Opinion ID: 111690
Heading Depth: 2
Heading Rank: 2

Heading: We turn to the challenged statutes:

Text: 1. Section 3205 (informed consent) and § 3208 (printed information). Section 3205(a) requires that the woman give her voluntary and informed consent to an abortion. Failure to observe the provisions of § 3205 subjects the physician to suspension or revocation of his license, and subjects any other person obligated to provide information relating to informed consent to criminal penalties. § 3205(c). A requirement that the woman give what is truly a voluntary and informed consent, as a general proposition, is, of course, proper and is surely not unconstitutional. See Planned Parenthood of Central Missouri v. Danforth, 428 U. S. 52, 67 (1976). But the State may not require the delivery of information designed to influence the woman's informed choice between abortion or childbirth. Akron, 462 U. S., at 443-444. Appellants refer to the Akron ordinance, Brief for Appellants 67, as did this Court in Akron itself, 462 U. S., at 445, as a litany of information and as  `a parade of horribles'  of dubious validity plainly designed to influence the woman's choice. They would distinguish the Akron situation, however, from the Pennsylvania one. Appellants assert that statutes describing the general subject matter relevant to informed consent, ibid., and stating in general terms the information to be disclosed, id., at 447, are permissible, and they further assert that the Pennsylvania statutes do no more than that. We do not agree. We conclude that, like Akron's ordinance, §§ 3205 and 3208 fail the Akron measurement. The two sections prescribe in detail the method for securing informed consent. Seven explicit kinds of information must be delivered to the woman at least 24 hours before her consent is given, and five of these must be presented by the woman's physician. The five are: (a) the name of the physician who will perform the abortion, (b) the fact that there may be detrimental physical and psychological effects which are not accurately foreseeable, (c) the particular medical risks associated with the particular abortion procedure to be employed, (d) the probable gestational age, and (e) the medical risks associated with carrying her child to term. The remaining two categories are (f) the fact that medical assistance benefits may be available for prenatal care, childbirth and neonatal care, and (g) the fact that the father is liable to assist in the child's support, even in instances where the father has offered to pay for the abortion. §§ 3205(a)(1) and (2). The woman also must be informed that materials printed and supplied by the Commonwealth that describe the fetus and that list agencies offering alternatives to abortion are available for her review. If she chooses to review the materials but is unable to read, the materials shall be read to her, and any answer she seeks must be provided her in her own language. § 3205(a)(2)(iii). She must certify in writing, prior to the abortion, that all this has been done. § 3205(a)(3). The printed materials shall include the following statement:  `There are many public and private agencies willing and able to help you to carry your child to term, and to assist you and your child after your child is born, whether you choose to keep your child or place her or him for adoption. The Commonwealth of Pennsylvania strongly urges you to contact them before making a final decision about abortion. The law requires that your physician or his agent give you the opportunity to call agencies like these before you undergo an abortion.'  § 3208(a)(1). The materials must describe the probable anatomical and physiological characteristics of the unborn child at two-week gestational increments from fertilization to full term, including any relevant information on the possibility of the unborn child's survival. § 3208(a)(2). In Akron, this Court noted: The validity of an informed consent requirement thus rests on the State's interest in protecting the health of the pregnant woman. 462 U. S., at 443. The Court went on to state: This does not mean, however, that a State has unreviewable authority to decide what information a woman must be given before she chooses to have an abortion. It remains primarily the responsibility of the physician to ensure that appropriate information is conveyed to his patient, depending on her particular circumstances. Danforth 's recognition of the State's interest in ensuring that this information be given will not justify abortion regulations designed to influence the woman's informed choice between abortion or childbirth. Id., at 443-444. The informational requirements in the Akron ordinance were invalid for two equally decisive reasons. Id., at 445. The first was that much of the information required is designed not to inform the woman's consent but rather to persuade her to withhold it altogether. Id., at 444. The second was that a rigid requirement that a specific body of information be given in all cases, irrespective of the particular needs of the patient, intrudes upon the discretion of the pregnant woman's physician and thereby imposes the undesired and uncomfortable straitjacket with which the Court in Danforth, 428 U. S., at 67, n. 8, was concerned. These two reasons apply with equal and controlling force to the specific and intrusive informational prescriptions of the Pennsylvania statutes. The printed materials required by §§ 3205 and 3208 seem to us to be nothing less than an outright attempt to wedge the Commonwealth's message discouraging abortion into the privacy of the informed-consent dialogue between the woman and her physician. The mandated description of fetal characteristics at 2-week intervals, no matter how objective, is plainly overinclusive. This is not medical information that is always relevant to the woman's decision, and it may serve only to confuse and punish her and to heighten her anxiety, contrary to accepted medical practice. [10] Even the listing of agencies in the printed Pennsylvania form presents serious problems; it contains names of agencies that well may be out of step with the needs of the particular woman and thus places the physician in an awkward position and infringes upon his or her professional responsibilities. Forcing the physician or counselor to present the materials and the list to the woman makes him or her in effect an agent of the State in treating the woman and places his or her imprimatur upon both the materials and the list. See Women's Medical Center of Providence, Inc. v. Roberts, 530 F. Supp. 1136, 1154 (RI 1982). All this is, or comes close to being, state medicine imposed upon the woman, not the professional medical guidance she seeks, and it officially structures  as it obviously was intended to do  the dialogue between the woman and her physician. The requirements of §§ 3205(a)(2)(i) and (ii) that the woman be advised that medical assistance benefits may be available, and that the father is responsible for financial assistance in the support of the child similarly are poorly disguised elements of discouragement for the abortion decision. Much of this would be nonmedical information beyond the physician's area of expertise and, for many patients, would be irrelevant and inappropriate. For a patient with a life-threatening pregnancy, the information in its very rendition may be cruel as well as destructive of the physician-patient relationship. As any experienced social worker or other counselor knows, theoretical financial responsibility often does not equate with fulfillment. And a victim of rape should not have to hear gratuitous advice that an unidentified perpetrator is liable for support if she continues the pregnancy to term. Under the guise of informed consent, the Act requires the dissemination of information that is not relevant to such consent, and, thus, it advances no legitimate state interest. The requirements of §§ 3205(a)(1)(ii) and (iii) that the woman be informed by the physician of detrimental physical and psychological effects and of all particular medical risks compound the problem of medical attendance, increase the patient's anxiety, and intrude upon the physician's exercise of proper professional judgment. This type of compelled information is the antithesis of informed consent. That the Commonwealth does not, and surely would not, compel similar disclosure of every possible peril of necessary surgery or of simple vaccination, reveals the anti-abortion character of the statute and its real purpose. Pennsylvania, like Akron, has gone far beyond merely describing the general subject matter relevant to informed consent. Akron, 462 U. S., at 445. In addition, the Commonwealth would require the physician to recite its litany regardless of whether in his judgment the information is relevant to [the patient's] personal decision. Ibid. These statutory defects cannot be saved by any facts that might be forthcoming at a subsequent hearing. Section 3205's informational requirements therefore are facially unconstitutional. [11] Appellants assert, however, that even if this be so, the remedy is to allow the remainder of § 3205 to be severed and become effective. We rule otherwise. The radical dissection necessary for this would leave § 3205 with little resemblance to that intended by the Pennsylvania Legislature. We rejected a similar suggestion as to the ordinance in Akron, 462 U. S, at 445, n. 37, despite the presence there of a broad severability clause. We reach the same conclusion here, where no such clause is present, and reject the plea for severance. See Carter v. Carter Coal Co., 298 U. S. 238, 312-313 (1936). 2. Sections 3214(a) and (h) (reporting) and § 3211(a) (determination of viability). Section 3214(a)(8), part of the general reporting section, incorporates § 3211(a). Section 3211(a) requires the physician to report the basis for his determination that a child is not viable. It applies only after the first trimester. The report required by §§ 3214(a) and (h) is detailed and must include, among other things, identification of the performing and referring physicians and of the facility or agency; information as to the woman's political subdivision and State of residence, age, race, marital status, and number of prior pregnancies; the date of her last menstrual period and the probable gestational age; the basis for any judgment that a medical emergency existed; the basis for any determination of nonviability; and the method of payment for the abortion. The report is to be signed by the attending physician. § 3214(b). Despite the fact that § 3214(e)(2) provides that such reports shall not be deemed public records, within the meaning of the Commonwealth's Right-to-Know Law, Pa. Stat. Ann., Tit. 65, § 66.1 et seq. (Purdon 1959 and Supp. 1985), each report shall be made available for public inspection and copying within 15 days of receipt in a form which will not lead to the disclosure of the identity of any person filing a report. Similarly, the report of complications, required by § 3214(h), shall be open to public inspection and copying. A willful failure to file a report required under § 3214 is unprofessional conduct and the noncomplying physician's license shall be subject to suspension or revocation. § 3214(i)(1). The scope of the information required and its availability to the public belie any assertions by the Commonwealth that it is advancing any legitimate interest. In Planned Parenthood of Central Missouri v. Danforth, 428 U. S., at 80, we recognized that recordkeeping and reporting provisions that are reasonably directed to the preservation of maternal health and that properly respect a patient's confidentiality and privacy are permissible. But the reports required under the Act before us today go well beyond the health-related interests that served to justify the Missouri reports under consideration in Danforth. Pennsylvania would require, as Missouri did not, information as to method of payment, as to the woman's personal history, and as to the bases for medical judgments. The Missouri reports were to be used only for statistical purposes. See id., at 87. They were to be maintained in confidence, with the sole exception of public health officers. In Akron, the Court explained its holding in Danforth when it said: The decisive factor was that the State met its burden of demonstrating that these regulations furthered important health-related state concerns. 462 U. S., at 430. The required Pennsylvania reports, on the other hand, while claimed not to be public, are available nonetheless to the public for copying. Moreover, there is no limitation on the use to which the Commonwealth or the public copiers may put them. The elements that proved persuasive for the ruling in Danforth are absent here. The decision to terminate a pregnancy is an intensely private one that must be protected in a way that assures anonymity. JUSTICE STEVENS, in his opinion concurring in the judgment in Bellotti v. Baird, 443 U. S. 622 (1979), aptly observed: It is inherent in the right to make the abortion decision that the right may be exercised without public scrutiny and in defiance of the contrary opinion of the sovereign or other third parties. Id., at 655. A woman and her physician will necessarily be more reluctant to choose an abortion if there exists a possibility that her decision and her identity will become known publicly. Although the statute does not specifically require the reporting of the woman's name, the amount of information about her and the circumstances under which she had an abortion are so detailed that identification is likely. Identification is the obvious purpose of these extreme reporting requirements. [12] The impermissible limits that Danforth mentioned and that Missouri approached, see 428 U. S., at 81, have been exceeded here. We note, as we reach this conclusion, that the Court consistently has refused to allow government to chill the exercise of constitutional rights by requiring disclosure of protected, but sometimes unpopular, activities. See, e. g., Lamont v. Postmaster General, 381 U. S. 301 (1965) (invalidating Post Office requirement that addressee affirmatively request delivery of communist materials in order to receive them); Talley v. California, 362 U. S. 60, 64-65 (1960) (striking down municipal ban on unsigned handbills); NAACP v. Alabama ex rel. Patterson, 357 U. S. 449, 462-465 (1958) (invalidating compelled disclosure of NAACP membership list). Pennsylvania's reporting requirements raise the specter of public exposure and harassment of women who choose to exercise their personal, intensely private, right, with their physician, to end a pregnancy. Thus, they pose an unacceptable danger of deterring the exercise of that right, and must be invalidated. 3. Section 3210(b) (degree of care for postviability abortions) and § 3210(c) (second-physician requirement when the fetus is possibly viable). Section 3210(b) [13] sets forth two independent requirements for a postviability abortion. First, it demands the exercise of that degree of care which such person would be required to exercise in order to preserve the life and health of any unborn child intended to be born and not aborted. Second, the abortion technique employed shall be that which would provide the best opportunity for the unborn child to be aborted alive unless, in the physician's good-faith judgment, that technique would present a significantly greater medical risk to the life or health of the pregnant woman. An intentional, knowing, or reckless violation of this standard is a felony of the third degree, and subjects the violator to the possibility of imprisonment for not more than seven years and to a fine of not more than $15,000. See 18 Pa. Cons. Stat. §§ 1101(2) and 1103(3) (1982). The Court of Appeals ruled that § 3210(b) was unconstitutional because it required a trade-off between the woman's health and fetal survival, and failed to require that maternal health be the physician's paramount consideration. 737 F. 2d, at 300, citing Colautti v. Franklin, 439 U. S. 379, 397-401 (1979) (where Pennsylvania's 1974 Abortion Control Act was reviewed). In Colautti, this Court recognized the undesirability of any  `trade-off' between the woman's health and additional percentage points of fetal survival. Id., at 400. Appellants do not take any real issue with this proposition. See Brief for Appellants 84-86. They argue instead, as did the District Court, see 552 F. Supp., at 806-807, that the statute's words significantly greater medical risk for the life or health of the woman do not mean some additional risk (in which case unconstitutionality apparently is conceded) but only a meaningfully increased risk. That interpretation, said the District Court, renders the statute constitutional. Id., at 807. The Court of Appeals disagreed, pointing out that such a reading is inconsistent with the statutory language and with the legislative intent reflected in that language; that the adverb significantly modifies the risk imposed on the woman; that the adverb is patently not surplusage; and that the language of the statute is not susceptible to a construction that does not require the mother to bear an increased medical risk in order to save her viable fetus. 737 F. 2d, at 300. We agree with the Court of Appeals and therefore find the statute to be facially invalid. [14] Section 3210(c) [15] requires that a second physician be present during an abortion performed when viability is possible. The second physician is to take control of the child and. . . provide immediate medical care for the child, taking all reasonable steps necessary, in his judgment, to preserve the child's life and health. Violation of this requirement is a felony of the third degree. In Planned Parenthood Assn. of Kansas City, Missouri, Inc. v. Ashcroft, 462 U. S. 476 (1983), the Court, by a 5-4 vote, but not by a controlling single opinion, ruled that a Missouri statute requiring the presence of a second physician during an abortion performed after viability was constitutional. JUSTICE POWELL, joined by THE CHIEF JUSTICE, concluded that the State had a compelling interest in protecting the life of a viable fetus and that the second physician's presence provided assurance that the State's interest was protected more fully than with only one physician in attendance. Id., at 482-486. [16] JUSTICE POWELL recognized that, to pass constitutional muster, the statute must contain an exception for the situation where the health of the mother was endangered by delay in the arrival of the second physician. Recognizing that there was no clearly expressed exception on the face of the Missouri statute for the emergency situation, JUSTICE POWELL found the exception implicit in the statutory requirement that action be taken to preserve the fetus provided it does not pose an increased risk to the life or health of the woman. Id., at 485, n. 8. Like the Missouri statute, § 3210(c) of the Pennsylvania statute contains no express exception for an emergency situation. While the Missouri statute, in the view of JUSTICE POWELL, was worded sufficiently to imply an emergency exception, Pennsylvania's statute contains no such comforting or helpful language and evinces no intent to protect a woman whose life may be at risk. Section 3210(a) [17] provides only a defense to criminal liability for a physician who concluded, in good faith, that a fetus was nonviable or that the abortion was necessary to preserve maternal life or health. It does not relate to the second-physician requirement and its words are not words of emergency. It is clear that the Pennsylvania Legislature knows how to provide a medical-emergency exception when it chooses to do so. It defined [m]edical emergency in general terms in § 3203, and it specifically provided a medical-emergency exception with respect to informational requirements, § 3205(b); for parental consent, § 3206; for post-first-trimester hospitalization, § 3209; and for a public official's issuance of an order for an abortion without the express voluntary consent of the woman, § 3215(f). We necessarily conclude that the legislature's failure to provide a medical-emergency exception in § 3210(c) was intentional. All the factors are here for chilling the performance of a late abortion, which, more than one performed at an earlier date, perhaps tends to be under emergency conditions.