Opinion ID: 4538315
Heading Depth: 3
Heading Rank: 2

Heading: Benefits

Text: After taking stock of the burdens imposed by H.B. 454, we must next consider the Act’s benefits. The Secretary asserts that H.B. 454 provides three primary benefits: It “shows Kentucky’s profound respect for unborn life. It eliminates the possibility of unborn children feeling pain while being dismembered. And [it] protects the integrity of the medical profession.” (Def. Br. at 57.) The Secretary contends that a statement by the district court—namely, “the fact that the Act furthers legitimate state interests does not end this constitutional inquiry”—suggests the district court found that H.B. 454 did advance the Commonwealth’s asserted interests. See Meier, 373 F. Supp. 3d at 817. This conclusion is debatable, at best. The district court clearly concluded that H.B. 454 did not benefit the Commonwealth’s interest in preventing fetal pain because “it is very unlikely that a fetus can feel pain before 24 weeks,” at which point physicians no longer perform D&Es. Id. at 823; accord Yost, 375 F. Supp. 3d at 865. In so finding, the court dismissed the Secretary’s expert’s testimony suggesting that a fetus may feel pain as early as fifteen weeks, purportedly because the development of a fetus’s ability to feel pain is like “a dimmer switch” that “turn[s] on over weeks of development.” (Tr. Vol. IV, R. 103 at PageID ##4020–21); Meier, 373 F. Supp. 3d at 822. Instead, the court credited Plaintiffs’ expert testimony, supported by multiple studies, that it is No. 19-5516 EMW Women’s Surgical Center, et al. v. Friedlander, et al. Page 25 not possible for a fetus to feel pain before twenty-four weeks because “fetal pain perception requires consciousness, which in turn requires two elements absent in a fetus before 24 weeks: intact [neural] connections from the periphery [of the brain] to the thalamus and then to the cortex, and a sufficiently developed cerebral cortex.” Meier, 373 F. Supp. 3d at 822 (citing Tr. Vol. IV, R. 103 at PageID ##4140–55, 4180–82, 4210). Given the abundant evidence supporting Plaintiffs’ account of pain perception, the district court’s conclusion was not clearly erroneous. And, accepting that a fetus cannot feel pain during the period in which D&Es are administered, we conclude that H.B. 454 does not benefit this Commonwealth interest. The district court made no clear findings regarding whether or how H.B. 454 advanced the Commonwealth’s interest in demonstrating respect for the dignity of human life. Upon consideration, we note that the Commonwealth’s interests in preventing fetal pain and demonstrating respect for human life are substantially intertwined, if not subsumed in one another. While H.B. 454 would prohibit separation of fetal tissue prior to fetal demise, it would not prohibit separation of fetal tissue following fetal demise. The most obvious potential benefit to separating fetal tissue post-demise rather than pre-demise is that it eliminates any possibility of fetal pain. But the district court permissibly found that it is impossible for a fetus to feel pain during the period in which D&Es are administered, and so H.B. 454 provides no benefit in that regard. Nevertheless, even recognizing the impossibility of fetal pain at this point, some may believe that separating fetal tissue prior to fetal demise is more “brutal and inhumane” than or “implicates additional ethical and moral concerns” beyond those implicated by separating fetal tissue following demise. See Gonzales, 550 U.S. at 157–158. In recognition of that fact, we assume that H.B. 454 provides some limited benefit in this regard. See Women’s Med. Prof’l Corp. v. Taft, 353 F.3d at 444 (“[A state’s] expression of . . . important and legitimate interests warrants a measure of deference . . . .”). Turning to the Commonwealth’s final interest in protecting the ethics, integrity, and reputation of the medical profession, the district court also came to no clear findings or conclusions regarding if or how H.B. 454 benefited this interest. We note that H.B. 454 would require physicians to subject their patients to additional harmful, experimental, and invasive medical procedures, in contravention of their ethical duties. (See, e.g., Tr. Vol. II, R. 107 at No. 19-5516 EMW Women’s Surgical Center, et al. v. Friedlander, et al. Page 26 PageID ##4819–20 (“H.B. 454 is inconsistent with the principle of nonmaleficence, the principle that physicians should not do unjustified harm to their patients” because fetal-demise procedures “offer[] only risks to [the patient], only the risk of harm, and do[] not offer [the patient] any potential for medical benefits.”).) And to the extent that physicians have any obligation to not do harm to a fetus, performing a D&E on a fetus prior to fetal demise subjects it to little harm, if any, because it cannot feel pain. If H.B. 454 provides any benefit to the Commonwealth’s interest in the medical profession, it also provides countervailing damage to that interest. We therefore conclude that H.B. 454 provides little to no benefit in this regard.