Document: 127 S. Ct. 1610 (2007) Alberto R. GONZALES, Attorney General, Petitioner, v. Leroy CARHART et al. Gonzales, Planned Parenthood Federation of America, Inc., Nos. 05-380, 05-1382. Supreme Court United States. Argued November 8, 2006. Decided April 18, 2007. *1619 Paul D. Clement, Washington, D.C., for Petitioner. Priscilla Smith, Respondents in 05-380. Eve C. Gartner, Jerry M. Hug, Omaha, NE, J. Janet Crepps, Nan E. Strauss, Sanford Cohen, New York, NY, Solicitor Peter Keisler, Assistant Gregory G. Garre, Deputy Katsas, Kannon K. Shanmugam, to the Marleigh Dover, Catherine Y. Hancock, Teal Luthy Miller, Dennis Herrera, Therese Stewart, Chief City Attorney, Aleeta Van Runkle, Deputy, Kathleen Morris, San Francisco, CA, Intervenor-Respondent and County Francisco. Beth H. Parker, Bingham McCutchen LLP, California, Roger Evans, Helene T. Krasnoff, Justice KENNEDY delivered opinion Court. These cases require us consider validity Partial-Birth Abortion Ban Act 2003(Act), 18 U.S.C. § 1531 (2000 ed., Supp. IV), a federal statute regulating abortion procedures. In recitations preceding its operative provisions refers Court's Stenberg Carhart, 530 U.S. 914, 120 2597, 147 L. Ed. 2d 743 (2000), which also addressed subject procedures used later stages pregnancy. Compared state at issue Stenberg, is more specific concerning instances it applies this respect precise coverage. We conclude should be sustained against objections lodged by broad, facial attack brought it. No. 05-380 (Carhart) respondents are LeRoy William Fitzhugh, Knorr, Jill Vibhakar, doctors who perform second-trimester abortions. filed their complaint General States District Nebraska. They challenged constitutionality sought permanent injunction enforcement. Carhart Ashcroft, 331 F. 805 (2004). 2004, after 2-week trial, granted that prohibited from enforcing all but those there was no dispute fetus viable. Id., 1048. The Appeals Eighth Circuit affirmed. 413 F.3d 791 (2005). certiorari. 546 1169, 126 2901, 165 916 (2006). 05-1382 (Planned Parenthood) Golden Gate, entities enjoin enforcement suit Northern California. *1620 Am. 320 957 Francisco intervened as plaintiff. held trial spanning period just short three weeks, it, too, enjoined Act. 1035. Ninth 435 1163 547 ___, I A proscribes particular manner ending fetal life, so necessary here, discuss some detail. Three Courts heard extensive evidence describing addition two courts involved instant Southern York considered Nat. 330 436 It found unconstitutional, id., 493, Second affirmed, 437 278 relied on similar medical evidence; indeed, much submitted court previously had been other courts. F.Supp.2d, 809-810. refer Courts' exhaustive opinions our own discussion methods vary depending extent preferences physician and, course, term pregnancy resulting stage unborn child's development. Between 85 90 percent approximately 1.3 million abortions performed each year take place first months pregnancy, say trimester. Parenthood, 960, n. 4; App. 05-1382, pp. 45-48. most common first-trimester method vacuum aspiration (otherwise known suction curettage) vacuums out embryonic tissue. Early trimester an alternative use medication, such mifepristone (commonly RU-486), terminate Federation, supra, 464, 20. does not regulate these Of remaining year, occur second surgical procedure referred "dilation evacuation" or "D & E" usual 960-961. Although individual techniques performing D E differ, general steps same. doctor must dilate cervix least needed insert instruments into uterus maneuver them evacuate fetus. 465; 61. taken cause dilation differ gestational age See, e.g., 852, 856, 859, 862-865, 868, 870, 873-874, 876-877, 880, 883, 886. often begins process inserting osmotic dilators, laminaria (sticks seaweed), cervix. dilators can combination with drugs, misoprostol, increase dilation. amount uniform, know advance how patient will respond. longer remain cervix, dilate. Yet length time employ varies. Some may keep *1621 days, while others day less. 464-465; 961. After sufficient operation commence. woman placed under anesthesia conscious sedation. doctor, guided ultrasound, inserts grasping forceps through woman's grab grips part pulls back vagina, continuing pull even meeting resistance friction causes tear apart. For example, leg might ripped off pulled woman. evacuating piece continues until has completely removed. make 10 15 passes entirety, though sometimes removal completed fewer passes. Once evacuated, placenta any material suctioned scraped uterus. examines different parts ensure entire body 962. doctors, especially trimester, kill before evacuation. inject digoxin potassium chloride fetus, umbilical cord, amniotic fluid. Fetal demise contractions greater possible. dead, moreover, fetus' soften, easier. Other refrain injecting chemical agents, believing adds risk little benefit. 907-912; 474-475. impetus numerous bans "partial-birth abortion," including Act, variation standard See Haskell, Dilation Extraction Late Trimester (1992), 1 Appellant's 04-3379(CA8), p. 109 (hereinafter Extraction). community reached unanimity appropriate name variation. "intact E," extraction" (D X), X." 440, 2; see Cunningham al., Williams Obstetrics 243 (22d ed.2005) (identifying X); Danforth's Gynecology 567 (J. Scott, Gibbs, B. Karlan, A. Haney eds. 9th ed.2003) intact Paul, Lichtenberg, Borgatta, Grimes, P. Stubblefield, Clinician's Guide Medical Surgical 136 (1999) E). purposes main difference between extracts largely only few There comprehensive statistics indicating what percentage Es manner. Intact E, like regular Sufficient essential procedure. To achieve extraction thus attempt degree. This approach called "serial" 873; 965. Doctors outset full days up 25 dilators. 110; 865, 876, *1622 way conducive pulling body, instead ripping One testified: "If have good reach starts come think accomplish delivery, then my bit differently. don't close quite much, gently draw tissue attempting if possible." 74. Rotating being decreases odds dismemberment. 868-869; 40-41; 5 1469. "may grasp part, down, re-grasp higher levelsometimes using both his hand forcepsto exert traction retrieve head [cervix]." 886-887. gained public notoriety when, 1992, Dr. Martin Haskell gave presentation operation. 110-111. lodges insufficient allow pass. ibid.; 577; 74, 282. explained next step follows: "`At point, right-handed surgeon slides fingers left [hand] along "hooks" shoulders index ring (palm down). "`While maintaining tension, lifting applying hand, takes pair blunt curved Metzenbaum scissors right hand. He carefully advances tip, spine middle finger he feels contact base skull tip finger. "`[T]he forces foramen magnum. Having safely entered skull, spreads enlarge opening. "`The removes introduces catheter hole evacuates contents. With still place, removing patient.'" H.R.Rep. 108-58, 3 (2003). doctor's clinical description. Here another description nurse witnessed same 26½-week testified Senate Judiciary Committee: "`Dr. went grabbed baby's legs down birth canal. Then armseverything head. kept inside . were clasping unclasping, feet kicking. stuck head, arms jerked out, startle reaction, flinch, baby when thinks going fall. opened scissors, high-powered tube opening, sucked brains out. Now limp. "`He cut cord placenta. threw *1623 pan, used.'" Ibid. Haskell's killing once "the evolved" since presentation. Another squeezes pierced "so enough brain exudes pass through." 41; 866-867, 874. Still physicians crush skull. 858, 881. Others continue disarticulates neck, effect decapitating forceps, remove 864, 878; without collapsing 866, 869. one would delivery live younger than 24 weeks because objective [his] birth. 408-409. answered affirmative asked whether "hold internal side [cervix] order collapse skull" born. 409; 862, 878. crushes reduce size dead staff deal "some viability movement limbs," according "[is] always difficult situation." 94; 858. methods. abort induction. medicates induce labor, deliver Induction, unlike hospital, last 6 hours 48. accounts about five 20 gestation weeks. turn abortion, hysterotomy hysterectomy, emergency situations they carry increased complications. hysterotomy, cesarean section, making incision abdomen uterine wall gain access cavity. hysterectomy requires represent .07% 467; 962-963. B received attention, ensuing increasing concern, "`partial abortion'" proliferated. By decision, 30 enacted designed prohibit U.S., 995-996, nn. 12-13, 2597 (THOMAS, J., dissenting); 4-5. 1996, Congress acted ban partial-birth abortion. President Clinton vetoed congressional legislation, failed override veto. approved bill banning 1997, again 2003, decision passed here. 12-14. On 5, *1624 Bush signed law. following day. 1531(a) IV). responded ways. First, made factual findings. determined "was required accept very questionable findings issued district judge," 2(7), 117 Stat. 1202, notes 768, ¶ (7) (Congressional Findings), "not bound findings," ibid., (8). found, among things, "[a] moral, medical, ethical consensus exists practice gruesome inhumane never medically prohibited." 767, (1). Second, relevant Act's language differs Nebraska struck Stenberg. 921-922, (quoting Neb.Rev.Stat. Ann. §§ 28-328(1), 28-326(9) (Supp.1999)). provide part: "(a) Any who, affecting interstate foreign commerce, knowingly performs thereby kills human shall fined title imprisoned 2 years, both. subsection apply save life mother whose endangered physical disorder, illness, injury, life-endangering condition caused arising itself. enactment. "(b) As section "(1) `partial-birth abortion' means person abortion "(A) deliberately intentionally vaginally delivers living until, case head-first presentation, outside mother, or, breech trunk past navel purpose overt act knows partially fetus; "(B) act, completion "(2) `physician' medicine osteopathy legally authorized surgery State activity, abortions: Provided, however, That otherwise abortions, nevertheless directly section. "(d)(1) defendant accused offense section seek hearing Board physician's conduct admissible defendant. Upon motion defendant, delay beginning *1625 permit place. "(e) upon whom prosecuted conspiracy violate 2, 3, 4 based violation section." includes provision authorizing civil actions relevance 1531(c). C concluded unconstitutional reasons. lacked exception allowing where health mother. 1004-1030. deficient covered merely certain Es. 1030-1037. lack exception. F.3d, 803-804. began analysis saw question"whether `substantial authority' supports necessity banned procedure." 796 938, 2597). proper framework, Appeals, "when community, Constitution legislatures err protecting women's exception." 796. rejected General's demonstrate changed evidentiary circumstances itself Stenberg's conclusion required. 803 (explaining "[t]he record [the] [were] significant respects"). invalidated "because (1) pose[d] undue burden ability choose abortion; (2)[was] unconstitutionally vague; (3) require[d] set forth Stenberg." 1034-1035. agreed. Like Circuit, absence rendered unconstitutional. interpreted unless "there preserve women." 1173. Even deferential review Congress' findings, "substantial disagreement regarding whether" ever health. 1175-1176. further obtain textual differences distinguish 1178-1180. result, imposed 1180-1181. Finally, void vagueness. 1181. uncertain *1626 criminal. did offer clear warning regulatory reach. 1181-1184. Resting understanding remedial framework established Ayotte Eng., 320, 328-330, 961, 163 812 (2006), face permanently enjoined. 1184-1191. II principles joint Southeastern Pa. Casey, 505 833, 112 2791, 674 find support join opinion. 979-1002, 2791 (SCALIA, joined THOMAS, inter alios, concurring judgment dissenting part). Whatever one's views Casey opinion, evident premise central conclusionthat government legitimate substantial interest preserving promoting lifewould repudiated now affirm judgments Appeals. challenge Roe Wade, 410 113, 93 705, 35 (1973). contains summary: "It stated clarity Roe's holding, holding we reaffirm, parts. First recognition interference State. Before viability, State's interests strong prohibition imposition obstacle effective elect confirmation power restrict law exceptions pregnancies endanger And third principle become child. do contradict another; adhere each." 846, (opinion Court). Though holdings implicated cases, extended discussion; determine furthers Government implement rigid interpretation previability regulations unwarranted. 875-876, 878, (plurality opinion). point overruled undervalued potential life. 881-883, (joint opinion) (overruling Thornburgh American College Obstetricians Gynecologists, 476 747, 106 2169, 779 (1986) Akron Center Reproductive Health, 462 416, 103 2481, 76 687 (1983)). assume ultimate her pregnancy." 879, impose burden, regulation's "purpose path *1627 seeking attains viability." 2791. "[r]egulations create structural mechanism State, parent guardian minor, express profound permitted, exercise choose." 877, short, balance. balance holding. bar. III begin determination effect. straightforward reading text demonstrates scope provisions: regulates proscribes, qualifications discussed, agree encompasses contend additional unclear excessive. assert that, least, vagueness indefinite. alternative, argue Because method, suggest imposes burden. litigation vagueness, overbreadth, invalid face. punishes "knowingly perform[ing]" abortion." defines unlawful explicit terms. 1531(b)(1). "vaginally delive[r] fetus." 1531(b)(1)(A). involving expired furthermore, inapplicable involve vaginal (for instance, hysterectomy). postviability because, scientific terminology, organism within womb, viable womb. 971-972. understand contested parties. definition "until, mother." 1531(b)(1)(A) concedes, agree, "anatomical `landmarks'"where, either motherthe prohibitions apply. Brief Petitioner 46. Third, fall "overt 1531(b)(1)(B) criminal liability, causing death separate delivery. *1628 anatomical landmark. delivered" which, read context, Fourth, scienter requirements with, "deliberately intentionally" landmarks. If critical accident inadvertence, inapplicable. addition, "for [doctor] [it]." intent absent, crime occurred. follows committed absent requisite mind. generally W. LaFave, Substantive Criminal Law 5.1 (2d LaFave); Torcia, Wharton's 27 (15th ed.1993). described above indeterminate, vague "As stated, void-for-vagueness doctrine penal define definiteness ordinary people encourage arbitrary discriminatory enforcement." Kolender Lawson, 461 352, 357, 1855, 75 903 (1983); Posters `N' Things, Ltd. States, 511 513, 525, 114 1747, 128 539 (1994). satisfies requirements. provides "of intelligence reasonable opportunity Grayned Rockford, 408 104, 108, 92 2294, 33 222 (1972). Indeed, sets "relatively guidelines conduct" "objective criteria" evaluate 525-526, 1747. Unlike statutory "`substantial portion'" fetus question portionthe line potentially lawful other. 922, Neb. Rev.Stat. landmark liability. buttressed proved alleviate concerns. 526, 1747; Colautti Franklin, 439 379, 395, 99 675, 58 596 (1979) ("This long recognized closely related incorporates requirement mens rea"). liability she beyond mistake, cannot "a trap faith." Colautti, *1629 S.Ct. 675 (internal quotation marks omitted). likewise show encourages Kolender, 1855. Just landmarks standards, "establish minimal govern Smith Goguen, 415 566, 574, 94 1242, 39 605 (1974). narrow limit prosecutorial discretion. said "vests virtually complete discretion hands [law enforcement] satisfied [its provisions]." 358, 1855 (invalidating loitering). Respondents' arguments enforcement, somewhat speculative. preenforcement challenge, "no been, could be, introduced indicate [Act] enforced aim inhibiting [constitutionally protected conduct]." Hoffman Estates Flipside, Estates, 455 489, 503, 102 1186, 71 362 (1982). vague. matter, restrictions too broad. discloses limits prohibits E; notwithstanding respondents' arguments, removed dual correspond undertaken during type usually proceeds pierce forceps. overt-act distinct 1531(b)(1)(B). requirements, intending undertake outset. excludes pieces, intact. intends outset, incur "tak[e] 10-15 `passes' Removing partial 1531(b)(1) comparison confirms point. "`deliberately delivering vagina child, portion thereof, *1630 child child.'" Neb.Rev. encompassed portion' say, arm leg, prior 939, 2597. limiting urged Nebraska's statute's reference "procedure" "`kill[s] child'" procedure, whole. 943, Congress, apparent, concerns departs ways adopts phrase "delivers fetus," "`delivering thereof,'" language, expresses meaning "deliver" connection "fetus," namely, rather pieces. Stedman's Dictionary 470 (27th ed.2000) (defining "[t]o assist childbirth" extract enclosed object body"); I. Dox, Melloni, Eisner, HarperCollins Illustrated 160 (4th ed.2001); Merriam Webster's Collegiate 306 (10th ed.1997). displaces "delivering" dictated portion" 944, (indicating "statute specifies `an child' `a thereof'"). interpreting texts terms context result. 2A N. Singer, Sutherland Statutes Statutory Construction 47:28 (rev. 6th ed.2000). Here, departure meaning. identification differentiates include leg. landmarks, contrast, clarify small prohibited. "outside ambit statute, vagina; sanctions. 938-939, adding meet Compare IV) (Supp.1999). makes distinction (but advanced) differentiating overall *1631 943-944, fatal landmark, something "other delivery." matters followed act. canon constitutional avoidance, finally, extinguishes lingering doubt covers prototypical elementary rule every construction resorted to, unconstitutionality.'" Edward DeBartolo Corp. Florida Gulf Coast Building Constr. Trades Council, 485 568, 575, 108 1392, 645 (1988) Hooper 155 648, 657, 207, 297 (1895)). true longstanding maxim has, past, fallen wayside confronted times employed antagonistic "`canon permissible [was] avoided costs.'" 977, (KENNEDY, dissenting) Thornburgh, 829, 2169 (O'Connor, dissenting)). put novel rest. dissenting). need revived stand uncontroversial proposition avoidance "genuinely susceptible constructions." Almendarez-Torres 523 224, 238, 118 1219, 140 350 (1998); Clark Martinez, 543 371, 385, 125 716, 734 938-945, Contrary unavailing. look arise examined contendrelying testimony doctorsthat result fraction cases. so, predict degree commit posit beforehand proceed Respondent 38. reasoning, account preclude attaching accidental nonetheless points, present. When situation completes *1632 inferred "knows practically follow conduct." LaFave 5.2(a), 341. "is from" conduct. number legislative almost choice happenstance. Doctors, chances 452. serial 110. far occasions. 857-858 ("In basis, Fitzhugh patients round laminaria"). belies claim foreseeing Many behalf respondents, objected accident. contrary, 869 ("Since Chasen believes safer dismemberment Chasen's goal time"); 873, prove, suggest, therefore intend adjust points. shown requiring vast majority then, grounds. IV Under accepted controlling "if affected postviability; quoted relies applicable. measured attack, late-term, previability, obstacle, reject validity. recitals provisions. rationale killed inches *1633 process. "Implicitly approving brutal choosing coarsen society humanity newborns, vulnerable innocent increasingly protect life." Congressional Findings (14)(N), 769. dignity concerned, effects reputation explain: "Partial-birth confuses legal, duties promote acts delivered, end (14)(J), ibid. "has integrity ethics profession." Washington Glucksberg, 521 702, 731, 2258, 138 772 (1997); Barsky Regents Univ. Y., 347 442, 451, 74 650, 98 829 (1954) "legitimate concern high standards professional medicine). precedents role play profession. reaffirmed governmental objectives. voice authority "undervalue[d] opinion); 871, plurality indicated fact serves valid purpose, strike itself, incidental expensive procure invalidate it." 874, idle assertion. premises coexist. premise, inception maintains naught Casey's becomes tantamount prefer. Where rational basis bar substitute others, furtherance profession unborn. Government's No many, laden devalue proscribed regulation implicates moral justify special prohibition. "disturbing similarity newborn infant," (14)(L), 769, concerned "draw[ing] *1634 bright clearly distinguishes infanticide." (14)(G), confirmed drawing boundaries prevent practices extinguish condemned. Glucksberg "fear permitting assisted suicide start voluntary perhaps involuntary euthanasia." 732-735, 23, 2258. Respect finds expression bond love recognizes reality well. Whether painful decision. 852-853, While reliable data measure phenomenon, seems unexceptionable women regret infant created sustained. Sandra Cano Amici Curiae 22-24. Severe depression loss esteem follow. fraught emotional consequence prefer disclose details used, confining themselves statement risks entails. From standpoint ought surprising. facing imminent hear details, lest anxiety invasive intense. likely here issue. 466, 22 ("Most [the plaintiffs'] experts acknowledged describe E] entail terms"); 479. is, precisely information ("States free enact laws lasting meaning"). ensuring grave well informed. self-evident comes struggle grief anguished sorrow learns, event, know: allowed fast-developing assuming form. inference knowledge conveys term, reducing absolute late-term profession, less shocking accommodating demand. advanced dialogue better informs political legal systems, expectant mothers, whole consequences respects brutal, more, legislation accomplishes little. What already said, shows ample justification regulation. Partial-birth defined former *1635 occurs "undermines public's perception process, perverts world." (14)(K), flaw logic, irony jurisprudence, overbroad irrational proscribe sum, contention "to bears upon, resolve, question: imposing barred "`necessary, judgment, preservation mother.'" Ayotte, 327-328, 961 opinion)). controlling, "subject[ed] [women] risks." 328, 961; parties agreed parental-involvement avert serious irreversible damage [a pregnant minor's] health." creates question. presented sides position. safest reasons adduced 932, testified, cervical laceration perforation bony fragments dismembered sharp. reduces complete. Respondents, proffered conditions fetuses anomalies. 923-929; 470-474; 982-983. contentions contradicted Congress. alleged advantages speculation studies them. safe alternative. 930-940; 983. *1636 documented women. 1033 ("[T]here division highly qualified safety E"); 482. appeared sometimes, 1017, California conclusion. 1002, (finding "under significantly disarticulation"). skeptical purported benefits "expert witnesses reasonably effectively refuted bases [intact over procedures." believe many why credible; [it be] theoretical false." 480. holds induction (however hypothetical unsubstantiated evidence) circumstances." uncertainty persists. instruct survive attack. given wide areas uncertainty. Kansas Hendricks, 346, 360, 2072, 501 Jones 463 354, 364-365, 13, 370, 3043, 77 694 Lambert Yellowley, 272 581, 597, 47 210, 422 (1926); Collins Texas, 223 288, 297-298, 32 286, 56 (1912); Jacobson Massachusetts, 197 11, 30-31, 49 643 (1905); 969-972, Marshall 414 417, 427, 700, 38 618 (1974) ("When undertakes uncertainties, options broad"). traditional consistent Physicians entitled ignore direct give unfettered course practice, nor elevate status community. informed-consent 884, doctor-patient relation solicitude receives contexts." Ibid.; Webster Health *1637 Services, 492 490, 518-519, 3040, (1989) (criticizing alia, "left serve country's ex officio board powers approve disapprove throughout States" omitted)); Mazurek Armstrong, 520 968, 973, 1865, 162 (1997) (per curiam) (upholding restriction performance licensed despite "all contradicts law" omitted)). foreclose contexts. 2072. supported considerations. Alternatives available noted, extremely low rates 1000, "generally trimester." 1031; 467-468 "[e]xperts testifying sides" safe). truly circumstances, appears injection allows Central Mo. Danforth, 428 52, 77-79, 96 2831, 788 (1976), saline amniocentesis, then-dominant method. Danforth "an unreasonable inhibit, having inhibiting, 12 weeks." 79, 2831. allows, means, commonly construct right. reaching urges uphold alone. 23. factfinding standard, dispositive weight retains independent duty rights stake. Crowell Benson, 285 22, 60, 52 285, 598 (1932) enforce rights, judicial necessarily extends questions, law, supreme function"). recognized, *1638 factually incorrect. 482, 488-491. accurate time, important superseded. Two examples suffice. schools instruction (14)(B), Courts, demonstrated taught schools. 490; 1029. existed necessary. (1), 767. 1012-1015, 2597; 488-489; 1025-1026. Uncritical deference inappropriate. relying contain health.'" 19 2597); (same). illustrated decisions leave margin error 796; 1173; 296 (Walker, concurring) insurmountable hurdle"). zero tolerance policy regulations, present one, disinclined proscription. exacting power, exercised instance Commerce Clause, Considerations marginal safety, risks, competence pursuit ends. available, mere convenience suffice displace them; altogether regulations. health, availability alternatives. V considerations discussed attacks entertained instance. as-applied challenge. preenforcement, challenges maintained. Tr. Oral Arg. 21-23. discrete well-defined used. *1639 nature quantified balanced latitude Amendment Broad heavy burden" suit. Rust Sullivan, 500 173, 183, 111 1759, 233 (1991). consists statutes Ohio 497 502, 514, 110 2972, 405 (1990) ("[B]ecause appellees valid" omitted)), 895, Court) spousal-notification "in large [it] relevant" facially invalid). Janklow Sioux Falls Clinic, 517 1174, 116 1582, 134 679 (1996). resolve debate. previous sections explain, note proposes suffers neither obligation institutional questions develop. "[I]t indeed undesirable conceivable possibly application complex legislation." Raines, 17, 21, 80 519, 524 (1960) reason, "[a]s-applied basic building blocks adjudication." Fallon, As-Applied Facial Challenges Third-Party Standing, 113 Harv. L.Rev. 1321, 1328 (2000). open case. Cf. Wisconsin Right Life, Inc. Federal Election Comm'n, 410, 411-412, 1016, 990 (2006) curiam). threatens * overbreadth Circuits reversed. ordered. SCALIA joins, concurring. accurately current (1992). write separately reiterate view (1973), Constitution. 979, *1640 part); 980-983, (2000) constitutes Clause raise brief issue; presented; lower address Cutter Wilkinson, 544 709, 727, 2113, 161 1020 (2005) concurring). GINSBURG, STEVENS, SOUTER, BREYER join, dissenting. 844, declared "[l]iberty refuge jurisprudence doubt." was, "imperative" dispel reach" 7-to-2 nearly decades earlier 845, Responsive need, endeavored secure guidance "[s]tate Union," defining respecting termination Taking care speak plainly, restated 845-846, viability. State." (emphasis added). child." reaffirming Roe, centrality bear child," Eisenstadt Baird, 438, 453, 1029, 31 349 (1972), "dignity autonomy," "personhood" "destiny," "conception society." 851-852, signal importance unmistakable procedures, woman." Seven years ago, criminalizing arena, dubbed abortion."[1] fidelity Roe-Casey precedent, *1641 protection 930, cf. 327, Today's alarming. refuses seriously. tolerates, applauds, intervention nationwide Gynecologists (ACOG). blurs line, firmly drawn And, blesses safeguarding dissent disposition. Retreating rulings upholds surely scrutiny attended state-decreed limitations reproductive choices. comprehended, stake challenging "control [own] destiny." 869, (majority opinion).[2] "There ago," "regarded center home family attendant responsibilities precluded Constitution." 896-897, Hoyt Florida, 368 57, 62, 82 159, 7 (1961)). Those views, "are family, individual, 897, Women, acknowledged, talent, capacity, participate equally economic social Nation." Their realize potential, intimately connected "their control lives." Thus, vindicate generalized notion privacy; rather, autonomy life's enjoy equal citizenship stature. Siegel, Reasoning Body: Historical Perspective Regulation Questions Equal Protection, 44 Stan. 261 (1992); Law, Rethinking Sex Constitution, 132 U. 955, 1002-1028 (1984). keeping comprehension choice, consistently safeguard ("[O]ur hold. necessary, [woman]." opinion))); *1642 validate regulation, minimum regulation."). 768-769, post-viability "fail[ure] woman's] paramount consideration"). ruled avoid subjecting danger, resort (1976) (holding "force[d] dangerous health"). 931, ("[Our cases] happens barring entirely."). applied hereintact evacuation E).[3] expressly 937, noted "division opinion" relative health," required, explained: "The word `necessary' `necessary, *1643 [pregnant woman],' proof. treatments (or inappropriate) light estimated comparative (and benefits) Neither estimation treatment. words `appropriate judgment' embody tolerate responsible ." (citation reasoned, "at uncertainty, factor signals presence risk, absence." "[A] forbids E]. consequently 948, ("Th[e] renders unconstitutional."). ruling Actwithout IV).[4] rests withstand inspection, obliged concede. Ante, 1637-1638. National 436, 482 (S.D.N.Y.2004) ("Congress arriving findings."), aff'd sub nom. (C.A.2 2006). 957, 1019 (N.D.Cal.2004) ("[N]one six Several services all; obgyn. [T]he oral unbalanced, polemic."), aff'd, (C.A.9 2006); 805, 1011 (Neb.2004) arbitrarily claimed little) recent experience disregarded procedures."), (C.A.8 2005). ante, 2(14)(B), 1204, (14)(B) Findings). But fact, leading teach 1029; ACOG Amicus ("Among variant Columbia, Cornell, Yale, University, Northwestern, University *1644 Pittsburgh, Pennsylvania, Rochester, Chicago."). More important, "very demonstrate[d] opposite." 1025. 1008-1009 compiled. opposition. anything establishes `consensus' favor procedure."); 488 ("The undermines [Congress'] finding" Similarly, "[t]here credible letters stating jeopardized statements nine associations, ACOG, Public Association, attesting carries meaningful 490. 1021 chose disregard organizations."). comparable groups ban. government's disagreed findings." 1024. contrast trials best evidence. benefit "much Es." 1014; (District "heard span eight years."). During trials, "numerous" "extraordinarily accomplished" experienced" women, 1024-1027; 1001 ("[A]ll actually option techniques, necessary."); 1635 ("Respondents Stenberg."). According expert plaintiffs introduced, marked conditions, *1645 scarring, bleeding disorders, heart disease, compromised immune systems. 924-929, 1026-1027; 472-473; 992-994, 1001. Further, plaintiffs' pregnancy-related previa accreta, carrying abnormalities, severe hydrocephalus. 924, 473-474; 929, 13-16. explained, several reasons: minimizes uterus, trauma of, uterusthe complication associated nonintact 923-928, 1025; 471; 982, intact, dismembering utero, likelihood retained infection, hemorrhage, infertility. 1025-1026; 472; diminishes exposing patient's tissues sharp 1026; operating dismemberment, bleeding, complications relating anesthesia. 928-929, 11-13. Based thoroughgoing record, 1008-1027; 488-491; 1032. concluded, "significant accord 1008-1009, 1017-1018; 480-482;[5] ("[T]he *1646 procedure."). merit respect. Fed. Rule Civ. Proc. 52(a); Salve Regina Russell, 499 225, 233, 1217, 190 supplies reason Nevertheless, appraisal evidence, undisguised conflict asserts persists." 1636. assertion bewildering. Not defy precedent affirming exception, carve-out 1641-1642; gives shrift records us, canvassed Courts. highly-qualified safest, 1034. 1644-1645. acknowledges 1635, insists experts' assessment stand. 1635-1636, 1638-1639. insistence, brushes rug well-supported slim opinions. training for, personal rare 980; 462-464. indulging assumption erase support[ing] 2597.[6] offers flimsy transparent justifications upholding *1647 sans ruling, declares, [Casey's] conclusion"i.e., 1625-1626. 1626 ("[W]e child."). scarcely interest: saves single destruction, targets lives 951, (GINSBURG, concurring); (recognizing interes[t]. woman" added)). doing nothing "preserv[e] life," 1626, bars although "reasonably [that procedure] [her]." 946, (STEVENS, ban, emphasizes 1637. not, ask. Nonintact characterized "brutal," 1633, "tear[ing] fetus] apart" "ripp[ing] off" limbs, 1620-1621, 1621-1622. "[T]he akin infanticide other, simply irrational." 946-947, Delivery albeit nonviable, warrants condemnation, maintains, resembles infant. 1633-1634. terminated evacuation, 1621, 1637-1638, cesarean, 1644. Yet, proceduresalong dismembermentthe says, declaration unconstitutionality. Never mind deemed acceptable risk. 1646, 6; 1635-1636. Ultimately, admits "moral concerns" work, yield 1633-1634 could. prohibition."). Notably, expressed untethered ground genuinely serving case, overriding fundamental dishonors precedent. 850, ("Some individuals offensive morality, Our liberty all, mandate code."); Lawrence 558, 571, 123 2472, 156 508 (2003) (Though "[f]or persons [objections homosexual conduct] trivial *1648 deep convictions principles," law." (citing 2791)). Revealing regard, invokes antiabortion shibboleth concededly evidence: Women choices, suffer "[s]evere esteem." 1634.[7] fragile "bond worries, withhold 1633-1634.[8] solution approves, *1649 inform adequately, risks. meaning."). Instead, deprives autonomous expense safety.[9] thinking reflects ancient notions Constitutionideas discredited. Compare, Muller Oregon, 208 412, 422-423, 28 324, 551 (1908) ("protective" hours-of-work "physical structure discharge maternal funct[ion]"); Bradwell 16 Wall. 130, 141, 21 442 (1873) (Bradley, ("Man protector defender. natural timidity delicacy belongs female sex evidently unfits occupations destiny mission fulfil[l] noble benign offices wife mother."), Virginia, 518 515, 533, 542, 12, 2264, 135 735 (1996) (State rely "overbroad generalizations" "talents, capacities, preferences" women; "[s]uch have. impeded progress toward stature Nation's history"); Califano Goldfarb, 430 199, 97 1021, 51 270 (1977) (gender-based Social Security classification rested "archaic "such assumptions [women's] dependency" today's regard feelings matter "self-evident," 1634, repeatedly shaped conception spiritual imperatives ("[M]eans chosen calculated hinder it."); 1641-1642. "woman's [continue] pregnancy," identified consideration. 869-870, "[T]here [more workable] *1650 viability," realistic possibility nourishing existence fairness overrides broad sense fails consented developing Today, [legitimately] appl[ies] womb." 1627. Instead differentiate "abortion infanticide" anatomically located performed. 769). wonders destruction hold concerns." 1647; 1627 (noting "[i]n litigation" "does E"). hostility secured concealed. Throughout, obstetrician-gynecologists surgeons titles specialties, pejorative label doctor." 1625, 1631, 1632, "unborn "baby," 1620, 1622-1623; second-trimester, "late-term," 1632; reasoned trained dismissed "preferences" motivated "mere convenience," 1638. heightened applied, determines "rational" 1633-1634, troubling, principles, confirming vitality Roe," "assume[d]" moment, "retained" "reaffirmed," declares "facial attacks" "these circumstances," i.e., exists. 1638; attack."). perplexing materially identical lacking (in bring patients" Sabri 541 600, 609-610, 124 1941, 158 891 (2004) setting challenges); Making Sense Overbreadth, 100 Yale L.J. 853, 29 (1991) *1651 ("[V]irtually statutes, Court, accepting rejecting merits, typically framing presented."). Accord 1356 (2000); Dorf, Statutes, 46 235, 271-276 Without decisions, survives cases." 1639 2791). determining poses "large fraction" class women," "seeking abortions." Rather, restricting "must judged actual irrelevant restriction," Thus burdens relevantwomen risk.[10] 934, (accepting "relative rarity" "highly relevant"for infrequent occasions"); (facial ... immediate serious, unnecessary: exceptional redemptive willing entirely open," states, case." 1639; maintained."). clue "proper" lawsuit like. Nor explain injunctions ordered trimmed exclude Surely mean immediately "suffer[ing] complications," 1639, needs *1652 wait unfold. appears, contemplate initiators actions. round, suggests, challengers succeed demonstrating used." anticipate mounted swiftly, ward irremediable harm, envisions balanced." escape notice hundreds pages identifying "discrete instances" recourse conditions. Record documents exigencies, unpredictable advance, well-trained unanimous ago counsels reversal. 331, (remanding reconsideration remedy suggesting prohibiting applications suffice). allowance "as-applied case," 1639jeopardizes places untenable able piecemeal instances," 1638, anticipated unprotected. treating prosecution, conviction, imprisonment patients. gravely mistaken wrote "overruling unjustifiable stare decisis, seriously weaken capacity function Nation dedicated concept underlying continuity definition, indispensable." 854, 867, ("[T]o overrule fire compelling reexamine watershed subvert legitimacy question."). go discard differently composed restrictive hardly faithful invocations "principles decisis." 1643, 4. crucible *1653 defers Constitution-based rulings. 1643-1644. staying power. simply, irrational. defense saving explanation. candor, understood effort chip away Court lives. 1641, vehicle legislators expressing undue." 952, Hope Clinic Ryan, 195 857, 881 (C.A.7 1999) (Posner, disposition review. NOTES [1] abortion" literature 964 (N.D.Cal.2004), X) (intact 1621; 927, [2] impact liberty. focus considerable "vindicat[ing] administer treatment judgment." 165, 705. [3] E) frequently pregnancy; 1621-1622; 966. Second-trimester (i.e., midpregnancy, abortions) are, relatively uncommon. 1620. 923-927, 464 (S.D.N.Y.2004), Adolescents indigent research difficulty obtaining Minors unaware late poor financial constraints timely receipt services. Finer, Frohwirth, Dauphinee, Singh, Moore, Timing Steps Reasons Delays Obtaining Abortions Contraception 334, 341-343 Drey Risk Factors Associated Presenting Trimester, 107 128, 133 (Jan.2006) (concluding discover pregnant). anomalies problems confronting abortions; diagnosed develop 344; 242, 290, 328-329, ed.2005); Schechtman, Gray, Baty, Rothman, Decision-Making Termination Pregnancies Anomalies: Analysis 53,000 Pregnancies, 216, 220-221 (Feb.2002) (nearly nervous system pregnancies). [4] sponsors intention nullify 743. 149 Cong. Rec. 5731 (statement Sen. Santorum) ("Why here? defended indefensible. Court."). 148 14273 (2002) Rep. Linder) (rejecting legislate horrible says cannot"). [5] recognized: Congress's findings"; "[p]rofessional associations women"; indicates considering contrary." 480-482. [6] contends "[i]f inducing inappropriate undergoing tangible 1028 omitted), injections "absolutely [medically] contraindicated." 1027. 474-475; 995-997. identifies labor hospital stay, rendering inaccessible resources, impermissible others. 940-949, 1017; 468-470; 1000-1002. [7] correct painfully "neither date observable comports idea long-term mental parenting Mental Health: Myths Realities, 9 Guttmacher Policy Rev. 8 (2006); Bazelon, Is Post-Abortion Syndrome? N.Y. Times Magazine, Jan. 2007, 40. also, Psychological APA Briefing Paper Impact theory postabortion syndrome "[a]ccess unwanted vital women"); Schmiege Russo, Depression Unwanted Pregnancy: Longitudinal Cohort Study, British 1303 contributes subsequent depression); Gilchrist, Hannaford, Frank, Kay, Pregnancy Psychiatric Morbidity, 167 Psychiatry 243, 247-248 (1995) (finding, cohort 13,000 rate psychiatric disorder carried term); Stodland, Myth Trauma Syndrome, 268 JAMA 2078, 2079 (1992) ("Scientific results deleterious sequelae compared possible outcomes syndrome."); Council Manual: (N)(I)(3), Interest (declaring assertions widespread negative psychological "without fact"). Cougle, Reardon, Coleman, Generalized Anxiety Following Unintended Resolved Through Childbirth Abortion: Study 1995 Survey Family Growth, Disorders 137, 142 (advancing acknowledging causal relationship outcome determined" study); Reardon Admissions Low-Income Childbirth, 168 Canadian Assn. 1253, 1255-1256 (May 2003) admission delivered); Major, Implications AbortionHighly Charged Rife Misleading Research, 1257, 1258 (critiquing study failing host samples). [8] Notwithstanding love" children, pregnancies, wanted, product consensual activity. 891, ("[O]n average 11,000 severely assaulted male partners. incidents sexual assault."). Glander, Michielutte, Parsons, Prevalence Domestic Violence Among Seeking Abortion, 91 1002 Holmes, Resnick, Kilpatrick, Best, Rape-Related Pregnancy; Estimates Descriptive Characteristics Sample 175 (Aug. 1996). [9] Eliminating choices manifestly cease option, coerced pregnancies. World Organization, Unsafe Global Regional Incidence Mortality 2000, ed. 2004) ("Restrictive incidence unsafe worldwide; represents 13% "maternal" deaths); Henshaw, Perspective, (M. Stubblefield ("Before legalization, numbers died abortions."); Boonstra, Gold, Richards, Women's Lives fig. 2.2 ("as 1965, illegal accounted 17% officially reported deaths"; "[d]eaths declined dramatically legalization"). [10] numerator denominator same: reaches Perhaps mandating safeguards invoked test.

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