

h e a l t h o f a woman, when t h e r e was h i g h l i k e l i h o o d of f e t a l a b n o r m a l i t y , o r

when p r e g n a n c y r e s u l t e d from r a p e o r i n c e s t .

Between 1967 and t h e Supreme C o u r t ' s 1973 d e c i s i o n s i n R o e and Doe,

a p p r o x i m a t e l y o n e - t h i r d of t h e S t a t e s had a d o p t e d , e i t h e r i n whole o r i n

p a r t , t h e Model P e n a l C o d e ' s p r o v i s i o n s a l l o w i n g a b o r t i o n s i n i n s t a n c e s

o t h e r t h a n where o n l y t h e m o t h e r ' s l i f e was i n d a n g e r .

A l s o , by t h e end

of 1 9 7 0 , 4 S t a t e s ( ~ l a s k a , H a w a i i , New York, and W a s h i n g t o n ) h a d r e p e a l e d

c r i m i n a l p e n a l t i e s f o r a b o r t i o n s performed i n e a r l y p r e g n a n c y by a

l i c e n s e d p h y s i c i a n , s u b j e c t t o s t a t e d p r o c e d u r a l and h e a l t h r e q u i r e m e n t s .

-.

The f i r s t U.S.

Supreme C o u r t d e c i s i o n d e a l i n g w i t h a b o r t i o n was

r e n d e r e d i n 1971

( U l v. V u i t c h , 402 U.S.' 6 2 ) .

I n Vuitch, t h e Court

d e n i e d a v a g u e n e s s c h a l l e n g e t o t h e D i s t r i c t o f Columbia a b o r t i o n s t a t u t e .

The n e t e f f e c t o f t h e V u i t c h d e c i s i o n was t o expand t h e a v a i l a b i l i t y o f

a b o r t i o n s u n d e r t h e D.C.

l a w ' s p r o v i s i o n a l l o w i n g a b o r t i o n s where

health."

" n e c e s s a r y f o r t h e p r e s e r v a t i o n of t h e m o t h e r ' s

...

The Supreme court's

1973 A b o r t i o n R u l i n g s

Between 1968 and 1972 t h e c o n s t i t u t i o n a l i t y o f r e s t r i c t i v e a b o r t i o n

s t a t u t e s of many S t a t e s was c h a l l e n g e d on t h e g r o u n d s o f v a g u e n e s s ,

v i o l a t i o n of t h e f u n d a m e n t a l r i g h t o f p r i v a c y , and d e n i a l o f e q u a l

p r o t e c t i o n under t h e s e laws.

T h e s e c h a l l e n g e s met w i t h mixed s u c c e s s i n

t h e l o w e r c o u r t s . However, on J a n . 22, 1973, t h e Supreme C o u r t i s s u e d i t s

r u l i n g s i n R o e v. W a d e , 410 U.S. 1 1 3 , and Doe v. B o l t o n , 410 U.S. 179. I n

t h o s e c a s e s t h e C o u r t found t h a t Texas and G e o r g i a s t a t u t e s r e g u l a t i n g

a b o r t i o n i n t e r f e r e d t o an u n c o n s t i t u t i o n a l e x t e n t w i t h a woman's r i g h t t o

d e c i d e w h e t h e r t o t e r m i n a t e h e r pregnancy.

The Texas s t a t u t e f o r b a d e a l l

a b o r t i o n s not n e c e s s a r y " f o r t h e purpose of s a v i n g t h e L i f e of t h e

The G e o r g i a e n a c t m e n t p e r m i t t e d a b o r t i o n s when c o n t i n u e d

mother

p r e g n a n c y s e r i o u s l y t h r e a t e n e d t h e woman's l i f e o r h e a l t h , when t h e f e t u s

was v e r y l i k e l y t o h a v e

s e v e r e b i r t h d e f e c t s , o r when t h e p r e g n a n c y

r e s u l t e d f r o m r a p e . The G e o r g i a s t a t u t e r e q u i r e d , however, t h a t a b o r t i o n s

be p e r f o r m e d o n l y a t a c c r e d i t e d h o s p i t a l s and o n l y a f t e r a p p r o v a l by a

h o s p i t a l c o m m i t t e e and two c o n s u l t i n g p h y s i c i a n s .

."

The c o u r t ' s d e c i s i o n s were d e l i v e r e d by Mr. J u s t i c e Blackmun f o r

h i m s e l f and s i x o t h e r J u s t i c e s .

J u s t i c e s White and R e h n q u i s t d i s s e n t e d .

The C o u r t r u l e d t h a t S t a t e s may n o t c a t e g o r i c a l l y p r o s c r i b e a b o r t i o n s by

making t h e i r p e r f o r m a n c e a c r i m e , and t h a t S t a t e s may n o t make a b o r t i o n s

u n n e c e s s a r i l y d i f f i c u l t t o o b t a i n by p r e s c r i b i n g e l a b o r a t e p r o c e d u r a l

guidelines.

The c o n s t i t u t i o n a l b a s i s f o r t h e d e c i s i o n s r e s t e d upon t h e

c o n c l u s i o n t h a t t h e F o u r t e e n t h Amendment r i g h t o f p e r s o n a l p r i v a c y

embraced a woman's d e c i s i o n w h e t h e r t o c a r r y a p r e g n a n c y t o term.

The

C o u r t n o t e d t h a t i t s p r i o r d e c i s i o n s had "found a t l e a s t t h e r o o t s of

...[a ] g u a r a n t e e of p e r s o n a l p r i v a c y ' '

i n v a r i o u s amendments t o t h e

C o n s t i t u t i o n o r t h e i r penumbras e . ,

p r o t e c t e d o f f s h o o t s ) and

c h a r a c t e r i z e d t h e r i g h t t o p r i v a c y a s grounded i n " t h e F o u r t e e n t h

~ r n e n d m e n t ' s c o n c e p t o f p e r s o n a l l i b e r t y and r e s t r i c t i o n s upon S t a t e

action."

(Roe v. W a d e , 410 U.S. 113, 152, 1 5 3 ( 1 9 7 3 1 . ) R e g a r d i n g t h e

s c o p e of t h a t r i g h t , t h e C o u r t s t a t e d t h a t i t i n c l u d e d " o n l y p e r s o n a l

r i g h t s t h a t c a n be deemed ' f u n d a m e n t a l ' o r ' i m p l i c i t i n t h e c o n c e p t of

ordered liberty"'

and " b e a r s some e x t e n s i o n t o a c t i v i t i e s r e l a t e d t o

m a r r i a g e , p r o c r e a t i o n , c o n t r a c e p t i o n , f a m i l y r e l a t i o n s h i p , and c h i l d

r e a r i n g and e d u c a t i o n . "

( I d . a t 152-153.)

Such a r i g h t , t h e C o u r t

c o n c l u d e d , " i s b r o a d enough t o encompass a woman's d e c i s i o n w h e t h e r o r n o t

t o t e r m i n a t e h e r pregnancy." ( I d . a t 153.)

With r e s p e c t t o p r o t e c t i o n o f t h e r i g h t a g a i n s t S t a t e i n t e r f e r e n c e ,

t h e Court held t h a t s i n c e t h e r i g h t of personal privacy i s a fundamental

r i g h t , o n l y a " c o m p e l l i n g S t a t e i n t e r e s t " c o u l d j u s t i f y i t s l i m i t a t i o n by

a S t a t e . Thus w h i l e i t r e c o g n i z e d t h e l e g i t i m a c y of t h e S t a t e i n t e r e s t i n

p r o t e c t i n g m a t e r n a l h e a l t h and t h e p r e s e r v a t i o n of t h e f e t u s ' p o t e n t i a l

l i f e ( I d . a t 148-1501, and t h e e x i s t e n c e of a r a t i o n a l c o n n e c t i o n b e t w e e n

t h e s e two i n t e r e s t s and t h e S t a t e ' s a n t i - a b o r t i o n l a w , t h e C o u r t h e l d

t h e s e i n t e r e s t s i n s u f f i c i e n t t o j u s t i f y a n a b s o l u t e ban on a b o r t i o n s .

I n s t e a d , t h e C o u r t emphasized t h e d u r a t i o n a l n a t u r e o f p r e g n a n c y a n d h e l d

t h e S t a t e ' s i n t e r e s t s t o be s u f f i c i e n t l y compelling t o permit c u r t a i l m e n t

o r p r o h i b i t i o n o f a b o r t i o n o n l y d u r i n g s p e c i f i e d s t a g e s of p r e g n a n c y .

The

High C o u r t c o n c l u d e d t h a t u n t i l t h e end of t h e f i r s t trimester a n a b o r t i o n

i s no more d a n g e r o u s t o m a t e r n a l h e a l t h t h a n c h i l d b i r t h i t s e l f , and f o u n d

that:

[ W l i t h r e s p e c t t o t h e s t a t e ' s i m p o r t a n t and l e g i t i m a t e

i n t e r e s t i n t h e h e a l t h of t h e m o t h e r , t h e " c o m p e l l i n g " p o i n t , i n

l i g h t of p r e s e n t m e d i c a l knowledge, i s a t a p p r o x i m a t e l y t h e end

of t h e f i r s t t r i m e s t e r .

( I d . a t 163.)

Only a f t e r t h e f i r s t t r i m e s t e r d o e s t h e s t a t e ' s i n t e r e s t i n p r o t e c t i n g

maternal h e a l t h provide a s u f f i c i e n t b a s i s t o j u s t i f y S t a t e r e g u l a t i o n of

a b o r t i o n , and t h e n o n l y t o p r o t e c t t h i s i n t e r e s t .

( I d . a t 163-164.)

The " c o m p e l l i n g " p o i n t w i t h r e s p e c t t o t h e S t a t e ' s i n t e r e s t i n t h e

Following v i a b i l i t y , t h e

p o t e n t i a l l i f e of t h e f e t u s "is a t v i a b i l i t y . "

S t a t e ' s i n t e r e s t p e r m i t s i t t o r e g u l a t e and even p r o s c r i b e a n a b o r t i o n

e x c e p t when n e c e s s a r y ,

i n a p p r o p r i a t e m e d i c a l judgment,

for the

p r e s e r v a t i o n o f t h e l i f e o r h e a l t h of t h e m o t h e r . . ( I d . a t 163-164.)

The

C o u r t d e f i n e d v i a b i l i t y a s t h e p o i n t a t which t h e f e t u s i s " p o t e n t i a l l y

a b l e t o l i v e o u t s i d e t h e m o t h e r ' s womb, a l b e i t w i t h a r t i f i c i a l a i d . "

(Id.

The C o u r t summarized i t s h o l d i n g a s f o l l o w s :

F o r t h e s t a g e p r i o r t o a p p r o x i m a t e l y t h e end o f t h e f i r s t

t r i m e s t e r [ o f p r e g n a n c y ] , t h e a b o r t i o n d e c i s i o n and i t s

e f f e c t u a t i o n must be l e f t t o t h e m e d i c a l judgment o f t h e

p r e g n a n t woman's a t t e n d i n g p h y s i c i a n .

F o r t h e s t a g e s u b s e q u e n t t o a p p r o x i m a t e l y t h e end o f t h e

f i r s t t r i m e s t e r , t h e S t a t e , i n promoting i t s i n t e r e s t i n

t h e h e a l t h of t h e m o t h e r , may, i f i t c h o o s e s , r e g u l a t e t h e

a b o r t i o n p r o c e d u r e i n ways t h a t a r e r e a s o n a b l y r e l a t e d t o

maternal health.

For t h e s t a g e subsequent t o v i a b i l i t y , t h e S t a t e , i n

p r o m o t i n g i t s i n t e r e s t i n t h e p o t e n t i a l i t y o f human l i f e

may, i f i t c h o o s e s , r e g u l a t e , and even p r o s c r i b e , a b o r t i o n

e x c e p t where i t i s n e c e s s a r y , i n a p p r o p r i a t e m e d i c a l

judgment, f o r t h e p r e s e r v a t i o n o f t h e l i f e o r h e a l t h o f t h e

mocher.

( 4 1 0 U.S. a t 164-165)

I n Doe v. B o l t o n , 410 U.S, 179 ( 1 9 7 3 ) , t h e C o u r t r e i t e r a t e d i t s

h o l d i n g i n ER

v . W a d e t h a t t h e b a s i c d e c i s i o n o f when a n a b o r t i o n i s

p r o p e r r e s t s w i t h t h e p r e g n a n t mother and h e r p h y s i c i a n , b u t e x t e n d e d R o e

by w a r n i n g t h a t j u s t a s S t a t e s may n o t p r e v e n t a b o r t i o n by making t h e

p e r f o r m a n c e a c r i m e , S t a t e s may n o t make a b o r t i o n s u n r e a s o n a b l y d i f f i c u l t

t o o b t a i n by p r e s c r i b i n g e l a b o r a t e p r o c e d u r a l b a r r i e r s .

I n Doe,

t h e r e f o r e , t h e C o u r t s t r u c k down S t a t e r e q u i r e m e n t s t h a t a b o r t i o n s b e

p e r f o r m e d i n l i c e n s e d h o s p i t a l s ; t h a t a b o r t i o n s b e a p p r o v e d b e f o r e h a n d by

a h o s p i t a l e o m m i t t e e ; and t h a t two p h y s i c i a n s c o n c u r i n t h e a b o r t i o n

decision.

( I d . a t 196-199.) The C o u r t a p p e a r e d t o n o t e , however, t h a t

t h i s would n o t a p p l y t o a s t a t u t e t h a t p r o t e c t e d t h e r e l i g i o u s o r m o r a l

b e l i e f s o f d e n o m i n a t i o n a l h o s p i t a l s and t h e i r employees.

( I d . a t 197-98.)

The C o u r t i n

a l s o d e a l t with t h e question whether a f e t u s i s a

p e r s o n u n d e r t h e F o u r t e e n t h Amendment and o t h e r p r o v i s i o n s o f t h e

constitution.

The C o u r t i n d i c a t e d t h a t t h e C o n s t i t u t i o n never

s p e c i f i c a l l y d e f i n e s " p e r s o n , " b u t added t h a t i n n e a r l y a l l t h e s e c t i o n s

where t h e word p e r s o n a p p e a r s , " . . . t h e u s e o f t h e word i s s u c h t h a t i t h a s

None i n d i c a t e s , w i t h a n y a s s u r a n c e , t h a t

a p p l i c a t i o n only post-natal l y .

i t has any p o s s i b l e pre-natal application."

( 4 1 0 U.S. a t 1 5 7 . ) The C o u r t

emphasized t h a t g i v e n t h e f a c t t h a t i n t h e major p a r t of t h e 1 9 t h c e n t u r y

p r e v a i l i n g l e g a l a b o r t i o n p r a c t i c e s were f a r f r e e r t h a n t o d a y , t h e C o u r t

a s used i n t h e F o u r t e e n t h

was p e r s u a d e d " t h a t

t h e word ' p e r s o n , '

Amendment, d o e s n o t i n c l u d e t h e unborn."

( I d . a t 158.)

The C o u r t d i d n o t , however, r e s o l v e t h e q u e s t i o n o f when l i f e

a c t u a l l y begins.

While n o t i n g t h e d i v e r g e n c e o f t h i n k i n g on t h i s i s s u e ,

i t , i n s t e a d , a r t i c u l a t e d t h e l e g a l c o n c e p t o f " v i a b i l i t y ," which i s

d e f i n e d a s t h e p o i n t a t which t h e f e t u s i s p o t e n t i a l l y a b l e t o l i v e

o u t s i d e t h e womb, a l t h o u g h t h e f e t u s may r e q u i r e a r t i f i c i a l a i d .

(Id. a t

160. )

The Supreme C o u r t ' s d e c i s i o n s i n R o e v. W a d e , and D o e v. B o l t o n d i d

n o t a d d r e s s a number o f i m p o r t a n t a b o r t i o n - r e l a t e d i s s u e s which h a v e

s u b s e q u e n t l y been r a i s e d by S t a t e a c t i o n s s e e k i n g t o r e s t r i c t t h e s c o p e o f

the Court's rulings.

These i n c l u d e t h e i s s u e s of informed c o n s e n t ,

s p o u s a l c o n s e n t , p a r e n t a l c o n s e n t , and r e p o r t i n g r e q u i r e m e n t s .

In

a d d i t i o n , Roe and Doe n e v e r r e s o l v e d t h e q u e s t i o n of w h a t , i f a n y , t y p e of

a b o r t i on p r o c e d u r e s may b e r e q u i r e d o r p r o h i b i t e d by s t a t u t e .

Moreover,

t h e r e remained t h e m a t t e r of w h e t h e r f e t a l p r o t e c t i o n s t a t u t e s were

constitutional.

Unanswered by t h e 1973 c a s e s a s w e l l was t h e

c o n s t i t u t i o n a l i t y of t h r e e o t h e r t y p e s o f s t a t u t e s a f f e c t i n g a c c e s s t o

abortion:

( 1) t h o s e

p r o s c r i b i n g t h e advertising regarding the

a v a i l a b i l i t y o f an a b o r t i o n o r a b o r t i o n - r e l a t e d s e r v i c e s i n a n o t h e r S t a t e ;

( 2 ) t h o s e p r o h i b i t i n g a b o r t i o n s by n o n - p h y s i c i a n s ; and ( 3 ) t h o s e a l l o w i n g

p r i v a t e h o s p i t a l s t o r e f u s e t o perform a b o r t i o n s .

In addition, since R o e

and D o e , q u e s t i o n s have a r i s e n w i t h r e s p e c t t o t h e c o n s t i t u t i o n a l i t y o f :

( 1 ) t h e experimental use of fetuses; (2) waiting period requirements; ( 3 )

t e r m i n a t i o n of p a r e n t a l r i g h t s ; ( 4 ) t h e r i g h t o f a p h y s i c i a n t o r e f u s e t o

Finally, the

p a r t i c i p a t e i n a n a b o r t i o n ; and ( 5 ) n o t i c e r e q u i r e m e n t s .

e n t i r e m a t t e r o f Government f u n d i n g of a b o r t i o n s was n o t d e a l t w i t h i n R o e

and Doe, s i n c e p u b l i c f u n d i n g was n o t a v a i l a b l e a t t h a t t i m e .

The P u b l i c Funding o f A b o r t i o n s

Two c a t e g o r i e s of p u b l i c f u n d i n g c a s e s have been h e a r d and d e c i d e d by

t h e 'supreme Court:

( 1 ) t h o s e involving funding r e s t r i c t i o n s f o r

n o n t h e r a p e u t i c ( e l e c t i v e ) a b o r t i o n s , and ( 2 ) t h o s e i n v o l v i n g f u n d i n g

l i m i t a t i o n s f o r therapeutic (medically necessary) abortions.

The 1977 T r i l o g y -- R e s t r i c t i o n s on P u b l i c Funding o f N o n t h e r a p e u t i c o r

E l e c t i v e Abort i o n s

On J u n e 2 0 , 1977, t h e Supreme C o u r t , i n t h r e e r e l a t e d d e c i s i o n s , r u l e d

on t h e q u e s t i o n w h e t h e r t h e Medicaid s t a t u t e o r t h e C o n s t i t u t i o n r e q u i r e s

p u b l i c f u n d i n g of n o n t h e r a p e u t i c ( e l e c t i v e ) a b o r t i o n s f o r i n d i g e n t women

o r a c c e s s t o p u b l i c f a c i l i t i e s f o r t h e p e r f o r m a n c e o f s u c h a b o r t i o n s . The

C o u r t h e l d t h a t t h e S t a t e s have n e i t h e r a s t a t u t o r y n o r a c o n s t i t u t i o n a l

( B e a l v. Doe, 432 U.S. 438 ( 1 9 7 7 ) ; Maher v.

o b l i g a t i o n in t h i s regard.

Roe, 432 U.S. 464 ( 1 9 7 7 ) ; and P o e l k e r v. D o e , 432 U.S. 519 ( 1 9 7 7 ) ( p e r

curiam). )

In

v. D o e , t h e Supreme C o u r t d e a l t w i t h t h e q u e s t i o n o f w h e t h e r

T i t l e X I X o f t h e S o c i a l S e c u r i t y Act r e q u i r e d t h e f u n d i n g o f nont h e r a p e u t i c a b o r t i o n a s a c o n d i t i o n of p a r t i c i p a t i o n i n t h e Medicaid

program e s t a b l i s h e d by t h e A c t .

The C o u r t h e l d t h a t n o t h i n g i n t h e

l a n g u a g e o r l e g i s l a t i v e h i s t o r y of T i t l e X I X r e q u i r e s a p a r t i c i p a t i n g

S t a t e t o fund e v e r y medical procedure f a l l i n g w i t h i n t h e d e l i n e a t e d

c a t e g o r i e s of medical c a r e .

The C o u r t r u l e d t h a t i t was n o t i n c o n s i s t e n t

w i t h t h e A c t ' s g o a l s t o r e f u s e t o fund unnecessary medical s e r v i c e s .

However, t h e C o u r t d i d i n d i c a t e t h a t T i t l e X I X l e f t a S t a t e f r e e t o

i n c l u d e coverage f o r non-therapeutic a b o r t i o n s should i t choose t o do so.

I n Maher v.

&, t h e Supreme C o u r t r e s o l v e d a c o n s t i t u t i o n a l

c h a l l e n g e t o C o n n e c t i c u t ' s r e f u s a l t o r e i m b u r s e Medicaid r e c i p i e n t s f o r

a b o r t i o n e x p e n s e s e x c e p t where t h e a t t e n d i n g p h y s i c i a n c e r t i f i e s t h e

a b o r t i o n t o h a v e been m e d i c a l l y o r p s y c h i a t r i c a l l y n e c e s s a r y .

The C o u r t

held that

t h e Equal P r o t e c t i o n C l a u s e d o e s n o t r e q u i r e a S t a t e

p a r t i c i p a t i n g i n t h e Medicaid program t o pay e x p e n s e s i n c i d e n t e o nont h e r a p e u t i c a b o r t i o n s s i m p l y b e c a u s e t h e S t a t e h a s made a p o l i c y c h o i c e t o

pay e x p e n s e s i n c i d e n t t o c h i l d b i r t h .

More p a r t i c u l a r l y , ~ o n n e c t i c u t ' s

p o l i c y of f a v o r i n g c h i l d b i r t h o v e r a b o r t i o n was h e l d n o t t o i m p i n g e upon

which p r o t e c t s

t h e f u n d a m e n t a l r i g h t of p r i v a c y r e c o g n i z e d i n R o e v. ,-W

a woman f r o m undue i n t e r f e r e n c e i n h e r d e c i s i o n t o t e r m i n a t e a p r e g n a n c y .

Doe,

t h e C o u r t u p h e l d a r e g u l a t i o n of

the

I n P o e l k e r v.

m u n i c i p a l i t i e s of S t . L o u i s t h a t d e n i e d i n d i g e n t p r e g n a n t women nontherapeutic abortions a t public hospitals.

The P u b l i c F u n d i n g o f T h e r a p e u t i c o r M e d i c a l l y N e c e s s a r y A b o r t i o n s

Supreme C o u r t ' s D e c i s i o n s i n McRae a n d Z b a r a z

-- The

The 1977 Supreme C o u r t d e c i s i o n s l e f t open t h e q u e s t i o n w h e t h e r

F e d e r a l l a w , s u c h a s t h e Hyde Amendment, o r s i m i l a r S t a t e l a w s , c o u l d

v a l i d l y p r o h i b i t g o v e r n m e n t a l f u n d i n g of t h e r a p e u t i c a b o r t i o n s .

On J u n e 3 0 , 1980, i n a 5-4 d e c i s i o n , t h e U.S. Supreme C o u r t r u l e d

that

t h e Hyde ~ m e n d m e n t ' s a b o r t i o n f u n d i n g r e s t r i c t i o n s w e r e

constitutional.

The c o u r t ' s m a j o r i t y found t h a t t h e Hyde Amendment

n e i t h e r v i o l a t e d t h e d u e p r o c e s s o r e q u a l p r o t e c t i o n g u a r a n t e e s of t h e

F i f t h Amendment n o r t h e E s t a b l i s h m e n t C l a u s e of t h e F i r s t Amendment.

The

C o u r t a l s o u p h e l d t h e r i g h t o f a S t a t e p a r t i c i p a t i n g i n t h e Medicaid

program t o fund o n l y t h o s e m e d i c a l l y n e c e s s a r y a b o r t i o n s f o r which i t

r e c e i v e d F e d e r a l r e i m b u r s e m e n t . Harris v. McRae

-9

448 U.S. 297 ( 1 9 8 0 ) .

In

companion c a s e s r a i s i n g s i m i l a r i s s u e s , t h e Court h e l d t h a t a S t a t e of

I l l i n o i s s t a t u t o r y f u n d i n g r e s t r i c t i o n comparable t o t h e F e d e r a l Hyde

Amendment a l s o d i d n o t c o n t r a v e n e t h e c o n s t i t u t i o n a l r e s t r i c t i o n s o f t h e

e q u a l p r o t e c t i o n c l a u s e o f t h e F o u r t e e n t h Amendment.

W i l l i a m s v. Z b a r a z ;

Miller v. Z b a r a z ; &

U

v. Z b a r a z , 448 U.S.

358 ( 1 9 8 0 ) .

The C o u r t ' s

r u l i n g s i n McRae and Z b a r a z mean t h e r e i s no s t a t u t o r y o r c o n s t i t u t i o n a l

o b l i g a t i o n of t h e S t a t e s o r t h e F e d e r a l Government t o f u n d a l l m e d i c a l l y

necessary abortions.

U.S.

Supreme C o u r t D e c i s i o n s Subsequent t o Roe and Doe

Involving t h e Substantive Right t o Abortion

I n £ ormed C o n s e n t ,

Requirements

Spousal

Consent,

Parental

Consent,

and

Reporting

I n P l a n n e d P a r e n t h o o d v. D a n f o r t h , 428 U.S. 52 ( 1 9 7 6 ) , t h e C o u r t h e l d

t h a t i n f o r m e d c o n s e n t s t a t u t e s , which r e q u i r e a d o c t o r t o o b t a i n t h e

w r i t t e n c o n s e n t o f a woman a f t e r i n f o r m i n g h e r o f t h e d a n g e r s o f a b o r t i o n

and p o s s i b l e a l t e r n a t i v e s , a r e c o n s t i t u t i o n a l i f t h e r e q u i r e m e n t s a r e

r e l a t e d t o m a t e r n a l h e a l t h and a r e n o t o v e r b e a r i n g .

( 4 2 8 U.S. 5 2 , 65-66.)

The f a c t t h a t t h e ' informed c o n s e n t l a w s must d e f i n e t h e i r r e q u i r e m e n t s

v e r y n a r r o w l y i n o r d e r t o be c o n s t i t u t i o n a l w a s l a t e r c o n f i r m e d by t h e

Supreme C o u r t i n 1979.

Freiman v. A s h c r o f t , 584 F.2d 247, 251 ( 8 t h C i r .

The r e q u i r e m e n t s of a n i n f o r m e d

1 9 7 8 ) a f f ' d m e m . , 440 U.S. 941 ( 1 9 7 9 ) .

c o n s e n t s t a t u t e must a l s o be n a r r o w l y drawn s o a s n o t t o unduly i n t e r f e r e

with t h e physician-patient relationship, although the type of information

r e q u i r e d t o b e g i v e n t o a woman o f n e c e s s i t y may v a r y a c c o r d i n g t o t h e

trimester of h e r pregnancy.

I n a d d i t i o n t o informed c o n s e n t , t h e D a n f o r t h d e c i s i o n d e a l t w i t h t h e

i s s u e of spousal consent.

The Supreme Court found t h a t s p o u s a l c o n s e n t

s t a t u t e s , which r e q u i r e a w r i t t e n s t a t e m e n t by t h e f a t h e r o f t h e f e t u s

affirming h i s consent t o t h e abortion, a r e unconstitutional i f t h e

s t a t u t e s a l l o w t h e husband t o u n i l a t e r a l l y p r o h i b i t t h e a b o r t i o n i n t h e

I t s h o u l d b e n o t e d t h a t on t h e same

f i r s t trimester.

( 4 2 8 U.S. 5 2 , 6 9 . )

d a y t h a t t h e Supreme Court d e c i d e d D a n f o r t h , i t a l s o s u m n a r i l y a f f i r m e d

t h e l o w e r c o u r t d e c i s i o n i n *C

v. G e r s t e i n , 376 F.Supp. 695 ( S . D . F l a .

19741, a f f ' d , 428 U.S. 901 (19761, which h e l d u n c o n s t i t u t i o n a l a s p o u s a l

c o n s e n t law r e g a r d l e s s o f t h e s t a g e of t h e woman's pregnancy.

With r e s p e c t t o p a r e n t a l c o n s e n t s t a t u t e s , t h e Supreme C o u r t h e l d i n

Danforth t h a t those s t a t u t e s t h a t allow a parent o r guardian t o absolutely

prohibit

an abortion

t o b e p e r f o r m e d o n a m i n o r c h i l d were

unconstitutional.

S u b s e q u e n t l y , i n B e l o t t i v. B a i r d , 443 U.S. 622 (19791,

t h e C o u r t r u l e d t h a t w h i l e a S t a t e may r e q u i r e a minor t o o b t a i n p a r e n t a l

c o n s e n t , t h e S t a t e must a l s o p r o v i d e a n a l t e r n a t i v e p r o c e d u r e t o p r o c u r e

a u t h o r i z a t i o n i f p a r e n t a l c o n s e n t i s d e n i e d o r t h e m i n o r d o e s n o t want t o

From t h e r e a s o n i n g u s e d i n B e l o t t i , i t a p p e a r s t h a t t h e C o u r t

seek it.

. f e l t a m i n o r i s e n t i t l e d t o some p r o c e e d i n g which a l l o w s h e r t o p r o v e h e r

a b i l i t y t o make a n i n f o r m e d d e c i s i o n i n d e p e n d e n t of h e r p a r e n t s , o r t h a t

e v e n i f s h e i s i n c a p a b l e o f making t h e d e c i s i o n , a t l e a s t showing t h a t t h e

a b o r t i o n would b e i n h e r b e s t i n t e r e s t s .

The C o u r t i n D a n f o r t h a l s o r u l e d t h a t r e p o r t i n g r e q u i r e m e n t s i n

s t a t u t e s r e q u i r i n g d o c t o r s and h e a l t h f a c i l i t i e s t o p r o v i d e i n f o r m a t i o n t o

S t a t e s r e g a r d i n g each a b o r t i o n performed, a r e c o n s t i t u t i o n a l .

The C o u r t

s p e c i f i e d , h o w e v e r , t h a t t h e s e r e p o r t i n g r e q u i r e m e n t s must r e l a t e t o

m a t e r n a l h e a l t h , remain c o n f i d e n t i a l , and may n o t be o v e r b e a r i n g .

(428

U.S. 5 2 , 80-81.)

F i n a l l y , a n o t h e r s i g n i f i c a n t r u l i n g made by t h e C o u r t i n D a n f o r t h was

that

fetal

p r o t e c t i o n s t a t u t e s were g e n e r a l l y overbroad

and

unconstitutional i f they pertained t o pre-viable fetuses.

Such s t a t u t e s

r e q u i r e a d o c t o r p e r f o r m i n g an a b o r t i o n t o u s e a v a i l a b l e means and m e d i c a l

s k i l l s t o s a v e t h e l i f e of t h e f e t u s .

I n a subsequent d e c i s i o n , C o l a u t t i

v. F r a n k l i n , 439 U.S. 379 ( 1 9 7 9 ) , t h e Supreme C o u r t h e l d t h a t s u c h f e t a l

p r o t e c t i o n s t a t u t e s c o u l d o n l y a p p l y t o v i a b l e f e t u s e s and t h a t t h e

s t a t u t e must be p r e c i s e i n s e t t i n g f o r t h t h e s t a n d a r d f o r d e t e r m i n i n g

viability.

I n a d d i t i o n , t h e Court i n C o l a u t t i s t r e s s e d t h a t i n o r d e r t o

meet t h e c o n s t i t u t i o n a l t e s t o f s u f f i c i e n t c e r t a i n t y , f e t a l p r o t e c t i o n

l a w s had t o d e f i n e w h e t h e r a d o c t o r ' s paramount d u t y was t o t h e p a t i e n t o r

w h e t h e r t h e p h y s i c i a n had t o b a l a n c e t h e p o s s i b l e d a n g e r t o t h e p a t i e n t

a g a i n s t t h e i n c r e a s e d odds o f f e t a l s u r v i v a l .

( 4 3 9 U.S. a t 3 7 9 , 397-401.)

Parental Notice

The Supreme C o u r t d i d a t t e m p t t o p r o v i d e f u r t h e r c l a r i f i c a t i o n of t h e

p a r e n t a l c o n s e n t and n o t i f i c a t i o n i s s u e s i n i t s d e c i s i o n i n B e l l o t t i v.

Baird

4 4 3 U.S. 622 ( 1 9 7 9 ) .

There t h e Court held u n c o n s t i t u t i o n a l a

9

Massachusetts s t a t u t e t h a t required parental consultation o r n o t i f i c a t i o n

i n e v e r y i n s t a n c e w i t h o u t a f f o r d i n g t h e p r e g n a n t minor a n o p p o r t u n i t y t o

r e c e i v e a n i n d e p e n d e n t j u d i c i a l d e t e r m i n a t i o n t h a t s h e was m a t u r e enough

t o c o n s e n t o r t h a t t h e a b o r t i o n would be i n h e r b e s t i n t e r e s t s .

The C o u r t

a l s o found u n c o n s t i t u t i o n a l a s t a t u t o r y p r o v i s i o n t h a t p e r m i t t e d j u d i c i a l

a u t h o r i z a t i o n f o r a n a b o r t i o n t o b e w i t h h e l d from a m i n o r who i s f o u n d by

t h e c o u r t t o b e m a t u r e and f u l l y competent t o make t h e d e c i s i o n w h e t h e r o r

n o t t o t e r m i n a t e h e r pregnancy independently.

However, i n a n e f f o r t t o

p r o v i d e some f u t u r e g u i d e l i n e s , t h e C o u r t , i n d i c t a , s u g g e s t e d t h a t i f a

S t a t e w i s h e d t o u s e p a r e n t a l n o t i f i c a t i o n , i t must a f f o r d t h e m i n o r t h e

option of proceeding d i r e c t l y t o court, without parental n o t i f i c a t i o n ,

w h e r e s h e must show t h a t s h e i s a m a t u r e minor o r t h a t , i f s h e i s f o u n d

n o t a b l e t o make t h e d e c i s i o n i n d e p e n d e n t l y , t h e d e s i r e d a b o r t i o n i s i n

her best interests.

Four o f t h e e i g h t j u s t i c e s o b j e c t e d t o t h i s

s u g g e s t i o n on t h e ground t h a t i t was a n a d v i s o r y o p i n i o n .

On Mar. 23, 1981, t h e C o u r t u p h e l d a Utah S t a t e l a w making i t a c r i m e

f o r d o c t o r s t o p e r f o r m a n a b o r t i o n on an u n e m a n c i p a t e d , d e p e n d e n t m i n o r

without notifying h e r parents.

I n & v. Matheson, 450 U.S. 398 ( 1 9 8 1 1 ,

a 6-3 d e c i s i o n , t h e C o u r t examined t h e n a r r o w q u e s t i o n of t h e f a c i a l

c o n s t i t u t i o n a l i t y of a s t a t u t e r e q u i r i n g a p h y s i c i a n t o g i v e n o t i c e t o

p a r e n t s , " i f p o s s i b l e , " p r i o r t o p e r f o r m i n g an a b o r t i o n on t h e i r m i n o r

d a u g h t e r , ( a ) when t h e g i r l i s l i v i n g w i t h and d e p e n d e n t upon h e r p a r e n t s ,

( b ) when s h e i s n o t e m a n c i p a t e d by m a r r i a g e o r o t h e r w i s e , and ( c ) when s h e

h a s made no c l a i m o r showing a s t o h e r m a t u r i t y o r a s t o h e r r e l a t i o n s h i p

with her parents.

The Supreme C o u r t c i t e d t h e i n t e r e s t i n p r e s e r v i n g

f a m i l y i n t e g r i t y and p r o t e c t i n g a d o l e s c e n t s i n a l l o w i n g S t a t e s t o r e q u i r e

t h a t p a r e n t s be i n f o r m e d t h a t t h e i r d a u g h t e r i s s e e k i n g a n a b o r t i o n , and

e m p h a s i z e d t h a t t h e s t a t u t e i n q u e s t i o n d i d n o t g i v e a v e t o power o v e r t h e

minor's

abortion decision.

The C o u r t r e j e c t e d t h e m i n o r woman's

c o n t e n t i o n t h a t a b o r t i o n w a s being s i n g l e d out f o r s p e c i a l t r e a t m e n t i n

c o n t r a s t t o o t h e r s u r g i c a l p r o c e d u r e s , l i k e c h i l d b i r t h , which d o n o t

require parental notice.

Thus, t h e C o u r t found t h e Utah l a w t o be

constitutional.

Advertisement of Abortion S e r v i c e s

The Supreme C o u r t h e l d i n Bigelow v. V i r g i n i a , 421 U.S. 8 0 9 ( 1 9 7 5 1 ,

t h a t a S t a t e may n o t p r o s c r i b e a d v e r t i s i n g r e g a r d i n g t h e a v a i l a b i l i t y o f

an a b o r t i o n o r - a b o r t i o n - r e l a t e d s e r v i c e s - i n a n o t h e r S t a t e .

The c o u r t

f o u n d t h a t t h e s t a t u t e i n q u e s t i o n was u n c o n s t i t u t i o n a l b e c a u s e t h e S t a t e

o f V i r g i n i a , where t h e a d v e r t i s e m e n t a p p e a r e d , had o n l y a minimal i n t e r e s t

i n t h e h e a l t h and m e d i c a l p r a c t i c e s of New York, t h e S t a t e i n which t h e

l e g a l a b o r t i o n s e r v i c e s were l o c a t e d .

A b o r t i o n s by Non-Physicians

I n C o n n e c t i c u t v. M e n i l l o , 423 U.S. 9 ( 1 9 7 5 ) , t h e Supreme C o u r t r u l e d

t h a t S t a t e s t a t u t e s s i m i l a r t o t h e Texas law c h a l l e n g e d i n R o e were

c o n s t i t u t i o n a l t o t h e e x t e n t t h a t t h e s t a t u t e s f o r b i d non-physicians from

performing a b o r t i o n s .

The R o e d e c i s i o n made i t c l e a r t h a t a S t a t e c o u l d

n o t i n t e r f e r e w i t h a woman's d e c i s i o n , made i n c o n s u l t a t i o n w i t h and upon

t h e a d v i c e of h e r d o c t o r , t o h a v e a n a b o r t i o n i n t h e f i r s t trimester o f

h e r pregnancy.

The M e n i l l o C o u r t found t h a t pre-Roe r e s t r i c t i v e a b o r t i o n

( 4 2 3 U.S. a t 9 , 1 1 . )

laws w e r e s t i l l e n f o r c e a b l e a g a i n s t n o n - p h y s i c i a n s .

A b o r t i o n s i n P u b l i c and P r i v a t e H o s p i t a l s

I n P o e l k e r v. D o e , 432 U.S. 519 ( 1 9 7 7 ) ( p e r c u r i a m ) , t h e Supreme

C o u r t h e l d t h a t t h e p o l i c y of t h e C i t y of S t . L o u i s i n r e f u s i n g t o a l l o w

t h e p e r f o r m a n c e o f n o n - t h e r a p e u t i c a b o r t i o n s i n i t s p u b l i c h o s p i t a l s , and

of s t a f f i n g t h o s e h o s p i t a l s w i t h p e r s o n n e l opposed t o t h e p e r f o r m a n c e of

abortions,

d i d n o t v i o l a t e t h e e q u a l p r o t e c t i o n c l a u s e of t h e

Constitution.

P o e l k e r , however, d i d n o t d e a l w i t h t h e q u e s t i o n of p r i v a t e

h o s p i t a l s and t h e i r a u t h o r i t y t o p r o h i b i t a b o r t i o n s e r v i c e s .

In Poelker,

t h e C o u r t d e a l t w i t h t h e r i g h t of a m u n i c i p a l i t y t o e l e c t t o p r o v i d e

publicly financed hospital services f o r c h i l d b i r t h without providing

corresponding s e r v i c e s f o r non-therapeutic abortions.

The C o u r t a p p r o v e d

t h i s practice.

The D e f i n i t i o n o f V i a b i l i t y

The

required

Supreme c o u r t ' s a r t i c u l a t i o n of t h e c o n c e p t o f v i a b i l i t y h a s

f u r t h e r elaboration, p a r t i c u l a r l y with regard t o t h e c r i t i c a l

q u e s t i o n of who d e f i n e s a t what p o i n t a f e t u s h a s r e a c h e d v i a b i l i t y .

In

Roe t h e C o u r t d e f i n e d v i a b i l i t y a s t h e p o i n t a t which t h e f e t u s i s

(

pI

o t e n t i a l l y a b l e t o l i v e o u t s i d e t h e m o t h e r ' s womb, a l b e i t w i t h

a r t i f i c i a l aid."

( 4 1 0 U.S. a t 1 6 0 . )

Such p o t e n t i a l i t y , however, must be

f o r " m e a n i n g f u l l i f e " and t h i s c a n n o t encompass s i m p l y momentary s u r v i v a l .

( 4 1 0 U.S. a t 1 6 3 . )

The C o u r t a l s o n o t e d t h a t w h i l e v i a b i l i t y i s u s u a l l y

p l a c e d a t a b o u t 28 weeks, i t c a n o c c u r e a r l i e r and e s s e n t i a l l y l e f t t h e

p o i n t f l e x i b l e f o r a n t i c i p a t e d advances i n medical s k i l l .

Finally, R o e

s t r e s s e d t h e c e n t r a l r o l e of t h e p r e g n a n t woman's d o c t o r , e m p h a s i z i n g t h a t

11

t h e a b o r t i o n d e c i s i o n i n a l l i t s a s p e c t s i s i n h e r e n t l y , and p r i m a r i l y , a

m e d i c a l d e c i s i o n . " ( 4 1 0 U.S. a t 1 6 0 . )

S i m i l a r themes w e r e s t r e s s e d i n

P l a n n e d P a r e n t h o o d o f C e n t r a l M i s s o u r i v . D a n f o r t h , 428 U.S. 52 ( 1 9 7 6 ) , i n

which a M i s s o u r i law, which d e f i n e d v i a b i l i t y a s " t h a t s t a g e of f e t a l

d e v e l o p m e n t when t h e l i f e o f t h e unborn c h i l d may be c o n t i n u e d

i n d e f i n i t e l y o u t s i d e t h e womb by n a t u r a l o r a r t i f i c i a l L i f e s u p p o r t

s y s t e m s 1 ' , was a t t a c k e d a s a n a t t e m p t t o a d v a n c e t h e p o i n t o f v i a b i l i t y t o

an e a r l i e r s t a g e o f g e s t a t i o n . The C o u r t d i s a g r e e d , f i n d i n g t h e s t a t u t o r y

I t re-emphasized t h a t v i a b i l i t y i s "a

d e f i n i t i o n consistent with R o e .

m a t t e r o f m e d i c a l judgment, s k i l l , and t e c h n i c a l a b i l i t y " and t h a t R o e

meant t o p r e s e r v e t h e f l e x i b i l i t y of t h e term. ( 4 2 8 U.S. a t 6 4 ) Moreover,

t h e D a n f o r t h C o u r t h e l d t h a t "it i s n o t t h e p r o p e r f u n c t i o n o f t h e

l e g i s l a t u r e o r t h e c o u r t s t o p l a c e v i a b i l i t y , which i s e s s e n t i a l l y a

medical concept, a t a s p e c i f i c point i n t h e g e s t a t i o n period.

The t i m e

when v i a b i l i t y i s a c h i e v e d may v a r y w i t R e a c h p r e g n a n c y ,

and t h e

d e t e r m i n a t i o n of w h e t h e r a p a r t i c u l a r f e t u s i s v i a b l e i s , and must b e , a

m a t t e r f o r t h e judgment of t h e a t t e n d i n g ~ h ~ s i c i a n . " ( 4 2 8 U.S. a t 64.)

The p h y s i c i a n ' s c e n t r a l r o l e i n d e t e r m i n i n g v i a b i l i t y , and t h e Lack of

s u c h d e f i n i t i o n a l a u t h o r i t y i n t h e l e g i s l a t u r e s and c o u r t s , was r e a f f i r m e d

by t h e C o u r t i n C o l a u t t i v. F r a n k l i n , 439 U.S. 379 ( 1 9 7 9 ) .

U.S.

Supreme C o u r t D e c i s i o n s

-- 1983 - 1987

On J u n e 1 5 , 1983, t h e U.S.

Supreme C o u r t

involving several d i f f e r e n t abortion questions.

decided

three

cases

I n C i t y o f Akron v. Akron C e n t e r f o r R e p r o d u c t i v e H e a l t h , I n c . , 462

U.S. 4 1 6 , ( h e r e i n a f t e r r e f e r r e d t o a s C i t y o f Akron), t h e Supreme C o u r t i n

a 6-3 v o t e d e c l a r e d t h a t f i v e s e c t i o n s of t h e Akron o r d i n a n c e r e s t r i c t i n g

t h e r i g h t of a woman t o an a b o r t i o n were u n c o n s t i t u t i o n a l .

They p r o v i d e d :

(1)

(2)

(3)

(4)

(5

t h a t a f t e r t h e f i r s t t r i m e s t e r of p r e g n a n c y , a l l a b o r t i o n s

be performed i n a h o s p i t a l ;

t h a t t h e r e be n o t i f i c a t i o n o f c o n s e n t by p a r e n t s

b e f o r e a b o r t i o n s may be performed on u n m a r r i e d m i n o r s ;

t h a t t h e a t t e n d i n g p h y s i c i a n make c e r t a i n s p e c i f i e d

statements t o t h e p a t i e n t so t h a t the r e s u l t i n g consent f o r

an a b o r t i o n would amount t o informed c o n s e n t ;

t h a t t h e r e b e a 24-hour w a i t i n g p e r i o d between t h e t i m e t h e

p a t i e n t s i g n s t h e c o n s e n t form and when t h e p h y s i c i a n

p e r f o r m s t h e a b o r t i o n ; and

t h a t f e t a l r e m a i n s be d i s p o s e d o f i n a "humane and s a n i t a r y

manner .I1

I n s t r i k i n g down a l l of t h e s e s e c t i o n s o f t h e Akron o r d i n a n c e a s

b e i n g v i o l a t i v e of t h e U.S. C o n s t i t u t i o n , t h e C o u r t a t t h e v e r y o u t s e t

r e a f f i r m e d i t s 1973 d e c i s i o n , Roe v. ,-W

410 U.S. 113, and p r o c e e d e d t o

a n a l y z e e a c h s e c t i o n of t h e Akron o r d i n a n c e w i t h i n t h e t r i m e s t e r framework

e s t a b l i s h e d by t h a t r u l i n g .

During t h e f i r s t trimester, a woman must be

f r e e i n c o n s u l t a t i o n w i t h h e r d o c t o r t o reach a d e c i s i o n t o have an

a b o r t i o n absent governmental i n t e r f e r e n c e .

I n C i t y of Akron, t h e C o u r t

d o e s p o i n t o u r t h a t a S t a t e may e n a c t some r e g u l a t i o n a p p l i c a b l e t o t h e

f i r s t trimester of p r e g n a n c y , b u t i t c a n n o t h a v e a s i g n i f i c a n t i m p a c t on

t h e woman's r i g h t t o d e c i d e t o t e r m i n a t e h e r pregnancy and must be

j u s t i f i e d by i m p o r t a n t S t a t e h e a l t h o b j e c t i v e s . The i m p o r t a n t p o i n t conc e r n i n g S t a t e r e g u l a t i o n i n t h e f i r s t t r i m e s t e r i s t h a t t h e r e be n o i n t e r f e r e n c e w i t h ( 1 ) d o c t o r - p a t i e n t c o n s u l t a t i o n , o r ( 2 ) t h e woman's c h o i c e

between a b o r t i o n and c h i l d b i r t h .

( C i t y of Akron, 462 U.S. a t 429-430.)

The c h a l l e n g e d Akron o r d i n a n c e p r o v i s i o n r e l a t i n g t o where a b o r t i o n s

c a n be performed p e r t a i n s s p e c i f i c a l l y t o second t r i m e s t e r a b o r t i o n s . The

r e q u i r e m e n t s t a t e d t h a t any second t r i m e s t e r a b o r t i o n had t o b e p e r f o r m e d

in a full-service hospital.

The a c c r e d i t a t i o n of t h e s e f a c i l i t i e s

r e q u i r e d c o m p l i a n c e w i t h comprehensive s t a n d a r d s g o v e r n i n g a n e x t e n s i v e

v a r i e t y o f h e a l t h and s u r g i c a l s e r v i c e s .

The r e s u l t was t h a t a b o r t i o n s

u n d e r t h i s s e c t i o n o f t h e Akron o r d i n a n c e c o u l d n o t b e p e r f c r m e d i n

o u t p a t i e n t e n t i t i e s t h a t were n o t p a r t of a n a c u t e - c a r e , f u l l s e r v i c e

hospital.

The C o u r t found t h i s r e s t r i c t i o n u n c o n s t i t u t i o n a l .

The C o u r t

noted t h a t t h e p o s s i b i l i t y of having t o t r a v e l t o f i n d f a c i l i t i e s could

r e s u l t i n b o t h f i n a n c i a l e x p e n s e and added r i s k t o a woman's h e a l t h .

(Id.

a t 4 3 5 . ) The Court a l s o c i t e d changed m e d i c a l c i r c u m s t a n c e s , and t h e

a v a i l a b i l i t y o f s a f e r p r o c e d u r e s f o r p e r f o r m i n g second trimester a b o r t i o n s

s i n c e R o e , f o r i t s c o n c l u s i o n t h a t t h e Akron h o s p i t a l i z a t i o n r e q u i r e m e n t

imposed a n u n r e a s o n a b l e burden on a woman's r i g h t t o a n a b o r t i o n .

The C o u r t a l s o i n v a l i d a t e d t h e p r o v i s i o n i n t h e Akron o r d i n a n c e which

p r o h i b i t e d a d o c t o r from p e r f o r m i n g a n a b o r t i o n on a n u n e m a n c i p a t e d m i n o r

u n l e s s t h e d o c t o r o b t a i n e d " t h e informed w r i t t e n c o n s e n t of o n e of h e r

p a r e n t s o r h e r l e g a l g u a r d i a n " o r u n l e s s t h e minor h e r s e l f o b t a i n e d "an

o r d e r f r o m a c o u r t h a v i n g j u r i s d i c t i o n o v e r h e r t h a t h e r a b o r t i o n be

performed o r induced."

( I d . a t 439.)

The C o u r t r e l i e d o n i t s e a r l i e r

r u l i n g s i n D a n f o r t h and B e l l o t t i I1 t o c o n c l u d e t h a t t h e C i t y of Akron

c o u l d "not make a b l a n k e t d e t e r m i n a t i o n t h a t a l l m i n o r s u n d e r t h e a g- e of

15 a r e t o o i m a t u r e t o make t h i s d e c i s i o n o r t h a t a n a b o r t i o n n e v e r may be

i n t h e m i n o r ' s b e s t i n t e r e s t s without p a r e n t a l approval."

( I d . a t 440.)

(Emphasis i n o r i g i n a l t e x t ) .

Moreover, t h e Akron o r d i n a n c e ' s p r o v i s i o n

concerning parental approval did not c r e a t e expressly t h e a l t e r n a t i v e

j u d i c i a l p r o c e d u r e r e q u i r e d by B e l l o t t i 11. Thus, t h e Akron o r d i n a n c e ' s

c o n s e n t p r o v i s i o n had t o f a l l b e c a u s e i t f o r e c l o s e d a n y p o s s i b i l i t y f o r

'I

case-by-case e v a l u a t i o n s o f t h e m a t u r i t y of p r e g n a n t minors."

(Id. a t

441, q u o t i n g B e l l o t t i 11, 443 U.S., a t 643, n. 2 3 ( p l u r a l i t y o p i n i o n ) . )

I n C i t y of Akron, t h e Supreme Court a l s o s t r u c k down t h e i n f o r m e d

w r i t t e n c o n s e n t s e c t i o n of t h e o r d i n a n c e .

This provision required t h a t

t h e a t t e n d i n g d o c t o r i n f o r m t h e woman "of t h e s t a t u s o f h e r p r e g n a n c y , t h e

development of h e r f e t u s , t h e d a t e o f p o s s i b l e v i a b i l i t y , t h e p h y s i c a l and

e m o t i o n a l c o m p l i c a t i o n s t h a t may r e s u l t from a n a b o r t i o n , and t h e

a v a i l a b i l i t y o f a g e n c i e s t o p r o v i d e h e r w i t h a s s i s t a n c e and i n f o r m a t i o n

w i t h r e s p e c t t o b i r t h c o n t r o l , a d o p t i o n , and c h i l d b i r t h . "

( I d . a t 442.)

The a t t e n d i n g p h y s i c i a n was a l s o r e q u i r e d t o t e l l t h e p a t i e n t o f t h e

r i s k s i n v o l v e d and a n y o t h e r i n f o r m a t i o n which i n t h e p h y s i c i a n ' s m e d i c a l

judgment would b e c r i t i c a l t o h e r d e c i s i o n o f w h e t h e r t o t e r m i n a t e t h e

pregnancy.

The C o u r t found t h i s informed c o n s e n t r e q u i r e m e n t t o be

c o n s t i t u t i o n a l l y u n a c c e p t a b l e b e c a u s e i t e s s e n t i a l l y g a v e t h e government

u n r e v i e w a b l e a u t h o r i t y o v e r what i n f o r m a t i o n was t o b e g i v e n a woman

b e f o r e s h e d e c i d e d w h e t h e r t o have an a b o r t i o n .

I n C i t y of Akron, t h e

C o u r t found t h a t t h e c i t y ' s r e g u l a t i o n c o n c e r n i n g i n f o r m e d c o n s e n t

exceeded p e r m i s s i b l e l i m i t s .

( I d . a t 444-445.)

I n a d d i t i o n , i t was a l s o

o b j e c t i o n a b l e b e c a u s e i t i n t r u d e d upon t h e d i s c r e t i o n of t h e p r e g n a n t

woman's d o c t o r .

( I d . a t 445.)

I n C i t y of Akron, t h e Supreme C o u r t a l s o c h o s e t o i n v a l i d a t e t h e 24hour w a i t i n g period.

( I d . a t 449.)

The C o u r t found t h a t t h e C i t y o f

Akron had n o t shown t h a t a n y l e g i t i m a t e s t a t e i n t e r e s t was b e i n g s e r v e d

I'

by a n a r b i t r a r y and i n f l e x i b l e w a i t i n g p e r i o d . "

( I d . a t 450.)

F i n a l l y , t h e C o u r t r u l e d t h a t t h e p o r t i o n of t h e Akron o r d i n a n c e

r e q u i r i n g t h a t physicians performing a b o r t ions s e e t o i t t h a t t h e remains

of t h e unborn c h i l d be d i s p o s e d " i n a humane and s a n i t a r y M way was v o i d

f o r vagueness.

The l e v e l of u n c e r t a i n t y p r e s e n t was u n a c c e p t a b l e i n a

s i t u a t i o n s u c h a s t h i s where t h e r e was t h e p r o s p e c t of c r i m i n a l l i a b i l i t y

b e i n g imposed.

( I d . a t 451.) T h i s p r o v i s i o n v i o l a t e d t h e Due P r o c e s s

Clause.

J u s t i c e O ' c o n n o r w r o t e a d i s s e n t i n which s h e was j o i n e d by J u s t i c e s

The d i s s e n t i n g o p i n i o n b a s i c a l l y t o o k i s s u e w i t h t h e

W h i t e and R e h n q u i s t .

t r i m e s t e r framework i n R o e v. W a d e .

I n P l a n n e d P a r e n t h o o d A s s o c i a t i o n of Kansas C i t y , M i s s o u r i , I n c . v.

A s h c r o f t , 462 U.S. 4 7 6 , ( h e r e i n a f t e r r e f e r r e d t o a s A s h c r o f t ) , t h e Supreme

C o u r t i n v a l i d a t e d M i s s o u r i ' s second t r i m e s t e r h o s p i t a l i z a t i o n r e q u i r e m e n t

by t h e same 6-3 v o t e a s i n C i t y of Akron; however, t h e C o u r t v o t e d 5-4 t o

u p h o l d t h r e e o t h e r s e c t i o n s of t h a t M i s s o u r i law.

The s t a t u t o r y

p r o v i s i o n s c h a l l e n g e d on c o n s t i t u t i o n a l g r o u n d s :

(1)

(2)

(3)

(4)

r e q u i r e d t h a t a f t e r 12 weeks o f p r e g n a n c y , a b o r t i o n s b e

performed i n a h o s p i t a l ;

mandated t h a t t h e r e be a p a t h o l o g y r e p o r t f o r e a c h a b o r t i o n

performed;

r e q u i r e d t h e p r e s e n c e o f a second p h y s i c i a n d u r i n g

a b o r t i o n s t h a t a r e performed a f t e r v i a b i l i t y ; and

r e q u i r e d t h a t minors o b t a i n p a r e n t a l consent o r c o n s e n t

from t h e j u v e n i l e c o u r t f o r a n a b o r t i o n .

With r e s p e c t t o t h e r e q u i r e m e n t t h a t a l l s e c o n d t r i m e s t e r a b o r t i o n s b e

p e r f o r m e d i n a f u l l s e r v i c e h o s p i t a l , t h e Supreme C o u r t h e l d t h a t i t s

d e c i s i o n and r a t i o n a l e f o r i n v a l i d a t i n g s u c h r e q u i r e m e n t i n C i t y o f Akron

was c o n t r o l l i n g .

( A s h c r o f t , 462 U.S. a t 481-482.)

'

The Court, however, found that the second-physician requirement

during rhe third trimester in Ashcroft was permissible under the

Constitution because i t "reasonably furthers the State's compelling

interest in protecting the lives of viable fetuses..."

(Id. at 486.)

The Court also upheld the pathology report requirement.

This

provision was "related to generally accepted medical standards" and

"further(s) important health-related State concerns."

(Ashcroft at 487,

quoting City of Akron at 430.) The Court further found that the cost of

the tissue examination "does not significantly burden a pregnant women's

abortion decision.'' (Id. at 490.)

The Court also upheld Missouri's parental consent requirement. (Id.

at 490-493.)

It distinguished the provision involved here from that

challenged in the City of Akron case. The Missouri requirement, unlike

the Akron one, did provide an alternative procedure by which a pregnant

immature minor could show in court that she was sufficiently mature to

make the abortion decision herself or that, despite her immaturity, an

abortion would be in her best interests.

In Ashcroft, Justice Blackmun wrote a separate opinion concurring in

the judgment invalidating the hospital requirement for all second

trimester abortions but dissenting with respect to the court's other

findings upholding the remaining provisions in question in the Missouri

law. He was joined by Justices Brennan, Marshall and Stevens.

Justice O'Connor, joined by Justices White and Rehnquist, concurred

in part and dissented in part. Justice O'connor emphasized that for the

same reasons she dissented in City of Akron regarding the hospital

requirement for second trimester abortions, she dissented here.

They

concurred with respect to the court's upholding the other sections of the

Missouri Law: the second-physician requirement, pathology report

requirement, and parental consent provision.

However, they used a

different rationale, one that did not utilize the trimester framework of

Roe v. .&W

'

In Simopoulos v. Virginia, 462 U.S. 506, (hereinafter referred to as

Simopoulos), the Supreme Court in an 8-1 decision ruled that Virginia's

mandatory hospitalization requirement for second trimester abortions is

constitutional. As in City of Akron and Ashcroft, Justice Powell wrote

the opinion for the Court.

Justice Stevens dissented.

The Court

distinguished the requirement in quest ion in Virginia from those it

invalidated in City of Akron and Ashcroft. The determination upholding

the Virginia provision actually turned on the definition of "hospital."

Justice O'Connor wrote a separate concurrence joined by Justices

Rehnquist and White.

Her reasoning, however, was not based on the

She stated: "Rather, I believe that

trimester framework of Roe v. W a d e .

the requirement in this case is not an undue burden on the decision to

undergo an abortion." (O'Connor, Concurrence, at 520.)

In summary, the 1983 Supreme Court decisions in City of Akron,

Ashcroft, and Simopoulos settled questions relating to hospital

requirements for second trimester abortions, informed consent

requirements, waiting periods, parental notification and consent, and

disposal of fetal remains. The Supreme Court reaffirmed its decision in

R o e v. Wade and its intention to continue to follow the trimester

framework balancing a woman's constitutional right to decide whether to

terminate a pregnancy with the State's interest in protecting potential

life.

The state's interest in protecting potential life becomes

11

compelling" at the point of viability, i.e., when the fetus can exist

outside of a woman's womb either on its own or through artificial means.

The definition of viability is the one used by the Court in its R o e v.

- decision in 1973.

Wade

For the Court's most recent reaffirmation of

v. Wade, see also

Thornburgh v. American College of Obstetricians and Gynecologists, 106

S.Ct. 2169 (1986).

In Diamond v. Charles, 106 S.Ct. 1697 (19861, the

Court avoided ruling on the substantive issues involved by finding that

the appellant pediatrician lacked standing to bring the action.

On Dsc. 14, 1987, an equally divided Supreme Court, without opinion,

let stand a 7th Circuit court of appeals decision invalidating an Illinois

law that would have restricted the right of teenagers to have abortions by

requiring them to notify their parents ( ~ a r t i ~ av.

n Zbaraz, 56 U.S.L.W.

4053).

The tie vote means that the ruling sets no nationwide precedent.

There are other States with parental notification laws similar to the one

in Illinois.

Thus, the Supreme Court may have another opportunity to

review the issue in the future.

FOR ADDITlONAL READING

U.S.

Library of Congress.

Congressional Research Service.

Abortion:

[Washington] 1988.

Legislative control [by] Thomas P. Carr.

(updated regularly)

CRS Issue Brief 88007