Planned Parenthood Association of Kansas City, Missouri Inc v. Ashcroft Ashcroft v. Planned Parenthood Association of Kansas City, Missouri Inc, s. 81-1255

Decision Date15 June 1983
Docket Number81-1623,Nos. 81-1255,s. 81-1255
Citation76 L.Ed.2d 733,462 U.S. 476,103 S.Ct. 2517
PartiesPLANNED PARENTHOOD ASSOCIATION OF KANSAS CITY, MISSOURI, INC., et al., Petitioners, v. John ASHCROFT, Attorney General of Missouri, et al. John ASHCROFT, Attorney General of Missouri, et al., Petitioners, v. PLANNED PARENTHOOD ASSOCIATION OF KANSAS CITY, MISSOURI, INC., et al., Petitioners
CourtU.S. Supreme Court
Syllabus

Missouri statutes require abortions after 12 weeks of pregnancy to be performed in a hospital (§ 188.025); require a pathology report for each abortion performed (§ 188.047); require the presence of a second physician during abortions performed after viability (§ 188.030.3); and require minors to secure parental consent or consent from the juvenile court for an abortion (§ 188.028). In an action challenging the constitutionality of these provisions, the District Court invalidated all provisions except § 188.047. The Court of Appeals reversed as to §§ 188.028 and 188.047 but affirmed as to §§ 188.030.3 and 188.025.

Held: Section 188.025 is unconstitutional, but §§ 188.047, 188.030.3, and 188.028 are constitutional.

655 F.2d 848 (8th Cir., 1981), affirmed in part, reversed in part, vacated in part, and remanded; 664 F.2d 687 (8th Cir., 1981), affirmed.

Justice POWELL delivered the opinion of the Court with respect to Parts I, II, and VI, concluding that the second-trimester hospitalization requirement of § 188.025 "unreasonably infringes upon a woman's constitutional right to obtain an abortion." City of Akron v. Akron Center of Reproductive Health, Inc., --- U.S. ----, 103 S.Ct. 2481, 75 L.Ed.2d ----. Pp.481-482

Justice POWELL, joined by THE CHIEF JUSTICE, concluded in Parts III, IV, and V that:

1. The second-physician requirement of § 188.030.3 is constitutional as reasonably furthering the State's compelling interest in protecting the lives of viable fetuses. Pp. 482-486.

2. The pathology-report requirement of § 188.047 is constitutional. On its face and in effect, such requirement is reasonably related to generally accepted medical standards and furthers important health-related state concerns. In light of the substantial benefits that a pathologist's examination can have, the small additional cost of such an examination does not significantly burden a pregnant woman's abortion decision. Pp. 486-490 3. Section 188.028 is constitutional. A State's interest in protecting immature minors will sustain a requirement of a consent substitute, either parental or judicial. And as interpreted by the Court of Appeals to mean that the juvenile court cannot deny a minor's application for consent to an abortion "for good cause" unless the court first finds that the minor was not mature enough to make her own decision, § 188.028 provides a judicial alternative that is consistent with established legal standards. See City of Akron v. Akron Center for Reproductive Health, Inc., at ----, 103 S.Ct., at 2497-2499. Pp. 490-493.

Justice O'CONNOR, joined by Justice WHITE and Justice REHNQUIST, concluded that:

1. The second-physician requirement of § 188.030.3 is constitutional because the State has a compelling interest, extant throughout pregnancy, in protecting and preserving fetal life. P. 505.

2. The pathology-report requirement of § 188.047 is constitutional because it imposes no undue burden on the limited right to undergo an abortion, and its validity is not contingent on the trimester of pregnancy in which it is imposed. P. 505.

3. Assuming, arguendo, that the Sta e cannot impose a parental veto on a minor's decision to undergo an abortion, the parental consent provision of § 188.028.2 is constitutional because it imposes no undue burden on any right that a minor may have to undergo an abortion. P. 505.

Frank Susman, Clayton, Mo., for Planned Parenthood Ass'n of Kansas City, Mo., Inc., et al.

John Ashcroft, Atty. Gen., Jefferson City, Mo., for the Atty. Gen. of Missouri, et al.

Justice POWELL delivered the opinion of the Court with respect to Parts I, II, and VI, and an opinion with respect to Parts III, IV, and V, in which THE CHIEF JUSTICE joins.

These cases, like City of Akron v. Akron Center for Reproductive Health, Inc., --- U.S. ----, 103 S.Ct. 2481, 75 L.Ed.2d ----, and Simopoulos v. Virginia, --- U.S. ----, 103 S.Ct. 2532, 75 L.Ed.2d ----, present questions as to the validity of state statutes regulating the performance of abortions.

I

Planned Parenthood of Kansas City, Missouri, Inc., two physicians who perform abortions, and an abortion clinic ("plaintiffs") filed a complaint in the District Court for the Western District of Missouri challenging, as unconstitutional, several sections of the Missouri statutes regulating the performance of abortions. The sections relevant here include Mo.Rev.Stat. § 188.025 (Supp.1982), requiring that abortions after 12 weeks of pregnancy be performed in a hospital; 1 § 188.047, requiring a pathology report for each abortion performed; 2 § 188.030, requiring the presence of a second physician during abortions performed after viability; 3 and § 188.028, requiring minors to secure parental or judicial consent.4 After hearing testimony from a number of expert witnesses, the District Court invalidated all of these sections except the pathology requirement. 483 F.Supp. 679, 699-701 (D.C.1980).5 The Court of Appeals for the Eighth Circuit reversed the District Court's judgment with respect to § 188.028, thereby upholding the requirement that a minor secure parental or judicial consent to an abortion. It also held that the District Court erred in sustaining § 188.047, the pathology requirement. The District Court's judgment with respect to the second-physician requirement was affirmed, and the case was remanded for further proceedings and findings relating to the second-trimester hospitalization requirement. 655 F.2d 848, 872-873 (8th Cir.1981). On remand, the District Court affirmed its holding that the second-trimester hospitalization requirement was unconstitutional. The Court of Appeals affirmed this judgment. 664 F.2d 687, 691 (8th Cir.1981). We granted certiorari. 456 U.S. 988, 102 S.Ct. 2267, 73 L.Ed.2d 1282 (1982).

The Court today in City of Akron, supra, --- U.S., at ---- - ----, 103 S.Ct., at 2490-2493, has stated fully the principles that govern judicial review of state statutes regulating abortions, and these need not be repeated here. With these principles in mind, we turn to the statutes at issue.

II

In City of Akron, we invalidated a city ordinance requiring physicians to perform all second-trimester abortions at general or special hospitals accredited by the Joint Commission on Accreditation of Hospitals (JCAH) or by the American Osteopathic Association. Supra, at ----, 103 S.Ct., at 2493. Missouri's hospitalization requirements are similar to those enacted by Akron, as all second-trimester abortions must be performed in general, acute-care facilities.6 For the reasons stated in City of Akron, we held that such a requirement "unreasonably infringes upon a woman's constitutional right to obtain an abortion." Supra, at ---- - ----, 103 S.Ct., at 2497-2498. For the same reasons, we affirm the Court of Appeals' judgment that § 188.025 is unconstitutional.

III

We turn now to the State's second-physician requirement. In Roe v. Wade, 410 U.S. 113, 93 S.Ct. 705, 35 L.Ed.2d 147 (1973), the Court recognized that the State has a compelling interest in the life of a viable fetus: "[T]he State in promoting its interest in the potentiality of human life may, if it chooses, regulate, and even proscribe, abortion except where it is necessary, in appropriate medical judgment, for the preservation of the life or health of the mother." Id., at 164-165, 93 S.Ct., at 732-733. See Colautti v. Franklin, 439 U.S. 379, 386-387, 99 S.Ct. 675, 680-681, 58 L.Ed.2d 596 (1979); Beal v. Doe, 432 U.S. 438, 445-446, 97 S.Ct. 2366, 2371-2372, 53 L.Ed.2d 464 (1977). Several of the Missouri statutes undertake such regulation. Post-viability abortions are proscribed except when necessary to preserve the life or the health of the woman. Mo.Rev.Stat. § 188.030.1 (Supp.1982). The State also forbids the use o abortion procedures fatal to the viable fetus unless alternative procedures pose a greater risk to the health of the woman. § 188.030.2.

The statutory provision at issue in this case requires the attendance of a second physician at the abortion of a viable fetus. § 188.030.3. This section requires that the second physician "take all reasonable steps in keeping with good medical practice . . . to preserve the life and health of the viable unborn child; provided that it does not pose an increased risk to the life or health of the woman." See n. 3, supra. It also provides that the second physician "shall take control of and provide immediate medical care for a child born as a result of the abortion."

The lower courts invalidated § 188.030.3.7 The plaintiffs, respondents here on this issue, urge affirmance on the grounds that the second-physician requirement distorts the traditional doctor-patient relationship, and is both impractical and costly. They note that Missouri does not require two physicians in attendance for any other medical or surgical procedure, including childbirth or delivery of a premature infant.

The first physician's primary concern will be the life and health of the woman. Many third-trimester abortions in Missouri will be emergency operations,8 as the State permits these late abortions only when they are necessary to preserve the life or the health of the woman. It is not unreasonable for the State to assume that during the operation the first physician's attention and skills will be directed to preserving the woman's health, and not to protecting the actual life of those fetuses who survive the abortion procedure. Viable fetuses will be in immediate and grave danger because of their premature birth. A second physician, in situations where Missouri permits...

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