Opinion ID: 201353
Heading Depth: 2
Heading Rank: 2

Heading: Death exception

Text: 29 Just as it requires a health exception, the Constitution also requires an exception to abortion restrictions when the life of a pregnant woman is in danger. Stenberg, 530 U.S. at 931, 120 S.Ct. 2597 ([T]he governing standard requires an exception `where it is necessary, in appropriate medical judgment for the preservation of the life or health of the mother.' (quoting Casey, 505 U.S. at 879, 112 S.Ct. 2791)). Accordingly, the New Hampshire Act waives its parental notice requirement when a physician can certify that abortion is necessary to prevent the minor's death and there is insufficient time to provide the required notice. RSA 132:26, I(a). Appellees argue that this death exception is unconstitutionally narrow because (1) it is not possible for a physician to determine with any certainty whether death will occur before the notice provisions could be complied with; (2) it does not allow for circumstances in which abortion is the best, but not the only, option for saving a minor's life; 7 and (3) it does not permit abortion providers to rely on their own good faith judgment about whether an abortion is necessary. The Attorney General does not refute these charges, but responds that the Act is sufficiently specific to give notice of prohibited conduct, and that a scienter requirement can be read into the Act from New Hampshire law. 30 A minimum of forty-eight hours is necessary for compliance with the Act's notification requirement. RSA 132:25, I. Dr. Wayne Goldner, a named plaintiff in this case, provided unopposed testimony that physicians cannot predict with adequate precision what course medical complications will take, and thus cannot always determine whether death will occur within this time window. Consequently, the time component of the Act's death exception forces physicians either to gamble with their patients' lives in hopes of complying with the notice requirement before a minor's death becomes inevitable, or to risk criminal and civil liability by providing an abortion without parental notice. See Declaration of Wayne Goldner, M.D., at ¶ 17 ([T]he Act will force me to choose between following the law and letting my patient's condition deteriorate, possibly past the point of being able to save her life at all, and alternatively providing appropriate medical care to my patient and risking criminal prosecution and being sued by her parents.). The threat of such sanctions will have a profound chilling effect on the willingness of physicians to perform abortions when a minor's life is at risk. Colautti, 439 U.S. at 396, 99 S.Ct. 675. Thus, the Act's death exception is drawn too narrowly to protect minors in need of a life-saving abortion. 31 The Attorney General apparently concedes that an abortion provider must be able to rely on his or her good faith medical judgment in determining whether her patient's life is in danger. See Colautti, 439 U.S. at 395, 99 S.Ct. 675 (We need not now decide whether, under a properly drafted statute, a finding of bad faith or some other type of scienter would be required before a physician could be held criminally responsible for an erroneous determination of viability. We reaffirm, however, that `the determination of whether a particular fetus is viable is, and must be, a matter for the judgment of the responsible attending physician.'). The Attorney General argues that RSA 626:2, I, which states that [a] person is guilty of a ... misdemeanor only if he acts purposely, knowingly, recklessly or negligently, as the law may require, with respect to each element of the offense, can be read together with the Act to provide the necessary scienter requirement. According to the Supreme Court of New Hampshire, [w]here a specific mental state is not provided for the offense, RSA 626:2, I(a) requires proof of a culpable mental state which is appropriate in light of the nature of the offense and the policy considerations for punishing the conduct in question. State v. Bergen, 141 N.H. 61, 677 A.2d 145, 146 (1996) (determining requisite mental state for indecent exposure). It is not clear, however, which of the four scienter requirements would be imposed in this circumstance. The definition of negligence imposes an objective reasonableness standard, see RSA 626:2, II(d), thus, a physician who acts on a good faith belief that abortion is necessary to save a patient's life could nonetheless face criminal or civil liability if a judge or jury later found that the physician's assessment was unreasonable. See Voinovich, 130 F.3d at 205 (In this area [of medical necessity] where there is such disagreement, it is unlikely that the prosecution could not find a physician willing to testify that the physician did not act reasonably.). 32 As the district court held, we cannot construe the Act to preclude liability for good faith judgments unless such a construction is reasonable and readily apparent. Heed, 296 F.Supp.2d at 66-67 (quoting Stenberg, 530 U.S. at 944, 120 S.Ct. 2597). The Act gives no indication that the negligence standard set out in RSA 626:2, I should not be applied. Thus, a physician cannot know whether his or her determination that a minor's life is at risk will be judged according to a standard (e.g., knowingly) that respects her good-faith medical assessment, or by an objective standard (negligently) that would leave the physician's judgment open to post hoc second guessing. The resulting uncertainty would, again, impermissibly chill physicians' willingness and ability to provide lifesaving abortions. See Voinovich, 130 F.3d at 205 (finding medical emergency exception unconstitutionally vague because physicians cannot know the standard under which their conduct will ultimately be judged). As Dr. Goldner explained, the Act forces doctors to think about criminal prosecution at a time when we need to be concentrating on doing what is best for our patients, thus creating unnecessary risk to patients' health and lives. Declaration of Wayne Goldner, M.D., at ¶ 19. That risk constitutes an undue burden for minors in need of life-saving abortions. 33 Because its time requirement is drawn too narrowly, and because it fails to safeguard a physician's good-faith medical judgment that a minor's life is at risk against criminal and civil liability, the Act's death exception is unconstitutional.