Source: https://caselaw.findlaw.com/us-supreme-court/432/519.html
Timestamp: 2019-04-20 10:49:50+00:00

Document:
The city of St. Louis, in electing, as a policy choice, to provide publicly financed hospital services for childbirth but not for nontherapeutic abortions, held not to violate any constitutional rights. Maher v. Roe, ante, p. 464.
Eugene P. Freeman argued the cause for petitioners. With him on the brief was Jack L. Koehr.
[ Footnote * ] Briefs of amici curiae urging affirmance were filed by Leo Pfeffer for the American Jewish Congress et al.; and by Sylvia A. Law, Harriet F. Pilpel, and Eve W. Paul for the American Public Health Assn. et al.
Briefs of amici curiae were filed by Dennis J. Horan, Dolores V. Horan, and Victor G. Rosenblum for Americans United for Life, Inc.; by Jerome M. McLaughlin for Missouri Doctors for Life; and by Robert E. Ratermann for James R. Butler et al.
The Court of Appeals concluded that Doe's inability to obtain an abortion resulted from a combination of a policy directive by the Mayor and a longstanding staffing practice at Starkloff Hospital. The directive, communicated to the Director of Health and Hospitals by the Mayor, prohibited the performance of abortions in the city hospitals except when there was a threat of grave physiological injury or death to the mother. Under the staffing practice, the doctors and medical students at the obstetrics-gynecology clinic at the hospital are drawn from the faculty and students at the St. Louis University School of Medicine, a Jesuit-operated institution opposed to abortion. Relying on our decisions in Roe v. Wade, 410 U.S. 113 (1973), and Doe v. Bolton, 410 U.S. 179 (1973), the Court of Appeals held that the city's policy and the hospital's staffing practice denied the "constitutional rights of indigent pregnant women . . . long after those rights had been clearly enunciated" in Roe and Doe. 515 F.2d, at 547. The court cast the issue in an equal protection mold, finding that the provision of publicly financed hospital services for childbirth but not for elective abortions constituted invidious discrimination. In support of its equal protection analysis, the court also emphasized the contrast between nonindigent women who can afford to obtain abortions in private hospitals and indigent women who cannot. Particular reliance was placed upon the previous decision in Wulff v. Singleton, 508 F.2d 1211 (CA8 1974), reversed on other grounds, 428 U.S. 106 (1976), in which the Court of Appeals [432 U.S. 519, 521] had held unconstitutional a state Medicaid statute that provided benefits for women who carried their pregnancies to term but denied them for women who sought elective abortions. The court stated that "[t]here is no practical distinction between that case and this one." 515 F.2d, at 545.
The judgment of the Court of Appeals for the Eighth Circuit [432 U.S. 519, 522] is reversed, and the case is remanded for further proceedings consistent with this opinion.
[ Footnote 1 ] The facts concerning Doe's visit to the hospital and the reason for her inability to obtain an abortion are hotly disputed. Our view that the Court of Appeals erred in the application of the law to the facts as stated in its opinion makes it unnecessary to describe or resolve this conflict.
[ Footnote 2 ] The Court of Appeals awarded attorney's fees to respondent under the "bad faith" exception to the traditional American Rule disfavoring allowance of such fees to the prevailing party. See Alyeska Pipeline Co. v. Wilderness Society, 421 U.S. 240 (1975). It follows from our decision on the constitutional merits that it was an error to award attorney's fees to respondent.
"Stripped of all rhetoric, the city here, through its policy and staffing procedure, is simply telling indigent women, like Doe, that if they choose to carry their pregnancies to term, the city will provide physicians and medical facilities for full maternity care; but if they choose to exercise their constitutionally protected right to determine that they wish to terminate the pregnancy, the city will not provide physicians and facilities for the abortion procedure, even though it is probably safer than going through a full pregnancy and childbirth." 515 F.2d 541, 544 (1975).
A number of difficulties lie beneath the surface of the Court's holding. Public hospitals that do not permit the performance of elective abortions will frequently have physicians on their staffs who would willingly perform them. This may operate in some communities significantly to reduce the number of physicians who are both willing and able to perform abortions in a hospital setting. It is not a complete answer that many abortions may safely be performed in clinics, for some physicians will not be affiliated with those clinics, and some abortions may pose unacceptable risks if performed outside a hospital. Indeed, such an answer would be ironic, for if the result is to force some abortions to be performed in a clinic that properly should be performed in a hospital, the city policy will have operated to increase rather than reduce health risks associated with abortions; and in Roe v. Wade, [432 U.S. 519, 524] 410 U.S. 113, 163 (1973), the Court permitted regulation by the State solely to protect maternal health.
Because the city policy constitutes "coercion [of women] to bear children which they do not wish to bear," Roe v. Wade and the cases following it require that the city show a compelling state interest that justifies this infringement upon the fundamental right to choose to have an abortion. "[E]xpressing a preference for normal childbirth," ante, at 521, does not satisfy that standard. Roe explicitly held that during the first trimester no state interest in regulating abortions was compelling, and that during the second trimester the State's interest was compelling only insofar as it protected maternal health. 410 U.S., at 162 -164. Under Roe, the State's "important and legitimate interest in potential life," id., at [432 U.S. 519, 525] 163 - which I take to be another way of referring to a State's "preference for normal childbirth" - becomes compelling only at the end of the second trimester. Thus it is clear that St. Louis' policy preference is insufficient to justify its infringement on the right of women to choose to have abortions during the first two trimesters of pregnancy without interference by the State on the ground of moral opposition to abortions. St. Louis' policy therefore "unduly burdens the right to seek an abortion," Bellotti v. Baird, 428 U.S. 132, 147 (1976).
[ Footnote 1 ] Sullivan, Tietze, & Dryfoos, Legal Abortion in the United States, 1975-1976, 9 Family Planning Perspectives 116, 121, 128 (1977).

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