Abortion: Judicial Control

In 1973 the U.S. Supreme Court held that the Constitution protects a woman's decision whether or not to terminate her pregnancy, Roe v. Wade, 410 U.S. 113, and that a State may not unduly burden the exercise of that fundamental right by regulations that prohibit or substantially limit access to the means of effectuating that decision, Doe v. Bolton, 410 U.S. 179. But rather than settling the issue, the Court's rulings have kindled heated debate and precipitated a variety of governmental actions at the national, State and local levels designed either to nullify the rulings or hinder their

effectuation. This brief discusses this ongoing issue, highlighting judicial history and decisions.

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 f o l l o w e d t h e p r e - e x i s t i n g common By t h e t i m e of t h e C i v i l War a revise t h e i r s t a t u t e s i n order gestation. The S t a t e s v a r i e d abortions. a b o r t i o n i n mid-19th c e n t u r y America law of England i n a l l b u t a few S t a t e s . number o f S t a t e s had begun t o add t o o 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 i n t h e i r exceptions f o r therapeutic 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: [Wlith respect t o i n t e r e s t i n t h e h e a l t h of l i g h t of p r e s e n t m e d i c a l of 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 ' s i m p o r t a n t and l e g i t i m a t e t h e mother, t h e "compelling" p o i n t , i n knowledge, i s a t a p p r o x i m a t e l y t h e end ( 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.) Finally, requiring that of t h e unborn f o r vagueness. s i t u a t i o n such b e i n g imposed. Clause. 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 physicians performing a b o r t ions s e e t o i t t h a t t h e remains 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 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 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 ( 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 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 performed i n a f u l l s e r v i c e h o s p i t a l , 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 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 a l l second t r i m e s t e r a b o r t i o n s be t h e Supreme C o u r t h e l d t h a t i t s s u c h r e q u i r e m e n t i n C i t y o f Akron 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