|
PLANNED PARENTHOOD OF SOUTHEASTERN PENNSYLVANIA, ET AL., v.
ROBERT P. CASEY, ET AL.
Court Cases
Index
O'Conner, Kennedy and Souter's Court Opinion 1
O'Conner, Kennedy and Souter's Court Opinion 2
O'Conner, Kennedy and Souter's Court Opinion 3
O'Conner, Kennedy and Souter's Court Opinion 4
O'Conner, Kennedy and Souter's Court Opinion 5
O'Conner, Kennedy and Souter's Court Appendix
Rehnquist's dissenting opinion 1
Rehnquist's dissenting opinion 2
Stevens, concurring in part, dissenting in part
Scalia, concurring in part , dissenting in part
Blackmun, concurring in part, dissenting in part
V
The Court of Appeals applied what it believed to be the undue burden
standard, and upheld each of the provisions except for the husband notification
requirement. We agree generally with this conclusion, but refine the undue burden analysis
in accordance with the principles articulated above. We now consider the separate
statutory sections at issue.
A
Because it is central to the operation of various other
requirements, we begin with the statute's definition of medical emergency. Under the
statute, a medical emergency is
"[t]hat condition which, on the basis of the physician's good
faith clinical judgment, so complicates the medical condition of a pregnant woman as to
necessitate the immediate abortion of her pregnancy to avert her death or for which a
delay will create serious risk of substantial and irreversible impairment of a major
bodily function." 18 Pa.Cons.Stat. § 3203 (1990).
[505 U.S. 833, 880]
Petitioners argue that the definition is too narrow, contending that
it forecloses the possibility of an immediate abortion despite some significant health
risks. If the contention were correct, we would be required to invalidate the restrictive
operation of the provision, for the essential holding of Roe forbids a State from
interfering with a woman's choice to undergo an abortion procedure if continuing her
pregnancy would constitute a threat to her health. 410 U.S., at 164. See also Harris v.
McRae, 448 U.S., at 316.
The District Court found that there were three serious conditions
which would not be covered by the statute: preeclampsia, inevitable abortion, and
premature ruptured membrane. 744 F.Supp., at 1378. Yet, as the Court of Appeals observed,
947 F.2d, at 700-701, it is undisputed that, under some circumstances, each of these
conditions could lead to an illness with substantial and irreversible consequences. While
the definition could be interpreted in an unconstitutional manner, the Court of Appeals
construed the phrase "serious risk" to include those circumstances. Id.,
at 701. It stated: "[W]e read the medical emergency exception as intended by the
Pennsylvania legislature to assure that compliance with its abortion regulations would not
in any way pose a significant threat to the life or health of a woman." Ibid.
As we said in Brockett v. Spokane Arcades, Inc., 472 U.S. 491, 499-500 (1985):
"Normally, . . . we defer to the construction of a state statute given it by the
lower federal courts." Indeed, we have said that we will defer to lower court
interpretations of state law unless they amount to "plain" error. Palmer v.
Hoffman, 318 U.S. 109, 118 (1943). This "reflect[s] our belief that district courts
and courts of appeals are better schooled in, and more able to interpret, the laws of
their respective States." Frisby v. Schultz, 487 U.S. 474, 482 (1988) (citation
omitted). We adhere to that course today, and conclude that, as construed by the Court of
Appeals, the medical emergency definition imposes no undue burden on a woman's abortion
right.
B
We next consider the informed consent requirement. 18 Pa. Cons.Stat.
§ 3205 (1990). Except in a medical emergency, the statute requires that at least 24 hours
before performing an abortion a physician inform the woman of the nature of the procedure,
the health risks of the abortion and of childbirth, and the "probable gestational age
of the unborn child." The physician or a qualified nonphysician must inform the woman
of the availability of printed materials published by the State describing the fetus and
providing information about medical assistance for childbirth, information about child
support from the father, and a list of agencies which provide adoption and other services
as alternatives to abortion. An abortion may not be performed unless the woman certifies
in writing that she has been informed of the availability of these printed materials and
has been provided them if she chooses to view them.
Our prior decisions establish that, as with any medical procedure,
the State may require a woman to give her written informed consent to an abortion. See
Planned Parenthood of Central Mo. v. Danforth, 428 U.S., at 67. In this respect, the
statute is unexceptional. Petitioners challenge the statute's definition of informed
consent because it includes the provision of specific information by the doctor and the
mandatory 24-hour waiting period. The conclusions reached by a majority of the Justices in
the separate opinions filed today and the undue burden standard adopted in this opinion
require us to overrule in part some of the Court's past decisions, decisions driven by the
trimester framework's prohibition of all pre-viability regulations designed to further the
State's interest in fetal life.
In Akron I, 462 U.S. 416, we invalidated an ordinance which required
that a woman seeking an abortion be provided by her physician with specific information
"designed to influence the woman's informed choice between abortion or
childbirth." Id., at 444. As we later described [505 U.S. 833, 882] the Akron
I holding in Thornburgh v. American College of Obstetricians and Gynecologists, 476 U.S.,
at 762, there were two purported flaws in the Akron ordinance: the information was
designed to dissuade the woman from having an abortion, and the ordinance imposed "a
rigid requirement that a specific body of information be given in all cases, irrespective
of the particular needs of the patient. . . ." Ibid.
To the extent Akron I and Thornburgh find a constitutional violation
when the government requires, as it does here, the giving of truthful, nonmisleading
information about the nature of the procedure, the attendant health risks and those of
childbirth, and the "probable gestational age" of the fetus, those cases go too
far, are inconsistent with Roe's acknowledgment of an important interest in potential
life, and are overruled. This is clear even on the very terms of Akron I and Thornburgh.
Those decisions, along with Danforth, recognize a substantial government interest
justifying a requirement that a woman be apprised of the health risks of abortion and
childbirth. E.g., Danforth, supra, at 66-67. It cannot be questioned that
psychological wellbeing is a facet of health. Nor can it be doubted that most women
considering an abortion would deem the impact on the fetus relevant, if not dispositive,
to the decision. In attempting to ensure that a woman apprehend the full consequences of
her decision, the State furthers the legitimate purpose of reducing the risk that a woman
may elect an abortion, only to discover later, with devastating psychological
consequences, that her decision was not fully informed. If the information the State
requires to be made available to the woman is truthful and not misleading, the requirement
may be permissible.
We also see no reason why the State may not require doctors to
inform a woman seeking an abortion of the availability of materials relating to the
consequences to the fetus, even when those consequences have no direct relation to her
health. An example illustrates the point. We would think [505 U.S. 833, 883] it
constitutional for the State to require that, in order for there to be informed consent to
a kidney transplant operation, the recipient must be supplied with information about risks
to the donor as well as risks to himself or herself. A requirement that the physician make
available information similar to that mandated by the statute here was described in
Thornburgh as an outright attempt to wedge the Commonwealth's message discouraging
abortion into the privacy of the informed consent dialogue between the woman and her
physician. 476 U.S., at 762. We conclude, however, that informed choice need not be
defined in such narrow terms that all considerations of the effect on the fetus are made
irrelevant. As we have made clear, we depart from the holdings of Akron I and Thornburgh
to the extent that we permit a State to further its legitimate goal of protecting the life
of the unborn by enacting legislation aimed at ensuring a decision that is mature and
informed, even when, in so doing, the State expresses a preference for childbirth over
abortion. In short, requiring that the woman be informed of the availability of
information relating to fetal development and the assistance available should she decide
to carry the pregnancy to full term is a reasonable measure to ensure an informed choice,
one which might cause the woman to choose childbirth over abortion. This requirement
cannot be considered a substantial obstacle to obtaining an abortion, and, it follows,
there is no undue burden.
Our prior cases also suggest that the "straitjacket,"
Thornburgh, supra, at 762 (quoting Danforth, supra, at 67, n. 8), of
particular information which must be given in each case interferes with a constitutional
right of privacy between a pregnant woman and her physician. As a preliminary matter, it
is worth noting that the statute now before us does not require a physician to comply with
the informed consent provisions if he or she can demonstrate by a preponderance of the
evidence that he or she reasonably believed that furnishing the information would have
resulted in a severely [505 U.S. 833, 884] adverse effect on the physical or mental health
of the patient. 18 Pa. Cons.Stat. § 3205 (1990). In this respect, the statute does not
prevent the physician from exercising his or her medical judgment.
Whatever constitutional status the doctor-patient relation may have
as a general matter, in the present context, it is derivative of the woman's position. The
doctor-patient relation does not underlie or override the two more general rights under
which the abortion right is justified: the right to make family decisions and the right to
physical autonomy. On its own, the doctor-patient relation here is entitled to the same
solicitude it receives in other contexts. Thus, a requirement that a doctor give a woman
certain information as part of obtaining her consent to an abortion is, for constitutional
purposes, no different from a requirement that a doctor give certain specific information
about any medical procedure.
All that is left of petitioners' argument is an asserted First
Amendment right of a physician not to provide information about the risks of abortion, and
childbirth, in a manner mandated by the State. To be sure, the physician's First Amendment
rights not to speak are implicated, see Wooley v. Maynard, 430 U.S. 705 (1977), but only
as part of the practice of medicine, subject to reasonable licensing and regulation by the
State cf. Whalen v. Roe, 429 U.S. 589, 603 (1977). We see no constitutional infirmity in
the requirement that the physician provide the information mandated by the State here.
The Pennsylvania statute also requires us to reconsider the holding
in Akron I that the State may not require that a physician, as opposed to a qualified
assistant, provide information relevant to a woman's informed consent. 462 U.S., at 448.
Since there is no evidence on this record that requiring a doctor to give the information
as provided by the statute would amount, in practical terms, to a substantial obstacle to
a woman seeking an abortion, we conclude that it is not [505 U.S. 833, 885] an undue
burden. Our cases reflect the fact that the Constitution gives the States broad latitude
to decide that particular functions may be performed only by licensed professionals, even
if an objective assessment might suggest that those same tasks could be performed by
others. See Williamson v. Lee Optical of Okla., Inc., 348 U.S. 483 (1955). Thus, we uphold
the provision as a reasonable means to ensure that the woman's consent is informed.
Our analysis of Pennsylvania's 24-hour waiting period between the
provision of the information deemed necessary to informed consent and the performance of
an abortion under the undue burden standard requires us to reconsider the premise behind
the decision in Akron I invalidating a parallel requirement. In Akron I we said: Nor are
we convinced that the State's legitimate concern that the woman's decision be informed is
reasonably served by requiring a 24-hour delay as a matter of course. 462 U.S., at 450. We
consider that conclusion to be wrong. The idea that important decisions will be more
informed and deliberate if they follow some period of reflection does not strike us as
unreasonable, particularly where the statute directs that important information become
part of the background of the decision. The statute, as construed by the Court of Appeals,
permits avoidance of the waiting period in the event of a medical emergency, and the
record evidence shows that, in the vast majority of cases, a 24-hour delay does not create
any appreciable health risk. In theory, at least, the waiting period is a reasonable
measure to implement the State's interest in protecting the life of the unborn, a measure
that does not amount to an undue burden.
Whether the mandatory 24-hour waiting period is nonetheless invalid
because, in practice, it is a substantial obstacle to a woman's choice to terminate her
pregnancy is a closer question. The findings of fact by the District Court indicate that,
because of the distances many women must travel to reach an abortion provider, the
practical effect will often be [505 U.S. 833, 886] a delay of much more than a day because
the waiting period requires that a woman seeking an abortion make at least two visits to
the doctor. The District Court also found that, in many instances, this will increase the
exposure of women seeking abortions to "the harassment and hostility of anti-abortion
protestors demonstrating outside a clinic." 744 F.Supp., at 1351. As a result, the
District Court found that, for those women who have the fewest financial resources, those
who must travel long distances, and those who have difficulty explaining their whereabouts
to husbands, employers, or others, the 24-hour waiting period will be "particularly
burdensome." Id., at 1352.
These findings are troubling in some respects, but they do not
demonstrate that the waiting period constitutes an undue burden. We do not doubt that, as
the District Court held, the waiting period has the effect of "increasing the cost
and risk of delay of abortions," id., at 1378, but the District Court did not
conclude that the increased costs and potential delays amount to substantial obstacles.
Rather, applying the trimester framework's strict prohibition of all regulation designed
to promote the State's interest in potential life before viability, see id., at
1374, the District Court concluded that the waiting period does not further the state
"interest in maternal health" and "infringes the physician's discretion to
exercise sound medical judgment," id., at 1378. Yet, as we have stated, under
the undue burden standard, a State is permitted to enact persuasive measures which favor
childbirth over abortion, even if those measures do not further a health interest. And
while the waiting period does limit a physician's discretion, that is not, standing alone,
a reason to invalidate it. In light of the construction given the statute's definition of
medical emergency by the Court of Appeals, and the District Court's findings, we cannot
say that the waiting period imposes a real health risk.
We also disagree with the District Court's conclusion that the
"particularly burdensome" effects of the waiting period [505 U.S. 833, 887] on
some women require its invalidation. A particular burden is not, of necessity, a
substantial obstacle. Whether a burden falls on a particular group is a distinct inquiry
from whether it is a substantial obstacle even as to the women in that group. And the
District Court did not conclude that the waiting period is such an obstacle even for the
women who are most burdened by it. Hence, on the record before us, and in the context of
this facial challenge, we are not convinced that the 24-hour waiting period constitutes an
undue burden.
We are left with the argument that the various aspects of the
informed consent requirement are unconstitutional because they place barriers in the way
of abortion on demand. Even the broadest reading of Roe, however, has not suggested that
there is a constitutional right to abortion on demand. See, e.g., Doe v. Bolton, 410 U.S.,
at 189. Rather, the right protected by Roe is a right to decide to terminate a pregnancy
free of undue interference by the State. Because the informed consent requirement
facilitates the wise exercise of that right, it cannot be classified as an interference
with the right Roe protects. The informed consent requirement is not an undue burden on
that right.
C
Section 3209 of Pennsylvania's abortion law provides, except in
cases of medical emergency, that no physician shall perform an abortion on a married woman
without receiving a signed statement from the woman that she has notified her spouse that
she is about to undergo an abortion. The woman has the option of providing an alternative
signed statement certifying that her husband is not the man who impregnated her; that her
husband could not be located; that the pregnancy is the result of spousal sexual assault
which she has reported; or that the woman believes that notifying her husband will cause
him or someone else to inflict bodily injury upon her. A physician who performs an
abortion on [505 U.S. 833, 888] a married woman without receiving the appropriate signed
statement will have his or her license revoked, and is liable to the husband for damages.
The District Court heard the testimony of numerous expert witnesses,
and made detailed findings of fact regarding the effect of this statute. These included:
"273. The vast majority of women consult their husbands prior
to deciding to terminate their pregnancy. . . .
. . . . .
"279. The "bodily injury" exception could not be
invoked by a married woman whose husband, if notified, would, in her reasonable belief,
threaten to (a) publicize her intent to have an abortion to family, friends or
acquaintances; (b) retaliate against her in future child custody or divorce proceedings;
(c) inflict psychological intimidation or emotional harm upon her, her children or other
persons; (d) inflict bodily harm on other persons such as children, family members or
other loved ones; or (e) use his control over finances to deprive of necessary monies for
herself or her children. . . .
. . . . .
"281. Studies reveal that family violence occurs in two million
families in the United States. This figure, however, is a conservative one that
substantially understates (because battering is usually not reported until it reaches
life-threatening proportions) the actual number of families affected by domestic violence.
In fact, researchers estimate that one of every two women will be battered at some time in
their life. . . .
"282. A wife may not elect to notify her husband of her
intention to have an abortion for a variety of reasons, including the husband's illness,
concern about her own health, the imminent failure of the marriage, or the husband's
absolute opposition to the abortion. . . .
"283. The required filing of the spousal consent form would
require plaintiff-clinics to change their counseling [505 U.S. 833, 889] procedures and
force women to reveal their most intimate decisionmaking on pain of criminal sanctions.
The confidentiality of these revelations could not be guaranteed, since the woman's
records are not immune from subpoena. . . .
"284. Women of all class levels, educational backgrounds, and
racial, ethnic and religious groups are battered. . . .
"285. Wife-battering or abuse can take on many physical and
psychological forms. The nature and scope of the battering can cover a broad range of
actions, and be gruesome and torturous. . . .
"286. Married women, victims of battering, have been killed in
Pennsylvania and throughout the United States. . . .
"287. Battering can often involve a substantial amount of
sexual abuse, including marital rape and sexual mutilation. . . .
"288. In a domestic abuse situation, it is common for the
battering husband to also abuse the children in an attempt to coerce the wife. . . .
"289. Mere notification of pregnancy is frequently a flashpoint
for battering and violence within the family. The number of battering incidents is high
during the pregnancy, and often the worst abuse can be associated with pregnancy. . . .
The battering husband may deny parentage and use the pregnancy as an excuse for abuse. . .
.
"290. Secrecy typically shrouds abusive families. Family
members are instructed not to tell anyone, especially police or doctors, about the abuse
and violence. Battering husbands often threaten their wives or her children with further
abuse if she tells an outsider of the violence, and tells her that nobody will believe
her. A battered woman, therefore, is highly unlikely to disclose [505 U.S. 833, 890] the
violence against her for fear of retaliation by the abuser. . . .
"291. Even when confronted directly by medical personnel or
other helping professionals, battered women often will not admit to the battering, because
they have not admitted to themselves that they are battered. . . .
. . . . .
"294. A woman in a shelter or a safe house unknown to her
husband is not "reasonably likely" to have bodily harm inflicted upon her by her
batterer; however, her attempt to notify her husband pursuant to section 3209 could
accidentally disclose her whereabouts to her husband. Her fear of future ramifications
would be realistic under the circumstances.
"295. Marital rape is rarely discussed with others or reported
to law enforcement authorities, and of those reported, only few are prosecuted. . . .
"296. It is common for battered women to have sexual
intercourse with their husbands to avoid being battered. While this type of coercive
sexual activity would be spousal sexual assault as defined by the Act, many women may not
consider it to be so, and others would fear disbelief. . . .
"297. The marital rape exception to section 3209 cannot be
claimed by women who are victims of coercive sexual behavior other than penetration. The
90-day reporting requirement of the spousal sexual assault statute, 18 Pa.Con.Stat.Ann.
3218(c), further narrows the class of sexually abused wives who can claim the exception,
since many of these women may be psychologically unable to discuss or report the rape for
several years after the incident. . . .
"298. Because of the nature of the battering relationship,
battered women are unlikely to avail themselves of the exceptions to section 3209 of the
Act, regardless of [505 U.S. 833, 891] whether the section applies to them. 744 F.Supp.,
at 1360-1362 (footnote omitted).
These findings are supported by studies of domestic violence. The
American Medical Association (AMA) has published a summary of the recent research in this
field, which indicates that, in an average 12-month period in this country, approximately
two million women are the victims of severe assaults by their male partners. In a 1985
survey, women reported that nearly one of every eight husbands had assaulted their wives
during the past year. The AMA views these figures as "marked underestimates,"
because the nature of these incidents discourages women from reporting them, and because
surveys typically exclude the very poor, those who do not speak English well, and women
who are homeless or in institutions or hospitals when the survey is conducted. According
to the AMA, [r]esearchers on family violence agree that the true incidence of partner
violence is probably double the above estimates; or four million severely assaulted
women per year. Studies suggest that from one-fifth to one-third of all women will be
physically assaulted by a partner or ex-partner during their lifetime. AMA Council on
Scientific Affairs, Violence Against Women 7 (1991) (emphasis in original). Thus, on an
average day in the United States, nearly 11,000 women are severely assaulted by their male
partners. Many of these incidents involve sexual assault. Id., at 3-4; Shields
& Hanneke, Battered Wives' Reactions to Marital Rape, in The Dark Side of Families:
Current Family Violence Research 131, 144 (D. Finkelhor, R. Gelles, G. Hataling, & M.
Straus eds. 1983). In families where wifebeating takes place, moreover, child abuse is
often present as well. Violence Against Women, supra, at 12.
Other studies fill in the rest of this troubling picture. Physical
violence is only the most visible form of abuse. Psychological abuse, particularly forced
social and economic isolation of women, is also common. L. Walker, The Battered [505 U.S.
833, 892] Woman Syndrome 27-28 (1984). Many victims of domestic violence remain with their
abusers, perhaps because they perceive no superior alternative. Herbert, Silver, &
Ellard, Coping with an Abusive Relationship: I. How and Why do Women Stay?, 53 J. Marriage
& the Family 311 (1991). Many abused women who find temporary refuge in shelters
return to their husbands, in large part because they have no other source of income.
Aguirre, Why Do They Return? Abused Wives in Shelters, 30 J.Nat.Assn. of Social Workers
350, 352 (1985). Returning to one's abuser can be dangerous. Recent Federal Bureau of
Investigation statistics disclose that 8.8 percent of all homicide victims in the United
States are killed by their spouses. Mercy & Saltzman, Fatal Violence Among Spouses in
the United States, 1976-85, 79 Am.J. Public Health 595 (1989). Thirty percent of female
homicide victims are killed by their male partners. Domestic Violence: Terrorism in the
Home, Hearing before the Subcommittee on Children, Family, Drugs and Alcoholism of the
Senate Committee on Labor and Human Resources, 101st Cong., 2d Sess., 3 (1990).
The limited research that has been conducted with respect to
notifying one's husband about an abortion, although involving samples too small to be
representative, also supports the District Court's findings of fact. The vast majority of
women notify their male partners of their decision to obtain an abortion. In many cases in
which married women do not notify their husbands, the pregnancy is the result of an
extramarital affair. Where the husband is the father, the primary reason women do not
notify their husbands is that the husband and wife are experiencing marital difficulties,
often accompanied by incidents of violence. Ryan & Plutzer, When Married Women Have
Abortions: Spousal Notification and Marital Interaction, 51 J. Marriage & the Family
41, 44 (1989).
This information and the District Court's findings reinforce what
common sense would suggest. In well-functioning [505 U.S. 833, 893] marriages, spouses
discuss important intimate decisions such as whether to bear a child. But there are
millions of women in this country who are the victims of regular physical and
psychological abuse at the hands of their husbands. Should these women become pregnant,
they may have very good reasons for not wishing to inform their husbands of their decision
to obtain an abortion. Many may have justifiable fears of physical abuse, but may be no
less fearful of the consequences of reporting prior abuse to the Commonwealth of
Pennsylvania. Many may have a reasonable fear that notifying their husbands will provoke
further instances of child abuse; these women are not exempt from § 3209's notification
requirement. Many may fear devastating forms of psychological abuse from their husbands,
including verbal harassment, threats of future violence, the destruction of possessions,
physical confinement to the home, the withdrawal of financial support, or the disclosure
of the abortion to family and friends. These methods of psychological abuse may act as
even more of a deterrent to notification than the possibility of physical violence, but
women who are the victims of the abuse are not exempt from § 3209's notification
requirement. And many women who are pregnant as a result of sexual assaults by their
husbands will be unable to avail themselves of the exception for spousal sexual assault,
§ 3209(b)(3), because the exception requires that the woman have notified law enforcement
authorities within 90 days of the assault, and her husband will be notified of her report
once an investigation begins, 3128(c). If anything in this field is certain, it is that
victims of spousal sexual assault are extremely reluctant to report the abuse to the
government; hence, a great many spousal rape victims will not be exempt from the
notification requirement imposed by § 3209.
The spousal notification requirement is thus likely to prevent a
significant number of women from obtaining an abortion. It does not merely make abortions
a little more difficult or expensive to obtain; for many women, it will impose [505 U.S.
833, 894] a substantial obstacle. We must not blind ourselves to the fact that the
significant number of women who fear for their safety and the safety of their children are
likely to be deterred from procuring an abortion as surely as if the Commonwealth had
outlawed abortion in all cases.
Respondents attempt to avoid the conclusion that § 3209 is invalid
by pointing out that it imposes almost no burden at all for the vast majority of women
seeking abortions. They begin by noting that only about 20 percent of the women who obtain
abortions are married. They then note that, of these women, about 95 percent notify their
husbands of their own volition. Thus, respondents argue, the effects of § 3209 are felt
by only one percent of the women who obtain abortions. Respondents argue that, since some
of these women will be able to notify their husbands without adverse consequences or will
qualify for one of the exceptions, the statute affects fewer than one percent of women
seeking abortions. For this reason, it is asserted, the statute cannot be invalid on its
face. See Brief for Respondents 83-86. We disagree with respondents' basic method of
analysis.
The analysis does not end with the one percent of women upon whom
the statute operates; it begins there. Legislation is measured for consistency with the
Constitution by its impact on those whose conduct it affects. For example, we would not
say that a law which requires a newspaper to print a candidate's reply to an unfavorable
editorial is valid on its face because most newspapers would adopt the policy even absent
the law. See Miami Herald Publishing Co. v. Tornillo, 418 U.S. 241 (1974). The proper
focus of constitutional inquiry is the group for whom the law is a restriction, not the
group for whom the law is irrelevant.
Respondents' argument itself gives implicit recognition to this
principle at one of its critical points. Respondents speak of the one percent of women
seeking abortions who are married and would choose not to notify their husbands of their
plans. By selecting as the controlling class women [505 U.S. 833, 895] who wish to obtain
abortions, rather than all women or all pregnant women, respondents, in effect, concede
that § 3209 must be judged by reference to those for whom it is an actual, rather than an
irrelevant, restriction. Of course, as we have said, § 3209's real target is narrower
even than the class of women seeking abortions identified by the State: it is married
women seeking abortions who do not wish to notify their husbands of their intentions and
who do not qualify for one of the statutory exceptions to the notice requirement. The
unfortunate yet persisting conditions we document above will mean that, in a large
fraction of the cases in which § 3209 is relevant, it will operate as a substantial
obstacle to a woman's choice to undergo an abortion. It is an undue burden, and therefore
invalid.
This conclusion is in no way inconsistent with our decisions
upholding parental notification or consent requirements. See, e.g., Akron II, 497 U.S., at
510-519; Bellotti v. Baird, 443 U.S. 622 (1979) (Bellotti II); Planned Parenthood of
Central Mo. v. Danforth, 428 U.S., at 74. Those enactments, and our judgment that they are
constitutional, are based on the quite reasonable assumption that minors will benefit from
consultation with their parents and that children will often not realize that their
parents have their best interests at heart. We cannot adopt a parallel assumption about
adult women.
We recognize that a husband has a deep and proper concern and
interest . . . in his wife's pregnancy and in the growth and development of the fetus she
is carrying. Danforth, supra, at 69. With regard to the children he has fathered
and raised, the Court has recognized his "cognizable and substantial" interest
in their custody. Stanley v. Illinois, 405 U.S. 645, 651-652 (1972); see also Quilloin v.
Walcott, 434 U.S. 246 (1978); Caban v. Mohammed, 441 U.S. 380 (1979); Lehr v. Robertson,
463 U.S. 248 (1983). If this case concerned a State's ability to require the mother to
notify the father before taking some action with respect to a living [505 U.S. 833, 896]
child raised by both, therefore, it would be reasonable to conclude, as a general matter,
that the father's interest in the welfare of the child and the mother's interest are
equal.
Before birth, however, the issue takes on a very different cast. It
is an inescapable biological fact that state regulation with respect to the child a woman
is carrying will have a far greater impact on the mother's liberty than on the father's.
The effect of state regulation on a woman's protected liberty is doubly deserving of
scrutiny in such a case, as the State has touched not only upon the private sphere of the
family, but upon the very bodily integrity of the pregnant woman. Cf. Cruzan v. Director,
Mo. Dept. of Health, 497 U.S., at 281. The Court has held that, when the wife and the
husband disagree on this decision, the view of only one of the two marriage partners can
prevail. Inasmuch as it is the woman who physically bears the child and who is the more
directly and immediately affected by the pregnancy, as between the two, the balance weighs
in her favor. Danforth, supra, at 71. This conclusion rests upon the basic nature
of marriage and the nature of our Constitution: [T]he marital couple is not an independent
entity with a mind and heart of its own, but an association of two individuals, each with
a separate intellectual and emotional makeup. If the right of privacy means anything, it
is the right of the individual, married or single, to be free from unwarranted
governmental intrusion into matters so fundamentally affecting a person as the decision
whether to bear or beget a child. Eisenstadt v. Baird, 405 U.S., at 453 (emphasis in
original). The Constitution protects individuals, men and women alike, from unjustified
state interference, even when that interference is enacted into law for the benefit of
their spouses.
There was a time, not so long ago, when a different understanding of
the family and of the Constitution prevailed. In Bradwell v. State, 16 Wall. 130 (1873),
three Members of this [505 U.S. 833, 897] Court reaffirmed the common law principle that a
woman had no legal existence separate from her husband, who was regarded as her head and
representative in the social state; and, notwithstanding some recent modifications of this
civil status, many of the special rules of law flowing from and dependent upon this
cardinal principle still exist in full force in most States. Id., at 141 (Bradley,
J., joined by Swayne and Field, JJ., concurring in judgment). Only one generation has
passed since this Court observed that "woman is still regarded as the center of home
and family life," with attendant "special responsibilities" that precluded
full and independent legal status under the Constitution. Hoyt v. Florida, 368 U.S. 57, 62
(1961). These views, of course, are no longer consistent with our understanding of the
family, the individual, or the Constitution.
In keeping with our rejection of the common law understanding of a
woman's role within the family, the Court held in Danforth that the Constitution does not
permit a State to require a married woman to obtain her husband's consent before
undergoing an abortion. 428 U.S., at 69. The principles that guided the Court in Danforth
should be our guides today. For the great many women who are victims of abuse inflicted by
their husbands, or whose children are the victims of such abuse, a spousal notice
requirement enables the husband to wield an effective veto over his wife's decision.
Whether the prospect of notification itself deters such women from seeking abortions, or
whether the husband, through physical force or psychological pressure or economic
coercion, prevents his wife from obtaining an abortion until it is too late, the notice
requirement will often be tantamount to the veto found unconstitutional in Danforth. The
women most affected by this law - those who most reasonably fear the consequences of
notifying their husbands that they are pregnant - are in the gravest danger. [505 U.S.
833, 898]
The husband's interest in the life of the child his wife is carrying
does not permit the State to empower him with this troubling degree of authority over his
wife. The contrary view leads to consequences reminiscent of the common law. A husband has
no enforceable right to require a wife to advise him before she exercises her personal
choices. If a husband's interest in the potential life of the child outweighs a wife's
liberty, the State could require a married woman to notify her husband before she uses a
post-fertilization contraceptive. Perhaps next in line would be a statute requiring
pregnant married women to notify their husbands before engaging in conduct causing risks
to the fetus. After all, if the husband's interest in the fetus' safety is a sufficient
predicate for state regulation, the State could reasonably conclude that pregnant wives
should notify their husbands before drinking alcohol or smoking. Perhaps married women
should notify their husbands before using contraceptives or before undergoing any type of
surgery that may have complications affecting the husband's interest in his wife's
reproductive organs. And if a husband's interest justifies notice in any of these cases,
one might reasonably argue that it justifies exactly what the Danforth Court held it did
not justify - a requirement of the husband's consent as well. A State may not give to a
man the kind of dominion over his wife that parents exercise over their children.
Section 3209 embodies a view of marriage consonant with the common
law status of married women, but repugnant to our present understanding of marriage and of
the nature of the rights secured by the Constitution. Women do not lose their
constitutionally protected liberty when they marry. The Constitution protects all
individuals, male or female, married or unmarried, from the abuse of governmental power,
even where that power is employed for the supposed benefit of a member of the individual's
family. These considerations confirm our conclusion that § 3209 is invalid. [505 U.S.
833, 899]
D
We next consider the parental consent provision. Except in a medical
emergency, an unemancipated young woman under 18 may not obtain an abortion unless she and
one of her parents (or guardian) provides informed consent as defined above. If neither a
parent nor a guardian provides consent, a court may authorize the performance of an
abortion upon a determination that the young woman is mature and capable of giving
informed consent and has, in fact, given her informed consent, or that an abortion would
be in her best interests.
We have been over most of this ground before. Our cases establish,
and we reaffirm today, that a State may require a minor seeking an abortion to obtain the
consent of a parent or guardian, provided that there is an adequate judicial bypass
procedure. See, e.g., Akron II, 497 U.S., at 510-519; Hodgson, 497 U.S., at 461 (O'Connor,
J., concurring in part and concurring in judgment in part); id., at 497-501
(Kennedy, J., concurring in judgment in part and dissenting in part); Akron I, 462 U.S.,
at 440; Bellotti II, 443 U.S., at 643-644 (plurality opinion). Under these precedents, in
our view, the one-parent consent requirement and judicial bypass procedure are
constitutional.
The only argument made by petitioners respecting this provision and
to which our prior decisions do not speak is the contention that the parental consent
requirement is invalid because it requires informed parental consent. For the most part,
petitioners' argument is a reprise of their argument with respect to the informed consent
requirement in general, and we reject it for the reasons given above. Indeed, some of the
provisions regarding informed consent have particular force with respect to minors: the
waiting period, for example, may provide the parent or parents of a pregnant young woman
the opportunity to consult with her in private, and to discuss the consequences of her
decision in [505 U.S. 833, 900] the context of the values and moral or religious
principles of their family. See Hodgson, supra, at 448-449 (opinion of Stevens, J.)
E
Under the recordkeeping and reporting requirements of the statute,
every facility which performs abortions is required to file a report stating its name and
address as well as the name and address of any related entity, such as a controlling or
subsidiary organization. In the case of state-funded institutions, the information becomes
public.
For each abortion performed, a report must be filed identifying: the
physician (and the second physician where required); the facility; the referring physician
or agency; the woman's age; the number of prior pregnancies and prior abortions she has
had; gestational age; the type of abortion procedure; the date of the abortion; whether
there were any preexisting medical conditions which would complicate pregnancy; medical
complications with the abortion; where applicable, the basis for the determination that
the abortion was medically necessary; the weight of the aborted fetus; and whether the
woman was married, and if so, whether notice was provided or the basis for the failure to
give notice. Every abortion facility must also file quarterly reports showing the number
of abortions performed broken down by trimester. See 18 Pa.Cons.Stat. § 3207, 3214
(1990). In all events, the identity of each woman who has had an abortion remains
confidential.
In Danforth, 428 U.S., at 80, we held that recordkeeping and
reporting provisions that are reasonably directed to the preservation of maternal health
and that properly respect a patient's confidentiality and privacy are permissible. We
think that, under this standard, all the provisions at issue here except that relating to
spousal notice are constitutional. Although they do not relate to the State's interest in
informing the woman's choice, they do relate to health. The collection of information with
respect to actual patients [505 U.S. 833, 901] is a vital element of medical research, and
so it cannot be said that the requirements serve no purpose other than to make abortions
more difficult. Nor do we find that the requirements impose a substantial obstacle to a
woman's choice. At most, they might increase the cost of some abortions by a slight
amount. While at some point increased cost could become a substantial obstacle, there is
no such showing on the record before us.
Subsection (12) of the reporting provision requires the reporting
of, among other things, a married woman's "reason for failure to provide notice"
to her husband. 3214(a)(12). This provision in effect requires women, as a condition of
obtaining an abortion, to provide the Commonwealth with the precise information we have
already recognized that many women have pressing reasons not to reveal. Like the spousal
notice requirement itself, this provision places an undue burden on a woman's choice, and
must be invalidated for that reason.
VI
Our Constitution is a covenant running from the first generation of
Americans to us, and then to future generations. It is a coherent succession. Each
generation must learn anew that the Constitution's written terms embody ideas and
aspirations that must survive more ages than one. We accept our responsibility not to
retreat from interpreting the full meaning of the covenant in light of all of our
precedents. We invoke it once again to define the freedom guaranteed by the Constitution's
own promise, the promise of liberty.
* * *
The judgment in No. 91-902 is affirmed. The judgment in No. 91-744
is affirmed in part and reversed in part, and the case is remanded for proceedings
consistent with this opinion, including consideration of the question of severability.
It is so ordered.
PLANNED PARENTHOOD OF SOUTHEASTERN
PENNSYLVANIA, ET AL., v. ROBERT P. CASEY, ET AL.
Court Cases
Index
O'Conner, Kennedy and Souter's Court Opinion 1
O'Conner, Kennedy and Souter's Court Opinion 2
O'Conner, Kennedy and Souter's Court Opinion 3
O'Conner, Kennedy and Souter's Court Opinion 4
O'Conner, Kennedy and Souter's Court Opinion 5
O'Conner, Kennedy and Souter's Court Appendix
Rehnquist's dissenting opinion 1
Rehnquist's dissenting opinion 2
Stevens, concurring in part, dissenting in part
Scalia, concurring in part , dissenting in part
Blackmun, concurring in part, dissenting in part
|