Opinion ID: 701298
Heading Depth: 1
Heading Rank: 4

Heading: choice of method provisions

Text: 45 Sections 307 and 308 require that a doctor perform a post-viability abortion in a manner that will give the unborn child the best chance of survival unless that method would cause grave damage to the woman's medical health. Utah Code Ann. Secs. 76-7-307 and 308. 7 Both plaintiffs and defendants characterize these two statutes as choice of method provisions given that they require a doctor to use the abortion method that would best assure the unborn child's chances of survival unless such a method would gravely damage a woman's medical health. The district court held that these two provisions were facially valid and bore a rational relationship to the legitimate state interest in preservation of viable fetal life. Jane L. III, 809 F.Supp. at 875-76. Relying on Thornburgh v. American College of Obstetricians & Gynecologists, 476 U.S. 747, 106 S.Ct. 2169, 90 L.Ed.2d 779 (1986), plaintiffs argue on appeal that these provisions violate a woman's right to privacy. We agree and reverse. 46 In Thornburgh, the Supreme Court invalidated a Pennsylvania choice of method statute. 8 The Court agreed with the Third Circuit that the statute 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. Thornburgh, 476 U.S. at 768-69, 106 S.Ct. at 2183 (citing Colautti, 439 U.S. at 400, 99 S.Ct. at 688). The Thornburgh analysis thus guides our disposition of this case. 47 Sections 307 and 308 require that the doctor focus on the unborn child's chances of survival until the risk to the woman's health becomes grave. In demanding that the woman's health be in grave danger before prevailing under the choice of method requirements, sections 307 and 308 are significantly more burdensome than the statute in Thornburgh. In Thornburgh, the woman's health risks outweighed those of the unborn child if the particular method or technique would present a significantly greater medical risk to the life or health of the pregnant woman. Id. at 768 n. 13, 106 S.Ct. at 2183 n. 13 (quoting 18 Pa.Cons.Stat. Sec. 3210(b) (1982)). Whether significantly greater in this context means an increased medical risk, as the majority then concluded, id. at 769, 106 S.Ct. at 2183, or nonnegligible or real and identifiable, as two dissenters noted, id. at 807, 106 S.Ct. at 2202 (White, J., dissenting) and 832 (O'Connor, J. dissenting), it is clear that sections 307 and 308 are notably more onerous. Testimony of several of defendants' witnesses underscores the health burden that these statutes place on a woman's right to choose to have an abortion. Dr. Cruikshank, an expert witness for defendants, defined grave as [l]oss of structure or function, shortening of life, irremedial pain and suffering. Aplt.App. at 95. Dr. Richard Hebertson, another of defendants' witnesses, testified that grave is synonymous with [s]erious, complex, threatening. Id. at 93. As admitted by defendants' witnesses, the woman must suffer serious or threatening loss of structure or function, shortening of life, or irremedial pain and suffering before her interests take precedence over the unborn child's interests. 48 Defendants argue that the relevant portions of Thornburgh were uprooted by Casey and cannot legitimately support a decision to hold sections 307 and 308 unconstitutional. Specifically, defendants assert that Thornburgh was a progeny of Roe and that Casey's discrediting of some aspects of Roe necessarily discredits Thornburgh. We disagree. While we recognize that Casey rejects Roe's trimester framework, Thornburgh does not rely decisively on that framework in invalidating the Pennsylvania statute. Casey admittedly replaces Roe's strict scrutiny with an undue burden analysis, and we now invalidate a state abortion regulation only if its purpose or effect is to place a substantial obstacle in the path of a woman seeking an abortion before the fetus attains viability. Casey, --- U.S. at ----, 112 S.Ct. at 2821. However, Casey explicitly reaffirms Roe's approach to post-viability abortions: 49 We also reaffirm Roe's holding that 'subsequent to viability, the 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.' 50 Casey, --- U.S. at ----, 112 S.Ct. at 2821 (quoting Roe v. Wade, 410 U.S. 113, 164-65, 93 S.Ct. 705, 732-33, 35 L.Ed.2d 147 (1973) (emphasis added)). Casey does not disturb Roe's approach to post-viability regulation. Roe therefore continues to govern the relevant portion of Thornburgh dealing with choice of method restrictions on post-viability abortions. 9 51 In invalidating Pennsylvania's choice of method statute, Thornburgh emphasized that the woman's health must be the physician's paramount consideration. Thornburgh, 476 U.S. at 768-69, 106 S.Ct. at 2183. This is consistent with the holding in Roe, reaffirmed in Casey, that limits the state's ability to regulate post-viability abortions when  'preservation of the life or health of the mother'  is at issue. Casey, --- U.S. at ----, 112 S.Ct. at 2821 (quoting Roe, 410 U.S. at 164-65, 93 S.Ct. at 732-33). The importance of maternal health is a unifying thread that runs from Roe to Thornburgh and then to Casey. In fact, defendants concede that Thornburgh's admonition that a woman's health must be the paramount concern remains vital in the wake of Casey. Aplee.Br. at 36 (Maternal health, not fetal survival, remains the physician's paramount consideration.). The Utah choice of method provisions violate this consistent strain of abortion jurisprudence. 52 Sections 307 and 308 dictate that the unborn child's life must take precedence over the woman's health absent a risk of grave damage to her medical health. Grave damage is clearly a higher standard than the Supreme Court has articulated. According to Casey, Thornburgh, and Roe, concern for the preservation of a woman's health suffices to elevate her liberty interests decisively above those of the state or the unborn child. By requiring a woman to suffer grave damage to her health before her liberty interests predominate, the Utah legislature violated those portions of Roe and Thornburgh that Casey reaffirmed, and unconstitutionally devalued a woman's privacy rights. 53 Defendants argue in the alternative that the Court in Thornburgh invalidated the Pennsylvania statute because it required the mother to bear an increased medical risk in order to save her viable fetus, Aplee.Br. at 36-37 (quoting Thornburgh, 476 U.S. at 769, 106 S.Ct. at 2183), and contend that the Utah statute does not require the mother to bear any increased medical risk in order to save her viable fetus. Aplee.Br. at 37. Defendants correctly note that sections 307 and 308 only affect women who are seeking post-viability abortions to prevent grave damage to the pregnant woman's medical health and to save the pregnant woman's life. Utah Code Ann. Sec. 76-7-302(3). 10 Defendants argue that because [t]he standard cited in sections 76-7-307 and 308, concerning the need to protect the mother's life and medical health, is the same standard that must be met to permit the post-viability abortion in the first place, Aplee.Br. at 34, the woman faces no increased risk. Id. at 37. But we have already concluded that section 302(3) is invalid. The grave damage standard in sections 307 and 308 no longer has a vital analog in the post-20 week abortion ban. Furthermore, defendants' analysis erroneously conflates the health risks attendant with continued pregnancy and the health risks attendant with a particular abortion method. A woman may opt for a post-viability abortion because continued pregnancy would cause grave damage to her health or jeopardize her life. Under the statute, however, she may have to endure additional health damage and suffering if the method most likely to save her unborn child's life, for example Cesarean section, would itself inflict damage, albeit not grave damage, on her health. Contrary to defendants' assertion, sections 307 and 308 clearly demand that a woman bear an increased medical risk in order to save the life of a viable fetus. 54 We hold that sections 307 and 308 impose an undue burden upon a woman's right to choose to terminate a pregnancy, and we reverse the district court's disposition of this claim.