I 
118TH CONGRESS 
1ST SESSION 
H. R. 461 
To amend title 18, United States Code, to prohibit discrimination by abortion 
against an unborn child on the basis of Down syndrome. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 24, 2023 
Mr. ESTES (for himself, Mr. ADERHOLT, Mr. BANKS, Mr. FEENSTRA, Mr. 
GAETZ, Mr. HIGGINS of Louisiana, Mr. KELLY of Mississippi, Mrs. MIL-
LER of Illinois, Mr. SMITH of New Jersey, and Mr. STAUBER) introduced 
the following bill; which was referred to the Committee on the Judiciary 
A BILL 
To amend title 18, United States Code, to prohibit discrimi-
nation by abortion against an unborn child on the basis 
of Down syndrome. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Protecting Individuals 
with Down Syndrome Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) On June 24, 2022, the United States Su-
preme Court issued a decision in Dobbs v. Jackson 
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Women’s Health Organization (No. 19–1392, 2022 
WL 2276808 (2022)), which overturned its prior, 
egregiously wrong holding in Roe v. Wade (410 U.S. 
113 (1973)). 
(2) Dobbs correctly affirmed that there is no 
constitutional right to abort an unborn child and 
that the Court’s prior decision in Roe was not based 
in the Constitution’s text nor was it deeply rooted in 
the history and tradition of the United States. 
(3) Federal law protects individuals with dis-
abilities against discrimination, including in the pro-
vision of medical care. 
(4) As Congress has previously affirmed, 
‘‘[d]isability is a natural part of the human experi-
ence and in no way diminishes the right of individ-
uals to live independently, enjoy self-determination, 
make choices, contribute to society, pursue meaning-
ful careers, and enjoy full inclusion and integration 
in the economic, political, social, and educational 
mainstream of American society.’’. 
(5) It is the policy of the United States to re-
spect the lives and the dignity of individuals with 
disabilities, including individuals with Down syn-
drome. 
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(6) Federal, State, and local government all 
have a role to play in preventing discrimination 
based on disability, including discrimination against 
individuals with Down syndrome. 
(7) Consistent with the overarching Federal 
policy of nondiscrimination, and in light of the 
shameful history of targeting unborn children for 
abortion based on race, gender, or disabilities, Con-
gress must combat invidious discrimination by pro-
hibiting doctors from aborting unborn children be-
cause the unborn child has been diagnosed with 
Down syndrome. 
(8) Tragically, in some countries that have 
failed to protect unborn children diagnosed with 
Down syndrome, virtually every unborn child diag-
nosed with Down syndrome is aborted. 
(9) Individuals with Down syndrome are inher-
ently valuable and worthy of dignity and respect. 
They enrich and strengthen our society in countless 
ways, including but not limited to by building mean-
ingful relationships, participating in and creating 
families, learning, and working alongside other 
Americans. 
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SEC. 3. DISCRIMINATION BY ABORTION AGAINST AN UN-
BORN CHILD ON THE BASIS OF DOWN SYN-
DROME PROHIBITED. 
(a) IN GENERAL.—Chapter 13 of title 18, United 
States Code, is amended by adding at the end the fol-
lowing: 
‘‘§ 250. Discrimination by abortion against an unborn 
child on the basis of Down syndrome pro-
hibited 
‘‘(a) DEFINITIONS.—In this section: 
‘‘(1) ABORTION.—The term ‘abortion’ means 
the act of using or prescribing any instrument, med-
icine, drug, or any other substance, device, or means 
with the intent to— 
‘‘(A) kill the unborn child of a woman 
known to be pregnant; or 
‘‘(B) terminate the pregnancy of a woman 
known to be pregnant, with an intention other 
than— 
‘‘(i) to produce a live birth and pre-
serve the life and health of the child born 
alive; 
‘‘(ii) to save the life of the pregnant 
woman; or 
‘‘(iii) to remove a dead unborn child. 
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‘‘(2) DOWN SYNDROME.—The term ‘Down syn-
drome’ means a chromosomal disorder associated 
with— 
‘‘(A) an extra copy of the chromosome 21, 
in whole or in part; or 
‘‘(B) an effective trisomy for chromosome 
21. 
‘‘(3) QUALIFIED PLAINTIFF.—The term ‘quali-
fied plaintiff’ means— 
‘‘(A) a woman upon whom an abortion is 
performed or attempted in violation of this sec-
tion; 
‘‘(B) a maternal grandparent of the un-
born child if the woman upon whom an abortion 
is performed or attempted in violation of this 
section is an unemancipated minor; 
‘‘(C) the father of an unborn child who is 
the subject of an abortion performed or at-
tempted in violation of this section unless the 
pregnancy or abortion resulted from the crimi-
nal conduct of the father; or 
‘‘(D) the Attorney General. 
‘‘(4) UNBORN CHILD.—The term ‘unborn child’ 
means an individual of the species homo sapiens 
from the beginning of the biological development of 
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that individual, including fertilization, until the point 
of being born alive, as defined in section 8(b) of title 
1. 
‘‘(b) OFFENSE.—It shall be unlawful to— 
‘‘(1) perform an abortion— 
‘‘(A) with the knowledge that a pregnant 
woman is seeking an abortion, in whole or in 
part, on the basis of— 
‘‘(i) a test result indicating that the 
unborn child has Down syndrome; 
‘‘(ii) a prenatal diagnosis that the un-
born child has Down syndrome; or 
‘‘(iii) any other reason to believe that 
the unborn child has or may have Down 
syndrome; or 
‘‘(B) without first— 
‘‘(i) asking the pregnant woman if she 
is aware of any test results, prenatal diag-
nosis, or any other evidence that the un-
born child has or may have Down syn-
drome; and 
‘‘(ii) if the woman is aware that the 
unborn child has or may have Down syn-
drome, informing the pregnant woman of 
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