l (SII OInIon) OCTOII! TI!

M, 2006
SyIInbus
OTI: Whoro If Is fonsIbIo, n syIInbus (hondnofo) wIII bo roIonsod, ns Is
boIng dono In connocfIon wIfh fhIs cnso, nf fho fImo fho oInIon Is Issuod.
Tho syIInbus consfIfufos no nrf of fho oInIon of fho Courf buf hns boon
ronrod by fho !oorfor of ocIsIons for fho convonIonco of fho rondor.
Soo UniIeJ SIoIee v. DeIroiI TinIer & IunIer Co., 200 !. S. 32l, 33?.
6835(0(&28572)7+(81,7('67$7(6
SyIInbus
COZA!IS, ATTO!IY CII!A! t. CA!HA!T IT A!.
CI!TIO!A!I TO THI !ITI STATIS CO!!T OI AIIIA!S IO!
THI IICHTH CI!C!IT
o. 05380. Arguod ovombor 8, 2006ocIdod ArII l8, 200?*
IoIIowIng fhIs Courf`s SIenIerg v. CorIorI, 530 !. S. 9l4, docIsIon fhnf
obrnskn`s nrfInI bIrfh nborfIon sfnfufo vIoInfod fho IodornI Con-
sfIfufIon, ns Inforrofod In PlonneJ PorenIIooJ of SouIIeoeIern Po.
v. Coee,, 505 !. S. 833, nnd Ioe v. WoJe, 4l0 !. S. ll3, Congross
nssod fho InrfInI-IIrfh AborfIon Inn Acf of 2003 (Acf) fo roscrIbo n
nrfIcuInr mofhod of ondIng fofnI IIfo In fho Infor sfngos of rognnncy.
Tho Acf doos nof roguInfo fho mosf common nborfIon rocoduros usod
In fho fIrsf frImosfor of rognnncy, whon fho vnsf mnjorIfy of nbor-
fIons fnko Inco. In fho usunI socond-frImosfor rocoduro, dIInfIon
nnd ovncunfIon (&I), fho docfor dIInfos fho corvIx nnd fhon Insorfs
surgIcnI Insfrumonfs Info fho uforus nnd mnnouvors fhom fo grnb fho
fofus nnd uII If bnck fhrough fho corvIx nnd vngInn. Tho fofus Is
usunIIy rIod nnrf ns If Is romovod, nnd fho docfor mny fnko l0 fo
l5 nssos fo romovo If In Ifs onfIrofy. Tho rocoduro fhnf romfod
fho fodornI Acf nnd vnrIous sfnfo sfnfufos, IncIudIng obrnskn`s, Is n
vnrInfIon of fho sfnndnrd &I, nnd Is horoIn roforrod fo ns Infncf
&I. Tho mnIn dIfforonco bofwoon fho fwo rocoduros Is fhnf In In-
fncf &I n docfor oxfrncfs fho fofus Infncf or InrgoIy Infncf wIfh onIy
n fow nssos, uIIIng ouf Ifs onfIro body Insfond of rIIng If nnrf.
In ordor fo nIIow fho hond fo nss fhrough fho corvIx, fho docfor fyI-
cnIIy Iorcos or crushos fho skuII.
Tho Acf rosondod fo SIenIerg In fwo wnys. IIrsf, Congross found
fhnf unIIko fhIs Courf In SIenIerg, If wns nof roquIrod fo nccof
fho IsfrIcf Courf`s fncfunI fIndIngs, nnd fhnf fhoro wns n mornI,

*Togofhor wIfh o. 05l382, Goncolee, AIIorne, Generol v. PlonneJ
PorenIIooJ IeJeroIion of Anerico, 1nc., eI ol., on corfIornrI fo fho
!nIfod Sfnfos Courf of AonIs for fho Infh CIrcuIf.
2 COZA!IS t. CA!HA!T
SyIInbus
modIcnI, nnd ofhIcnI consonsus fhnf nrfInI-bIrfh nborfIon Is n gruo-
somo nnd Inhumnno rocoduro fhnf Is novor modIcnIIy nocossnry nnd
shouId bo rohIbIfod. Socond, fho Acf`s Inngungo dIffors from fhnf of
fho obrnskn sfnfufo sfruck down In SIenIerg. Among ofhor fhIngs,
fho Acf rohIbIfs knowIngIy orform|Ing] n nrfInI-bIrfh nborfIon . . .
fhnf Is |nof] nocossnry fo snvo fho IIfo of n mofhor, l8 !. S. C.
l53l(n). If dofInos nrfInI-bIrfh nborfIon, l53l(b)(l), ns n roco-
duro In whIch fho docfor: (A) doIIbornfoIy nnd InfonfIonnIIy vngInnIIy
doIIvors n IIvIng fofus unfII, In fho cnso of n hond-fIrsf rosonfnfIon,
fho onfIro fofnI hond Is oufsIdo fho |mofhor`s] body . . . , or, In fho cnso
of brooch rosonfnfIon, nny nrf of fho fofnI frunk nsf fho nnvoI Is
oufsIdo fho |mofhor`s] body . . . , for fho uroso of orformIng nn
ovorf ncf fhnf fho orson knows wIII kIII fho nrfInIIy doIIvorod IIvIng
fofus; nnd (I) orforms fho ovorf ncf, ofhor fhnn comIofIon of do-
IIvory, fhnf kIIIs fho fofus.
In o. 05380, rosondonf nborfIon docfors chnIIongod fho Acf`s
consfIfufIonnIIfy on Ifs fnco, nnd fho IodornI IsfrIcf Courf grnnfod n
ormnnonf InjuncfIon rohIbIfIng ofIfIonor Affornoy ConornI from
onforcIng fho Acf In nII cnsos buf fhoso In whIch fhoro wns no dIsufo
fho fofus wns vInbIo. Tho courf found fho Acf unconsfIfufIonnI bo-
cnuso If (l) Inckod nn oxcofIon nIIowIng fho rohIbIfod rocoduro
whoro nocossnry for fho mofhor`s honIfh nnd (2) covorod nof moroIy
Infncf &I buf nIso ofhor &Is. AffIrmIng, fho IIghfh CIrcuIf
found fhnf n Inck of consonsus oxIsfod In fho modIcnI communIfy ns fo
fho bnnnod rocoduro`s nocossIfy, nnd fhus SIenIerg roquIrod IogIsIn-
furos fo orr on fho sIdo of rofocfIng womon`s honIfh by IncIudIng n
honIfh oxcofIon. In o. 05l382, rosondonf nborfIon ndvocncy
grous broughf suIf chnIIongIng fho Acf. Tho IsfrIcf Courf onjoInod
fho Affornoy ConornI from onforcIng fho Acf, concIudIng If wns un-
consfIfufIonnI on Ifs fnco bocnuso If (l) unduIy burdonod n womnn`s
nbIIIfy fo chooso n socond-frImosfor nborfIon, (2) wns foo vnguo, nnd
(3) Inckod n honIfh oxcofIon ns roquIrod by SIenIerg. Tho Infh
CIrcuIf ngrood nnd nffIrmod.
HelJ. !osondonfs hnvo nof domonsfrnfod fhnf fho Acf, ns n fncInI mnf-
for, Is voId for vnguonoss, or fhnf If Imosos nn unduo burdon on n
womnn`s rIghf fo nborfIon bnsod on Ifs ovorbrondfh or Inck of n honIfh
oxcofIon. I. l439.
l. Tho Coee, Courf ronffIrmod whnf If formod Ioe`s fhroo-nrf os-
sonfInI hoIdIng: IIrsf, n womnn hns fho rIghf fo chooso fo hnvo nn
nborfIon boforo fofnI vInbIIIfy nnd fo obfnIn If wIfhouf unduo Inforfor-
onco from fho Sfnfo. Socond, fho Sfnfo hns fho owor fo rosfrIcf nbor-
fIons nffor vInbIIIfy, If fho Inw confnIns oxcofIons for rognnncIos
ondnngorIng fho womnn`s IIfo or honIfh. And fhIrd, fho Sfnfo hns Io-
gIfImnfo Inforosfs from fho rognnncy`s oufsof In rofocfIng fho
3 CIfo ns: 550 !. S. ____ (200?)
SyIInbus
honIfh of fho womnn nnd fho IIfo of fho fofus fhnf mny bocomo n
chIId. 505 !. S., nf 846. Though nII fhroo nro ImIIcnfod horo, If Is
fho fhIrd fhnf roquIros fho mosf oxfondod dIscussIon. In docIdIng
whofhor fho Acf furfhors fho Covornmonf`s IogIfImnfo Inforosf In ro-
focfIng fofnI IIfo, fho Courf nssumos, inIer olio, fhnf nn unduo bur-
don on fho rovInbIIIfy nborfIon rIghf oxIsfs If n roguInfIon`s uroso
or offocf Is fo Inco n subsfnnfInI obsfncIo In fho |womnn`s] nfh, iJ.,
nf 8?8, buf fhnf |r]oguInfIons whIch do no moro fhnn cronfo n sfruc-
furnI mochnnIsm by whIch fho Sfnfo . . . mny oxross rofound ro-
socf for fho IIfo of fho unborn nro ormIffod, If fhoy nro nof n sub-
sfnnfInI obsfncIo fo fho womnn`s oxorcIso of fho rIghf fo chooso, iJ.,
nf 8??. Coee, sfruck n bnInnco fhnf wns confrnI fo Ifs hoIdIng, nnd
fho Courf nIIos Coee,`s sfnndnrd horo. A confrnI romIso of Coee,`s
joInf oInIonfhnf fho govornmonf hns n IogIfImnfo, subsfnnfInI In-
forosf In rosorvIng nnd romofIng fofnI IIfowouId bo roudInfod
woro fho Courf now fo nffIrm fho judgmonfs boIow. I. l4l6.
2. Tho Acf, on Ifs fnco, Is nof voId for vnguonoss nnd doos nof Im-
oso nn unduo burdon from nny ovorbrondfh. I. l626.
(n) Tho Acf`s foxf domonsfrnfos fhnf If roguInfos nnd roscrIbos
orformIng fho Infncf &I rocoduro. IIrsf, sInco fho docfor musf
vngInnIIy doIIvo|r] n IIvIng fofus, l53l(b)(l)(A), fho Acf doos nof
rosfrIcf nborfIons InvoIvIng doIIvory of nn oxIrod fofus or fhoso nof
InvoIvIng vngInnI doIIvory, e.g., hysforofomy or hysforocfomy. And If
nIIos bofh rovInbIIIfy nnd osfvInbIIIfy bocnuso, by common un-
dorsfnndIng nnd scIonfIfIc formInoIogy, n fofus Is n IIvIng orgnnIsm
wIfhIn fho womb, whofhor or nof If Is vInbIo oufsIdo fho womb. Soc-
ond, bocnuso fho Acf roquIros fho IIvIng fofus fo bo doIIvorod fo n so-
cIfIc nnnfomIcnI Inndmnrk doondIng on fho fofus` rosonfnfIon, iIiJ.,
nn nborfIon nof InvoIvIng such nrfInI doIIvory Is ormIffod. ThIrd,
bocnuso fho docfor musf orform nn ovorf ncf, ofhor fhnn comIofIon
of doIIvory, fhnf kIIIs fho nrfInIIy doIIvorod fofus, l53l(b)(l)(I),
fho ovorf ncf musf bo sonrnfo from doIIvory. If musf nIso occur nf-
for doIIvory fo nn nnnfomIcnI Inndmnrk, sInco kIIIIng fho nrfInIIy
doIIvorod fofus, whon rond In confoxf, rofors fo n fofus fhnf hns boon
so doIIvorod, iIiJ. Iourfh, gIvon fho Acf`s scIonfor roquIromonfs, do-
IIvory of n IIvIng fofus nsf nn nnnfomIcnI Inndmnrk by nccIdonf or
Inndvorfonco Is nof n crImo bocnuso If Is nof doIIbornf|o] nnd Infon-
fIonn|I], l53l(b)(l)(A). or Is such n doIIvory rohIbIfod If fho fofus
|hns nof] boon doIIvorod for fho uroso of orformIng nn ovorf ncf
fhnf fho |docfor] knows wIII kIII |If]. 1IiJ. I. l6l8.
(b) Tho Acf Is nof unconsfIfufIonnIIy vnguo on Ifs fnco. If snfIs-
fIos bofh roquIromonfs of fho voId-for-vnguonoss docfrIno. IIrsf, If
rovIdos docfors of ordInnry InfoIIIgonco n ronsonnbIo oorfunIfy fo
know whnf Is rohIbIfod, Gro,neJ v. CiI, of IoclforJ, 408 !. S. l04,
4 COZA!IS t. CA!HA!T
SyIInbus
l08, soffIng forfh roInfIvoIy cIonr guIdoIInos ns fo rohIbIfod con-
ducf nnd rovIdIng objocfIvo crIforIn fo ovnIunfo whofhor n docfor
hns orformod n rohIbIfod rocoduro, PoeIere 'A` TIinge, IIJ. v.
UniIeJ SIoIee, 5ll !. S. 5l3, 525526. Socond, If doos nof oncourngo
nrbIfrnry or dIscrImInnfory onforcomonf. KolenJer v. Ioueon, 46l
!. S. 352, 35?. Ifs nnnfomIcnI Inndmnrks osfnbIIsh mInImnI guIdo-
IInos fo govorn Inw onforcomonf, SniII v. Goguen, 4l5 !. S. 566,
5?4, nnd Ifs scIonfor roquIromonfs nnrrow fho scoo of Ifs rohIbIfIon
nnd IImIf rosocuforInI dIscrofIon, soo KolenJer, eupro, nf 358. !o-
sondonfs` nrbIfrnry onforcomonf nrgumonfs, furfhormoro, nro
somowhnf socuInfIvo, sInco fhIs Is n roonforcomonf chnIIongo.
I. l820.
(c) Tho Courf rojocfs rosondonfs` nrgumonf fhnf fho Acf Imosos
nn unduo burdon, ns n fncInI mnffor, bocnuso Ifs rosfrIcfIons on soc-
ond-frImosfor nborfIons nro foo brond. I. 2026.
(I) Tho Acf`s foxf dIscIosos fhnf If rohIbIfs n docfor from Infon-
fIonnIIy orformIng nn Infncf &I. Ifs dunI rohIbIfIons corrosond
wIfh fho sfos gonornIIy undorfnkon In fhIs rocoduro: Tho docfor (l)
doIIvors fho fofus unfII Ifs hond Iodgos In fho corvIx, usunIIy nsf fho
nnnfomIcnI Inndmnrk for n brooch rosonfnfIon, soo l53l(b)(l)(A),
nnd (2) rocoods fo fho ovorf ncf of IorcIng or crushIng fho fofnI skuII
nffor fho nrfInI doIIvory, soo l53l(b)(l)(I). Tho Acf`s scIonfor ro-
quIromonfs IImIf Ifs ronch fo fhoso hysIcInns who cnrry ouf fho In-
fncf &I, wIfh fho Infonf fo undorfnko bofh sfos nf fho oufsof. Tho
Acf oxcIudos mosf &Is In whIch fho docfor Infonds fo romovo fho
fofus In Iocos from fho oufsof. ThIs InforrofnfIon Is confIrmod by
comnrIng fho Acf wIfh fho obrnskn sfnfufo In SIenIerg. Thoro, fho
Courf concIudod fhnf fho sfnfufo oncomnssod &I, whIch offon In-
voIvo|s] n hysIcInn uIIIng n 'subsfnnfInI orfIon` of n sfIII IIvIng fo-
fus . . . , sny, nn nrm or Iog, Info fho vngInn rIor fo fho donfh of fho
fofus, 530 !. S., nf 939, nnd rojocfod fho obrnskn Affornoy Con-
ornI`s IImIfIng InforrofnfIon fhnf fho sfnfufo`s roforonco fo n roco-
duro fhnf kIII|s] fho unborn chIId wns fo n dIsfIncf rocoduro, nof
fo fho nborfIon rocoduro ns n whoIo, iJ., nf 943. If Is nnronf Con-
gross rosondod fo fhoso concorns bocnuso fho Acf ndofs fho hrnso
doIIvors n IIvIng fofus, l8 !. S. C. l53l(b)(l)(A), Insfond of 'doIIv-
orIng . . . n IIvIng unborn chIId, or n subsfnnfInI orfIon fhoroof,` 530
!. S., nf 938, fhoroby fnrgofIng oxfrncfIon of nn onfIro fofus rnfhor
fhnn romovnI of fofnI Iocos; IdonfIfIos socIfIc nnnfomIcnI Inndmnrks
fo whIch fho fofus musf bo nrfInIIy doIIvorod, l53l(b)(l)(A), fhoroby
cInrIfyIng fhnf fho romovnI of n smnII orfIon of fho fofus Is nof ro-
hIbIfod; roquIros fho fofus fo bo doIIvorod so fhnf If Is nrfInIIy ouf-
sIdo fho |mofhor`s] body, l53l(b)(l)(A), fhoroby osfnbIIshIng fhnf
doIIvorIng n subsfnnfInI orfIon of fho fofus Info fho vngInn wouId nof
5 CIfo ns: 550 !. S. ____ (200?)
SyIInbus
subjocf n docfor fo crImInnI snncfIons; nnd ndds fho ovorf-ncf ro-
quIromonf, l53l(b)(l), fhoroby mnkIng fho dIsfIncfIon fho obrnskn
sfnfufo fnIIod fo drnw (buf fho obrnskn Affornoy ConornI ndvnncod).
IInnIIy, fho cnnon of consfIfufIonnI nvoIdnnco, soo, e.g., 1JuorJ J.
DeBorIolo Corp. v. IloriJo Gulf CooeI BuilJing & ConeIr. TroJee
Council, 485 !. S. 568, 5?5, oxfInguIshos nny IIngorIng doubf. Infor-
rofIng fho Acf nof fo rohIbIf sfnndnrd &I Is fho mosf ronsonnbIo
rondIng nnd undorsfnndIng of Ifs forms. I. 2024.
(II) !osondonfs` confrnry nrgumonfs nro unnvnIIIng. Tho con-
fonfIon fhnf nny &I mny rosuIf In fho doIIvory of n IIvIng fofus bo-
yond fho Acf`s nnnfomIcnI Inndmnrks bocnuso docfors cnnnof rodIcf
fho nmounf fho corvIx wIII dIInfo boforo fho rocoduro doos nof fnko
nccounf of fho Acf`s Infonf roquIromonfs, whIch rocIudo IInbIIIfy for
nn nccIdonfnI Infncf &I. Tho ovIdonco suorfs fho IogIsInfIvo do-
formInnfIon fhnf nn Infncf doIIvory Is nImosf nIwnys n conscIous
choIco rnfhor fhnn n hnonsfnnco, boIyIng nny cInIm fhnf n sfnndnrd
&I cnnnof bo orformod wIfhouf InfondIng or forosooIng nn Infncf
&I. Thnf mnny docfors bogIn ovory &I wIfh fho objocfIvo of ro-
movIng fho fofus ns Infncf ns ossIbIo bnsod on fhoIr boIIof fhnf fhIs Is
snfor doos nof rovo, ns rosondonfs suggosf, fhnf ovory &I mIghf
vIoInfo fho Acf, fhoroby ImosIng nn unduo burdon. If domonsfrnfos
onIy fhnf fhoso docfors musf ndjusf fhoIr conducf fo fho Inw by nof
nffomfIng fo doIIvor fho fofus fo nn nnnfomIcnI Inndmnrk. !oson-
donfs hnvo nof shown fhnf roquIrIng docfors fo Infond dIsmombor-
monf boforo such n doIIvory wIII rohIbIf fho vnsf mnjorIfy of &I
nborfIons. I. 2426.
3. Tho Acf, monsurod by Ifs foxf In fhIs fncInI nffnck, doos nof Im-
oso n subsfnnfInI obsfncIo fo Info-form, buf rovInbIIIfy, nborfIons,
ns rohIbIfod by fho Coee, IurnIIfy, 505 !. S., nf 8?8. I. 263?.
(n) Tho confonfIon fhnf fho Acf`s congrossIonnI uroso wns fo
cronfo such nn obsfncIo Is rojocfod. Tho Acf`s sfnfod urosos nro
rofocfIng Innoconf humnn IIfo from n brufnI nnd Inhumnno roco-
duro nnd rofocfIng fho modIcnI communIfy`s ofhIcs nnd roufnfIon.
Tho govornmonf undoubfodIy hns nn Inforosf In rofocfIng fho In-
fogrIfy nnd ofhIcs of fho modIcnI rofossIon. WoeIingIon v. Glucle-
Ierg, 52l !. S. ?02, ?3l. Moroovor, Coee, ronffIrmod fhnf fho gov-
ornmonf mny uso Ifs voIco nnd Ifs roguInfory nufhorIfy fo show Ifs
rofound rosocf for fho IIfo wIfhIn fho womnn. Soo, e.g., 505 !. S.,
nf 8?3. Tho Acf`s bnn on nborfIons InvoIvIng nrfInI doIIvory of n IIv-
Ing fofus furfhors fho Covornmonf`s objocfIvos. Congross doformInod
fhnf such nborfIons nro sImIInr fo fho kIIIIng of n nowborn Infnnf.
ThIs Courf hns confIrmod fho vnIIdIfy of drnwIng boundnrIos fo ro-
vonf rncfIcos fhnf oxfInguIsh IIfo nnd nro cIoso fo ncfIons fhnf nro
condomnod. GlucleIerg, eupro, nf ?32?35, nnd n. 23. Tho Acf nIso
6 COZA!IS t. CA!HA!T
SyIInbus
rocognIzos fhnf rosocf for humnn IIfo fInds nn uIfImnfo oxrossIon In
n mofhor`s Iovo for hor chIId. Whofhor fo hnvo nn nborfIon roquIros n
dIffIcuIf nnd nInfuI mornI docIsIon, Coee,, 505 !. S., nf 852853,
whIch somo womon como fo rogrof. In n docIsIon so frnughf wIfh
omofIonnI consoquonco, somo docfors mny rofor nof fo dIscIoso ro-
cIso dofnIIs of fho nborfIon rocoduro fo bo usod. If Is, howovor, ro-
cIsoIy fhIs Inck of InformnfIon fhnf Is of IogIfImnfo concorn fo fho
Sfnfo. 1J., nf 8?3. Tho Sfnfo`s Inforosf In rosocf for IIfo Is ndvnncod
by fho dInIoguo fhnf boffor Informs fho oIIfIcnI nnd IognI sysfoms,
fho modIcnI rofossIon, oxocfnnf mofhors, nnd socIofy ns n whoIo of
fho consoquoncos fhnf foIIow from n docIsIon fo oIocf n Info-form nbor-
fIon. Tho objocfIon fhnf fho Acf nccomIIshos IIffIo bocnuso fho sfnn-
dnrd &I Is In somo rosocfs ns brufnI, If nof moro, fhnn Infncf
&I, Is unorsunsIvo. If wns ronsonnbIo for Congross fo fhInk fhnf
nrfInI-bIrfh nborfIon, moro fhnn sfnndnrd &I, undormInos fho
ubIIc`s orcofIon of fho docfor`s nrorInfo roIo durIng doIIvory,
nnd orvorfs fho bIrfh rocoss. I. 2630.
(b) Tho Acf`s fnIIuro fo nIIow fho bnnnod rocoduro`s uso whoro
'nocossnry, In nrorInfo modIcnI judgmonf, for rosorvnfIon of fho
|mofhor`s] honIfh,` A,oIIe v. PlonneJ PorenIIooJ of AorIIern Aeu
1ng., 546 !. S. 320, 32?328, doos nof hnvo fho offocf of ImosIng nn
unconsfIfufIonnI burdon on fho nborfIon rIghf. Tho Courf nssumos
fho Acf`s rohIbIfIon wouId bo unconsfIfufIonnI, undor confroIIIng
rocodonfs, If If subjocf|od] |womon] fo sIgnIfIcnnf honIfh rIsks. 1J.,
nf 328. Whofhor fho Acf cronfos such rIsks wns, howovor, n confosfod
fncfunI quosfIon boIow: Tho ovIdonco rosonfod In fho frInI courfs nnd
boforo Congross domonsfrnfos bofh sIdos hnvo modIcnI suorf for
fhoIr osIfIons. Tho Courf`s rocodonfs Insfrucf fhnf fho Acf cnn sur-
vIvo fncInI nffnck whon fhIs modIcnI uncorfnInfy orsIsfs. Soo, e.g.,
Koneoe v. HenJricle, 52l !. S. 346, 360, n. 3. ThIs frndIfIonnI ruIo Is
consIsfonf wIfh Coee,, whIch confIrms bofh fhnf fho Sfnfo hns nn In-
forosf In romofIng rosocf for humnn IIfo nf nII sfngos In fho rog-
nnncy, nnd fhnf nborfIon docfors shouId bo fronfod fho snmo ns ofhor
docfors. ModIcnI uncorfnInfy doos nof forocIoso fho oxorcIso of IogIs-
InfIvo owor In fho nborfIon confoxf nny moro fhnn If doos In ofhor
confoxfs. Ofhor consIdornfIons nIso suorf fho Courf`s concIusIon,
IncIudIng fho fncf fhnf snfo nIfornnfIvos fo fho rohIbIfod rocoduro,
such ns &I, nro nvnIInbIo. In nddIfIon, If Infncf &I Is fruIy nocos-
snry In somo cIrcumsfnncos, n rIor InjocfIon fo kIII fho fofus nIIows n
docfor fo orform fho rocoduro, gIvon fhnf fho Acf`s rohIbIfIon onIy
nIIos fo fho doIIvory of n IIvIng fofus, l8 !. S. C. l53l(b)(l)(A).
PlonneJ PorenIIooJ of CenIrol Mo. v. DonforII, 428 !. S. 52, ???9,
dIsfInguIshod. Tho Courf rojocfs corfnIn of fho nrfIos` nrgumonfs.
On fho ono hnnd, fho Affornoy ConornI`s confonfIon fhnf fho Acf
? CIfo ns: 550 !. S. ____ (200?)
SyIInbus
shouId bo uhoId bnsod on fho congrossIonnI fIndIngs nIono fnIIs bo-
cnuso somo of fho Acf`s rocIfnfIons nro fncfunIIy Incorrocf nnd somo of
fho Imorfnnf fIndIngs hnvo boon suorsodod. AIso unnvnIIIng, how-
ovor, Is rosondonfs` confonfIon fhnf nn nborfIon roguInfIon musf
confnIn n honIfh oxcofIon If subsfnnfInI modIcnI nufhorIfy suorfs
fho roosIfIon fhnf bnnnIng n nrfIcuInr rocoduro couId ondnngor
womon`s honIfh, SIenIerg, 530 !. S., nf 938. InforrofIng SIenIerg
ns IonvIng no mnrgIn for IogIsInfIvo orror In fho fnco of modIcnI uncor-
fnInfy Is foo oxncfIng n sfnndnrd. MnrgInnI snfofy consIdornfIons, In-
cIudIng fho bnInnco of rIsks, nro wIfhIn fho IogIsInfIvo comofonco
whoro, ns horo, fho roguInfIon Is rnfIonnI nnd ursuos IogIfImnfo
onds, nnd sfnndnrd, snfo modIcnI ofIons nro nvnIInbIo. I. 3l3?.
4. Thoso fncInI nffncks shouId nof hnvo boon onforfnInod In fho fIrsf
Insfnnco. In fhoso cIrcumsfnncos fho roor monns fo consIdor oxco-
fIons Is by ns-nIIod chnIIongo. Cf. Wieconein IigII Io Iife, 1nc. v.
IeJerol 1lecIion Conn`n, 546 !. S. ___, ___. ThIs Is fho roor mnn-
nor fo rofocf fho womnn`s honIfh If If cnn bo shown fhnf In dIscrofo
nnd woII-dofInod Insfnncos n condIfIon hns or Is IIkoIy fo occur In
whIch fho rocoduro rohIbIfod by fho Acf musf bo usod. o ns-
nIIod chnIIongo nood bo broughf If fho Acf`s rohIbIfIon fhronfons n
womnn`s IIfo, bocnuso fho Acf nIrondy confnIns n IIfo oxcofIon. l8
!. S. C. l53l(n). I. 3?39.
o. 05380, 4l3 I. 3d ?9l; 05l382, 435 I. 3d ll63, rovorsod.
KIIY, J., doIIvorod fho oInIon of fho Courf, In whIch !OII!TS,
C. J., nnd SCA!IA, THOMAS, nnd A!ITO, JJ., joInod. THOMAS, J., fIIod n
concurrIng oInIon, In whIch SCA!IA, J., joInod. CISI!!C, J., fIIod n
dIssonfIng oInIon, In whIch STIVIS, SO!TI!, nnd I!IYI!, JJ., joInod.
_________________
_________________
l CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
OTICI: ThIs oInIon Is subjocf fo formnI rovIsIon boforo ubIIcnfIon In fho
roIImInnry rInf of fho !nIfod Sfnfos !oorfs. !ondors nro roquosfod fo
nofIfy fho !oorfor of ocIsIons, Suromo Courf of fho !nIfod Sfnfos, Wnsh-
Ingfon, . C. 20543, of nny fyogrnhIcnI or ofhor formnI orrors, In ordor
fhnf corrocfIons mny bo mndo boforo fho roIImInnry rInf goos fo ross.
6835(0(&28572)7+(81,7('67$7(6
os. 05380 nnd 05l382
A!II!TO !. COZA!IS, ATTO!IY CII!A!,
IITITIOI!
05380 t.
!I!OY CA!HA!T IT A!.
O W!IT OI CI!TIO!A!I TO THI !ITI STATIS CO!!T OI
AIIIA!S IO! THI IICHTH CI!C!IT
A!II!TO !. COZA!IS, ATTO!IY CII!A!,
IITITIOI!
05l382 t.
I!AI IA!ITHOO III!ATIO OI
AMI!ICA, IC., IT A!.
O W!IT OI CI!TIO!A!I TO THI !ITI STATIS CO!!T OI
AIIIA!S IO! THI ITH CI!C!IT
|ArII l8, 200?]
J!STICI KIIY doIIvorod fho oInIon of fho Courf.
Thoso cnsos roquIro us fo consIdor fho vnIIdIfy of fho
InrfInI-IIrfh AborfIon Inn Acf of 2003 (Acf), l8 !. S. C.
l53l (2000 od., Su. IV), n fodornI sfnfufo roguInfIng
nborfIon rocoduros. In rocIfnfIons rocodIng Ifs oornfIvo
rovIsIons fho Acf rofors fo fho Courf`s oInIon In SIenIerg
v. CorIorI, 530 !. S. 9l4 (2000), whIch nIso nddrossod fho
subjocf of nborfIon rocoduros usod In fho Infor sfngos of
rognnncy. Comnrod fo fho sfnfo sfnfufo nf Issuo In
SIenIerg, fho Acf Is moro socIfIc concornIng fho Insfnncos
2 COZA!IS t. CA!HA!T
OInIon of fho Courf
fo whIch If nIIos nnd In fhIs rosocf moro rocIso In Ifs
covorngo. Wo concIudo fho Acf shouId bo susfnInod
ngnInsf fho objocfIons Iodgod by fho brond, fncInI nffnck
broughf ngnInsf If.
In o. 05380 (CorIorI) rosondonfs nro !o!oy
Cnrhnrf, WIIIInm C. IIfzhugh, WIIIInm H. Knorr, nnd JIII
!. VIbhnknr, docfors who orform socond-frImosfor nbor-
fIons. Thoso docfors fIIod fhoIr comInInf ngnInsf fho
Affornoy ConornI of fho !nIfod Sfnfos In fho !nIfod
Sfnfos IsfrIcf Courf for fho IsfrIcf of obrnskn. Thoy
chnIIongod fho consfIfufIonnIIfy of fho Acf nnd soughf n
ormnnonf InjuncfIon ngnInsf Ifs onforcomonf. CorIorI v.
AeIcrofI, 33l I. Su. 2d 805 (2004). In 2004, nffor n 2-
wook frInI, fho IsfrIcf Courf grnnfod n ormnnonf Injunc-
fIon fhnf rohIbIfod fho Affornoy ConornI from onforcIng
fho Acf In nII cnsos buf fhoso In whIch fhoro wns no dIs-
ufo fho fofus wns vInbIo. 1J., nf l048. Tho Courf of
AonIs for fho IIghfh CIrcuIf nffIrmod. 4l3 I. 3d ?9l
(2005). Wo grnnfod corfIornrI. 546 !. S. ll69 (2006).
In o. 05l382 (PlonneJ PorenIIooJ) rosondonfs nro
IInnnod Inronfhood IodornfIon of AmorIcn, Inc., IInnnod
Inronfhood CoIdon Cnfo, nnd fho CIfy nnd Counfy of Snn
IrnncIsco. Tho IInnnod Inronfhood onfIfIos soughf fo
onjoIn onforcomonf of fho Acf In n suIf fIIod In fho !nIfod
Sfnfos IsfrIcf Courf for fho orfhorn IsfrIcf of CnIIfor-
nIn. PlonneJ PorenIIooJ IeJeroIion of An. v. AeIcrofI,
320 I. Su. 2d 95? (2004). Tho CIfy nnd Counfy of Snn
IrnncIsco Inforvonod ns n InInfIff. In 2004, fho IsfrIcf
Courf hoId n frInI snnnIng n orIod jusf shorf of fhroo
wooks, nnd If, foo, onjoInod fho Affornoy ConornI from
onforcIng fho Acf. 1J., nf l035. Tho Courf of AonIs for
fho Infh CIrcuIf nffIrmod. 435 I. 3d ll63 (2006). Wo
grnnfod corfIornrI. 54? !. S. ___ (2006).
3 CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
I
A
Tho Acf roscrIbos n nrfIcuInr mnnnor of ondIng fofnI
IIfo, so If Is nocossnry horo, ns If wns In SIenIerg, fo dIs-
cuss nborfIon rocoduros In somo dofnII. Throo !nIfod
Sfnfos IsfrIcf Courfs honrd oxfonsIvo ovIdonco doscrIbIng
fho rocoduros. In nddIfIon fo fho fwo courfs InvoIvod In
fho Insfnnf cnsos fho IsfrIcf Courf for fho Soufhorn
IsfrIcf of ow York nIso consIdorod fho consfIfufIonnIIfy
of fho Acf. AoI. AIorIion IeJeroIion v. AeIcrofI, 330
I. Su. 2d 436 (2004). If found fho Acf unconsfIfufIonnI,
iJ., nf 493, nnd fho Courf of AonIs for fho Socond CIrcuIf
nffIrmod, AoI. AIorIion IeJeroIion v. Goncolee, 43? I. 3d
2?8 (2006). Tho fhroo IsfrIcf Courfs roIIod on sImIInr
modIcnI ovIdonco; Indood, much of fho ovIdonco submIffod
fo fho CorIorI courf rovIousIy hnd boon submIffod fo fho
ofhor fwo courfs. 33l I. Su. 2d, nf 8098l0. Wo rofor
fo fho IsfrIcf Courfs` oxhnusfIvo oInIons In our own
dIscussIon of nborfIon rocoduros.
AborfIon mofhods vnry doondIng fo somo oxfonf on fho
roforoncos of fho hysIcInn nnd, of courso, on fho form of
fho rognnncy nnd fho rosuIfIng sfngo of fho unborn
chIId`s dovoIomonf. Iofwoon 85 nnd 90 orconf of fho
nroxImnfoIy l.3 mIIIIon nborfIons orformod onch yonr
In fho !nIfod Sfnfos fnko Inco In fho fIrsf fhroo monfhs of
rognnncy, whIch Is fo sny In fho fIrsf frImosfor. PlonneJ
PorenIIooJ, 320 I. Su. 2d, nf 960, nnd n. 4; A. In o.
05l382, . 4548. Tho mosf common fIrsf-frImosfor
nborfIon mofhod Is vncuum nsIrnfIon (ofhorwIso known
ns sucfIon curoffngo) In whIch fho hysIcInn vncuums ouf
fho ombryonIc fIssuo. InrIy In fhIs frImosfor nn nIfornn-
fIvo Is fo uso modIcnfIon, such ns mIforIsfono (commonIy
known ns !!486), fo formInnfo fho rognnncy. AoI.
AIorIion IeJeroIion, eupro, nf 464, n. 20. Tho Acf doos
nof roguInfo fhoso rocoduros.
Of fho romnInIng nborfIons fhnf fnko Inco onch yonr,
4 COZA!IS t. CA!HA!T
OInIon of fho Courf
mosf occur In fho socond frImosfor. Tho surgIcnI roco-
duro roforrod fo ns dIInfIon nnd ovncunfIon or &I Is
fho usunI nborfIon mofhod In fhIs frImosfor. PlonneJ
PorenIIooJ, 320 I. Su. 2d, nf 96096l. AIfhough IndI-
vIdunI fochnIquos for orformIng &I dIffor, fho gonornI
sfos nro fho snmo.
A docfor musf fIrsf dIInfo fho corvIx nf Ionsf fo fho ox-
fonf noodod fo Insorf surgIcnI Insfrumonfs Info fho uforus
nnd fo mnnouvor fhom fo ovncunfo fho fofus. AoI. AIor-
Iion IeJeroIion, eupro, nf 465; A. In o. 05l382, nf 6l.
Tho sfos fnkon fo cnuso dIInfIon dIffor by hysIcInn nnd
gosfnfIonnI ngo of fho fofus. Soo, e.g., CorIorI, 33l
I. Su. 2d, nf 852, 856, 859, 862865, 868, 8?0, 8?38?4,
8?68??, 880, 883, 886. A docfor offon bogIns fho dIInfIon
rocoss by InsorfIng osmofIc dIInfors, such ns InmInnrIn
(sfIcks of sonwood), Info fho corvIx. Tho dIInfors cnn bo
usod In combInnfIon wIfh drugs, such ns mIsorosfoI, fhnf
Incronso dIInfIon. Tho rosuIfIng nmounf of dIInfIon Is nof
unIform, nnd n docfor doos nof know In ndvnnco how nn
IndIvIdunI nfIonf wIII rosond. In gonornI fho Iongor
dIInfors romnIn In fho corvIx, fho moro If wIII dIInfo. Yof
fho Iongfh of fImo docfors omIoy osmofIc dIInfors vnrIos.
Somo mny koo dIInfors In fho corvIx for fwo dnys, whIIo
ofhors uso dIInfors for n dny or Ioss. AoI. AIorIion IeJero-
Iion, eupro, nf 464465; PlonneJ PorenIIooJ, eupro, nf
96l.
Affor suffIcIonf dIInfIon fho surgIcnI oornfIon cnn com-
monco. Tho womnn Is Incod undor gonornI nnosfhosIn or
conscIous sodnfIon. Tho docfor, offon guIdod by uIfrn-
sound, Insorfs grnsIng forcos fhrough fho womnn`s
corvIx nnd Info fho uforus fo grnb fho fofus. Tho docfor
grIs n fofnI nrf wIfh fho forcos nnd uIIs If bnck
fhrough fho corvIx nnd vngInn, confInuIng fo uII ovon
nffor moofIng rosIsfnnco from fho corvIx. Tho frIcfIon
cnusos fho fofus fo fonr nnrf. Ior oxnmIo, n Iog mIghf bo
rIod off fho fofus ns If Is uIIod fhrough fho corvIx nnd
5 CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
ouf of fho womnn. Tho rocoss of ovncunfIng fho fofus
Ioco by Ioco confInuos unfII If hns boon comIofoIy ro-
movod. A docfor mny mnko l0 fo l5 nssos wIfh fho for-
cos fo ovncunfo fho fofus In Ifs onfIrofy, fhough somo-
fImos romovnI Is comIofod wIfh fowor nssos. Onco fho
fofus hns boon ovncunfod, fho Inconfn nnd nny romnInIng
fofnI mnforInI nro sucfIonod or scrnod ouf of fho uforus.
Tho docfor oxnmInos fho dIfforonf nrfs fo onsuro fho
onfIro fofnI body hns boon romovod. Soo, e.g., AoI. AIor-
Iion IeJeroIion, eupro, nf 465; PlonneJ PorenIIooJ, eupro,
nf 962.
Somo docfors, osocInIIy Infor In fho socond frImosfor,
mny kIII fho fofus n dny or fwo boforo orformIng fho
surgIcnI ovncunfIon. Thoy Injocf dIgoxIn or ofnssIum
chIorIdo Info fho fofus, fho umbIIIcnI cord, or fho nmnIofIc
fIuId. IofnI domIso mny cnuso confrncfIons nnd mnko
gronfor dIInfIon ossIbIo. Onco dond, moroovor, fho fofus`
body wIII soffon, nnd Ifs romovnI wIII bo onsIor. Ofhor
docfors rofrnIn from InjocfIng chomIcnI ngonfs, boIIovIng If
ndds rIsk wIfh IIffIo or no modIcnI bonofIf. CorIorI, eupro,
nf 90?9l2; AoI. AIorIion IeJeroIion, eupro, nf 4?44?5.
Tho nborfIon rocoduro fhnf wns fho Imofus for fho
numorous bnns on nrfInI-bIrfh nborfIon, IncIudIng fho
Acf, Is n vnrInfIon of fhIs sfnndnrd &I. Soo M. HnskoII,
IInfIon nnd IxfrncfIon for !nfo Socond TrImosfor Abor-
fIon (l992), l AoIInnf`s A. In o. 0433?9 (CA8), .
l09 (horoInnffor IInfIon nnd IxfrncfIon). Tho modIcnI
communIfy hns nof ronchod unnnImIfy on fho nrorInfo
nnmo for fhIs &I vnrInfIon. If hns boon roforrod fo ns
Infncf &I, dIInfIon nnd oxfrncfIon (&X), nnd Infncf
&X. AoI. AIorIion IeJeroIion, eupro, nf 440, n. 2; soo
nIso I. CunnInghnm of nI., WIIIInms ObsfofrIcs 243 (22d
od. 2005) (IdonfIfyIng fho rocoduro ns &X); nnforfh`s
ObsfofrIcs nnd CynocoIogy 56? (J. Scoff, !. CIbbs, I.
KnrInn, & A. Hnnoy ods. 9fh od. 2003) (IdonfIfyIng fho
rocoduro ns Infncf &X); M. InuI, I. !Ichfonborg, !.
6 COZA!IS t. CA!HA!T
OInIon of fho Courf
Iorgnffn, . CrImos, & I. SfubbIofIoId, A CIInIcInn`s
CuIdo fo ModIcnI nnd SurgIcnI AborfIon l36 (l999) (IdonfI-
fyIng fho rocoduro ns Infncf &I). Ior dIscussIon ur-
osos fhIs &I vnrInfIon wIII bo roforrod fo ns Infncf
&I. Tho mnIn dIfforonco bofwoon fho fwo rocoduros Is
fhnf In Infncf &I n docfor oxfrncfs fho fofus Infncf or
InrgoIy Infncf wIfh onIy n fow nssos. Thoro nro no com-
rohonsIvo sfnfIsfIcs IndIcnfIng whnf orconfngo of nII
&Is nro orformod In fhIs mnnnor.
Infncf &I, IIko roguInr &I, bogIns wIfh dIInfIon of
fho corvIx. SuffIcIonf dIInfIon Is ossonfInI for fho roco-
duro. To nchIovo Infncf oxfrncfIon somo docfors fhus mny
nffomf fo dIInfo fho corvIx fo n gronfor dogroo. ThIs
nronch hns boon cnIIod sorInI dIInfIon. CorIorI, eupro,
nf 856, 8?0, 8?3; PlonneJ PorenIIooJ, eupro, nf 965.
ocfors who nffomf nf fho oufsof fo orform Infncf &I
mny dIInfo for fwo fuII dnys or uso u fo 25 osmofIc dIIn-
fors. Soo, e.g., IInfIon nnd IxfrncfIon ll0; CorIorI,
eupro, nf 865, 868, 8?6, 886.
In nn Infncf &I rocoduro fho docfor oxfrncfs fho fofus
In n wny conducIvo fo uIIIng ouf Ifs onfIro body, Insfond of
rIIng If nnrf. Ono docfor, for oxnmIo, fosfIfIod:
If I know I hnvo good dIInfIon nnd I ronch In nnd
fho fofus sfnrfs fo como ouf nnd I fhInk I cnn nccom-
IIsh If, fho nborfIon wIfh nn Infncf doIIvory, fhon I
uso my forcos n IIffIo bIf dIfforonfIy. I don`f cIoso
fhom quIfo so much, nnd I jusf gonfIy drnw fho fIssuo
ouf nffomfIng fo hnvo nn Infncf doIIvory, If ossIbIo.
A. In o. 05l382, nf ?4.
!ofnfIng fho fofus ns If Is boIng uIIod docronsos fho odds
of dIsmombormonf. CorIorI, eupro, nf 868869; A. In
o. 05380, . 404l; 5 AoIInnf`s A. In o. 0433?9
(CA8), . l469. A docfor nIso mny uso forcos fo grns n
fofnI nrf, uII If down, nnd ro-grns fho fofus nf n hIghor
IovoIsomofImos usIng bofh hIs hnnd nnd n forcosfo
? CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
oxorf frncfIon fo rofrIovo fho fofus Infncf unfII fho hond Is
Iodgod In fho |corvIx]. CorIorI, 33l I. Su. 2d, nf 886
88?.
Infncf &I gnInod ubIIc noforIofy whon, In l992, r.
MnrfIn HnskoII gnvo n rosonfnfIon doscrIbIng hIs mofhod
of orformIng fho oornfIon. IInfIon nnd IxfrncfIon ll0
lll. In fho usunI Infncf &I fho fofus` hond Iodgos In fho
corvIx, nnd dIInfIon Is InsuffIcIonf fo nIIow If fo nss. Soo,
e.g., iIiJ., A. In o. 05380, nf 5??; A. In o. 05
l382, nf ?4, 282. HnskoII oxInInod fho noxf sfo ns
foIIows:
'Af fhIs oInf, fho rIghf-hnndod surgoon sIIdos fho
fIngors of fho Ioff |hnnd] nIong fho bnck of fho fofus
nnd hooks fho shouIdors of fho fofus wIfh fho Indox
nnd rIng fIngors (nIm down).
'WhIIo mnInfnInIng fhIs fonsIon, IIffIng fho corvIx
nnd nIyIng frncfIon fo fho shouIdors wIfh fho fIn-
gors of fho Ioff hnnd, fho surgoon fnkos n nIr of bIunf
curvod Mofzonbnum scIssors In fho rIghf hnnd. Ho
cnrofuIIy ndvnncos fho fI, curvod down, nIong fho
sIno nnd undor hIs mIddIo fIngor unfII ho fooIs If con-
fncf fho bnso of fho skuII undor fho fI of hIs mIddIo
fIngor.
'|T]ho surgoon fhon forcos fho scIssors Info fho bnso
of fho skuII or Info fho fornmon mngnum. HnvIng
snfoIy onforod fho skuII, ho sronds fho scIssors fo
onInrgo fho oonIng.
'Tho surgoon romovos fho scIssors nnd Infroducos n
sucfIon cnfhofor Info fhIs hoIo nnd ovncunfos fho skuII
confonfs. WIfh fho cnfhofor sfIII In Inco, ho nIIos
frncfIon fo fho fofus, romovIng If comIofoIy from fho
nfIonf.` H. !. !o. o. l0858, . 3 (2003).
ThIs Is nn nborfIon docfor`s cIInIcnI doscrIfIon. Horo Is
nnofhor doscrIfIon from n nurso who wIfnossod fho snmo
mofhod orformod on n 26-wook fofus nnd who fosfIfIod
8 COZA!IS t. CA!HA!T
OInIon of fho Courf
boforo fho Sonnfo JudIcInry CommIffoo:
'r. HnskoII wonf In wIfh forcos nnd grnbbod fho
bnby`s Iogs nnd uIIod fhom down Info fho bIrfh cnnnI.
Thon ho doIIvorod fho bnby`s body nnd fho nrms
ovoryfhIng buf fho hond. Tho docfor kof fho hond
rIghf InsIdo fho uforus. . . .
'Tho bnby`s IIffIo fIngors woro cInsIng nnd un-
cInsIng, nnd hIs IIffIo foof woro kIckIng. Thon fho
docfor sfuck fho scIssors In fho bnck of hIs hond, nnd
fho bnby`s nrms jorkod ouf, IIko n sfnrfIo roncfIon, IIko
n fIInch, IIko n bnby doos whon ho fhInks ho Is goIng fo
fnII.
'Tho docfor oonod u fho scIssors, sfuck n hIgh-
oworod sucfIon fubo Info fho oonIng, nnd suckod fho
bnby`s brnIns ouf. ow fho bnby wonf comIofoIy
IIm. . . .
'Ho cuf fho umbIIIcnI cord nnd doIIvorod fho In-
confn. Ho fhrow fho bnby In n nn, nIong wIfh fho
Inconfn nnd fho Insfrumonfs ho hnd jusf usod.`
1IiJ.
r. HnskoII`s nronch Is nof fho onIy mofhod of kIIIIng
fho fofus onco Ifs hond Iodgos In fho corvIx, nnd fho roc-
oss hns ovoIvod sInco hIs rosonfnfIon. PlonneJ PorenI-
IooJ, 320 I. Su. 2d, nf 965. Anofhor docfor, for oxnm-
Io, squoozos fho skuII nffor If hns boon Iorcod so fhnf
onough brnIn fIssuo oxudos fo nIIow fho hond fo nss
fhrough. A. In o. 05380, nf 4l; soo nIso CorIorI,
eupro, nf 86686?, 8?4. SfIII ofhor hysIcInns ronch Info
fho corvIx wIfh fhoIr forcos nnd crush fho fofus` skuII.
CorIorI, eupro, nf 858, 88l. Ofhors confInuo fo uII fho
fofus ouf of fho womnn unfII If dIsnrfIcuInfos nf fho nock,
In offocf docnIfnfIng If. Thoso docfors fhon grns fho
hond wIfh forcos, crush If, nnd romovo If. 1J., nf 864,
8?8; soo nIso PlonneJ PorenIIooJ, eupro, nf 965.
Somo docfors orformIng nn Infncf &I nffomf fo
9 CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
romovo fho fofus wIfhouf coIInsIng fho skuII. Soo
CorIorI, eupro, nf 866, 869. Yof ono docfor wouId nof
nIIow doIIvory of n IIvo fofus youngor fhnn 24 wooks bo-
cnuso fho objocfIvo of |hIs] rocoduro Is fo orform nn
nborfIon, nof n bIrfh. A. In o. 05l382, nf 408409.
Tho docfor fhus nnsworod In fho nffIrmnfIvo whon nskod
whofhor ho wouId hoId fho fofus` hond on fho InfornnI
sIdo of fho |corvIx] In ordor fo coIInso fho skuII nnd kIII
fho fofus boforo If Is born. 1J., nf 409; soo nIso CorIorI,
eupro, nf 862, 8?8. Anofhor docfor fosfIfIod ho crushos n
fofus` skuII nof onIy fo roduco Ifs sIzo buf nIso fo onsuro
fho fofus Is dond boforo If Is romovod. Ior fho sfnff fo hnvo
fo donI wIfh n fofus fhnf hns somo vInbIIIfy fo If, somo
movomonf of IImbs, nccordIng fo fhIs docfor, |Is] nIwnys n
dIffIcuIf sIfunfIon. A. In o. 05380, nf 94; soo
CorIorI, eupro, nf 858.
&I nnd Infncf &I nro nof fho onIy socond-frImosfor
nborfIon mofhods. ocfors nIso mny nborf n fofus fhrough
modIcnI InducfIon. Tho docfor modIcnfos fho womnn fo
Induco Inbor, nnd confrncfIons occur fo doIIvor fho fofus.
InducfIon, whIch unIIko &I shouId occur In n hosIfnI,
cnn Insf ns IIffIo ns 6 hours buf cnn fnko Iongor fhnn 48. If
nccounfs for nbouf fIvo orconf of socond-frImosfor nbor-
fIons boforo 20 wooks of gosfnfIon nnd l5 orconf of fhoso
nffor 20 wooks. ocfors furn fo fwo ofhor mofhods of
socond-frImosfor nborfIon, hysforofomy nnd hysforocfomy,
onIy In omorgoncy sIfunfIons bocnuso fhoy cnrry Incronsod
rIsk of comIIcnfIons. In n hysforofomy, ns In n cosnronn
socfIon, fho docfor romovos fho fofus by mnkIng nn IncI-
sIon fhrough fho nbdomon nnd uforIno wnII fo gnIn nccoss
fo fho uforIno cnvIfy. A hysforocfomy roquIros fho ro-
movnI of fho onfIro uforus. Thoso fwo rocoduros roro-
sonf nbouf .0? of socond-frImosfor nborfIons. AoI. AIor-
Iion IeJeroIion, 330 I. Su. 2d, nf 46?; PlonneJ
PorenIIooJ, eupro, nf 962963.
l0 COZA!IS t. CA!HA!T
OInIon of fho Courf
I
Affor r. HnskoII`s rocoduro rocoIvod ubIIc nffonfIon,
wIfh onsuIng nnd IncronsIng ubIIc concorn, bnns on 'nr-
fInI bIrfh nborfIon` roIIfornfod. Iy fho fImo of fho SIen-
Ierg docIsIon, nbouf 30 Sfnfos hnd onncfod bnns dosIgnod
fo rohIbIf fho rocoduro. 530 !. S., nf 995996, nnd nn.
l2l3 (THOMAS, J., dIssonfIng); soo nIso H. !. !o. o.
l0858, nf 45. In l996, Congross nIso ncfod fo bnn nr-
fInI-bIrfh nborfIon. IrosIdonf CIInfon vofood fho congros-
sIonnI IogIsInfIon, nnd fho Sonnfo fnIIod fo ovorrIdo fho
vofo. Congross nrovod nnofhor bIII bnnnIng fho roco-
duro In l99?, buf IrosIdonf CIInfon ngnIn vofood If. In
2003, nffor fhIs Courf`s docIsIon In SIenIerg, Congross
nssod fho Acf nf Issuo horo. H. !. !o. o. l0858, nf
l2l4. On ovombor 5, 2003, IrosIdonf Iush sIgnod fho
Acf Info Inw. If wns fo fnko offocf fho foIIowIng dny. l8
!. S. C. l53l(n) (2000 od., Su. IV).
Tho Acf rosondod fo SIenIerg In fwo wnys. IIrsf,
Congross mndo fncfunI fIndIngs. Congross doformInod
fhnf fhIs Courf In SIenIerg wns roquIrod fo nccof fho
vory quosfIonnbIo fIndIngs Issuod by fho dIsfrIcf courf
judgo, 2(?), ll? Sfnf. l202, nofos foIIowIng l8 !. S. C.
l53l (2000 od., Su. IV), . ?68, (?) (CongrossIonnI
IIndIngs), buf fhnf Congross wns nof bound fo nccof fho
snmo fncfunI fIndIngs, iIiJ., (8). Congross found, nmong
ofhor fhIngs, fhnf |n] mornI, modIcnI, nnd ofhIcnI conson-
sus oxIsfs fhnf fho rncfIco of orformIng n nrfInI-bIrfh
nborfIon . . . Is n gruosomo nnd Inhumnno rocoduro fhnf
Is novor modIcnIIy nocossnry nnd shouId bo rohIbIfod.
1J., nf ?6?, (l).
Socond, nnd moro roIovnnf horo, fho Acf`s Inngungo
dIffors from fhnf of fho obrnskn sfnfufo sfruck down In
SIenIerg. Soo 530 !. S., nf 92l922 (quofIng ob. !ov.
Sfnf. Ann. 28328(l), 28326(9) (Su. l999)). Tho
oornfIvo rovIsIons of fho Acf rovIdo In roIovnnf nrf:
ll CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
(n) Any hysIcInn who, In or nffocfIng Inforsfnfo or
foroIgn commorco, knowIngIy orforms n nrfInI-bIrfh
nborfIon nnd fhoroby kIIIs n humnn fofus shnII bo
fInod undor fhIs fIfIo or ImrIsonod nof moro fhnn 2
yonrs, or bofh. ThIs subsocfIon doos nof nIy fo n
nrfInI-bIrfh nborfIon fhnf Is nocossnry fo snvo fho IIfo
of n mofhor whoso IIfo Is ondnngorod by n hysIcnI
dIsordor, hysIcnI IIInoss, or hysIcnI Injury, IncIudIng
n IIfo-ondnngorIng hysIcnI condIfIon cnusod by or
nrIsIng from fho rognnncy IfsoIf. ThIs subsocfIon
fnkos offocf l dny nffor fho onncfmonf.
(b) As usod In fhIs socfIon
(l) fho form 'nrfInI-bIrfh nborfIon` monns nn nbor-
fIon In whIch fho orson orformIng fho nborfIon
(A) doIIbornfoIy nnd InfonfIonnIIy vngInnIIy doIIvors
n IIvIng fofus unfII, In fho cnso of n hond-fIrsf roson-
fnfIon, fho onfIro fofnI hond Is oufsIdo fho body of fho
mofhor, or, In fho cnso of brooch rosonfnfIon, nny
nrf of fho fofnI frunk nsf fho nnvoI Is oufsIdo fho
body of fho mofhor, for fho uroso of orformIng nn
ovorf ncf fhnf fho orson knows wIII kIII fho nrfInIIy
doIIvorod IIvIng fofus; nnd
(I) orforms fho ovorf ncf, ofhor fhnn comIofIon of
doIIvory, fhnf kIIIs fho nrfInIIy doIIvorod IIvIng fofus;
nnd
(2) fho form 'hysIcInn` monns n docfor of modIcIno
or osfoonfhy IognIIy nufhorIzod fo rncfIco modIcIno
nnd surgory by fho Sfnfo In whIch fho docfor orforms
such ncfIvIfy, or nny ofhor IndIvIdunI IognIIy nufhor-
Izod by fho Sfnfo fo orform nborfIons: ProtiJeJ, Iou-
eter, Thnf nny IndIvIdunI who Is nof n hysIcInn or nof
ofhorwIso IognIIy nufhorIzod by fho Sfnfo fo orform
nborfIons, buf who novorfhoIoss dIrocfIy orforms n
nrfInI-bIrfh nborfIon, shnII bo subjocf fo fho rovI-
sIons of fhIs socfIon.
. . . . .
l2 COZA!IS t. CA!HA!T
OInIon of fho Courf
(d)(l) A dofondnnf nccusod of nn offonso undor fhIs
socfIon mny sook n honrIng boforo fho Sfnfo ModIcnI
Ionrd on whofhor fho hysIcInn`s conducf wns nocos-
snry fo snvo fho IIfo of fho mofhor whoso IIfo wns on-
dnngorod by n hysIcnI dIsordor, hysIcnI IIInoss, or
hysIcnI Injury, IncIudIng n IIfo-ondnngorIng hysIcnI
condIfIon cnusod by or nrIsIng from fho rognnncy
IfsoIf.
(2) Tho fIndIngs on fhnf Issuo nro ndmIssIbIo on fhnf
Issuo nf fho frInI of fho dofondnnf. !on n mofIon of
fho dofondnnf, fho courf shnII doIny fho bogInnIng of
fho frInI for nof moro fhnn 30 dnys fo ormIf such n
honrIng fo fnko Inco.
(o) A womnn uon whom n nrfInI-bIrfh nborfIon Is
orformod mny nof bo rosocufod undor fhIs socfIon,
for n consIrncy fo vIoInfo fhIs socfIon, or for nn of-
fonso undor socfIon 2, 3, or 4 of fhIs fIfIo bnsod on n
vIoInfIon of fhIs socfIon. l8 !. S. C. l53l (2000 od.,
Su. IV).
Tho Acf nIso IncIudos n rovIsIon nufhorIzIng cIvII ncfIons
fhnf Is nof of roIovnnco horo. l53l(c).
C
Tho IsfrIcf Courf In CorIorI concIudod fho Acf wns
unconsfIfufIonnI for fwo ronsons. IIrsf, If doformInod fho
Acf wns unconsfIfufIonnI bocnuso If Inckod nn oxcofIon
nIIowIng fho rocoduro whoro nocossnry for fho honIfh of
fho mofhor. 33l I. Su. 2d, nf l004l030. Socond, fho
IsfrIcf Courf found fho Acf dofIcIonf bocnuso If covorod
nof moroIy Infncf &I buf nIso corfnIn ofhor &Is. 1J.,
nf l030l03?.
Tho Courf of AonIs for fho IIghfh CIrcuIf nddrossod
onIy fho Inck of n honIfh oxcofIon. 4l3 I. 3d, nf 803804.
Tho courf bognn Ifs nnnIysIs wIfh whnf If snw ns fho n-
rorInfo quosfIonwhofhor 'subsfnnfInI modIcnI nufhor-
Ify` suorfs fho modIcnI nocossIfy of fho bnnnod roco-
l3 CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
duro. 1J., nf ?96 (quofIng SIenIerg, 530 !. S., nf 938).
ThIs wns fho roor frnmowork, nccordIng fo fho Courf of
AonIs, bocnuso whon n Inck of consonsus oxIsfs In fho
modIcnI communIfy, fho ConsfIfufIon roquIros IogIsInfuros
fo orr on fho sIdo of rofocfIng womon`s honIfh by IncIud-
Ing n honIfh oxcofIon. 4l3 I. 3d, nf ?96. Tho courf
rojocfod fho Affornoy ConornI`s nffomf fo domonsfrnfo
chnngod ovIdonfInry cIrcumsfnncos sInco SIenIerg nnd
consIdorod IfsoIf bound by SIenIerg`s concIusIon fhnf n
honIfh oxcofIon wns roquIrod. 4l3 I. 3d, nf 803 (oxInIn-
Ing |f]ho rocord In |fho] cnso nnd fho rocord In SIenIerg
|woro] sImIInr In nII sIgnIfIcnnf rosocfs). If InvnIIdnfod
fho Acf. 1IiJ.

Tho IsfrIcf Courf In PlonneJ PorenIIooJ concIudod fho
Acf wns unconsfIfufIonnI bocnuso If (l) oso|d] nn unduo
burdon on n womnn`s nbIIIfy fo chooso n socond frImosfor
nborfIon; (2) |wns] unconsfIfufIonnIIy vnguo; nnd (3) ro-
quIro|d] n honIfh oxcofIon ns sof forfh by . . . SIenIerg.
320 I. Su. 2d, nf l034l035.
Tho Courf of AonIs for fho Infh CIrcuIf ngrood. !Iko
fho Courf of AonIs for fho IIghfh CIrcuIf, If concIudod
fho nbsonco of n honIfh oxcofIon rondorod fho Acf uncon-
sfIfufIonnI. Tho courf Inforrofod SIenIerg fo roquIro n
honIfh oxcofIon unIoss fhoro Is coneeneue in IIe neJicol
connuniI, fhnf fho bnnnod rocoduro Is novor modIcnIIy
nocossnry fo rosorvo fho honIfh of womon. 435 I. 3d, nf
ll?3. Ivon nffor nIyIng n doforonfInI sfnndnrd of ro-
vIow fo Congross` fncfunI fIndIngs, fho Courf of AonIs
doformInod subsfnnfInI dIsngroomonf oxIsfs In fho modI-
cnI communIfy rognrdIng whofhor fho rocoduros rohIb-
Ifod by fho Acf nro ovor nocossnry fo rosorvo n womnn`s
honIfh. 1J., nf ll?5ll?6.
Tho Courf of AonIs concIudod furfhor fhnf fho Acf
Incod nn unduo burdon on n womnn`s nbIIIfy fo obfnIn n
l4 COZA!IS t. CA!HA!T
OInIon of fho Courf
socond-frImosfor nborfIon. Tho courf found fho foxfunI
dIfforoncos bofwoon fho Acf nnd fho obrnskn sfnfufo
sfruck down In SIenIerg InsuffIcIonf fo dIsfInguIsh &I
nnd Infncf &I. 435 I. 3d, nf ll?8ll80. As n rosuIf,
nccordIng fo fho Courf of AonIs, fho Acf Imosod nn
unduo burdon bocnuso If rohIbIfod &I. 1J., nf ll80
ll8l.
IInnIIy, fho Courf of AonIs found fho Acf voId for
vnguonoss. 1J., nf ll8l. AborfIon docfors fosfIfIod fhoy
woro uncorfnIn whIch rocoduros fho Acf mndo crImInnI.
Tho courf fhus concIudod fho Acf dId nof offor hysIcInns
cIonr wnrnIng of Ifs roguInfory ronch. 1J., nf ll8lll84.
!osfIng on Ifs undorsfnndIng of fho romodInI frnmowork
osfnbIIshod by fhIs Courf In A,oIIe v. PlonneJ PorenIIooJ
of AorIIern Aeu 1ng., 546 !. S. 320, 328330 (2006), fho
Courf of AonIs hoId fho Acf wns unconsfIfufIonnI on Ifs
fnco nnd shouId bo ormnnonfIy onjoInod. 435 I. 3d, nf
ll84ll9l.
II
Tho rIncIIos sof forfh In fho joInf oInIon In PlonneJ
PorenIIooJ of SouIIeoeIern Po. v. Coee,, 505 !. S. 833
(l992), dId nof fInd suorf from nII fhoso who joIn fho
Insfnnf oInIon. Soo iJ., nf 9?9l002 (SCA!IA, J., joInod
by THOMAS, J., inIer olioe, concurrIng In judgmonf In nrf
nnd dIssonfIng In nrf). Whnfovor ono`s vIows concornIng
fho Coee, joInf oInIon, If Is ovIdonf n romIso confrnI fo
Ifs concIusIonfhnf fho govornmonf hns n IogIfImnfo nnd
subsfnnfInI Inforosf In rosorvIng nnd romofIng fofnI
IIfowouId bo roudInfod woro fho Courf now fo nffIrm
fho judgmonfs of fho Courfs of AonIs.
Coee, InvoIvod n chnIIongo fo Ioe v. WoJe, 4l0 !. S. ll3
(l9?3). Tho oInIon confnIns fhIs summnry:
If musf bo sfnfod nf fho oufsof nnd wIfh cInrIfy
fhnf Ioe`s ossonfInI hoIdIng, fho hoIdIng wo ronffIrm,
hns fhroo nrfs. IIrsf Is n rocognIfIon of fho rIghf of
l5 CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
fho womnn fo chooso fo hnvo nn nborfIon boforo vInbII-
Ify nnd fo obfnIn If wIfhouf unduo Inforforonco from
fho Sfnfo. Ioforo vInbIIIfy, fho Sfnfo`s Inforosfs nro
nof sfrong onough fo suorf n rohIbIfIon of nborfIon
or fho ImosIfIon of n subsfnnfInI obsfncIo fo fho
womnn`s offocfIvo rIghf fo oIocf fho rocoduro. Socond
Is n confIrmnfIon of fho Sfnfo`s owor fo rosfrIcf nbor-
fIons nffor fofnI vInbIIIfy, If fho Inw confnIns oxco-
fIons for rognnncIos whIch ondnngor fho womnn`s IIfo
or honIfh. And fhIrd Is fho rIncIIo fhnf fho Sfnfo
hns IogIfImnfo Inforosfs from fho oufsof of fho rog-
nnncy In rofocfIng fho honIfh of fho womnn nnd fho
IIfo of fho fofus fhnf mny bocomo n chIId. Thoso rIn-
cIIos do nof confrndIcf ono nnofhor; nnd wo ndhoro fo
onch. 505 !. S., nf 846 (oInIon of fho Courf).
Though nII fhroo hoIdIngs nro ImIIcnfod In fho Insfnnf
cnsos, If Is fho fhIrd fhnf roquIros fho mosf oxfondod
dIscussIon; for wo musf doformIno whofhor fho Acf fur-
fhors fho IogIfImnfo Inforosf of fho Covornmonf In rofocf-
Ing fho IIfo of fho fofus fhnf mny bocomo n chIId.
To ImIomonf Ifs hoIdIng, Coee, rojocfod bofh Ioe`s rIgId
frImosfor frnmowork nnd fho InforrofnfIon of Ioe fhnf
consIdorod nII rovInbIIIfy roguInfIons of nborfIon unwnr-
rnnfod. 505 !. S., nf 8?58?6, 8?8 (IurnIIfy oInIon). On
fhIs oInf Coee, ovorruIod fho hoIdIngs In fwo cnsos bo-
cnuso fhoy undorvnIuod fho Sfnfo`s Inforosf In ofonfInI
IIfo. Soo iJ., nf 88l883 (joInf oInIon) (ovorruIIng TIorn-
IurgI v. Anericon College of OIeIeIricione onJ G,necolo-
gieIe, 4?6 !. S. ?4? (l986) nnd Alron v. Alron CenIer for
IeproJucIite HeolII, 1nc., 462 !. S. 4l6 (l983)).
Wo nssumo fho foIIowIng rIncIIos for fho urosos of
fhIs oInIon. Ioforo vInbIIIfy, n Sfnfo mny nof rohIbIf
nny womnn from mnkIng fho uIfImnfo docIsIon fo formI-
nnfo hor rognnncy. 505 !. S., nf 8?9 (IurnIIfy oInIon).
If nIso mny nof Imoso uon fhIs rIghf nn unduo burdon,
l6 COZA!IS t. CA!HA!T
OInIon of fho Courf
whIch oxIsfs If n roguInfIon`s uroso or offocf Is fo Inco
n subsfnnfInI obsfncIo In fho nfh of n womnn sookIng nn
nborfIon boforo fho fofus nffnIns vInbIIIfy. 1J., nf 8?8. On
fho ofhor hnnd, |r]oguInfIons whIch do no moro fhnn
cronfo n sfrucfurnI mochnnIsm by whIch fho Sfnfo, or fho
nronf or gunrdInn of n mInor, mny oxross rofound
rosocf for fho IIfo of fho unborn nro ormIffod, If fhoy nro
nof n subsfnnfInI obsfncIo fo fho womnn`s oxorcIso of fho
rIghf fo chooso. 1J., nf 8??. Coee,, In shorf, sfruck n
bnInnco. Tho bnInnco wns confrnI fo Ifs hoIdIng. Wo now
nIy Ifs sfnndnrd fo fho cnsos nf bnr.
III
Wo bogIn wIfh n doformInnfIon of fho Acf`s oornfIon
nnd offocf. A sfrnIghfforwnrd rondIng of fho Acf`s foxf
domonsfrnfos Ifs uroso nnd fho scoo of Ifs rovIsIons: If
roguInfos nnd roscrIbos, wIfh oxcofIons or qunIIfIcnfIons
fo bo dIscussod, orformIng fho Infncf &I rocoduro.
!osondonfs ngroo fho Acf oncomnssos Infncf &I,
buf fhoy confond Ifs nddIfIonnI ronch Is bofh uncIonr nnd
oxcossIvo. !osondonfs nssorf fhnf, nf fho Ionsf, fho Acf Is
voId for vnguonoss bocnuso Ifs scoo Is IndofInIfo. In fho
nIfornnfIvo, rosondonfs nrguo fho Acf`s foxf roscrIbos nII
&Is. Iocnuso &I Is fho mosf common socond-
frImosfor nborfIon mofhod, rosondonfs suggosf fho Acf
Imosos nn unduo burdon. In fhIs IIfIgnfIon fho Affornoy
ConornI doos nof dIsufo fhnf fho Acf wouId Imoso nn
unduo burdon If If covorod sfnndnrd &I.
Wo concIudo fhnf fho Acf Is nof voId for vnguonoss, doos
nof Imoso nn unduo burdon from nny ovorbrondfh, nnd Is
nof InvnIId on Ifs fnco.
A
Tho Acf unIshos knowIngIy orform|Ing] n nrfInI-
bIrfh nborfIon. l53l(n) (2000 od., Su. IV). If dofInos
fho unInwfuI nborfIon In oxIIcIf forms. l53l(b)(l).
l? CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
IIrsf, fho orson orformIng fho nborfIon musf vngI-
nnIIy doIIvo|r] n IIvIng fofus. l53l(b)(l)(A). Tho Acf
doos nof rosfrIcf nn nborfIon rocoduro InvoIvIng fho
doIIvory of nn oxIrod fofus. Tho Acf, furfhormoro, Is
InnIIcnbIo fo nborfIons fhnf do nof InvoIvo vngInnI doIIv-
ory (for Insfnnco, hysforofomy or hysforocfomy). Tho Acf
doos nIy bofh rovInbIIIfy nnd osfvInbIIIfy bocnuso, by
common undorsfnndIng nnd scIonfIfIc formInoIogy, n fofus
Is n IIvIng orgnnIsm whIIo wIfhIn fho womb, whofhor or
nof If Is vInbIo oufsIdo fho womb. Soo, e.g., PlonneJ Por-
enIIooJ, 320 I. Su. 2d, nf 9?l9?2. Wo do nof undor-
sfnnd fhIs oInf fo bo confosfod by fho nrfIos.
Socond, fho Acf`s dofInIfIon of nrfInI-bIrfh nborfIon
roquIros fho fofus fo bo doIIvorod unfII, In fho cnso of n
hond-fIrsf rosonfnfIon, fho onfIro fofnI hond Is oufsIdo fho
body of fho mofhor, or, In fho cnso of brooch rosonfnfIon,
nny nrf of fho fofnI frunk nsf fho nnvoI Is oufsIdo fho
body of fho mofhor. l53l(b)(l)(A) (2000 od., Su. IV).
Tho Affornoy ConornI concodos, nnd wo ngroo, fhnf If nn
nborfIon rocoduro doos nof InvoIvo fho doIIvory of n IIvIng
fofus fo ono of fhoso nnnfomIcnI 'Inndmnrks` whoro,
doondIng on fho rosonfnfIon, oIfhor fho fofnI hond or fho
fofnI frunk nsf fho nnvoI Is oufsIdo fho body of fho
mofhorfho rohIbIfIons of fho Acf do nof nIy. IrIof for
IofIfIonor In o. 05380, . 46.
ThIrd, fo fnII wIfhIn fho Acf, n docfor musf orform nn
ovorf ncf, ofhor fhnn comIofIon of doIIvory, fhnf kIIIs fho
nrfInIIy doIIvorod IIvIng fofus. l53l(b)(l)(I) (2000 od.,
Su. IV). Ior urosos of crImInnI IInbIIIfy, fho ovorf ncf
cnusIng fho fofus` donfh musf bo sonrnfo from doIIvory.
And fho ovorf ncf musf occur nffor fho doIIvory fo nn
nnnfomIcnI Inndmnrk. ThIs Is bocnuso fho Acf roscrIbos
kIIIIng fho nrfInIIy doIIvorod fofus, whIch, whon rond In
confoxf, rofors fo n fofus fhnf hns boon doIIvorod fo nn
nnnfomIcnI Inndmnrk. 1IiJ.
Iourfh, fho Acf confnIns scIonfor roquIromonfs concorn-
l8 COZA!IS t. CA!HA!T
OInIon of fho Courf
Ing nII fho ncfIons InvoIvod In fho rohIbIfod nborfIon. To
bogIn wIfh, fho hysIcInn musf hnvo doIIbornfoIy nnd
InfonfIonnIIy doIIvorod fho fofus fo ono of fho Acf`s nnn-
fomIcnI Inndmnrks. l53l(b)(l)(A). If n IIvIng fofus Is
doIIvorod nsf fho crIfIcnI oInf by nccIdonf or Inndvor-
fonco, fho Acf Is InnIIcnbIo. In nddIfIon, fho fofus musf
hnvo boon doIIvorod for fho uroso of orformIng nn
ovorf ncf fhnf fho |docfor] knows wIII kIII |If]. 1IiJ. If
oIfhor Infonf Is nbsonf, no crImo hns occurrod. ThIs foI-
Iows from fho gonornI rIncIIo fhnf whoro scIonfor Is
roquIrod no crImo Is commIffod nbsonf fho roquIsIfo sfnfo
of mInd. Soo gonornIIy l W. !nInvo, SubsfnnfIvo CrImI-
nnI !nw 5.l (2d od. 2003) (horoInnffor !nInvo); l C.
TorcIn, Whnrfon`s CrImInnI !nw 2? (l5fh od. l993).
I
!osondonfs confond fho Inngungo doscrIbod nbovo Is
IndoformInnfo, nnd fhoy fhus nrguo fho Acf Is unconsfIfu-
fIonnIIy vnguo on Ifs fnco. As gonornIIy sfnfod, fho voId-
for-vnguonoss docfrIno roquIros fhnf n onnI sfnfufo dofIno
fho crImInnI offonso wIfh suffIcIonf dofInIfonoss fhnf ordI-
nnry ooIo cnn undorsfnnd whnf conducf Is rohIbIfod
nnd In n mnnnor fhnf doos nof oncourngo nrbIfrnry nnd
dIscrImInnfory onforcomonf. KolenJer v. Ioueon, 46l
!. S. 352, 35? (l983); PoeIere 'A` TIinge, IIJ. v. UniIeJ
SIoIee, 5ll !. S. 5l3, 525 (l994). Tho Acf snfIsfIos bofh
roquIromonfs.
Tho Acf rovIdos docfors of ordInnry InfoIIIgonco n
ronsonnbIo oorfunIfy fo know whnf Is rohIbIfod.
Gro,neJ v. CiI, of IoclforJ, 408 !. S. l04, l08 (l9?2).
Indood, If sofs forfh roInfIvoIy cIonr guIdoIInos ns fo ro-
hIbIfod conducf nnd rovIdos objocfIvo crIforIn fo ovnIu-
nfo whofhor n docfor hns orformod n rohIbIfod roco-
duro. PoeIere 'A` TIinge, eupro, nf 525526. !nIIko fho
sfnfufory Inngungo In SIenIerg fhnf rohIbIfod fho doIIv-
ory of n 'subsfnnfInI orfIon` of fho fofuswhoro n doc-
l9 CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
for mIghf quosfIon how much of fho fofus Is n subsfnnfInI
orfIonfho Acf dofInos fho IIno bofwoon ofonfInIIy
crImInnI conducf on fho ono hnnd nnd InwfuI nborfIon on
fho ofhor. SIenIerg, 530 !. S., nf 922 (quofIng ob. !ov.
Sfnf. Ann. 28326(9) (Su. l999)). ocfors orformIng
&I wIII know fhnf If fhoy do nof doIIvor n IIvIng fofus
fo nn nnnfomIcnI Inndmnrk fhoy wIII nof fnco crImInnI
IInbIIIfy.
ThIs concIusIon Is buffrossod by fho Infonf fhnf musf bo
rovod fo Imoso IInbIIIfy. Tho Courf hns mndo cIonr fhnf
scIonfor roquIromonfs nIIovInfo vnguonoss concorns.
PoeIere 'A` TIinge, eupro, nf 526; soo nIso ColouIIi v.
Ironllin, 439 !. S. 3?9, 395 (l9?9) (ThIs Courf hns Iong
rocognIzod fhnf fho consfIfufIonnIIfy of n vnguo sfnfufory
sfnndnrd Is cIosoIy roInfod fo whofhor fhnf sfnndnrd In-
corornfos n roquIromonf of nene reo). Tho Acf roquIros
fho docfor doIIbornfoIy fo hnvo doIIvorod fho fofus fo nn
nnnfomIcnI Inndmnrk. l53l(b)(l)(A) (2000 od., Su. IV).
Iocnuso n docfor orformIng n &I wIII nof fnco crImInnI
IInbIIIfy If ho or sho doIIvors n fofus boyond fho rohIbIfod
oInf by mIsfnko, fho Acf cnnnof bo doscrIbod ns n frn
for fhoso who ncf In good fnIfh. ColouIIi, eupro, nf 395
(InfornnI quofnfIon mnrks omIffod).
!osondonfs IIkowIso hnvo fnIIod fo show fhnf fho Acf
shouId bo InvnIIdnfod on Ifs fnco bocnuso If oncourngos
nrbIfrnry or dIscrImInnfory onforcomonf. KolenJer, eupro,
nf 35?. Jusf ns fho Acf`s nnnfomIcnI Inndmnrks rovIdo
docfors wIfh objocfIvo sfnndnrds, fhoy nIso osfnbIIsh
mInImnI guIdoIInos fo govorn Inw onforcomonf. SniII v.
Goguen, 4l5 !. S. 566, 5?4 (l9?4). Tho scIonfor roquIro-
monfs nnrrow fho scoo of fho Acf`s rohIbIfIon nnd IImIf
rosocuforInI dIscrofIon. If cnnnof bo snId fhnf fho Acf
vosfs vIrfunIIy comIofo dIscrofIon In fho hnnds of |Inw
onforcomonf] fo doformIno whofhor fho |docfor] hns snfIs-
fIod |Ifs rovIsIons]. KolenJer, eupro, nf 358 (InvnIIdnfIng
n sfnfufo roguInfIng IoIforIng). !osondonfs` nrgumonfs
20 COZA!IS t. CA!HA!T
OInIon of fho Courf
concornIng nrbIfrnry onforcomonf, furfhormoro, nro somo-
whnf socuInfIvo. ThIs Is n roonforcomonf chnIIongo,
whoro no ovIdonco hns boon, or couId bo, Infroducod fo
IndIcnfo whofhor fho |Acf] hns boon onforcod In n dIs-
crImInnfory mnnnor or wIfh fho nIm of InhIbIfIng |consfI-
fufIonnIIy rofocfod conducf]. Hoffnon 1eIoIee v. Ilip-
eiJe, Hoffnon 1eIoIee, 1nc., 455 !. S. 489, 503 (l982). Tho
Acf Is nof vnguo.
C
Wo noxf doformIno whofhor fho Acf Imosos nn unduo
burdon, ns n fncInI mnffor, bocnuso Ifs rosfrIcfIons on
socond-frImosfor nborfIons nro foo brond. A rovIow of fho
sfnfufory foxf dIscIosos fho IImIfs of Ifs ronch. Tho Acf
rohIbIfs Infncf &I; nnd, nofwIfhsfnndIng rosondonfs`
nrgumonfs, If doos nof rohIbIf fho &I rocoduro In
whIch fho fofus Is romovod In nrfs.
l
Tho Acf rohIbIfs n docfor from InfonfIonnIIy orformIng
nn Infncf &I. Tho dunI rohIbIfIons of fho Acf, bofh of
whIch nro nocossnry for crImInnI IInbIIIfy, corrosond wIfh
fho sfos gonornIIy undorfnkon durIng fhIs fyo of roco-
duro. IIrsf, n docfor doIIvors fho fofus unfII Ifs hond
Iodgos In fho corvIx, whIch Is usunIIy nsf fho nnnfomIcnI
Inndmnrk for n brooch rosonfnfIon. Soo l8 !. S. C.
l53l(b)(l)(A) (2000 od., Su. IV). Socond, fho docfor
rocoods fo Iorco fho fofnI skuII wIfh scIssors or crush If
wIfh forcos. ThIs sfo snfIsfIos fho ovorf-ncf roquIromonf
bocnuso If kIIIs fho fofus nnd Is dIsfIncf from doIIvory. Soo
l53l(b)(l)(I). Tho Acf`s Infonf roquIromonfs, howovor,
IImIf Ifs ronch fo fhoso hysIcInns who cnrry ouf fho Infncf
&I nffor InfondIng fo undorfnko bofh sfos nf fho oufsof.
Tho Acf oxcIudos mosf &Is In whIch fho fofus Is ro-
movod In Iocos, nof Infncf. If fho docfor Infonds fo ro-
movo fho fofus In nrfs from fho oufsof, fho docfor wIII nof
2l CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
hnvo fho roquIsIfo Infonf fo Incur crImInnI IInbIIIfy. A
docfor orformIng n sfnndnrd &I rocoduro cnn offon
fnk|o] nbouf l0l5 'nssos` fhrough fho uforus fo romovo
fho onfIro fofus. PlonneJ PorenIIooJ, 320 I. Su. 2d, nf
962. !omovIng fho fofus In fhIs mnnnor doos nof vIoInfo
fho Acf bocnuso fho docfor wIII nof hnvo doIIvorod fho
IIvIng fofus fo ono of fho nnnfomIcnI Inndmnrks or commIf-
fod nn nddIfIonnI ovorf ncf fhnf kIIIs fho fofus nffor nrfInI
doIIvory. l53l(b)(l) (2000 od., Su. IV).
A comnrIson of fho Acf wIfh fho obrnskn sfnfufo
sfruck down In SIenIerg confIrms fhIs oInf. Tho sfnfufo
In SIenIerg rohIbIfod 'doIIbornfoIy nnd InfonfIonnIIy
doIIvorIng Info fho vngInn n IIvIng unborn chIId, or n sub-
sfnnfInI orfIon fhoroof, for fho uroso of orformIng n
rocoduro fhnf fho orson orformIng such rocoduro
knows wIII kIII fho unborn chIId nnd doos kIII fho unborn
chIId.` 530 !. S., nf 922 (quofIng ob. !ov. Sfnf. Ann.
28326(9) (Su. l999)). Tho Courf concIudod fhnf fhIs
sfnfufo oncomnssod &I bocnuso &I wIII offon In-
voIvo n hysIcInn uIIIng n 'subsfnnfInI orfIon` of n sfIII
IIvIng fofus, sny, nn nrm or Iog, Info fho vngInn rIor fo fho
donfh of fho fofus. 530 !. S., nf 939. Tho Courf nIso
rojocfod fho IImIfIng InforrofnfIon urgod by obrnskn`s
Affornoy ConornI fhnf fho sfnfufo`s roforonco fo n roco-
duro fhnf 'kIII|s] fho unborn chIId` wns fo n dIsfIncf
rocoduro, nof fo fho nborfIon rocoduro ns n whoIo. 1J.,
nf 943.
Congross, If Is nnronf, rosondod fo fhoso concorns
bocnuso fho Acf donrfs In mnforInI wnys from fho sfnfufo
In SIenIerg. If ndofs fho hrnso doIIvors n IIvIng fofus,
l53l(b)(l)(A) (2000 od., Su. IV), Insfond of 'doIIvorIng
. . . n IIvIng unborn chIId, or n subsfnnfInI orfIon
fhoroof,` 530 !. S., nf 938 (quofIng ob. !ov. Sfnf. Ann.
28326(9) (Su. l999)). Tho Acf`s Inngungo, unIIko fho
sfnfufo In SIenIerg, oxrossos fho usunI monnIng of do-
IIvor whon usod In connocfIon wIfh fofus, nnmoIy, ox-
22 COZA!IS t. CA!HA!T
OInIon of fho Courf
frncfIon of nn onfIro fofus rnfhor fhnn romovnI of fofnI
Iocos. Soo Sfodmnn`s ModIcnI IcfIonnry 4?0 (2?fh od.
2000) (dofInIng doIIvor ns |f]o nssIsf n womnn In chIId-
bIrfh nnd |f]o oxfrncf from nn oncIosod Inco, ns fho fofus
from fho womb, nn objocf or foroIgn body); soo nIso I. ox,
I. MoIIonI, C. IIsnor, & J. MoIIonI, Tho HnrorCoIIIns
IIIusfrnfod ModIcnI IcfIonnry l60 (4fh od. 200l); Mor-
rInm Wobsfor`s CoIIogInfo IcfIonnry 306 (l0fh od. l99?).
Tho Acf fhus dIsIncos fho InforrofnfIon of doIIvorIng
dIcfnfod by fho obrnskn sfnfufo`s roforonco fo n subsfnn-
fInI orfIon of fho fofus. SIenIerg, eupro, nf 944 (IndIcnf-
Ing fhnf fho obrnskn sfnfufo IfsoIf socIfIos fhnf If n-
IIos IoII fo doIIvorIng 'nn Infncf unborn chIId` or 'n
subsfnnfInI orfIon fhoroof` ). In InforrofIng sfnfufory
foxfs courfs uso fho ordInnry monnIng of forms unIoss
confoxf roquIros n dIfforonf rosuIf. Soo, e.g., 2A . SIngor,
SufhorInnd on Sfnfufos nnd Sfnfufory ConsfrucfIon 4?:28
(rov. 6fh od. 2000). Horo, unIIko In SIenIerg, fho Inngungo
doos nof roquIro n donrfuro from fho ordInnry monnIng.
&I doos nof InvoIvo fho doIIvory of n fofus bocnuso If
roquIros fho romovnI of fofnI nrfs fhnf nro rIod from
fho fofus ns fhoy nro uIIod fhrough fho corvIx.
Tho IdonfIfIcnfIon of socIfIc nnnfomIcnI Inndmnrks fo
whIch fho fofus musf bo nrfInIIy doIIvorod nIso dIfforonfI-
nfos fho Acf from fho sfnfufo nf Issuo In SIenIerg.
l53l(b)(l)(A) (2000 od., Su. IV). Tho Courf In SIenIerg
Inforrofod 'subsfnnfInI orfIon` of fho fofus fo IncIudo
nn nrm or n Iog. 530 !. S., nf 939. Tho Acf`s nnnfomIcnI
Inndmnrks, by confrnsf, cInrIfy fhnf fho romovnI of n smnII
orfIon of fho fofus Is nof rohIbIfod. Tho Inndmnrks nIso
roquIro fho fofus fo bo doIIvorod so fhnf If Is nrfInIIy
oufsIdo fho body of fho mofhor. l53l(b)(l)(A). To como
wIfhIn fho nmbIf of fho obrnskn sfnfufo, on fho ofhor
hnnd, n subsfnnfInI orfIon of fho fofus onIy hnd fo bo
doIIvorod Info fho vngInn; no nrf of fho fofus hnd fo bo
oufsIdo fho body of fho mofhor boforo n docfor couId fnco
23 CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
crImInnI snncfIons. 1J., nf 938939.
Iy nddIng nn ovorf-ncf roquIromonf Congross soughf
furfhor fo moof fho Courf`s objocfIons fo fho sfnfo sfnfufo
consIdorod In SIenIerg. Comnro l8 !. S. C. l53l(b)(l)
(2000 od., Su. IV) wIfh ob. !ov. Sfnf. Ann. 28326(9)
(Su. l999). Tho Acf mnkos fho dIsfIncfIon fho obrnskn
sfnfufo fnIIod fo drnw (buf fho obrnskn Affornoy ConornI
ndvnncod) by dIfforonfInfIng bofwoon fho ovornII nrfInI-
bIrfh nborfIon nnd fho dIsfIncf ovorf ncf fhnf kIIIs fho
fofus. Soo SIenIerg, 530 !. S., nf 943944. Tho fnfnI
ovorf ncf musf occur nffor doIIvory fo nn nnnfomIcnI Innd-
mnrk, nnd If musf bo somofhIng ofhor fhnn |fho] comIo-
fIon of doIIvory. l53l(b)(l)(I). ThIs dIsfIncfIon mnffors
bocnuso, unIIko Infncf &I, sfnndnrd &I doos nof In-
voIvo n doIIvory foIIowod by n fnfnI ncf.
Tho cnnon of consfIfufIonnI nvoIdnnco, fInnIIy, oxfIn-
guIshos nny IIngorIng doubf ns fo whofhor fho Acf covors
fho rofofyIcnI &I rocoduro. '|T]ho oIomonfnry ruIo
Is fhnf ovory ronsonnbIo consfrucfIon musf bo rosorfod fo,
In ordor fo snvo n sfnfufo from unconsfIfufIonnIIfy.`
1JuorJ J. DeBorIolo Corp. v. IloriJo Gulf CooeI BuilJing
& ConeIr. TroJee Council, 485 !. S. 568, 5?5 (l988) (quof-
Ing Hooper v. Colifornio, l55 !. S. 648, 65? (l895)). If Is
fruo fhIs IongsfnndIng mnxIm of sfnfufory InforrofnfIon
hns, In fho nsf, fnIIon by fho wnysIdo whon fho Courf
confronfod n sfnfufo roguInfIng nborfIon. Tho Courf nf
fImos omIoyod nn nnfngonIsfIc 'cnnon of consfrucfIon
undor whIch In cnsos InvoIvIng nborfIon, n ormIssIbIo
rondIng of n sfnfufo |wns] fo bo nvoIdod nf nII cosfs.`
SIenIerg, eupro, nf 9?? (KIIY, J., dIssonfIng) (quofIng
TIornIurgI, 4?6 !. S., nf 829 (O`Connor, J., dIssonfIng)).
Coee, uf fhIs novoI sfnfufory nronch fo rosf. SIenIerg,
eupro, nf 9?? (KIIY, J., dIssonfIng). SIenIerg nood
nof bo Inforrofod fo hnvo rovIvod If. Wo rond fhnf docI-
sIon Insfond fo sfnnd for fho unconfrovorsInI roosIfIon
fhnf fho cnnon of consfIfufIonnI nvoIdnnco doos nof nIy
24 COZA!IS t. CA!HA!T
OInIon of fho Courf
If n sfnfufo Is nof gonuInoIy suscofIbIo fo fwo consfruc-
fIons. AlnenJorec-Torree v. UniIeJ SIoIee, 523 !. S. 224,
238 (l998); soo nIso Clorl v. MorIinec, 543 !. S. 3?l, 385
(2005). In SIenIerg fho Courf found fho sfnfufo covorod
&I. 530 !. S., nf 938945. Horo, by confrnsf, Inforrof-
Ing fho Acf so fhnf If doos nof rohIbIf sfnndnrd &I Is
fho mosf ronsonnbIo rondIng nnd undorsfnndIng of Ifs
forms.
2
Confrnry nrgumonfs by fho rosondonfs nro unnvnIIIng.
!osondonfs Iook fo sIfunfIons fhnf mIghf nrIso durIng
&I, sIfunfIons nof oxnmInod In SIenIerg. Thoy con-
fondroIyIng on fho fosfImony of numorous nborfIon
docforsfhnf &I mny rosuIf In fho doIIvory of n IIvIng
fofus boyond fho Acf`s nnnfomIcnI Inndmnrks In n sIgnIfI-
cnnf frncfIon of cnsos. ThIs Is so, rosondonfs sny, bocnuso
docfors cnnnof rodIcf fho nmounf fho corvIx wIII dIInfo
boforo fho nborfIon rocoduro. If mIghf dIInfo fo n dogroo
fhnf fho fofus wIII bo romovod InrgoIy Infncf. To comIofo
fho nborfIon, docfors wIII commIf nn ovorf ncf fhnf kIIIs
fho nrfInIIy doIIvorod fofus. !osondonfs fhus osIf fhnf
nny &I hns fho ofonfInI fo vIoInfo fho Acf, nnd fhnf n
hysIcInn wIII nof know boforohnnd whofhor fho nborfIon
wIII rocood In n rohIbIfod mnnnor. IrIof for !osondonf
IInnnod Inronfhood of nI. In o. 05l382, . 38.
ThIs ronsonIng, howovor, doos nof fnko nccounf of fho
Acf`s Infonf roquIromonfs, whIch rocIudo IInbIIIfy from
nffnchIng fo nn nccIdonfnI Infncf &I. If n docfor`s Infonf
nf fho oufsof Is fo orform n &I In whIch fho fofus wouId
nof bo doIIvorod fo oIfhor of fho Acf`s nnnfomIcnI Innd-
mnrks, buf fho fofus nonofhoIoss Is doIIvorod nsf ono of
fhoso oInfs, fho roquIsIfo nnd rohIbIfod scIonfor Is nof
rosonf. l8 !. S. C. l53l(b)(l)(A) (2000 od., Su. IV).
Whon n docfor In fhnf sIfunfIon comIofos nn nborfIon by
orformIng nn Infncf &I, fho docfor doos nof vIoInfo fho
25 CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
Acf. If Is fruo fhnf Infonf fo cnuso n rosuIf mny somofImos
bo Inforrod If n orson knows fhnf fhnf rosuIf Is rncfI-
cnIIy corfnIn fo foIIow from hIs conducf. l !nInvo 5.2(n),
nf 34l. Yof nborfIon docfors InfondIng nf fho oufsof fo
orform n sfnndnrd &I rocoduro wIII nof know fhnf n
rohIbIfod nborfIon Is rncfIcnIIy corfnIn fo foIIow from
fhoIr conducf. 1IiJ. A fofus Is onIy doIIvorod InrgoIy
Infncf In n smnII frncfIon of fho ovornII numbor of &I
nborfIons. PlonneJ PorenIIooJ, 320 I. Su. 2d, nf 965.
Tho ovIdonco nIso suorfs n IogIsInfIvo doformInnfIon
fhnf nn Infncf doIIvory Is nImosf nIwnys n conscIous choIco
rnfhor fhnn n hnonsfnnco. ocfors, for oxnmIo, mny
romovo fho fofus In n mnnnor fhnf wIII Incronso fho
chnncos of nn Infncf doIIvory. Soo, e.g., A. In o. 05
l382, nf ?4, 452. And Infncf &I Is usunIIy doscrIbod ns
InvoIvIng somo mnnnor of sorInI dIInfIon. Soo, e.g., IIn-
fIon nnd IxfrncfIon ll0. ocfors who do nof sook fo ob-
fnIn fhIs sorInI dIInfIon orform nn Infncf &I on fnr
fowor occnsIons. Soo, e.g., CorIorI, 33l I. Su. 2d, nf
85?858 (In ordor for Infncf romovnI fo occur on n roguInr
bnsIs, r. IIfzhugh wouId hnvo fo dIInfo hIs nfIonfs wIfh
n socond round of InmInnrIn). ThIs ovIdonco boIIos nny
cInIm fhnf n sfnndnrd &I cnnnof bo orformod wIfhouf
InfondIng or forosooIng nn Infncf &I.
Mnny docfors who fosfIfIod on bohnIf of rosondonfs,
nnd who objocfod fo fho Acf, do nof orform nn Infncf &I
by nccIdonf. On fho confrnry, fhoy bogIn ovory &I nbor-
fIon wIfh fho objocfIvo of romovIng fho fofus ns Infncf ns
ossIbIo. Soo, e.g., iJ., nf 869 (SInco r. Chnson boIIovos
fhnf fho Infncf & I Is snfor fhnn fho dIsmombormonf
& I, r. Chnson`s gonI Is fo orform nn Infncf & I ovory
fImo); soo nIso iJ., nf 8?3, 886. ThIs doos nof rovo, ns
rosondonfs suggosf, fhnf ovory &I mIghf vIoInfo fho
Acf nnd fhnf fho Acf fhoroforo Imosos nn unduo burdon.
If domonsfrnfos onIy fhnf fhoso docfors who Infond fo
orform n &I fhnf wouId InvoIvo doIIvory of n IIvIng
26 COZA!IS t. CA!HA!T
OInIon of fho Courf
fofus fo ono of fho Acf`s nnnfomIcnI Inndmnrks musf ndjusf
fhoIr conducf fo fho Inw by nof nffomfIng fo doIIvor fho
fofus fo oIfhor of fhoso oInfs. !osondonfs hnvo nof
shown fhnf roquIrIng docfors fo Infond dIsmombormonf
boforo doIIvory fo nn nnnfomIcnI Inndmnrk wIII rohIbIf
fho vnsf mnjorIfy of &I nborfIons. Tho Acf, fhon, cnnnof
bo hoId InvnIId on Ifs fnco on fhoso grounds.
IV
!ndor fho rIncIIos nccofod ns confroIIIng horo, fho
Acf, ns wo hnvo Inforrofod If, wouId bo unconsfIfufIonnI
If Ifs uroso or offocf Is fo Inco n subsfnnfInI obsfncIo In
fho nfh of n womnn sookIng nn nborfIon boforo fho fofus
nffnIns vInbIIIfy. Coee,, 505 !. S., nf 8?8 (IurnIIfy oIn-
Ion). Tho nborfIons nffocfod by fho Acf`s roguInfIons fnko
Inco bofh rovInbIIIfy nnd osfvInbIIIfy; so fho quofod
Inngungo nnd fho unduo burdon nnnIysIs If roIIos uon nro
nIIcnbIo. Tho quosfIon Is whofhor fho Acf, monsurod by
Ifs foxf In fhIs fncInI nffnck, Imosos n subsfnnfInI obsfncIo
fo Info-form, buf rovInbIIIfy, nborfIons. Tho Acf doos nof
on Ifs fnco Imoso n subsfnnfInI obsfncIo, nnd wo rojocf
fhIs furfhor fncInI chnIIongo fo Ifs vnIIdIfy.
A
Tho Acf`s urosos nro sof forfh In rocIfnIs rocodIng Ifs
oornfIvo rovIsIons. A doscrIfIon of fho rohIbIfod nbor-
fIon rocoduro domonsfrnfos fho rnfIonnIo for fho congros-
sIonnI onncfmonf. Tho Acf roscrIbos n mofhod of nborfIon
In whIch n fofus Is kIIIod jusf Inchos boforo comIofIon of
fho bIrfh rocoss. Congross sfnfod ns foIIows: ImIIcIfIy
nrovIng such n brufnI nnd Inhumnno rocoduro by
choosIng nof fo rohIbIf If wIII furfhor conrson socIofy fo
fho humnnIfy of nof onIy nowborns, buf nII vuInornbIo nnd
Innoconf humnn IIfo, mnkIng If IncronsIngIy dIffIcuIf fo
rofocf such IIfo. CongrossIonnI IIndIngs (l4)(), In
nofos foIIowIng l8 !. S. C. l53l (2000 od., Su. IV), .
2? CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
?69. Tho Acf oxrossos rosocf for fho dIgnIfy of humnn
IIfo.
Congross wns concornod, furfhormoro, wIfh fho offocfs
on fho modIcnI communIfy nnd on Ifs roufnfIon cnusod by
fho rncfIco of nrfInI-bIrfh nborfIon. Tho fIndIngs In fho
Acf oxInIn:
InrfInI-bIrfh nborfIon . . . confusos fho modIcnI, IognI,
nnd ofhIcnI dufIos of hysIcInns fo rosorvo nnd ro-
mofo IIfo, ns fho hysIcInn ncfs dIrocfIy ngnInsf fho
hysIcnI IIfo of n chIId, whom ho or sho hnd jusf doIIv-
orod, nII buf fho hond, ouf of fho womb, In ordor fo ond
fhnf IIfo. CongrossIonnI IIndIngs (l4)(J), iIiJ.
Thoro cnn bo no doubf fho govornmonf hns nn Inforosf In
rofocfIng fho InfogrIfy nnd ofhIcs of fho modIcnI rofos-
sIon. WoeIingIon v. GlucleIerg, 52l !. S. ?02, ?3l
(l99?); soo nIso Borel, v. BoorJ of IegenIe of Unit. of A.
Y., 34? !. S. 442, 45l (l954) (IndIcnfIng fho Sfnfo hns
IogIfImnfo concorn for mnInfnInIng hIgh sfnndnrds of
rofossIonnI conducf In fho rncfIco of modIcIno). !ndor
our rocodonfs If Is cIonr fho Sfnfo hns n sIgnIfIcnnf roIo fo
Iny In roguInfIng fho modIcnI rofossIon.
Coee, ronffIrmod fhoso govornmonfnI objocfIvos. Tho
govornmonf mny uso Ifs voIco nnd Ifs roguInfory nufhorIfy
fo show Ifs rofound rosocf for fho IIfo wIfhIn fho womnn.
A confrnI romIso of fho oInIon wns fhnf fho Courf`s
rocodonfs nffor Ioe hnd undorvnIuo|d] fho Sfnfo`s Infor-
osf In ofonfInI IIfo. 505 !. S., nf 8?3 (IurnIIfy oInIon);
soo nIso iJ., nf 8?l. Tho IurnIIfy oInIon IndIcnfod |f]ho
fncf fhnf n Inw whIch sorvos n vnIId uroso, ono nof
dosIgnod fo sfrIko nf fho rIghf IfsoIf, hns fho IncIdonfnI
offocf of mnkIng If moro dIffIcuIf or moro oxonsIvo fo
rocuro nn nborfIon cnnnof bo onough fo InvnIIdnfo If.
1J., nf 8?4. ThIs wns nof nn IdIo nssorfIon. Tho fhroo
romIsos of Coee, musf cooxIsf. Soo iJ., nf 846 (oInIon of
fho Courf). Tho fhIrd romIso, fhnf fho Sfnfo, from fho
28 COZA!IS t. CA!HA!T
OInIon of fho Courf
IncofIon of fho rognnncy, mnInfnIns Ifs own roguInfory
Inforosf In rofocfIng fho IIfo of fho fofus fhnf mny bocomo
n chIId, cnnnof bo sof nf nnughf by InforrofIng Coee,`s
roquIromonf of n honIfh oxcofIon so If bocomos fnnfn-
mounf fo nIIowIng n docfor fo chooso fho nborfIon mofhod
ho or sho mIghf rofor. Whoro If hns n rnfIonnI bnsIs fo
ncf, nnd If doos nof Imoso nn unduo burdon, fho Sfnfo
mny uso Ifs roguInfory owor fo bnr corfnIn rocoduros
nnd subsfIfufo ofhors, nII In furfhornnco of Ifs IogIfImnfo
Inforosfs In roguInfIng fho modIcnI rofossIon In ordor fo
romofo rosocf for IIfo, IncIudIng IIfo of fho unborn.
Tho Acf`s bnn on nborfIons fhnf InvoIvo nrfInI doIIvory
of n IIvIng fofus furfhors fho Covornmonf`s objocfIvos. o
ono wouId dIsufo fhnf, for mnny, &I Is n rocoduro
IfsoIf Indon wIfh fho owor fo dovnIuo humnn IIfo. Con-
gross couId nonofhoIoss concIudo fhnf fho fyo of nborfIon
roscrIbod by fho Acf roquIros socIfIc roguInfIon bocnuso
If ImIIcnfos nddIfIonnI ofhIcnI nnd mornI concorns fhnf
jusfIfy n socInI rohIbIfIon. Congross doformInod fhnf
fho nborfIon mofhods If roscrIbod hnd n dIsfurbIng
sImIInrIfy fo fho kIIIIng of n nowborn Infnnf, Congros-
sIonnI IIndIngs (l4)(!), In nofos foIIowIng l8 !. S. C.
l53l (2000 od., Su. IV), . ?69, nnd fhus If wns con-
cornod wIfh drnw|Ing] n brIghf IIno fhnf cIonrIy dIsfIn-
guIshos nborfIon nnd InfnnfIcIdo. CongrossIonnI IIndIngs
(l4)(C), iIiJ. Tho Courf hns In fho nsf confIrmod fho
vnIIdIfy of drnwIng boundnrIos fo rovonf corfnIn rncfIcos
fhnf oxfInguIsh IIfo nnd nro cIoso fo ncfIons fhnf nro con-
domnod. GlucleIerg found ronsonnbIo fho Sfnfo`s fonr
fhnf ormIffIng nssIsfod suIcIdo wIII sfnrf If down fho nfh
fo voIunfnry nnd orhns ovon InvoIunfnry oufhnnnsIn.
52l !. S., nf ?32?35, nnd n. 23.
!osocf for humnn IIfo fInds nn uIfImnfo oxrossIon In
fho bond of Iovo fho mofhor hns for hor chIId. Tho Acf
rocognIzos fhIs ronIIfy ns woII. Whofhor fo hnvo nn nbor-
fIon roquIros n dIffIcuIf nnd nInfuI mornI docIsIon. Coee,,
29 CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
eupro, nf 852853 (oInIon of fho Courf). WhIIo wo fInd no
roIInbIo dnfn fo monsuro fho honomonon, If sooms unox-
cofIonnbIo fo concIudo somo womon como fo rogrof fhoIr
choIco fo nborf fho Infnnf IIfo fhoy onco cronfod nnd sus-
fnInod. Soo IrIof for Snndrn Cnno of nI. ns Anici Curioe
In o. 05380, . 2224. Sovoro dorossIon nnd Ioss of
osfoom cnn foIIow. Soo iIiJ.
In n docIsIon so frnughf wIfh omofIonnI consoquonco
somo docfors mny rofor nof fo dIscIoso rocIso dofnIIs of
fho monns fhnf wIII bo usod, confInIng fhomsoIvos fo fho
roquIrod sfnfomonf of rIsks fho rocoduro onfnIIs. Irom
ono sfnndoInf fhIs oughf nof fo bo surrIsIng. Any num-
bor of nfIonfs fncIng ImmInonf surgIcnI rocoduros wouId
rofor nof fo honr nII dofnIIs, Iosf fho usunI nnxIofy rocod-
Ing InvnsIvo modIcnI rocoduros bocomo fho moro Infonso.
ThIs Is IIkoIy fho cnso wIfh fho nborfIon rocoduros horo In
Issuo. Soo, e.g., AoI. AIorIion IeJeroIion, 330 I. Su. 2d,
nf 466, n. 22 (Mosf of |fho InInfIffs`] oxorfs ncknowI-
odgod fhnf fhoy do nof doscrIbo fo fhoIr nfIonfs whnf |fho
&I nnd Infncf &I] rocoduros onfnII In cIonr nnd
rocIso forms); soo nIso iJ., nf 4?9.
If Is, howovor, rocIsoIy fhIs Inck of InformnfIon concorn-
Ing fho wny In whIch fho fofus wIII bo kIIIod fhnf Is of
IogIfImnfo concorn fo fho Sfnfo. Coee,, eupro, nf 8?3
(IurnIIfy oInIon) (Sfnfos nro froo fo onncf Inws fo ro-
vIdo n ronsonnbIo frnmowork for n womnn fo mnko n docI-
sIon fhnf hns such rofound nnd InsfIng monnIng). Tho
Sfnfo hns nn Inforosf In onsurIng so grnvo n choIco Is woII
Informod. If Is soIf-ovIdonf fhnf n mofhor who comos fo
rogrof hor choIco fo nborf musf sfruggIo wIfh grIof moro
nnguIshod nnd sorrow moro rofound whon sho Ionrns,
onIy nffor fho ovonf, whnf sho onco dId nof know: fhnf sho
nIIowod n docfor fo Iorco fho skuII nnd vncuum fho fnsf-
dovoIoIng brnIn of hor unborn chIId, n chIId nssumIng fho
humnn form.
If Is n ronsonnbIo Inforonco fhnf n nocossnry offocf of fho
30 COZA!IS t. CA!HA!T
OInIon of fho Courf
roguInfIon nnd fho knowIodgo If convoys wIII bo fo oncour-
ngo somo womon fo cnrry fho Infnnf fo fuII form, fhus
roducIng fho nbsoIufo numbor of Info-form nborfIons. Tho
modIcnI rofossIon, furfhormoro, mny fInd dIfforonf nnd
Ioss shockIng mofhods fo nborf fho fofus In fho socond
frImosfor, fhoroby nccommodnfIng IogIsInfIvo domnnd.
Tho Sfnfo`s Inforosf In rosocf for IIfo Is ndvnncod by fho
dInIoguo fhnf boffor Informs fho oIIfIcnI nnd IognI sys-
foms, fho modIcnI rofossIon, oxocfnnf mofhors, nnd
socIofy ns n whoIo of fho consoquoncos fhnf foIIow from n
docIsIon fo oIocf n Info-form nborfIon.
If Is objocfod fhnf fho sfnndnrd &I Is In somo rosocfs
ns brufnI, If nof moro, fhnn fho Infncf &I, so fhnf fho
IogIsInfIon nccomIIshos IIffIo. Whnf wo hnvo nIrondy
snId, howovor, shows nmIo jusfIfIcnfIon for fho roguIn-
fIon. InrfInI-bIrfh nborfIon, ns dofInod by fho Acf, dIffors
from n sfnndnrd &I bocnuso fho formor occurs whon fho
fofus Is nrfInIIy oufsIdo fho mofhor fo fho oInf of ono of
fho Acf`s nnnfomIcnI Inndmnrks. If wns ronsonnbIo for
Congross fo fhInk fhnf nrfInI-bIrfh nborfIon, moro fhnn
sfnndnrd &I, undormInos fho ubIIc`s orcofIon of fho
nrorInfo roIo of n hysIcInn durIng fho doIIvory rocoss,
nnd orvorfs n rocoss durIng whIch IIfo Is broughf Info
fho worId. CongrossIonnI IIndIngs (l4)(K), In nofos
foIIowIng l8 !. S. C. l53l (2000 od., Su. IV), . ?69.
Thoro wouId bo n fInw In fhIs Courf`s IogIc, nnd nn Irony In
Ifs jurIsrudonco, woro wo fIrsf fo concIudo n bnn on bofh
&I nnd Infncf &I wns ovorbrond nnd fhon fo sny If Is
IrrnfIonnI fo bnn onIy Infncf &I bocnuso fhnf doos nof
roscrIbo bofh rocoduros. In sum, wo rojocf fho confon-
fIon fhnf fho congrossIonnI uroso of fho Acf wns fo
Inco n subsfnnfInI obsfncIo In fho nfh of n womnn sook-
Ing nn nborfIon. 505 !. S., nf 8?8 (IurnIIfy oInIon).
I
Tho Acf`s furfhornnco of IogIfImnfo govornmonf Infor-
3l CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
osfs bonrs uon, buf doos nof rosoIvo, fho noxf quosfIon:
whofhor fho Acf hns fho offocf of ImosIng nn unconsfIfu-
fIonnI burdon on fho nborfIon rIghf bocnuso If doos nof
nIIow uso of fho bnrrod rocoduro whoro 'nocossnry, In
nrorInfo modIcnI judgmonf, for |fho] rosorvnfIon of
fho . . . honIfh of fho mofhor.` A,oIIe, 546 !. S., nf 32?
328 (quofIng Coee,, eupro, nf 8?9 (IurnIIfy oInIon)). Tho
rohIbIfIon In fho Acf wouId bo unconsfIfufIonnI, undor
rocodonfs wo horo nssumo fo bo confroIIIng, If If sub-
jocf|od] |womon] fo sIgnIfIcnnf honIfh rIsks. A,oIIe, eu-
pro, nf 328; soo nIso Coee,, eupro, nf 880 (oInIon of fho
Courf). In A,oIIe fho nrfIos ngrood n honIfh oxcofIon fo
fho chnIIongod nronfnI-InvoIvomonf sfnfufo wns nocos-
snry fo nvorf sorIous nnd offon IrrovorsIbIo dnmngo fo |n
rognnnf mInor`s] honIfh. 546 !. S., nf 328. Horo, by
confrnsf, whofhor fho Acf cronfos sIgnIfIcnnf honIfh rIsks
for womon hns boon n confosfod fncfunI quosfIon. Tho
ovIdonco rosonfod In fho frInI courfs nnd boforo Congross
domonsfrnfos bofh sIdos hnvo modIcnI suorf for fhoIr
osIfIon.
!osondonfs rosonfod ovIdonco fhnf Infncf &I mny
bo fho snfosf mofhod of nborfIon, for ronsons sImIInr fo
fhoso ndducod In SIenIerg. Soo 530 !. S., nf 932. Abor-
fIon docfors fosfIfIod, for oxnmIo, fhnf Infncf &I do-
cronsos fho rIsk of corvIcnI IncornfIon or uforIno orforn-
fIon bocnuso If roquIros fowor nssos Info fho uforus wIfh
surgIcnI Insfrumonfs nnd doos nof roquIro fho romovnI of
bony frngmonfs of fho dIsmomborod fofus, frngmonfs fhnf
mny bo shnr. !osondonfs nIso rosonfod ovIdonco fhnf
Infncf &I wns snfor bofh bocnuso If roducos fho rIsks
fhnf fofnI nrfs wIII romnIn In fho uforus nnd bocnuso If
fnkos Ioss fImo fo comIofo. !osondonfs, In nddIfIon,
rofforod ovIdonco fhnf Infncf &I wns snfor for womon
wIfh corfnIn modIcnI condIfIons or womon wIfh fofusos
fhnf hnd corfnIn nnomnIIos. Soo, e.g., CorIorI, 33l
I. Su. 2d, nf 923929; AoI. AIorIion IeJeroIion, eupro,
32 COZA!IS t. CA!HA!T
OInIon of fho Courf
nf 4?04?4; PlonneJ PorenIIooJ, 320 I. Su. 2d, nf 982
983.
Thoso confonfIons woro confrndIcfod by ofhor docfors
who fosfIfIod In fho IsfrIcf Courfs nnd boforo Congross.
Thoy concIudod fhnf fho nIIogod honIfh ndvnnfngos woro
bnsod on socuInfIon wIfhouf scIonfIfIc sfudIos fo suorf
fhom. Thoy consIdorod &I nIwnys fo bo n snfo nIfornn-
fIvo. Soo, e.g., CorIorI, eupro, nf 930940; AoI. AIorIion
IeJeroIion, 330 I. Su. 2d, nf 4?04?4; PlonneJ PorenI-
IooJ, 320 I. Su. 2d, nf 983.
Thoro Is documonfod modIcnI dIsngroomonf whofhor fho
Acf`s rohIbIfIon wouId ovor Imoso sIgnIfIcnnf honIfh
rIsks on womon. Soo, e.g., iJ., nf l033 (|T]horo confInuos
fo bo n dIvIsIon of oInIon nmong hIghIy qunIIfIod oxorfs
rognrdIng fho nocossIfy or snfofy of Infncf & I); soo nIso
AoI. AIorIion IeJeroIion, eupro, nf 482. Tho fhroo Is-
frIcf Courfs fhnf consIdorod fho Acf`s consfIfufIonnIIfy
nonrod fo bo In somo dIsngroomonf on fhIs confrnI fnc-
funI quosfIon. Tho IsfrIcf Courf for fho IsfrIcf of o-
brnskn concIudod fho bnnnod rocoduro Is, somofImos,
fho snfosf nborfIon rocoduro fo rosorvo fho honIfh of
womon. CorIorI, eupro, nf l0l?. Tho IsfrIcf Courf for
fho orfhorn IsfrIcf of CnIIfornIn ronchod n sImIInr
concIusIon. PlonneJ PorenIIooJ, eupro, nf l002 (fIndIng
Infncf &I wns undor corfnIn cIrcumsfnncos . . . sIgnIfI-
cnnfIy snfor fhnn & I by dIsnrfIcuInfIon). Tho IsfrIcf
Courf for fho Soufhorn IsfrIcf of ow York wns moro
skofIcnI of fho urorfod honIfh bonofIfs of Infncf &I.
If found fho Affornoy ConornI`s oxorf wIfnossos ron-
sonnbIy nnd offocfIvoIy rofufod |fho InInfIffs`] rofforod
bnsos for fho oInIon fhnf |Infncf &I] hns snfofy ndvnn-
fngos ovor ofhor socond-frImosfor nborfIon rocoduros.
AoI. AIorIion IeJeroIion, 330 I. Su. 2d, nf 4?9. In
nddIfIon If dId nof boIIovo fhnf mnny of |fho InInfIffs`]
urorfod ronsons for why |Infncf &I] Is modIcnIIy noc-
ossnry |woro] crodIbIo; rnfhor |If found fhom fo bo] fhoo-
33 CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
rofIcnI or fnIso. 1J., nf 480. Tho courf nonofhoIoss InvnII-
dnfod fho Acf bocnuso If doformInod n sIgnIfIcnnf body of
modIcnI oInIon . . . hoIds fhnf & I hns snfofy ndvnn-
fngos ovor InducfIon nnd fhnf |Infncf &I] hns somo
snfofy ndvnnfngos (howovor hyofhofIcnI nnd unsubsfnn-
fInfod by scIonfIfIc ovIdonco) ovor & I for somo womon
In somo cIrcumsfnncos. 1IiJ.
Tho quosfIon bocomos whofhor fho Acf cnn sfnnd whon
fhIs modIcnI uncorfnInfy orsIsfs. Tho Courf`s rocodonfs
Insfrucf fhnf fho Acf cnn survIvo fhIs fncInI nffnck. Tho
Courf hns gIvon sfnfo nnd fodornI IogIsInfuros wIdo dIscro-
fIon fo nss IogIsInfIon In nrons whoro fhoro Is modIcnI nnd
scIonfIfIc uncorfnInfy. Soo Koneoe v. HenJricle, 52l !. S.
346, 360, n. 3 (l99?); Jonee v. UniIeJ SIoIee, 463 !. S. 354,
364365, n. l3, 3?0 (l983); IonIerI v. Yelloule,, 2?2 !. S.
58l, 59? (l926); Colline v. Texoe, 223 !. S. 288, 29?298
(l9l2); JocoIeon v. MoeeocIueeIIe, l9? !. S. ll, 303l
(l905); soo nIso SIenIerg, eupro, nf 9699?2 (KIIY, J.,
dIssonfIng); MoreIoll v. UniIeJ SIoIee, 4l4 !. S. 4l?, 42?
(l9?4) (Whon Congross undorfnkos fo ncf In nrons frnughf
wIfh modIcnI nnd scIonfIfIc uncorfnInfIos, IogIsInfIvo o-
fIons musf bo osocInIIy brond).
ThIs frndIfIonnI ruIo Is consIsfonf wIfh Coee,, whIch
confIrms fho Sfnfo`s Inforosf In romofIng rosocf for
humnn IIfo nf nII sfngos In fho rognnncy. IhysIcInns nro
nof onfIfIod fo Ignoro roguInfIons fhnf dIrocf fhom fo uso
ronsonnbIo nIfornnfIvo rocoduros. Tho Inw nood nof gIvo
nborfIon docfors unfofforod choIco In fho courso of fhoIr
modIcnI rncfIco, nor shouId If oIovnfo fhoIr sfnfus nbovo
ofhor hysIcInns In fho modIcnI communIfy. In Coee, fho
confroIIIng oInIon hoId nn Informod-consonf roquIromonf
In fho nborfIon confoxf wns no dIfforonf from n roquIro-
monf fhnf n docfor gIvo corfnIn socIfIc InformnfIon nbouf
nny modIcnI rocoduro. 505 !. S., nf 884 (joInf oInIon).
Tho oInIon sfnfod fho docfor-nfIonf roInfIon horo Is
onfIfIod fo fho snmo soIIcIfudo If rocoIvos In ofhor con-
34 COZA!IS t. CA!HA!T
OInIon of fho Courf
foxfs. 1IiJ., soo nIso WeIeIer v. IeproJucIite HeolII
Serticee, 492 !. S. 490, 5l85l9 (l989) (IurnIIfy oInIon)
(crIfIcIzIng Ioe`s frImosfor frnmowork bocnuso, inIer olio,
If Ioff fhIs Courf fo sorvo ns fho counfry`s ex officio modI-
cnI bonrd wIfh owors fo nrovo or dIsnrovo modIcnI
nnd oornfIvo rncfIcos nnd sfnndnrds fhroughouf fho
!nIfod Sfnfos (InfornnI quofnfIon mnrks omIffod));
Mocurel v. ArneIrong, 520 !. S. 968, 9?3 (l99?) (per
curion) (uhoIdIng n rosfrIcfIon on fho orformnnco of
nborfIons fo IIconsod hysIcInns dosIfo fho rosondonfs`
confonfIon nII honIfh ovIdonco confrndIcfs fho cInIm fhnf
fhoro Is nny honIfh bnsIs for fho Inw (InfornnI quofnfIon
mnrks omIffod)).
ModIcnI uncorfnInfy doos nof forocIoso fho oxorcIso of
IogIsInfIvo owor In fho nborfIon confoxf nny moro fhnn If
doos In ofhor confoxfs. Soo HenJricle, eupro, nf 360, n. 3.
Tho modIcnI uncorfnInfy ovor whofhor fho Acf`s rohIbI-
fIon cronfos sIgnIfIcnnf honIfh rIsks rovIdos n suffIcIonf
bnsIs fo concIudo In fhIs fncInI nffnck fhnf fho Acf doos nof
Imoso nn unduo burdon.
Tho concIusIon fhnf fho Acf doos nof Imoso nn unduo
burdon Is suorfod by ofhor consIdornfIons. AIfornnfIvos
nro nvnIInbIo fo fho rohIbIfod rocoduro. As wo hnvo
nofod, fho Acf doos nof roscrIbo &I. Ono IsfrIcf Courf
found &I fo hnvo oxfromoIy Iow rnfos of modIcnI comII-
cnfIons. PlonneJ PorenIIooJ, eupro, nf l000. Anofhor
IndIcnfod &I wns gonornIIy fho snfosf mofhod of nbor-
fIon durIng fho socond frImosfor. CorIorI, 33l I. Su.
2d, nf l03l; soo nIso AoI. AIorIion IeJeroIion, eupro, nf
46?468 (oxInInIng fhnf |o]xorfs fosfIfyIng for bofh
sIdos ngrood &I wns snfo). In nddIfIon fho Acf`s rohI-
bIfIon onIy nIIos fo fho doIIvory of n IIvIng fofus. l8
!. S. C. l53l(b)(l)(A) (2000 od., Su. IV). If fho Infncf
&I rocoduro Is fruIy nocossnry In somo cIrcumsfnncos,
If nonrs IIkoIy nn InjocfIon fhnf kIIIs fho fofus Is nn
nIfornnfIvo undor fho Acf fhnf nIIows fho docfor fo orform
35 CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
fho rocoduro.
Tho Insfnnf cnsos, fhon, nro dIfforonf from PlonneJ
PorenIIooJ of CenIrol Mo. v. DonforII, 428 !. S. 52, ??
?9 (l9?6), In whIch fho Courf InvnIIdnfod n bnn on snIIno
nmnIoconfosIs, fho fhon-domInnnf socond-frImosfor nbor-
fIon mofhod. Tho Courf found fho bnn In DonforII fo bo
nn unronsonnbIo or nrbIfrnry roguInfIon dosIgnod fo
InhIbIf, nnd hnvIng fho offocf of InhIbIfIng, fho vnsf mnjor-
Ify of nborfIons nffor fho fIrsf l2 wooks. 1J., nf ?9. Horo
fho Acf nIIows, nmong ofhor monns, n commonIy usod nnd
gonornIIy nccofod mofhod, so If doos nof consfrucf n
subsfnnfInI obsfncIo fo fho nborfIon rIghf.
In ronchIng fho concIusIon fho Acf doos nof roquIro n
honIfh oxcofIon wo rojocf corfnIn nrgumonfs mndo by fho
nrfIos on bofh sIdos of fhoso cnsos. On fho ono hnnd, fho
Affornoy ConornI urgos us fo uhoId fho Acf on fho bnsIs
of fho congrossIonnI fIndIngs nIono. IrIof for IofIfIonor In
o. 05380, nf 23. AIfhough wo rovIow congrossIonnI
fncffIndIng undor n doforonfInI sfnndnrd, wo do nof In fho
cIrcumsfnncos horo Inco dIsosIfIvo woIghf on Congross`
fIndIngs. Tho Courf rofnIns nn Indoondonf consfIfufIonnI
dufy fo rovIow fncfunI fIndIngs whoro consfIfufIonnI rIghfs
nro nf sfnko. Soo Crouell v. Beneon, 285 !. S. 22, 60
(l932) (In cnsos broughf fo onforco consfIfufIonnI rIghfs,
fho judIcInI owor of fho !nIfod Sfnfos nocossnrIIy oxfonds
fo fho Indoondonf doformInnfIon of nII quosfIons, bofh of
fncf nnd Inw, nocossnry fo fho orformnnco of fhnf su-
romo funcfIon).
As rosondonfs hnvo nofod, nnd fho IsfrIcf Courfs
rocognIzod, somo rocIfnfIons In fho Acf nro fncfunIIy Incor-
rocf. Soo AoI. AIorIion IeJeroIion, 330 I. Su. 2d, nf
482, 48849l. Whofhor or nof nccurnfo nf fho fImo, somo
of fho Imorfnnf fIndIngs hnvo boon suorsodod. Two
oxnmIos suffIco. Congross doformInod no modIcnI schooIs
rovIdo InsfrucfIon on fho rohIbIfod rocoduro. Congros-
sIonnI IIndIngs (l4)(I), In nofos foIIowIng l8 !. S. C.
36 COZA!IS t. CA!HA!T
OInIon of fho Courf
l53l (2000 od., Su. IV), . ?69. Tho fosfImony In fho
IsfrIcf Courfs, howovor, domonsfrnfod Infncf &I Is
fnughf nf modIcnI schooIs. AoI. AIorIion IeJeroIion,
eupro, nf 490; PlonneJ PorenIIooJ, 320 I. Su. 2d, nf
l029. Congross nIso found fhoro oxIsfod n modIcnI conson-
sus fhnf fho rohIbIfod rocoduro Is novor modIcnIIy noc-
ossnry. CongrossIonnI IIndIngs (l), In nofos foIIowIng l8
!. S. C. l53l (2000 od., Su. IV), . ?6?. Tho ovIdonco
rosonfod In fho IsfrIcf Courfs confrndIcfs fhnf concIu-
sIon. Soo, e.g., CorIorI, eupro, nf l0l2l0l5; AoI. AIor-
Iion IeJeroIion, eupro, nf 488489; PlonneJ PorenIIooJ,
eupro, nf l025l026. !ncrIfIcnI doforonco fo Congross`
fncfunI fIndIngs In fhoso cnsos Is InnrorInfo.
On fho ofhor hnnd, roIyIng on fho Courf`s oInIon In
SIenIerg, rosondonfs confond fhnf nn nborfIon roguInfIon
musf confnIn n honIfh oxcofIon If 'subsfnnfInI modIcnI
nufhorIfy suorfs fho roosIfIon fhnf bnnnIng n nrfIcu-
Inr rocoduro couId ondnngor womon`s honIfh.` IrIof for
!osondonfs In o. 05380, . l9 (quofIng 530 !. S., nf
938); soo nIso IrIof for !osondonf IInnnod Inronfhood
of nI. In o. 05l382, nf l2 (snmo). As IIIusfrnfod by
rosondonfs` nrgumonfs nnd fho docIsIons of fho Courfs of
AonIs, SIenIerg hns boon Inforrofod fo Ionvo no mnrgIn
of orror for IogIsInfuros fo ncf In fho fnco of modIcnI uncor-
fnInfy. CorIorI, 4l3 I. 3d, nf ?96; PlonneJ PorenIIooJ,
435 I. 3d, nf ll?3; soo nIso AoI. AIorIion IeJeroIion, 43?
I. 3d, nf 296 (WnIkor, C. J., concurrIng) (oxInInIng fho
sfnndnrd undor SIenIerg Is n vIrfunIIy InsurmounfnbIo
ovIdonfInry hurdIo).
A zoro foIornnco oIIcy wouId sfrIko down IogIfImnfo
nborfIon roguInfIons, IIko fho rosonf ono, If somo nrf of
fho modIcnI communIfy woro dIsIncIInod fo foIIow fho
roscrIfIon. ThIs Is foo oxncfIng n sfnndnrd fo Imoso on
fho IogIsInfIvo owor, oxorcIsod In fhIs Insfnnco undor fho
Commorco CInuso, fo roguInfo fho modIcnI rofossIon.
ConsIdornfIons of mnrgInnI snfofy, IncIudIng fho bnInnco of
3? CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
rIsks, nro wIfhIn fho IogIsInfIvo comofonco whon fho
roguInfIon Is rnfIonnI nnd In ursuIf of IogIfImnfo onds.
Whon sfnndnrd modIcnI ofIons nro nvnIInbIo, moro con-
vonIonco doos nof suffIco fo dIsInco fhom; nnd If somo
rocoduros hnvo dIfforonf rIsks fhnn ofhors, If doos nof
foIIow fhnf fho Sfnfo Is nIfogofhor bnrrod from ImosIng
ronsonnbIo roguInfIons. Tho Acf Is nof InvnIId on Ifs fnco
whoro fhoro Is uncorfnInfy ovor whofhor fho bnrrod roco-
duro Is ovor nocossnry fo rosorvo n womnn`s honIfh, gIvon
fho nvnIInbIIIfy of ofhor nborfIon rocoduros fhnf nro
consIdorod fo bo snfo nIfornnfIvos.
V
Tho consIdornfIons wo hnvo dIscussod suorf our fur-
fhor doformInnfIon fhnf fhoso fncInI nffncks shouId nof
hnvo boon onforfnInod In fho fIrsf Insfnnco. In fhoso
cIrcumsfnncos fho roor monns fo consIdor oxcofIons Is
by ns-nIIod chnIIongo. Tho Covornmonf hns ncknowI-
odgod fhnf roonforcomonf, ns-nIIod chnIIongos fo fho
Acf cnn bo mnInfnInod. Tr. of OrnI Arg. In o. 05380, .
2l23. ThIs Is fho roor mnnnor fo rofocf fho honIfh of
fho womnn If If cnn bo shown fhnf In dIscrofo nnd woII-
dofInod Insfnncos n nrfIcuInr condIfIon hns or Is IIkoIy fo
occur In whIch fho rocoduro rohIbIfod by fho Acf musf
bo usod. In nn ns-nIIod chnIIongo fho nnfuro of fho
modIcnI rIsk cnn bo boffor qunnfIfIod nnd bnInncod fhnn In
n fncInI nffnck.
Tho InfIfudo gIvon fncInI chnIIongos In fho IIrsf
Amondmonf confoxf Is InnIIcnbIo horo. Irond chnI-
Iongos of fhIs fyo Imoso n honvy burdon uon fho
nrfIos mnInfnInIng fho suIf. IueI v. Sulliton, 500 !. S.
l?3, l83 (l99l). Whnf fhnf burdon consIsfs of In fho
socIfIc confoxf of nborfIon sfnfufos hns boon n subjocf of
somo quosfIon. Comnro OIio v. Alron CenIer for Iepro-
JucIite HeolII, 49? !. S. 502, 5l4 (l990) (|I]ocnuso
noIIoos nro mnkIng n fncInI chnIIongo fo n sfnfufo, fhoy
38 COZA!IS t. CA!HA!T
OInIon of fho Courf
musf show fhnf no sof of cIrcumsfnncos oxIsfs undor whIch
fho Acf wouId bo vnIId (InfornnI quofnfIon mnrks omIf-
fod)), wIfh Coee,, 505 !. S., nf 895 (oInIon of fho Courf)
(IndIcnfIng n sousnI-nofIfIcnfIon sfnfufo wouId Imoso nn
unduo burdon In n Inrgo frncfIon of fho cnsos In whIch |If]
Is roIovnnf nnd hoIdIng fho sfnfufory rovIsIon fncInIIy
InvnIId). Soo nIso Jonllou v. PlonneJ PorenIIooJ, Sioux
Iolle Clinic, 5l? !. S. ll?4 (l996). Wo nood nof rosoIvo
fhnf dobnfo.
As fho rovIous socfIons of fhIs oInIon oxInIn, roson-
donfs hnvo nof domonsfrnfod fhnf fho Acf wouId bo uncon-
sfIfufIonnI In n Inrgo frncfIon of roIovnnf cnsos. Coee,,
eupro, nf 895 (oInIon of fho Courf). Wo nofo fhnf fho
sfnfufo horo nIIos fo nII Insfnncos In whIch fho docfor
roosos fo uso fho rohIbIfod rocoduro, nof moroIy fhoso
In whIch fho womnn suffors from modIcnI comIIcnfIons.
If Is noIfhor our obIIgnfIon nor wIfhIn our frndIfIonnI
InsfIfufIonnI roIo fo rosoIvo quosfIons of consfIfufIonnIIfy
wIfh rosocf fo onch ofonfInI sIfunfIon fhnf mIghf do-
voIo. |I]f wouId Indood bo undosIrnbIo for fhIs Courf fo
consIdor ovory concoIvnbIo sIfunfIon whIch mIghf ossIbIy
nrIso In fho nIIcnfIon of comIox nnd comrohonsIvo
IogIsInfIon. UniIeJ SIoIee v. Ioinee, 362 !. S. l?, 2l
(l960) (InfornnI quofnfIon mnrks omIffod). Ior fhIs ron-
son, |n]s-nIIod chnIIongos nro fho bnsIc buIIdIng bIocks
of consfIfufIonnI ndjudIcnfIon. InIIon, As-AIIod nnd
IncInI ChnIIongos nnd ThIrd-Inrfy SfnndIng, ll3 Hnrv.
!. !ov. l32l, l328 (2000).
Tho Acf Is oon fo n roor ns-nIIod chnIIongo In n
dIscrofo cnso. Cf. Wieconein IigII Io Iife, 1nc. v. IeJerol
1lecIion Conn`n, 546 !. S. 4l0, 4ll4l2 (2006) (per
curion). o ns-nIIod chnIIongo nood bo broughf If fho
rohIbIfIon In fho Acf fhronfons n womnn`s IIfo bocnuso fho
Acf nIrondy confnIns n IIfo oxcofIon. l8 !. S. C. l53l(n)
(2000 od., Su. IV).
39 CIfo ns: 550 !. S. ____ (200?)
OInIon of fho Courf
* * *
!osondonfs hnvo nof domonsfrnfod fhnf fho Acf, ns n
fncInI mnffor, Is voId for vnguonoss, or fhnf If Imosos nn
unduo burdon on n womnn`s rIghf fo nborfIon bnsod on Ifs
ovorbrondfh or Inck of n honIfh oxcofIon. Ior fhoso ron-
sons fho judgmonfs of fho Courfs of AonIs for fho IIghfh
nnd Infh CIrcuIfs nro rovorsod.
1I ie eo orJereJ.
_________________
_________________
l CIfo ns: 550 !. S. ____ (200?)
THOMAS, J., concurrIng
6835(0(&28572)7+(81,7('67$7(6
os. 05380 nnd 05l382
A!II!TO !. COZA!IS, ATTO!IY CII!A!,
IITITIOI!
05380 t.
!I!OY CA!HA!T IT A!.
O W!IT OI CI!TIO!A!I TO THI !ITI STATIS CO!!T OI
AIIIA!S IO! THI IICHTH CI!C!IT
A!II!TO !. COZA!IS, ATTO!IY CII!A!,
IITITIOI!
05l382 t.
I!AI IA!ITHOO III!ATIO OI
AMI!ICA, IC., IT A!.
O W!IT OI CI!TIO!A!I TO THI !ITI STATIS CO!!T OI
AIIIA!S IO! THI ITH CI!C!IT
|ArII l8, 200?]
J!STICI THOMAS, wIfh whom J!STICI SCA!IA joIns,
concurrIng.
I joIn fho Courf`s oInIon bocnuso If nccurnfoIy nIIos
curronf jurIsrudonco, IncIudIng PlonneJ PorenIIooJ of
SouIIeoeIern Po. v. Coee,, 505 !. S. 833 (l992). I wrIfo
sonrnfoIy fo roIfornfo my vIow fhnf fho Courf`s nborfIon
jurIsrudonco, IncIudIng Coee, nnd Ioe v. WoJe, 4l0 !. S.
ll3 (l9?3), hns no bnsIs In fho ConsfIfufIon. Soo Coee,,
eupro, nf 9?9 (SCA!IA, J., concurrIng In judgmonf In nrf
nnd dIssonfIng In nrf); SIenIerg v. CorIorI, 530 !. S.
9l4, 980983 (2000) (THOMAS, J., dIssonfIng). I nIso nofo
fhnf whofhor fho Acf consfIfufos n ormIssIbIo oxorcIso of
Congross` owor undor fho Commorco CInuso Is nof boforo
fho Courf. Tho nrfIos dId nof rnIso or brIof fhnf Issuo; If
2 COZA!IS t. CA!HA!T
THOMAS, J., concurrIng
Is oufsIdo fho quosfIon rosonfod; nnd fho Iowor courfs dId
nof nddross If. Soo CuIIer v. Willineon, 544 !. S. ?09,
?2?, n. 2 (2005) (THOMAS, J., concurrIng).
_________________
_________________
l CIfo ns: 550 !. S. ____ (200?)
CISI!!C, J., dIssonfIng
6835(0(&28572)7+(81,7('67$7(6
os. 05380 nnd 05l382
A!II!TO !. COZA!IS, ATTO!IY CII!A!,
IITITIOI!
05380 t.
!I!OY CA!HA!T IT A!.
O W!IT OI CI!TIO!A!I TO THI !ITI STATIS CO!!T OI
AIIIA!S IO! THI IICHTH CI!C!IT
A!II!TO !. COZA!IS, ATTO!IY CII!A!,
IITITIOI!
05l382 t.
I!AI IA!ITHOO III!ATIO OI
AMI!ICA, IC., IT A!.
O W!IT OI CI!TIO!A!I TO THI !ITI STATIS CO!!T OI
AIIIA!S IO! THI ITH CI!C!IT
|ArII l8, 200?]
J!STICI CISI!!C, wIfh whom J!STICI STIVIS,
J!STICI SO!TI!, nnd J!STICI I!IYI! joIn, dIssonfIng.
In PlonneJ PorenIIooJ of SouIIeoeIern Po. v. Coee,,
505 !. S. 833, 844 (l992), fho Courf docInrod fhnf
|I]Iborfy fInds no rofugo In n jurIsrudonco of doubf.
Thoro wns, fho Courf snId, nn ImornfIvo nood fo dIsoI
doubf ns fo fho monnIng nnd ronch of fho Courf`s ?-fo-2
judgmonf, rondorod nonrIy fwo docndos onrIIor In Ioe v.
WoJe, 4l0 !. S. ll3 (l9?3). 505 !. S., nf 845. !osonsIvo
fo fhnf nood, fho Courf ondonvorod fo rovIdo socuro
guIdnnco fo |s]fnfo nnd fodornI courfs ns woII ns IogIsIn-
furos fhroughouf fho !nIon, by dofInIng fho rIghfs of fho
womnn nnd fho IogIfImnfo nufhorIfy of fho Sfnfo rosocf-
Ing fho formInnfIon of rognnncIos by nborfIon roco-
2 COZA!IS t. CA!HA!T
CISI!!C, J., dIssonfIng
duros. 1IiJ.
TnkIng cnro fo sonk InInIy, fho Coee, Courf rosfnfod
nnd ronffIrmod Ioe`s ossonfInI hoIdIng. 505 !. S., nf 845
846. IIrsf, fho Courf nddrossod fho fyo of nborfIon rogu-
InfIon ormIssIbIo rIor fo fofnI vInbIIIfy. If rocognIzod
fho rIghf of fho womnn fo chooso fo hnvo nn nborfIon
boforo vInbIIIfy nnd fo obfnIn If wIfhouf unduo Inforfor-
onco from fho Sfnfo. 1J., nf 846. Socond, fho Courf nc-
knowIodgod fho Sfnfo`s owor fo rosfrIcf nborfIons ofIer
feIol tioIiliI,, If fho Inw confnIns oxcofIons for rognnn-
cIos whIch ondnngor fho womnn`s IIfo or IeolII. 1IiJ.
(omhnsIs nddod). ThIrd, fho Courf confIrmod fhnf fho
Sfnfo hns IogIfImnfo Inforosfs from fho oufsof of fho rog-
nnncy In rofocfIng IIe IeolII of IIe uonon nnd fho IIfo of
fho fofus fhnf mny bocomo n chIId. 1IiJ. (omhnsIs
nddod).
In ronffIrmIng Ioe, fho Coee, Courf doscrIbod fho con-
frnIIfy of fho docIsIon whofhor fo bonr . . . n chIId, 1ieen-
eIoJI v. BoirJ, 405 !. S. 438, 453 (l9?2), fo n womnn`s
dIgnIfy nnd nufonomy, hor orsonhood nnd dosfIny,
hor concofIon of . . . hor Inco In socIofy. 505 !. S., nf
85l852. Of sIgnnI Imorfnnco horo, fho Coee, Courf
sfnfod wIfh unmIsfnknbIo cInrIfy fhnf sfnfo roguInfIon of
nccoss fo nborfIon rocoduros, ovon nffor vInbIIIfy, musf
rofocf fho honIfh of fho womnn. 1J., nf 846.
Sovon yonrs ngo, In SIenIerg v. CorIorI, 530 !. S. 9l4
(2000), fho Courf InvnIIdnfod n obrnskn sfnfufo crImInnI-
IzIng fho orformnnco of n modIcnI rocoduro fhnf, In fho
oIIfIcnI nronn, hns boon dubbod nrfInI-bIrfh nborfIon.
l

l
Tho form nrfInI-bIrfh nborfIon Is noIfhor rocognIzod In fho modI-
cnI IIfornfuro nor usod by hysIcInns who orform socond-frImosfor
nborfIons. Soo PlonneJ PorenIIooJ IeJeroIion of An. v. AeIcrofI, 320
I. Su. 2d 95?, 964 ( CnI. 2004), nff`d, 435 I. 3d ll63 (CA9 2006).
Tho modIcnI communIfy rofors fo fho rocoduro ns oIfhor dIInfIon &
oxfrncfIon (&X) or Infncf dIInfIon nnd ovncunfIon (Infncf &I). Soo,
e.g., onIe, nf 5; SIenIerg v. CorIorI, 530 !. S. 9l4, 92? (2000).
3 CIfo ns: 550 !. S. ____ (200?)
CISI!!C, J., dIssonfIng
WIfh fIdoIIfy fo fho Ioe-Coee, IIno of rocodonf, fho Courf
hoId fho obrnskn sfnfufo unconsfIfufIonnI In nrf bo-
cnuso If Inckod fho roquIsIfo rofocfIon for fho rosorvn-
fIon of n womnn`s honIfh. SIenIerg, 530 !. S., nf 930; cf.
A,oIIe v. PlonneJ PorenIIooJ of AorIIern Aeu 1ng., 546
!. S. 320, 32? (2006).
Todny`s docIsIon Is nInrmIng. If rofusos fo fnko Coee,
nnd SIenIerg sorIousIy. If foIornfos, Indood nInuds,
fodornI InforvonfIon fo bnn nnfIonwIdo n rocoduro found
nocossnry nnd roor In corfnIn cnsos by fho AmorIcnn
CoIIogo of ObsfofrIcInns nnd CynocoIogIsfs (ACOC). If
bIurs fho IIno, fIrmIy drnwn In Coee,, bofwoon rovInbIIIfy
nnd osfvInbIIIfy nborfIons. And, for fho fIrsf fImo sInco
Ioe, fho Courf bIossos n rohIbIfIon wIfh no oxcofIon
snfogunrdIng n womnn`s honIfh.
I dIssonf from fho Courf`s dIsosIfIon. !ofronfIng from
rIor ruIIngs fhnf nborfIon rosfrIcfIons cnnnof bo Imosod
nbsonf nn oxcofIon snfogunrdIng n womnn`s honIfh, fho
Courf uhoIds nn Acf fhnf suroIy wouId nof survIvo undor
fho cIoso scrufIny fhnf rovIousIy nffondod sfnfo-docrood
IImIfnfIons on n womnn`s roroducfIvo choIcos.
I
A
As Coee, comrohondod, nf sfnko In cnsos chnIIongIng
nborfIon rosfrIcfIons Is n womnn`s confroI ovor hor |own]
dosfIny. 505 !. S., nf 869 (IurnIIfy oInIon). Soo nIso
iJ., nf 852 (mnjorIfy oInIon).
2
Thoro wns n fImo, nof so
Iong ngo, whon womon woro rognrdod ns fho confor of
homo nnd fnmIIy IIfo, wIfh nffondnnf socInI rosonsIbIII-

2
PlonneJ PorenIIooJ of SouIIeoeIern Po. v. Coee,, 505 !. S. 833,
85l852 (l992), doscrIbod moro rocIsoIy fhnn dId Ioe v. WoJe, 4l0
!. S. ll3 (l9?3), fho Imncf of nborfIon rosfrIcfIons on womon`s IIborfy.
Ioe`s focus wns In consIdornbIo monsuro on vIndIcnf|Ing] fho rIghf of
fho hysIcInn fo ndmInIsfor modIcnI fronfmonf nccordIng fo hIs rofos-
sIonnI judgmonf. 1J., nf l65.
4 COZA!IS t. CA!HA!T
CISI!!C, J., dIssonfIng
fIos fhnf rocIudod fuII nnd Indoondonf IognI sfnfus
undor fho ConsfIfufIon. 1J., nf 89689? (quofIng Ho,I v.
IloriJo, 368 !. S. 5?, 62 (l96l)). Thoso vIows, fhIs Courf
mndo cIonr In Coee,, nro no Iongor consIsfonf wIfh our
undorsfnndIng of fho fnmIIy, fho IndIvIdunI, or fho ConsfI-
fufIon. 505 !. S., nf 89?. Womon, If Is now ncknowI-
odgod, hnvo fho fnIonf, cnncIfy, nnd rIghf fo nrfIcInfo
oqunIIy In fho oconomIc nnd socInI IIfo of fho nfIon. 1J.,
nf 856. ThoIr nbIIIfy fo ronIIzo fhoIr fuII ofonfInI, fho
Courf rocognIzod, Is InfImnfoIy connocfod fo fhoIr nbIIIfy
fo confroI fhoIr roroducfIvo IIvos. 1IiJ. Thus, IognI
chnIIongos fo unduo rosfrIcfIons on nborfIon rocoduros do
nof sook fo vIndIcnfo somo gonornIIzod nofIon of rIvncy;
rnfhor, fhoy confor on n womnn`s nufonomy fo doformIno
hor IIfo`s courso, nnd fhus fo onjoy oqunI cIfIzonshI sfnf-
uro. Soo, e.g., SIogoI, !onsonIng from fho Iody: A HIsforI-
cnI IorsocfIvo on AborfIon !oguInfIon nnd QuosfIons of
IqunI IrofocfIon, 44 Sfnn. !. !ov. 26l (l992); !nw, !o-
fhInkIng Sox nnd fho ConsfIfufIon, l32 !. In. !. !ov. 955,
l002l028 (l984).
In kooIng wIfh fhIs comrohonsIon of fho rIghf fo ro-
roducfIvo choIco, fho Courf hns consIsfonfIy roquIrod fhnf
Inws roguInfIng nborfIon, nf nny sfngo of rognnncy nnd In
nII cnsos, snfogunrd n womnn`s honIfh. Soo, e.g., A,oIIe,
546 !. S., nf 32?328 (|O]ur rocodonfs hoId . . . fhnf n
Sfnfo mny nof rosfrIcf nccoss fo nborfIons fhnf nro nocos-
snry, In nrorInfo modIcnI judgmonf, for rosorvnfIon of
fho IIfo or honIfh of fho |womnn]. (quofIng Coee,, 505
!. S., nf 8?9 (IurnIIfy oInIon))); SIenIerg, 530 !. S., nf
930 (SInco fho Inw roquIros n honIfh oxcofIon In ordor fo
vnIIdnfo ovon n osfvInbIIIfy nborfIon roguInfIon, If nf n
mInImum roquIros fho snmo In rosocf fo rovInbIIIfy
roguInfIon.). Soo nIso TIornIurgI v. Anericon College of
OIeIeIricione onJ G,necologieIe, 4?6 !. S. ?4?, ?68?69
(l986) (InvnIIdnfIng n poeI-vInbIIIfy nborfIon roguInfIon for
fnII|uro] fo roquIro fhnf |n rognnnf womnn`s] honIfh bo
5 CIfo ns: 550 !. S. ____ (200?)
CISI!!C, J., dIssonfIng
fho hysIcInn`s nrnmounf consIdornfIon).
Wo hnvo fhus ruIod fhnf n Sfnfo musf nvoId subjocfIng
womon fo honIfh rIsks nof onIy whoro fho rognnncy IfsoIf
cronfos dnngor, buf nIso whoro sfnfo roguInfIon forcos
womon fo rosorf fo Ioss snfo mofhods of nborfIon. Soo
PlonneJ PorenIIooJ of CenIrol Mo. v. DonforII, 428 !. S.
52, ?9 (l9?6) (hoIdIng unconsfIfufIonnI n bnn on n mofhod
of nborfIon fhnf forco|d] n womnn . . . fo formInnfo hor
rognnncy by mofhods moro dnngorous fo hor honIfh).
Soo nIso SIenIerg, 530 !. S., nf 93l (|Our cnsos] mnko
cIonr fhnf n rIsk fo . . . womon`s honIfh Is fho snmo
whofhor If hnons fo nrIso from roguInfIng n nrfIcuInr
mofhod of nborfIon, or from bnrrIng nborfIon onfIroIy.).
Indood, wo hnvo nIIod fho ruIo fhnf nborfIon roguInfIon
musf snfogunrd n womnn`s honIfh fo fho nrfIcuInr roco-
duro nf Issuo horoInfncf dIInfIon nnd ovncunfIon (&I).
3

3
IInfIon nnd ovncunfIon (&I) Is fho mosf froquonfIy usod nborfIon
rocoduro durIng fho socond frImosfor of rognnncy; Infncf &I Is n
vnrInnf of fho &I rocoduro. Soo onIe, nf 4, 6; SIenIerg, 530 !. S., nf
924, 92?; PlonneJ PorenIIooJ, 320 I. Su. 2d, nf 966. Socond-
frImosfor nborfIons (i.e., mIdrognnncy, rovInbIIIfy nborfIons) nro,
howovor, roInfIvoIy uncommon. Iofwoon 85 nnd 90 orconf of nII
nborfIons orformod In fho !nIfod Sfnfos fnko Inco durIng fho fIrsf
fhroo monfhs of rognnncy. Soo onIe, nf 3. Soo nIso SIenIerg, 530
!. S., nf 92392?; AoIionol AIorIion IeJeroIion v. AeIcrofI, 330
I. Su. 2d 436, 464 (SY 2004), nff`d euI non. AoIionol AIorIion
IeJeroIion v. Goncolee, 43? I. 3d 2?8 (CA2 2006); PlonneJ PorenIIooJ,
320 I. Su. 2d, nf 960, nnd n. 4.
AdoIosconfs nnd IndIgonf womon, rosonrch suggosfs, nro moro IIkoIy
fhnn ofhor womon fo hnvo dIffIcuIfy obfnInIng nn nborfIon durIng fho
fIrsf frImosfor of rognnncy. MInors mny bo unnwnro fhoy nro rog-
nnnf unfII roInfIvoIy Info In rognnncy, whIIo oor womon`s fInnncInI
consfrnInfs nro nn obsfncIo fo fImoIy rocoIf of sorvIcos. Soo IInor,
IrohwIrfh, nuhInoo, SIngh, & Mooro, TImIng of Sfos nnd !onsons
for oInys In ObfnInIng AborfIons In fho !nIfod Sfnfos, ?4 Confrnco-
fIon 334, 34l343 (2006). Soo nIso roy of nI., !Isk Incfors AssocInfod
wIfh IrosonfIng for AborfIon In fho Socond TrImosfor, l0? ObsfofrIcs &
CynocoIogy l28, l33 (Jnn. 2006) (concIudIng fhnf womon who hnvo
socond-frImosfor nborfIons fyIcnIIy dIscovor roInfIvoIy Info fhnf fhoy
6 COZA!IS t. CA!HA!T
CISI!!C, J., dIssonfIng
In SIenIerg, wo oxrossIy hoId fhnf n sfnfufo bnnnIng
Infncf &I wns unconsfIfufIonnI In nrf bocnuso If Inckod
n honIfh oxcofIon. 530 !. S., nf 930, 93?. Wo nofod fhnf
fhoro oxIsfod n dIvIsIon of modIcnI oInIon nbouf fho
roInfIvo snfofy of Infncf &I, iJ., nf 93?, buf wo mndo
cIonr fhnf ns Iong ns subsfnnfInI modIcnI nufhorIfy su-
orfs fho roosIfIon fhnf bnnnIng n nrfIcuInr nborfIon
rocoduro couId ondnngor womon`s honIfh, n honIfh ox-
cofIon Is roquIrod, iJ., nf 938. Wo oxInInod:
Tho word 'nocossnry` In Coee,`s hrnso 'nocossnry,
In nrorInfo modIcnI judgmonf, for fho rosorvnfIon
of fho IIfo or honIfh of fho |rognnnf womnn],` cnnnof
rofor fo nn nbsoIufo nocossIfy or fo nbsoIufo roof.
ModIcnI fronfmonfs nnd rocoduros nro offon consId-
orod nrorInfo (or InnrorInfo) In IIghf of osfI-
mnfod comnrnfIvo honIfh rIsks (nnd honIfh bonofIfs)
In nrfIcuInr cnsos. oIfhor cnn fhnf hrnso roquIro
unnnImIfy of modIcnI oInIon. ocfors offon dIffor In
fhoIr osfImnfIon of comnrnfIvo honIfh rIsks nnd n-
rorInfo fronfmonf. And Coee,`s words 'nrorInfo
modIcnI judgmonf` musf ombody fho judIcInI nood fo
foIornfo rosonsIbIo dIfforoncos of modIcnI oInIon
. . . . 1J., nf 93? (cIfnfIon omIffod).
Thus, wo ronsonod, dIvIsIon In modIcnI oInIon nf mosf
monns uncorfnInfy, n fncfor fhnf sIgnnIs fho rosonco of

nro rognnnf). Sovoro fofnI nnomnIIos nnd honIfh robIoms confronfIng
fho rognnnf womnn nro nIso cnusos of socond-frImosfor nborfIons;
mnny such condIfIons cnnnof bo dIngnosod or do nof dovoIo unfII fho
socond frImosfor. Soo, e.g., IInor, eupro, nf 344; I. CunnInghnm of nI.,
WIIIInms ObsfofrIcs 242, 290, 328329, (22d od. 2005); cf. Schochfmnn,
Crny, Infy, & !ofhmnn, ocIsIon-MnkIng for TormInnfIon of Irognnn-
cIos wIfh IofnI AnomnIIos: AnnIysIs of 53,000 IrognnncIos, 99 Obsfof-
rIcs & CynocoIogy 2l6, 22022l (Iob. 2002) (nonrIy nII womon cnrryIng
fofusos wIfh fho mosf sorIous confrnI norvous sysfom nnomnIIos choso
fo nborf fhoIr rognnncIos).
? CIfo ns: 550 !. S. ____ (200?)
CISI!!C, J., dIssonfIng
rIsk, nof Ifs nbsonco. 1IiJ. |A] sfnfufo fhnf nIfogofhor
forbIds |Infncf &I] . . . . consoquonfIy musf confnIn n
honIfh oxcofIon. 1J., nf 938. Soo nIso iJ., nf 948
(O`Connor, J., concurrIng) (Th|o] Inck of n honIfh oxco-
fIon nocossnrIIy rondors fho sfnfufo unconsfIfufIonnI.).
I
In 2003, n fow yonrs nffor our ruIIng In SIenIerg, Con-
gross nssod fho InrfInI-IIrfh AborfIon Inn AcfwIfhouf
nn oxcofIon for womon`s honIfh. Soo l8 !. S. C. l53l(n)
(2000 od., Su. IV).
4
Tho congrossIonnI fIndIngs on whIch
fho InrfInI-IIrfh AborfIon Inn Acf rosfs do nof wIfhsfnnd
InsocfIon, ns fho Iowor courfs hnvo doformInod nnd fhIs
Courf Is obIIgod fo concodo. AnIe, nf 3536. Soo AoIionol
AIorIion IeJeroIion v. AeIcrofI, 330 I. Su. 2d 436, 482
(SY 2004) (Congross dId nof . . . cnrofuIIy consIdor fho
ovIdonco boforo nrrIvIng nf Ifs fIndIngs.), nff`d euI non.
AoIionol AIorIion IeJeroIion v. Goncolee, 43? I. 3d 2?8
(CA2 2006). Soo nIso PlonneJ PorenIIooJ IeJeroIion of
An. v. AeIcrofI, 320 I. Su. 2d 95?, l0l9 ( CnI. 2004)
(|]ono of fho sIx hysIcInns who fosfIfIod boforo Con-
gross hnd ovor orformod nn Infncf &I. SovornI dId nof
rovIdo nborfIon sorvIcos nf nII; nnd ono wns nof ovon nn
obgyn. . . . |T]ho ornI fosfImony boforo Congross wns nof
onIy unbnInncod, buf InfonfIonnIIy oIomIc.), nff`d, 435
I. 3d ll63 (CA9 2006); CorIorI v. AeIcrofI, 33l I. Su.
2d 805, l0ll (ob. 2004) (Congross nrbIfrnrIIy roIIod
uon fho oInIons of docfors who cInImod fo hnvo no (or
vory IIffIo) roconf nnd roIovnnf oxorIonco wIfh surgIcnI

4
Tho Acf`s sonsors Ioff no doubf fhnf fhoIr InfonfIon wns fo nuIIIfy
our ruIIng In SIenIerg, 530 !. S. 9l4. Soo, e.g., l49 Cong. !oc. 5?3l
(2003) (sfnfomonf of Son. Snnforum) (Why nro wo horo` Wo nro horo
bocnuso fho Suromo Courf dofondod fho IndofonsIbIo. . . . Wo hnvo
rosondod fo fho Suromo Courf.). Soo nIso l48 Cong. !oc. l42?3
(2002) (sfnfomonf of !o. !Indor) (rojocfIng roosIfIon fhnf Congross
hns no rIghf fo IogIsInfo n bnn on fhIs horrIbIo rncfIco bocnuso fho
Suromo Courf snys |If] cnnnof).
8 COZA!IS t. CA!HA!T
CISI!!C, J., dIssonfIng
nborfIons, nnd dIsrognrdod fho vIows of docfors who hnd
sIgnIfIcnnf nnd roIovnnf oxorIonco wIfh fhoso roco-
duros.), nff`d, 4l3 I. 3d ?9l (CA8 2005).
Mnny of fho Acf`s rocIfnfIons nro Incorrocf. Soo onIe, nf
3536. Ior oxnmIo, Congross doformInod fhnf no modIcnI
schooIs rovIdo InsfrucfIon on Infncf &I. 2(l4)(I), ll?
Sfnf. l204, nofos foIIowIng l8 !. S. C. l53l (2000 od.,
Su. IV), . ?69, (l4)(I) (CongrossIonnI IIndIngs). Iuf
In fncf, numorous IondIng modIcnI schooIs fonch fho roco-
duro. Soo PlonneJ PorenIIooJ, 320 I. Su. 2d, nf l029;
AoIionol AIorIion IeJeroIion, 330 I. Su. 2d, nf 4?9.
Soo nIso IrIof for ACOC ns Anicue Curioe l8 (Among fho
schooIs fhnf now fonch fho Infncf vnrInnf nro CoIumbIn,
CornoII, YnIo, ow York !nIvorsIfy, orfhwosforn, !nI-
vorsIfy of IIffsburgh, !nIvorsIfy of IonnsyIvnnIn, !nIvor-
sIfy of !ochosfor, nnd !nIvorsIfy of ChIcngo.).
Moro Imorfnnf, Congross cInImod fhoro wns n modIcnI
consonsus fhnf fho bnnnod rocoduro Is novor nocossnry.
CongrossIonnI IIndIngs (l), In nofos foIIowIng l8 !. S. C.
l53l (2000 od., Su. IV), . ?6?. Iuf fho ovIdonco vory
cIonrIy domonsfrnfo|d] fho oosIfo. PlonneJ PorenI-
IooJ, 320 I. Su. 2d, nf l025. Soo nIso CorIorI, 33l
I. Su. 2d, nf l008l009 (|T]horo wns no ovIdonf con-
sonsus In fho rocord fhnf Congross comIIod. Thoro wns,
howovor, n subsfnnfInI body of modIcnI oInIon rosonfod
fo Congross In oosIfIon. If nnyfhIng . . . fho congros-
sIonnI rocord osfnbIIshos fhnf fhoro wns n 'consonsus` In
fnvor of fho bnnnod rocoduro.); AoIionol AIorIion IeJ-
eroIion, 330 I. Su. 2d, nf 488 (Tho congrossIonnI rocord
IfsoIf undormInos |Congross`] fIndIng fhnf fhoro Is n
modIcnI consonsus fhnf Infncf &I Is novor modIcnIIy
nocossnry nnd shouId bo rohIbIfod. (InfornnI quofnfIon
mnrks omIffod)).
SImIInrIy, Congross found fhnf |f]horo Is no crodIbIo
modIcnI ovIdonco fhnf nrfInI-bIrfh nborfIons nro snfo or
nro snfor fhnn ofhor nborfIon rocoduros. CongrossIonnI
9 CIfo ns: 550 !. S. ____ (200?)
CISI!!C, J., dIssonfIng
IIndIngs (l4)(I), In nofos foIIowIng l8 !. S. C. l53l
(2000 od., Su. IV), . ?69. Iuf fho congrossIonnI rocord
IncIudos Ioffors from numorous IndIvIdunI hysIcInns
sfnfIng fhnf rognnnf womon`s honIfh wouId bo joonrd-
Izod undor fho Acf, ns woII ns sfnfomonfs from nIno ro-
fossIonnI nssocInfIons, IncIudIng ACOC, fho AmorIcnn
IubIIc HonIfh AssocInfIon, nnd fho CnIIfornIn ModIcnI
AssocInfIon, nffosfIng fhnf Infncf &I cnrrIos monnIngfuI
snfofy ndvnnfngos ovor ofhor mofhods. Soo AoIionol
AIorIion IeJeroIion, 330 I. Su. 2d, nf 490. Soo nIso
PlonneJ PorenIIooJ, 320 I. Su. 2d, nf l02l (Congross
In Ifs fIndIngs . . . choso fo dIsrognrd fho sfnfomonfs by
ACOC nnd ofhor modIcnI orgnnIznfIons.). o comnrnbIo
modIcnI grous suorfod fho bnn. In fncf, nII of fho
govornmonf`s own wIfnossos dIsngrood wIfh mnny of fho
socIfIc congrossIonnI fIndIngs. 1J., nf l024.
C
In confrnsf fo Congross, fho IsfrIcf Courfs mndo fInd-
Ings nffor fuII frInIs nf whIch nII nrfIos hnd fho oorfu-
nIfy fo rosonf fhoIr bosf ovIdonco. Tho courfs hnd fho
bonofIf of much moro oxfonsIvo modIcnI nnd scIonfIfIc
ovIdonco . . . concornIng fho snfofy nnd nocossIfy of Infncf
&Is. PlonneJ PorenIIooJ, 320 I. Su. 2d, nf l0l4; cf.
AoIionol AIorIion IeJeroIion, 330 I. Su. 2d, nf 482
(IsfrIcf Courf honrd moro ovIdonco durIng Ifs frInI fhnn
Congross honrd ovor fho snn of oIghf yonrs.).
urIng fho IsfrIcf Courf frInIs, numorous oxfrnor-
dInnrIIy nccomIIshod nnd vory oxorIoncod modIcnI
oxorfs oxInInod fhnf, In corfnIn cIrcumsfnncos nnd for
corfnIn womon, Infncf &I Is snfor fhnn nIfornnfIvo ro-
coduros nnd nocossnry fo rofocf womon`s honIfh.
CorIorI, 33l I. Su. 2d, nf l024l02?; soo PlonneJ
PorenIIooJ, 320 I. Su. 2d, nf l00l (|A]II of fho docfors
who ncfunIIy orform Infncf &Is concIudod fhnf In fhoIr
oInIon nnd cIInIcnI judgmonf, Infncf &Is romnIn fho
l0 COZA!IS t. CA!HA!T
CISI!!C, J., dIssonfIng
snfosf ofIon for corfnIn IndIvIdunI womon undor corfnIn
IndIvIdunI honIfh cIrcumsfnncos, nnd nro sIgnIfIcnnfIy
snfor for fhoso womon fhnn ofhor nborfIon fochnIquos, nnd
nro fhus modIcnIIy nocossnry.); cf. onIe, nf 3l (!oson-
donfs rosonfod ovIdonco fhnf Infncf &I mny bo fho
snfosf mofhod of nborfIon, for ronsons sImIInr fo fhoso
ndducod In SIenIerg.).
AccordIng fo fho oxorf fosfImony InInfIffs Infroducod,
fho snfofy ndvnnfngos of Infncf &I nro mnrkod for
womon wIfh corfnIn modIcnI condIfIons, for oxnmIo,
uforIno scnrrIng, bIoodIng dIsordors, honrf dIsonso, or
comromIsod Immuno sysfoms. Soo CorIorI, 33l I. Su.
2d, nf 924929, l026l02?; AoIionol AIorIion IeJeroIion,
330 I. Su. 2d, nf 4?24?3; PlonneJ PorenIIooJ, 320
I. Su. 2d, nf 992994, l00l. Iurfhor, InInfIffs` oxorfs
fosfIfIod fhnf Infncf &I Is sIgnIfIcnnfIy snfor for womon
wIfh corfnIn rognnncy-roInfod condIfIons, such ns In-
confn rovIn nnd nccrofn, nnd for womon cnrryIng fofusos
wIfh corfnIn nbnormnIIfIos, such ns sovoro hydrocohnIus.
Soo CorIorI, 33l I. Su. 2d, nf 924, l026l02?; AoIionol
AIorIion IeJeroIion, 330 I. Su. 2d, nf 4?34?4; PlonneJ
PorenIIooJ, 320 I. Su. 2d, nf 992994, l00l. Soo nIso
SIenIerg, 530 !. S., nf 929; IrIof for ACOC ns Anicue
Curioe 2, l3l6.
Infncf &I, InInfIffs` oxorfs oxInInod, rovIdos
snfofy bonofIfs ovor &I by dIsmombormonf for sovornI
ronsons: IireI, Infncf &I mInImIzos fho numbor of fImos
n hysIcInn musf Insorf Insfrumonfs fhrough fho corvIx
nnd Info fho uforus, nnd fhoroby roducos fho rIsk of
frnumn fo, nnd orfornfIon of, fho corvIx nnd uforusfho
mosf sorIous comIIcnfIon nssocInfod wIfh nonInfncf &I.
Soo CorIorI, 33l I. Su. 2d, nf 923928, l025; AoIionol
AIorIion IeJeroIion, 330 I. Su. 2d, nf 4?l; PlonneJ
PorenIIooJ, 320 I. Su. 2d, nf 982, l00l. SeconJ, romov-
Ing fho fofus Infncf, Insfond of dIsmomborIng If in uIero,
docronsos fho IIkoIIhood fhnf fofnI fIssuo wIII bo rofnInod
ll CIfo ns: 550 !. S. ____ (200?)
CISI!!C, J., dIssonfIng
In fho uforus, n condIfIon fhnf cnn cnuso InfocfIon, homor-
rhngo, nnd InforfIIIfy. Soo CorIorI, 33l I. Su. 2d, nf
923928, l025l026; AoIionol AIorIion IeJeroIion, 330
I. Su. 2d, nf 4?2; PlonneJ PorenIIooJ, 320 I. Su. 2d,
nf l00l. TIirJ, Infncf &I dImInIshos fho chnncos of
oxosIng fho nfIonf`s fIssuos fo shnr bony frngmonfs
somofImos rosuIfIng from dIsmombormonf of fho fofus.
Soo CorIorI, 33l I. Su. 2d, nf 923928, l026; AoIionol
AIorIion IeJeroIion, 330 I. Su. 2d, nf 4?l; PlonneJ
PorenIIooJ, 320 I. Su. 2d, nf l00l. IourII, Infncf &I
fnkos Ioss oornfIng fImo fhnn &I by dIsmombormonf,
nnd fhus mny roduco bIoodIng, fho rIsk of InfocfIon, nnd
comIIcnfIons roInfIng fo nnosfhosIn. Soo CorIorI, 33l
I. Su. 2d, nf 923928, l026; AoIionol AIorIion IeJero-
Iion, 330 I. Su. 2d, nf 4?2; PlonneJ PorenIIooJ, 320
I. Su. 2d, nf l00l. Soo nIso SIenIerg, 530 !. S., nf 928
929, 932; IrIof for ACOC ns Anicue Curioe 2, lll3.
Insod on fhoroughgoIng rovIow of fho frInI ovIdonco nnd
fho congrossIonnI rocord, onch of fho IsfrIcf Courfs fo
consIdor fho Issuo rojocfod Congross` fIndIngs ns unron-
sonnbIo nnd nof suorfod by fho ovIdonco. Soo CorIorI,
33l I. Su. 2d, nf l008l02?; AoIionol AIorIion IeJero-
Iion, 330 I. Su. 2d, nf 482, 48849l; PlonneJ PorenI-
IooJ, 320 I. Su. 2d, nf l032. Tho frInI courfs concIudod,
In confrnsf fo Congross` fIndIngs, fhnf sIgnIfIcnnf modIcnI
nufhorIfy suorfs fho roosIfIon fhnf In somo cIrcum-
sfnncos, |Infncf &I] Is fho snfosf rocoduro. 1J., nf l033
(quofIng SIenIerg, 530 !. S., nf 932); nccord CorIorI, 33l
I. Su. 2d, nf l008l009, l0l?l0l8; AoIionol AIorIion
IeJeroIion, 330 I. Su. 2d, nf 480482;
5
cf. SIenIerg, 530

5
Ivon fho IsfrIcf Courf for fho Soufhorn IsfrIcf of ow York,
whIch wns moro skofIcnI of fho honIfh bonofIfs of Infncf &I, soo onIe,
nf 32, rocognIzod: |T]ho Covornmonf`s own oxorfs dIsngrood wIfh
nImosf nII of Congross`s fncfunI fIndIngs; n sIgnIfIcnnf body of modIcnI
oInIon hoIds fhnf Infncf &I hns snfofy ndvnnfngos ovor nonInfncf
&I; |]rofossIonnI modIcnI nssocInfIons hnvo nIso oxrossod fhoIr
l2 COZA!IS t. CA!HA!T
CISI!!C, J., dIssonfIng
!. S., nf 932 (|T]ho rocord shows fhnf sIgnIfIcnnf modIcnI
nufhorIfy suorfs fho roosIfIon fhnf In somo cIrcum-
sfnncos, |Infncf &I] wouId bo fho snfosf rocoduro.).
Tho IsfrIcf Courfs` fIndIngs morIf fhIs Courf`s rosocf.
Soo, e.g., Iod. !uIo CIv. Iroc. 52(n); Solte Iegino College
v. Iueeell, 499 !. S. 225, 233 (l99l). Todny`s oInIon
suIIos no ronson fo rojocf fhoso fIndIngs. ovorfhoIoss,
dosIfo fho IsfrIcf Courfs` nrnIsnI of fho woIghf of fho
ovIdonco, nnd In undIsguIsod confIIcf wIfh SIenIerg, fho
Courf nssorfs fhnf fho InrfInI-IIrfh AborfIon Inn Acf cnn
survIvo whon . . . modIcnI uncorfnInfy orsIsfs. AnIe, nf
33. ThIs nssorfIon Is bowIIdorIng. of onIy doos If dofy
fho Courf`s IongsfnndIng rocodonf nffIrmIng fho nocossIfy
of n honIfh oxcofIon, wIfh no cnrvo-ouf for cIrcumsfnncos
of modIcnI uncorfnInfy, soo eupro, nf 45; If gIvos shorf
shrIff fo fho rocords boforo us, cnrofuIIy cnnvnssod by fho
IsfrIcf Courfs. Thoso rocords IndIcnfo fhnf fho mnjorIfy
of hIghIy-qunIIfIod oxorfs on fho subjocf boIIovo Infncf
&I fo bo fho snfosf, mosf nrorInfo rocoduro undor
corfnIn cIrcumsfnncos. PlonneJ PorenIIooJ, 320 I. Su.
2d, nf l034. Soo eupro, nf 9l0.
Tho Courf ncknowIodgos somo of fhIs ovIdonco, onIe, nf
3l, buf InsIsfs fhnf, bocnuso somo wIfnossos dIsngrood
wIfh fho ACOC nnd ofhor oxorfs` nssossmonf of rIsk, fho
Acf cnn sfnnd. AnIe, nf 3233, 3?. In fhIs InsIsfonco, fho
Courf brushos undor fho rug fho IsfrIcf Courfs` woII-
suorfod fIndIngs fhnf fho hysIcInns who fosfIfIod fhnf
Infncf &I Is novor nocossnry fo rosorvo fho honIfh of n
womnn hnd sIIm nufhorIfy for fhoIr oInIons. Thoy hnd no
frnInIng for, or orsonnI oxorIonco wIfh, fho Infncf &I

vIow fhnf |Infncf &I] mny bo fho snfosf rocoduro for somo womon;
nnd |f]ho ovIdonco IndIcnfos fhnf fho snmo dIsngroomonf nmong
oxorfs found by fho Suromo Courf In SIenIerg oxIsfod fhroughouf fho
fImo fhnf Congross wns consIdorIng fho IogIsInfIon, dosIfo Congross`s
fIndIngs fo fho confrnry. AoIionol AIorIion IeJeroIion, 330 I. Su.
2d, nf 480482.
l3 CIfo ns: 550 !. S. ____ (200?)
CISI!!C, J., dIssonfIng
rocoduro, nnd mnny orformod nborfIons onIy on rnro
occnsIons. Soo PlonneJ PorenIIooJ, 320 I. Su. 2d, nf
980; CorIorI, 33l I. Su. 2d, nf l025; cf. AoIionol AIor-
Iion IeJeroIion, 330 I. Su. 2d, nf 462464. Ivon In-
duIgIng fho nssumfIon fhnf fho Covornmonf wIfnossos
woro oqunIIy qunIIfIod fo ovnIunfo fho roInfIvo rIsks of
nborfIon rocoduros, fhoIr fosfImony couId nof ornso fho
sIgnIfIcnnf modIcnI nufhorIfy suorf|Ing] fho roosIfIon
fhnf In somo cIrcumsfnncos, |Infncf &I] wouId bo fho
snfosf rocoduro. SIenIerg, 530 !. S., nf 932
6
II
A
Tho Courf offors fIImsy nnd frnnsnronf jusfIfIcnfIons
for uhoIdIng n nnfIonwIdo bnn on Infncf &I eone nny
oxcofIon fo snfogunrd n womon`s honIfh. Todny`s ruIIng,
fho Courf docInros, ndvnncos n romIso confrnI fo |Co-
ee,`s] concIusIoni.e., fho Covornmonf`s IogIfImnfo nnd
subsfnnfInI Inforosf In rosorvIng nnd romofIng fofnI

6
Tho mnjorIfy confonds fhnf |I]f fho Infncf &I rocoduro Is fruIy
nocossnry In somo cIrcumsfnncos, If nonrs IIkoIy nn InjocfIon fhnf
kIIIs fho fofus Is nn nIfornnfIvo undor fho Acf fhnf nIIows fho docfor fo
orform fho rocoduro. AnIe, nf 3435. Iuf n sIgnIfIcnnf body of
modIcnI oInIon boIIovos fhnf InducIng fofnI donfh by InjocfIon Is nImosf
nIwnys InnrorInfo fo fho rosorvnfIon of fho honIfh of womon
undorgoIng nborfIon bocnuso If osos fnngIbIo rIsk nnd rovIdos no
bonofIf fo fho womnn. CorIorI v. AeIcrofI, 33l I. Su. 2d 805, l028
(ob. 2004) (InfornnI quofnfIon mnrks omIffod), nff`d, 4l3 I. 3d ?9l
(CA8 2005). In somo cIrcumsfnncos, InjocfIons nro nbsoIufoIy |modI-
cnIIy] confrnIndIcnfod. 33l I. Su. 2d, nf l02?. Soo nIso iJ., nf 90?
9l2; AoIionol AIorIion IeJeroIion, 330 I. Su. 2d, nf 4?44?5;
PlonneJ PorenIIooJ, 320 I. Su. 2d, nf 99599?. Tho Courf nIso
IdonfIfIos modIcnI InducfIon of Inbor ns nn nIfornnfIvo. Soo onIe, nf 9.
Thnf rocoduro, howovor, roquIros n hosIfnI sfny, iIiJ., rondorIng If
InnccossIbIo fo nfIonfs who Inck fInnncInI rosourcos, nnd If foo Is
consIdorod Ioss snfo for mnny womon, nnd ImormIssIbIo for ofhors.
Soo CorIorI, 33l I. Su. 2d, nf 940949, l0l?; AoIionol AIorIion
IeJeroIion, 330 I. Su. 2d, nf 4684?0; PlonneJ PorenIIooJ, 320
I. Su. 2d, nf 96l, n. 5, 992994, l000l002.
l4 COZA!IS t. CA!HA!T
CISI!!C, J., dIssonfIng
IIfo. AnIe, nf l4. Soo nIso onIe, nf l5 (|W]o musf dofor-
mIno whofhor fho Acf furfhors fho IogIfImnfo Inforosf of
fho Covornmonf In rofocfIng fho IIfo of fho fofus fhnf mny
bocomo n chIId.). Iuf fho Acf scnrcoIy furfhors fhnf In-
forosf: Tho Inw snvos nof n sIngIo fofus from dosfrucfIon,
for If fnrgofs onIy n neIIoJ of orformIng nborfIon. Soo
SIenIerg, 530 !. S., nf 930. And suroIy fho sfnfufo wns
nof dosIgnod fo rofocf fho IIvos or honIfh of rognnnf
womon. 1J., nf 95l (CISI!!C, J., concurrIng); cf. Coee,,
505 !. S., nf 846 (rocognIzIng nIong wIfh fho Sfnfo`s Io-
gIfImnfo Inforosf In fho IIfo of fho fofus, Ifs IogIfImnfo
Inforos|f] . . . In rofocfIng fho IeolII of IIe uonon (om-
hnsIs nddod)). In shorf, fho Courf uhoIds n Inw fhnf,
whIIo doIng nofhIng fo rosorv|o] . . . fofnI IIfo, onIe, nf
l4, bnrs n womnn from choosIng Infncf &I nIfhough hor
docfor ronsonnbIy boIIovos |fhnf rocoduro] wIII bosf
rofocf |hor]. SIenIerg, 530 !. S., nf 946 (STIVIS, J.,
concurrIng).
As nnofhor ronson for uhoIdIng fho bnn, fho Courf
omhnsIzos fhnf fho Acf doos nof roscrIbo fho nonInfncf
&I rocoduro. Soo onIe, nf 34. Iuf why nof, ono mIghf
nsk. onInfncf &I couId oqunIIy bo chnrncforIzod ns
brufnI, onIe, nf 26, InvoIvIng ns If doos fonr|Ing] |n
fofus] nnrf nnd rI|Ing] off Ifs IImbs, onIe, nf 4, 6.
|T]ho nofIon fhnf oIfhor of fhoso fwo oqunIIy gruosomo
rocoduros . . . Is moro nkIn fo InfnnfIcIdo fhnn fho ofhor,
or fhnf fho Sfnfo furfhors nny IogIfImnfo Inforosf by bnn-
nIng ono buf nof fho ofhor, Is sImIy IrrnfIonnI. SIenIerg,
530 !. S., nf 94694? (STIVIS, J., concurrIng).
oIIvory of nn Infncf, nIboIf nonvInbIo, fofus wnrrnnfs
socInI condomnnfIon, fho Courf mnInfnIns, bocnuso n
fofus fhnf Is nof dIsmomborod rosombIos nn Infnnf. AnIe,
nf 28. Iuf so, foo, doos n fofus doIIvorod Infncf nffor If Is
formInnfod by InjocfIon n dny or fwo boforo fho surgIcnI
ovncunfIon, onIe, nf 5, 3435, or n fofus doIIvorod fhrough
modIcnI InducfIon or cosnronn, onIe, nf 9. Yof, fho nvnII-
l5 CIfo ns: 550 !. S. ____ (200?)
CISI!!C, J., dIssonfIng
nbIIIfy of fhoso rocodurosnIong wIfh &I by dIsmom-
bormonffho Courf snys, snvos fho bnn on Infncf &I
from n docInrnfIon of unconsfIfufIonnIIfy. AnIe, nf 3435.
ovor mInd fhnf fho rocoduros doomod nccofnbIo mIghf
uf n womnn`s honIfh nf gronfor rIsk. Soo eupro, nf l3,
nnd n. 6; cf. onIe, nf 5, 3l32.
!IfImnfoIy, fho Courf ndmIfs fhnf mornI concorns nro
nf work, concorns fhnf couId yIoId rohIbIfIons on nny
nborfIon. Soo onIe, nf 28 (Congross couId . . . concIudo
fhnf fho fyo of nborfIon roscrIbod by fho Acf roquIros
socIfIc roguInfIon bocnuso If ImIIcnfos nddIfIonnI ofhIcnI
nnd mornI concorns fhnf jusfIfy n socInI rohIbIfIon.).
ofnbIy, fho concorns oxrossod nro unfofhorod fo nny
ground gonuInoIy sorvIng fho Covornmonf`s Inforosf In
rosorvIng IIfo. Iy nIIowIng such concorns fo cnrry fho
dny nnd cnso, ovorrIdIng fundnmonfnI rIghfs, fho Courf
dIshonors our rocodonf. Soo, e.g., Coee,, 505 !. S., nf 850
(Somo of us ns IndIvIdunIs fInd nborfIon offonsIvo fo our
mosf bnsIc rIncIIos of mornIIfy, buf fhnf cnnnof confroI
our docIsIon. Our obIIgnfIon Is fo dofIno fho IIborfy of nII,
nof fo mnndnfo our own mornI codo.); Iourence v. Texoe,
539 !. S. 558, 5?l (2003) (Though |f]or mnny orsons
|objocfIons fo homosoxunI conducf] nro nof frIvInI concorns
buf rofound nnd doo convIcfIons nccofod ns ofhIcnI nnd
mornI rIncIIos, fho owor of fho Sfnfo mny nof bo usod
fo onforco fhoso vIows on fho whoIo socIofy fhrough o-
ornfIon of fho crImInnI Inw. (cIfIng Coee,, 505 !. S., nf
850)).
!ovonIIng In fhIs rognrd, fho Courf Invokos nn nnfInbor-
fIon shIbboIofh for whIch If concododIy hns no roIInbIo
ovIdonco: Womon who hnvo nborfIons como fo rogrof fhoIr
choIcos, nnd consoquonfIy suffor from |s]ovoro dorossIon
nnd Ioss of osfoom. AnIe, nf 29.
?
Iocnuso of womon`s

?
Tho Courf Is suroIy corrocf fhnf, for mosf womon, nborfIon Is n nIn-
fuIIy dIffIcuIf docIsIon. Soo onIe, nf 28. Iuf noIfhor fho woIghf of fho
l6 COZA!IS t. CA!HA!T
CISI!!C, J., dIssonfIng

scIonfIfIc ovIdonco fo dnfo nor fho obsorvnbIo ronIIfy of 33 yonrs of IognI
nborfIon In fho !nIfod Sfnfos comorfs wIfh fho Idon fhnf hnvIng nn
nborfIon Is nny moro dnngorous fo n womnn`s Iong-form monfnI honIfh
fhnn doIIvorIng nnd nronfIng n chIId fhnf sho dId nof Infond fo hnvo
. . . . Cohon, AborfIon nnd MonfnI HonIfh: Myfhs nnd !onIIfIos, 9
Cuffmnchor IoIIcy !ov. 8 (2006); soo gonornIIy InzoIon, Is Thoro n
Iosf-AborfIon Syndromo` . Y. TImos MngnzIno, Jnn. 2l, 200?, . 40.
Soo nIso, e.g., AmorIcnn IsychoIogIcnI AssocInfIon, AIA IrIofIng Inor
on fho Imncf of AborfIon (2005) (rojocfIng fhoory of n osfnborfIon
syndromo nnd sfnfIng fhnf |n]ccoss fo IognI nborfIon fo formInnfo nn
unwnnfod rognnncy Is vIfnI fo snfogunrd bofh fho hysIcnI nnd monfnI
honIfh of womon); SchmIogo & !usso, orossIon nnd !nwnnfod IIrsf
Irognnncy: !ongIfudInnI Cohorf Sfudy, 33l IrIfIsh ModIcnI J. l303
(2005) (fIndIng no crodIbIo ovIdonco fhnf choosIng fo formInnfo nn
unwnnfod fIrsf rognnncy confrIbufos fo rIsk of subsoquonf dorossIon);
CIIchrIsf, Hnnnnford, Irnnk, & Kny, TormInnfIon of Irognnncy nnd
IsychInfrIc MorbIdIfy, l6? IrIfIsh J. of IsychInfry 243, 24?248 (l995)
(fIndIng, In n cohorf of moro fhnn l3,000 womon, fhnf fho rnfo of
sychInfrIc dIsordor wns no hIghor nmong womon who formInnfod
rognnncy fhnn nmong fhoso who cnrrIod rognnncy fo form); SfodInnd,
Tho Myfh of fho AborfIon Trnumn Syndromo, 268 JAMA 20?8, 20?9
(l992) (ScIonfIfIc sfudIos IndIcnfo fhnf IognI nborfIon rosuIfs In fowor
doIoforIous soquoIno for womon comnrod wIfh ofhor ossIbIo oufcomos
of unwnnfod rognnncy. Thoro Is no ovIdonco of nn nborfIon frnumn
syndromo.); AmorIcnn IsychoIogIcnI AssocInfIon, CouncII IoIIcy
MnnunI: ()(I)(3), IubIIc Inforosf (l989) (docInrIng nssorfIons nbouf
wIdosrond sovoro nognfIvo sychoIogIcnI offocfs of nborfIon fo bo
wIfhouf fncf). Iuf soo CougIo, !onrdon, & CoIomnn, ConornIIzod
AnxIofy IoIIowIng !nInfondod IrognnncIos !osoIvod Through ChIId-
bIrfh nnd AborfIon: A Cohorf Sfudy of fho l995 nfIonnI Survoy of
InmIIy Crowfh, l9 J. AnxIofy Isordors l3?, l42 (2005) (ndvnncIng
fhoory of n osfnborfIon syndromo buf ncknowIodgIng fhnf no cnusnI
roInfIonshI bofwoon rognnncy oufcomo nnd nnxIofy couId bo dofor-
mInod from sfudy); !onrdon of nI., IsychInfrIc AdmIssIons of !ow-
Incomo Womon foIIowIng AborfIon nnd ChIIdbIrfh, l68 CnnndInn
ModIcnI Assn. J. l253, l255l256 (Mny l3, 2003) (concIudIng fhnf
sychInfrIc ndmIssIon rnfos woro hIghor for womon who hnd nn nbor-
fIon comnrod wIfh womon who doIIvorod); cf. Mnjor, IsychoIogIcnI
ImIIcnfIons of AborfIonHIghIy Chnrgod nnd !Ifo wIfh MIsIondIng
!osonrch, l68 CnnndInn ModIcnI Assn. J. l25?, l258 (Mny l3, 2003)
(crIfIquIng !onrdon sfudy for fnIIIng fo confroI for n hosf of dIfforoncos
bofwoon womon In fho doIIvory nnd nborfIon snmIos).
l? CIfo ns: 550 !. S. ____ (200?)
CISI!!C, J., dIssonfIng
frngIIo omofIonnI sfnfo nnd bocnuso of fho bond of Iovo fho
mofhor hns for hor chIId, fho Courf worrIos, docfors mny
wIfhhoId InformnfIon nbouf fho nnfuro of fho Infncf &I
rocoduro. AnIe, nf 2829.
8
Tho soIufIon fho Courf n-
rovos, fhon, Is noI fo roquIro docfors fo Inform womon,
nccurnfoIy nnd ndoqunfoIy, of fho dIfforonf rocoduros nnd
fhoIr nffondnnf rIsks. Cf. Coee,, 505 !. S., nf 8?3 (IurnI-
Ify oInIon) (Sfnfos nro froo fo onncf Inws fo rovIdo n
ronsonnbIo frnmowork for n womnn fo mnko n docIsIon
fhnf hns such rofound nnd InsfIng monnIng.). Insfond,
fho Courf dorIvos womon of fho rIghf fo mnko nn
nufonomous choIco, ovon nf fho oxonso of fhoIr snfofy.
9

8
ofwIfhsfnndIng fho bond of Iovo womon offon hnvo wIfh fhoIr
chIIdron, soo onIe, nf 28, nof nII rognnncIos, fhIs Courf hns rocognIzod,
nro wnnfod, or ovon fho roducf of consonsunI ncfIvIfy. Soo Coee,, 505
!. S., nf 89l (|O]n nn nvorngo dny In fho !nIfod Sfnfos, nonrIy ll,000
womon nro sovoroIy nssnuIfod by fhoIr mnIo nrfnors. Mnny of fhoso
IncIdonfs InvoIvo soxunI nssnuIf.). Soo nIso CInndor, Mooro, MIchIo-
Iuffo, & Inrsons, Tho IrovnIonco of omosfIc VIoIonco Among Womon
SookIng AborfIon, 9l ObsfofrIcs & CynocoIogy l002 (l998); HoImos,
!osnIck, KIInfrIck, & Iosf, !no-!oInfod Irognnncy; IsfImnfos nnd
oscrIfIvo ChnrncforIsfIcs from n nfIonnI SnmIo of Womon, l?5 Am.
J. ObsfofrIcs & CynocoIogy 320 (Aug. l996).
9
IIImInnfIng or roducIng womon`s roroducfIvo choIcos Is mnnIfosfIy
noI n monns of rofocfIng fhom. Whon snfo nborfIon rocoduros conso
fo bo nn ofIon, mnny womon sook ofhor monns fo ond unwnnfod or
coorcod rognnncIos. Soo, e.g., WorId HonIfh OrgnnIznfIon, !nsnfo
AborfIon: CIobnI nnd !ogIonnI IsfImnfos of fho IncIdonco of !nsnfo
AborfIon nnd AssocInfod MorfnIIfy In 2000, . 3, l6 (4fh od. 2004)
(!osfrIcfIvo IogIsInfIon Is nssocInfod wIfh n hIgh IncIdonco of unsnfo
nborfIon worIdwIdo; unsnfo nborfIon rorosonfs l3 of nII mnfornnI
donfhs); Honshnw, !nInfondod Irognnncy nnd AborfIon: A IubIIc
HonIfh IorsocfIvo, In A CIInIcInn`s CuIdo fo ModIcnI nnd SurgIcnI
AborfIon ll, l9 (M. InuI, I. !Ichfonborg, !. Iorgnffn, . CrImos, & I.
SfubbIofIoId ods. l999) (Ioforo IognIIznfIon, Inrgo numbors of womon
In fho !nIfod Sfnfos dIod from unsnfo nborfIons.); H. Ioonsfrn, !.
CoId, C. !Ichnrds, & !. IInor, AborfIon In Womon`s !Ivos l3, nnd fIg.
2.2 (2006) (ns Info ns l965, IIIognI nborfIon sfIII nccounfod for nn
osfImnfod . . . l? of nII offIcInIIy roorfod rognnncy-roInfod donfhs;
|d]onfhs from nborfIon docIInod drnmnfIcnIIy nffor IognIIznfIon).
l8 COZA!IS t. CA!HA!T
CISI!!C, J., dIssonfIng
ThIs wny of fhInkIng rofIocfs nncIonf nofIons nbouf
womon`s Inco In fho fnmIIy nnd undor fho ConsfIfufIon
Idons fhnf hnvo Iong sInco boon dIscrodIfod. Comnro, e.g.,
Muller v. Oregon, 208 !. S. 4l2, 422423 (l908) (rofoc-
fIvo IogIsInfIon ImosIng hours-of-work IImIfnfIons on
womon onIy hoId ormIssIbIo In vIow of womon`s hysIcnI
sfrucfuro nnd n roor dIschnrgo of hor mnfornnI func-
f|Ion]); BroJuell v. SIoIe, l6 WnII. l30, l4l (l8?3) (Irnd-
Ioy, J., concurrIng) (Mnn Is, or shouId bo, womnn`s rofoc-
for nnd dofondor. Tho nnfurnI nnd roor fImIdIfy nnd
doIIcncy whIch boIongs fo fho fomnIo sox ovIdonfIy unfIfs If
for mnny of fho occunfIons of cIvII IIfo. . . . Tho nrnmounf
dosfIny nnd mIssIon of womnn nro fo fuIfII|I] fho nobIo nnd
bonIgn offIcos of wIfo nnd mofhor.), wIfh UniIeJ SIoIee v.
Virginio, 5l8 !. S. 5l5, 533, 542, n. l2 (l996) (Sfnfo mny
nof roIy on ovorbrond gonornIIznfIons nbouf fho fnIonfs,
cnncIfIos, or roforoncos of womon; |s]uch judgmonfs
hnvo . . . Imodod . . . womon`s rogross fownrd fuII cIfI-
zonshI sfnfuro fhroughouf our nfIon`s hIsfory); Coli-
fono v. GolJforI, 430 !. S. l99, 20? (l9??) (gondor-bnsod
SocInI SocurIfy cInssIfIcnfIon rojocfod bocnuso If rosfod on
nrchnIc nnd ovorbrond gonornIIznfIons such ns nssum-
fIons ns fo |womon`s] doondoncy (InfornnI quofnfIon
mnrks omIffod)).
Though fodny`s mnjorIfy mny rognrd womon`s fooIIngs
on fho mnffor ns soIf-ovIdonf, onIe, nf 29, fhIs Courf hns
roonfodIy confIrmod fhnf |f]ho dosfIny of fho womnn
musf bo shnod . . . on hor own concofIon of hor sIrIfunI
ImornfIvos nnd hor Inco In socIofy. Coee,, 505 !. S., nf
852. Soo nIso iJ., nf 8?? (IurnIIfy oInIon) (|M]onns
choson by fho Sfnfo fo furfhor fho Inforosf In ofonfInI IIfo
musf bo cnIcuInfod fo Inform fho womnn`s froo choIco, nof
hIndor If.); eupro, nf 34.
I
In cnsos on n womnn`s IIborfy fo doformIno whofhor fo
l9 CIfo ns: 550 !. S. ____ (200?)
CISI!!C, J., dIssonfIng
|confInuo] hor rognnncy, fhIs Courf hns IdonfIfIod vInbII-
Ify ns n crIfIcnI consIdornfIon. Soo Coee,, 505 !. S., nf
8698?0 (IurnIIfy oInIon). |T]horo Is no IIno |moro
worknbIo] fhnn vInbIIIfy, fho Courf oxInInod In Coee,,
for vInbIIIfy Is fho fImo nf whIch fhoro Is n ronIIsfIc ossI-
bIIIfy of mnInfnInIng nnd nourIshIng n IIfo oufsIdo fho
womb, so fhnf fho Indoondonf oxIsfonco of fho socond IIfo
cnn In ronson nnd nII fnIrnoss bo fho objocf of sfnfo rofoc-
fIon fhnf now ovorrIdos fho rIghfs of fho womnn. . . . In
somo brond sonso If mIghf bo snId fhnf n womnn who fnIIs
fo ncf boforo vInbIIIfy hns consonfod fo fho Sfnfo`s Infor-
vonfIon on bohnIf of fho dovoIoIng chIId. 1J., nf 8?0.
Todny, fho Courf bIurs fhnf IIno, mnInfnInIng fhnf |f]ho
Acf |IogIfImnfoIy] nI|Ios] bofh rovInbIIIfy nnd osfvI-
nbIIIfy bocnuso . . . n fofus Is n IIvIng orgnnIsm whIIo
wIfhIn fho womb, whofhor or nof If Is vInbIo oufsIdo fho
womb. AnIe, nf l?. Insfond of drnwIng fho IIno nf vInbII-
Ify, fho Courf rofors fo Congross` uroso fo dIfforonfInfo
nborfIon nnd InfnnfIcIdo bnsod nof on whofhor n fofus
cnn survIvo oufsIdo fho womb, buf on whoro n fofus Is
nnnfomIcnIIy Iocnfod whon n nrfIcuInr modIcnI rocoduro
Is orformod. Soo onIe, nf 28 (quofIng CongrossIonnI
IIndIngs (l4)(C), In nofos foIIowIng l8 !. S. C. l53l
(2000 od., Su. IV), . ?69).
Ono wondors how Iong n IIno fhnf snvos no fofus from
dosfrucfIon wIII hoId In fnco of fho Courf`s mornI con-
corns. Soo eupro, nf l5; cf. onIe, nf l6 (nofIng fhnf |I]n
fhIs IIfIgnfIon fho Affornoy ConornI doos nof dIsufo fhnf
fho Acf wouId Imoso nn unduo burdon If If covorod sfnn-
dnrd &I). Tho Courf`s hosfIIIfy fo fho rIghf Ioe nnd
Coee, socurod Is nof conconIod. Throughouf, fho oInIon
rofors fo obsfofrIcInn-gynocoIogIsfs nnd surgoons who
orform nborfIons nof by fho fIfIos of fhoIr modIcnI socInI-
fIos, buf by fho ojornfIvo InboI nborfIon docfor. AnIe, nf
l4, 24, 25, 3l, 33. A fofus Is doscrIbod ns nn unborn
chIId, nnd ns n bnby, onIe, nf 3, 8; socond-frImosfor,
20 COZA!IS t. CA!HA!T
CISI!!C, J., dIssonfIng
rovInbIIIfy nborfIons nro roforrod fo ns Info-form, onIe,
nf 26; nnd fho ronsonod modIcnI judgmonfs of hIghIy
frnInod docfors nro dIsmIssod ns roforoncos mofIvnfod
by moro convonIonco, onIe, nf 3, 3?. Insfond of fho
hoIghfonod scrufIny wo hnvo rovIousIy nIIod, fho Courf
doformInos fhnf n rnfIonnI ground Is onough fo uhoId
fho Acf, onIe, nf 28, 3?. And, mosf froubIIng, Coee,`s
rIncIIos, confIrmIng fho confInuIng vIfnIIfy of fho osson-
fInI hoIdIng of Ioe, nro moroIy nssumo|d] for fho mo-
monf, onIe, nf l5, 3l, rnfhor fhnn rofnInod or ronf-
fIrmod, Coee,, 505 !. S., nf 846.
III
A
Tho Courf furfhor confusos our jurIsrudonco whon If
docInros fhnf fncInI nffncks nro nof ormIssIbIo In fhoso
cIrcumsfnncos, i.e., whoro modIcnI uncorfnInfy oxIsfs.
AnIe, nf 3?; soo iIiJ. (In nn ns-nIIod chnIIongo fho
nnfuro of fho modIcnI rIsk cnn bo boffor qunnfIfIod nnd
bnInncod fhnn In n fncInI nffnck.). ThIs hoIdIng Is or-
IoxIng gIvon fhnf, In mnforInIIy IdonfIcnI cIrcumsfnncos
wo hoId fhnf n sfnfufo InckIng n honIfh oxcofIon wns
unconsfIfufIonnI on Ifs fnco. SIenIerg, 530 !. S., nf 930;
soo iJ., nf 93? (In fncInI chnIIongo, Inw hoId unconsfIfu-
fIonnI bocnuso sIgnIfIcnnf body of modIcnI oInIon bo-
IIovos |fho] rocoduro mny brIng wIfh If gronfor snfofy for
eone poIienIe (omhnsIs nddod)). Soo nIso SoIri v.
UniIeJ SIoIee, 54l !. S. 600, 6096l0 (2004) (IdonfIfyIng
nborfIon ns ono soffIng In whIch wo hnvo rocognIzod fho
vnIIdIfy of fncInI chnIIongos); InIIon, MnkIng Sonso of
Ovorbrondfh, l00 YnIo !. J. 853, 859, n. 29 (l99l)
(|V]IrfunIIy nII of fho nborfIon cnsos ronchIng fho Su-
romo Courf sInco Ioe v. WoJe, 4l0 !. S. ll3 (l9?3), hnvo
InvoIvod fncInI nffncks on sfnfo sfnfufos, nnd fho Courf,
whofhor nccofIng or rojocfIng fho chnIIongos on fho mor-
Ifs, hns fyIcnIIy nccofod fhIs frnmIng of fho quosfIon
2l CIfo ns: 550 !. S. ____ (200?)
CISI!!C, J., dIssonfIng
rosonfod.). Accord InIIon, As-AIIod nnd IncInI ChnI-
Iongos nnd ThIrd-Inrfy SfnndIng, ll3 Hnrv. !. !ov. l32l,
l356 (2000); orf, IncInI ChnIIongos fo Sfnfo nnd IodornI
Sfnfufos, 46 Sfnn. !. !ov. 235, 2?l2?6 (l994).
WIfhouf nffomfIng fo dIsfInguIsh SIenIerg nnd onrIIor
docIsIons, fho mnjorIfy nssorfs fhnf fho Acf survIvos ro-
vIow bocnuso rosondonfs hnvo nof shown fhnf fho bnn on
Infncf &I wouId bo unconsfIfufIonnI In n Inrgo frncfIon
of roIovnnf cnsos. AnIe, nf 38 (cIfIng Coee,, 505 !. S., nf
895). Iuf Coee, mnkos cIonr fhnf, In doformInIng whofhor
nny rosfrIcfIon osos nn unduo burdon on n Inrgo frnc-
fIon of womon, fho roIovnnf cInss Is noI nII womon, nor
nII rognnnf womon, nor ovon nII womon sookIng nbor-
fIons. 505 !. S., nf 895. !nfhor, n rovIsIon rosfrIcfIng
nccoss fo nborfIon, musf bo judgod by roforonco fo fhoso
|womon] for whom If Is nn ncfunI rnfhor fhnn nn IrroIovnnf
rosfrIcfIon, iIiJ. Thus fho nbsonco of n honIfh oxcofIon
burdons oll womon for whom If Is roIovnnfwomon who,
In fho judgmonf of fhoIr docfors, roquIro nn Infncf &I
bocnuso ofhor rocoduros wouId Inco fhoIr honIfh nf
rIsk.
l0
Cf. SIenIerg, 530 !. S., nf 934 (nccofIng fho roIn-
fIvo rnrIfy of modIcnIIy IndIcnfod Infncf &Is ns fruo buf
nof hIghIy roIovnnffor fho honIfh oxcofIon quosfIon
Is whofhor rofocfIng womon`s honIfh roquIros nn oxco-
fIon for fhoso Infroquonf occnsIons); A,oIIe, 546 !. S., nf
328 (fncInI chnIIongo onforfnInod whoro |I]n somo vory
smnII orconfngo of cnsos . . . womon . . . nood ImmodInfo
nborfIons fo nvorf sorIous, nnd offon IrrovorsIbIo dnmngo
fo fhoIr honIfh). If mnkos no sonso fo concIudo fhnf fhIs
fncInI chnIIongo fnIIs bocnuso rosondonfs hnvo nof shown
fhnf n honIfh oxcofIon Is nocossnry for n Inrgo frncfIon of

l0
Thoro Is, In shorf, no frncfIon bocnuso fho numornfor nnd donomI-
nnfor nro fho snmo: Tho honIfh oxcofIon ronchos onIy fhoso cnsos
whoro n womnn`s honIfh Is nf rIsk. Iorhns for fhIs ronson, In mnndnf-
Ing snfogunrds for womon`s honIfh, wo hnvo novor boforo Invokod fho
Inrgo frncfIon fosf.
22 COZA!IS t. CA!HA!T
CISI!!C, J., dIssonfIng
socond-frImosfor nborfIons, IncIudIng fhoso for whIch n
honIfh oxcofIon Is unnocossnry: Tho vory uroso of n
honIfh excepIion Is fo rofocf womon In excepIionol cnsos.
I
If fhoro Is nnyfhIng nf nII rodomfIvo fo bo snId of fo-
dny`s oInIon, If Is fhnf fho Courf Is nof wIIIIng fo forocIoso
onfIroIy n consfIfufIonnI chnIIongo fo fho Acf. Tho Acf Is
oon, fho Courf sfnfos, fo n roor ns-nIIod chnIIongo
In n dIscrofo cnso. AnIe, nf 38; soo onIe, nf 3? (Tho Cov-
ornmonf hns ncknowIodgod fhnf roonforcomonf, ns-
nIIod chnIIongos fo fho Acf cnn bo mnInfnInod.). Iuf
fho Courf offors no cIuo on whnf n roor InwsuIf mIghf
Iook IIko. Soo onIe, nf 3?38. or doos fho Courf oxInIn
why fho InjuncfIons ordorod by fho IsfrIcf Courfs shouId
nof romnIn In Inco, frImmod onIy fo oxcIudo Insfnncos In
whIch nnofhor rocoduro wouId snfogunrd n womnn`s
honIfh nf Ionsf oqunIIy woII. SuroIy fho Courf cnnnof
monn fhnf no suIf mny bo broughf unfII n womnn`s honIfh
Is ImmodInfoIy joonrdIzod by fho bnn on Infncf &I. A
womnn suffor|Ing] from modIcnI comIIcnfIons, onIe, nf
38, noods nccoss fo fho modIcnI rocoduro nf onco nnd
cnnnof wnIf for fho judIcInI rocoss fo unfoId. Soo A,oIIe,
546 !. S., nf 328.
Tho Courf nonrs, fhon, fo confomInfo nnofhor Inw-
suIf by fho InIfInfors of fho Insfnnf ncfIons. In such n
socond round, fho Courf suggosfs, fho chnIIongors couId
succood uon domonsfrnfIng fhnf In dIscrofo nnd woII-
dofInod Insfnncos n nrfIcuInr condIfIon hns or Is IIkoIy fo
occur In whIch fho rocoduro rohIbIfod by fho Acf musf
bo usod. AnIe, nf 3?. Ono mny nnfIcInfo fhnf such n
roonforcomonf chnIIongo wIII bo mounfod swIffIy, fo wnrd
off sorIous, somofImos IrromodInbIo hnrm, fo womon
whoso honIfh wouId bo ondnngorod by fho Infncf &I
rohIbIfIon.
Tho Courf onvIsIons fhnf In nn ns-nIIod chnIIongo,
23 CIfo ns: 550 !. S. ____ (200?)
CISI!!C, J., dIssonfIng
fho nnfuro of fho modIcnI rIsk cnn bo boffor qunnfIfIod
nnd bnInncod. 1IiJ. Iuf If shouId nof oscno nofIco fhnf
fho rocord nIrondy IncIudos hundrods nnd hundrods of
ngos of fosfImony IdonfIfyIng dIscrofo nnd woII-dofInod
Insfnncos In whIch rocourso fo nn Infncf &I wouId
boffor rofocf fho honIfh of womon wIfh nrfIcuInr condI-
fIons. Soo eupro, nf l0ll. !ocord ovIdonco nIso docu-
monfs fhnf modIcnI oxIgoncIos, unrodIcfnbIo In ndvnnco,
mny IndIcnfo fo n woII-frnInod docfor fhnf Infncf &I Is
fho snfosf rocoduro. Soo iIiJ. In IIghf of fhIs ovIdonco,
our unnnImous docIsIon jusf ono yonr ngo In A,oIIe coun-
soIs ngnInsf rovorsnI. Soo 546 !. S., nf 33l (romnndIng for
roconsIdornfIon of fho romody for fho nbsonco of n honIfh
oxcofIon, suggosfIng fhnf nn InjuncfIon rohIbIfIng un-
consfIfufIonnI nIIcnfIons mIghf suffIco).
Tho Courf`s nIIownnco onIy of nn ns-nIIod chnIIongo
In n dIscrofo cnso, onIe, nf 38joonrdIzos womon`s
honIfh nnd Incos docfors In nn unfonnbIo osIfIon. Ivon
If courfs woro nbIo fo cnrvo-ouf oxcofIons fhrough Ioco-
monI IIfIgnfIon for dIscrofo nnd woII-dofInod Insfnncos,
onIe, nf 3?, womon whoso cIrcumsfnncos hnvo nof boon
nnfIcInfod by rIor IIfIgnfIon couId woII bo Ioff unro-
focfod. In fronfIng fhoso womon, hysIcInns wouId rIsk
crImInnI rosocufIon, convIcfIon, nnd ImrIsonmonf If fhoy
oxorcIso fhoIr bosf judgmonf ns fo fho snfosf modIcnI ro-
coduro for fhoIr nfIonfs. Tho Courf Is fhus grnvoIy mIs-
fnkon fo concIudo fhnf nnrrow ns-nIIod chnIIongos nro
fho roor mnnnor fo rofocf fho honIfh of fho womnn.
Cf. iIiJ.
IV
As fho Courf wrofo In Coee,, ovorruIIng Ioe`s confrnI
hoIdIng wouId nof onIy ronch nn unjusfIfInbIo rosuIf undor
rIncIIos of eIore Jecieie, buf wouId sorIousIy wonkon fho
Courf`s cnncIfy fo oxorcIso fho judIcInI owor nnd fo
funcfIon ns fho Suromo Courf of n nfIon dodIcnfod fo
24 COZA!IS t. CA!HA!T
CISI!!C, J., dIssonfIng
fho ruIo of Inw. 505 !. S., nf 865. |T]ho vory concof of
fho ruIo of Inw undorIyIng our own ConsfIfufIon roquIros
such confInuIfy ovor fImo fhnf n rosocf for rocodonf Is,
by dofInIfIon, IndIsonsnbIo. 1J., nf 854. Soo nIso iJ., nf
86? (|T]o ovorruIo undor fIro In fho nbsonco of fho mosf
comoIIIng ronson fo rooxnmIno n wnforshod docIsIon
wouId subvorf fho Courf`s IogIfImncy boyond nny sorIous
quosfIon.).
Though fodny`s oInIon doos nof go so fnr ns fo dIscnrd
Ioe or Coee,, fho Courf, dIfforonfIy comosod fhnn If wns
whon wo Insf consIdorod n rosfrIcfIvo nborfIon roguInfIon,
Is hnrdIy fnIfhfuI fo our onrIIor InvocnfIons of fho ruIo of
Inw nnd fho rIncIIos of eIore Jecieie. Congross Im-
osod n bnn dosIfo our cIonr rIor hoIdIngs fhnf fho Sfnfo
cnnnof roscrIbo nn nborfIon rocoduro whon Ifs uso Is
nocossnry fo rofocf n womnn`s honIfh. Soo eupro, nf ?,
n. 4. AIfhough Congross` fIndIngs couId nof wIfhsfnnd fho
crucIbIo of frInI, fho Courf dofors fo fho IogIsInfIvo ovorrIdo
of our ConsfIfufIon-bnsod ruIIngs. Soo eupro, nf ?9. A
docIsIon so nf odds wIfh our jurIsrudonco shouId nof hnvo
sfnyIng owor.
In sum, fho nofIon fhnf fho InrfInI-IIrfh AborfIon Inn
Acf furfhors nny IogIfImnfo govornmonfnI Inforosf Is, quIfo
sImIy, IrrnfIonnI. Tho Courf`s dofonso of fho sfnfufo
rovIdos no snvIng oxInnnfIon. In cnndor, fho Acf, nnd
fho Courf`s dofonso of If, cnnnof bo undorsfood ns nnyfhIng
ofhor fhnn nn offorf fo chI nwny nf n rIghf docInrod ngnIn
nnd ngnIn by fhIs Courfnnd wIfh IncronsIng comrohon-
sIon of Ifs confrnIIfy fo womon`s IIvos. Soo eupro, nf 3,
n. 2; eupro, nf ?, n. 4. Whon n sfnfufo burdons consfIfu-
fIonnI rIghfs nnd nII fhnf cnn bo snId on Ifs bohnIf Is fhnf If
Is fho vohIcIo fhnf IogIsInfors hnvo choson for oxrossIng
fhoIr hosfIIIfy fo fhoso rIghfs, fho burdon Is unduo. SIen-
Ierg, 530 !. S., nf 952 (CISI!!C, J., concurrIng) (quofIng
Hope Clinic v. I,on, l95 I. 3d 85?, 88l (CA? l999) (Ios-
nor, C. J., dIssonfIng)).
25 CIfo ns: 550 !. S. ____ (200?)
CISI!!C, J., dIssonfIng
* * *
Ior fho ronsons sfnfod, I dIssonf from fho Courf`s dIso-
sIfIon nnd wouId nffIrm fho judgmonfs boforo us for ro-
vIow.