Document: 462 U.S. 416 103 S.Ct. 2481 76 L.Ed.2d 687 CITY OF AKRON, Petitioner,v.AKRON CENTER FOR REPRODUCTIVE HEALTH, INC., et al. AKRON al., Petitioners v. Nos. 81-746, 81-1172. Argued Nov. 30, 1982. Decided June 15, 1983. Syllabus An Akron, Ohio, ordinance, inter alia, (1) requires all abortions performed after the first trimester of pregnancy to be in a hospital (§ 1870.03); (2) prohibits physician from performing an abortion on unmarried minor under age 15 unless he obtains consent one her parents or order court having jurisdiction over that 1870.05(B)); (3) attending inform his patient status pregnancy, development fetus, date possible viability, physical and emotional complications may result abortion, availability agencies provide with assistance information respect birth control, adoption, childbirth 1870.06(B)), also particular risks associated technique employed 1870.06(C)); (4) until 24 hours pregnant woman signs form 1870.07); (5) physicians ensure fetal remains are disposed "humane sanitary manner" 1870.16). A violation ordinance is punishable as misdemeanor. Respondents cross-petitioners filed action Federal District Court against petitioners cross-respondents, challenging ordinance. The invalidated §§ 1870.05(B), 1870.06(B), 1870.16, but upheld 1870.03, 1870.06(C), 1870.07. Appeals affirmed reversed 1870.06(C) Held: 1. Section 1870.03 unconstitutional. Pp. 431-439. (a) While State's interest health regulation becomes compelling at approximately end trimester, only if it reasonably designed further interest. If during substantial portion second departs accepted medical practice, not simply because reasonable for remaining trimester. Rather, State obligated make effort limit effect its regulations period which furthered. 433-434. (b) It cannot said lines drawn § reasonable. By preventing performance dilatation-and-evacuation appropriate nonhospital setting, Akron has imposed heavy unnecessary burden women's access relatively inexpensive, otherwise accessible, safe procedure. inhibiting vast majority therefore unreasonably infringes upon woman's constitutional right obtain abortion. 434-439. 2. 1870.05(B) unconstitutional making blanket determination minors too immature decision never minor's best interests without parental approval. Under circumstances where Ohio statute governing juvenile proceedings does mention minors' nor suggest Juvenile authority inquire into maturity emancipation, applied proceedings, susceptible being construed create opportunity case-by-case evaluations minors. 439-442. 3. Sections 1870.06(B) 442-449. validity informed requirement rests protecting health. But this mean unreviewable decide what must given before she chooses have adopt influence choice between childbirth. 442-444. attempts extend ensuring "informed consent" beyond permissible limits, intrudes discretion physician. require certain understands implications goes far merely describing general subject matter relevant consent. insisting recitation lengthy inflexible list information, section placed obstacles path 444-445. (c) With 1870.06(C)'s "attending physician" specified unreasonable insist competent counseling 446-449. 4. 1870.07 failed demonstrate any legitimate state furthered by arbitrary waiting period. There no evidence procedure will m re safely. Nor appear concern served requiring 24-hour delay course. Pp.449-451 5. 1870.16 violates Due Process Clause failing give fair notice contemplated conduct forbidden. 451-452. 651 F.2d 1198 (6th Cir., 1981), part part. Alan G. Segedy, City Akron. Sol. Gen. Rex E. Lee, Washington, D.C., amicus curiae, special leave Court. Stephan A. Landsman, Cleveland-Marshall College Law, Cleveland University, Cleveland, Center Reproductive Health, Inc., Justice POWELL delivered opinion 1 In litigation we constitutionality several provisions enacted city regulate abortions. Today review Missouri, see Planned Parenthood Ass'n Kansas City, Mo., Inc. Ashcroft, --- ----, 2517, 75 Virginia, Simopoulos ---- 2532, ----. 2 These cases come us decade held Roe Wade, 410 113, 93 705, 35 147 (1973), privacy, grounded concept personal liberty guaranteed Constitution, encompasses whether terminate pregnancy. Legislative responses Court's required occasions, again today, define limits And arguments continue made, these well, erred interpreting Constitution. Nonetheless, doctrine stare decisis, while perhaps entirely persuasive question, demands society governed rule law.1 We reaffirm Wade. 3 * February 1978 council Ordinance No. 160-1978, entitled "Regulation Abortions."2 sets forth 17 abortions, Codified Ordinances ch. 1870, five issue case: 4 (i) hospital.3 5 (ii) 1870.05 requirements notification minors.4 6 (iii) 1870.06 statements "to insure truly consent."5 7 (iv) time performed.6 8 (v) "disposed humane manner."7 9 criminal 1870.18. provision invalidated, severed remainder ordinance.8 became effective May 1, 1978. 10 On April 19 1978, lawsuit virtually ordinance's was Northern Ohio. plaintiffs, respondents Court, were three corporations operate clinics who clinics. defendants, cross-respondents here, officials ("Akron"). Two individuals ("intervenors") permitted intervene co-defendants "in their individual capacity daughters child-bearing age." 479 F.Supp. 1172, 1181 (ND 1979). 27, preliminarily enjoined enforcement 11 August 1979, hearing evidence, ruled merits. found plaintiffs lacked standing challenge seven none four provisions, including (parental consent), (requiring disclosure facts concerning development, available assist woman), (disposal remains). (hospitalization trimester), employed), (24-hour period). 12 All parties appealed some judgment. Sixth Circuit (CA6 1981). 1870.03's hospitalization constitutional. ruling 1870.05, 1870.07, finding 13 Three separate petitions certiorari filed. light importance issues presented, conflicting decisions second-trimester hospital,9 granted both Akron's plaintiffs' petitions. 456 988, 102 2266, 73 1282 (1982). denied intervenors' petition, Seguin 989, 2268, 1283 (1982), they participated our Rule 19.6. now reverse judgment upholding requirement, affirm invalidating consent, period, disposal remains. II 14 "right . founded Fourteenth Amendment's restrictions action, broad enough encompass pregnancy." U.S., 153, S.Ct., 726. Although Constitution specifically identify right, history adjudication leaves doubt "the full scope limited precise terms spec fic guarantees elsewhere provided Constitution." Poe Ullman, 367 497, 543, 81 1752, 1776, 989 (1961) (Harlan, J., dissenting dismissal appeal). Central among protected liberties individual's "freedom matters marriage family life." Roe, 169, 734 (Stewart, concurring). See, e.g., Eisenstadt Baird, 405 438, 92 1029, 31 349 (1972); Loving 388 87 1817, 18 1010 (1967); Griswold Connecticut, 381 479, 85 1678, 510 (1965); Pierce Society Sisters, 268 510, 45 571, 69 L.Ed. 1070 (1925); Meyer Nebraska, 262 390, 43 625, 67 1042 (1923). based firmly long-recognized essential element liberty. recognized, procedure, vindication fundamental necessarily room needs judgment." Doe Bolton, 179, 192, 739, 747, 201 (1973). See Whalen 429 589, 604-605, n. 33, 97 869, 878-879, 51 64 (1977). physician's exercise assisting decisionmaking process implementing should choose Colautti Franklin, 439 379, 387, 99 675, 681, 58 596 (1979). 16 At same time, acknowledged "is unqualified considered important abortion." 154, 727. restrictive other rights searching judicial examination, supported Id., 155, recognized two such justify abortions.10 First, "important potentiality human 162, 731. exists "throughout course pregnancy," Beal Doe, 432 446, 2366, 2371, 53 464 (1977), point fetus "has capability meaningful life outside mother's womb," 163, Mo. Danforth, 428 52, 63-65, 96 2831, 2838-2839, 49 788 (1976). viability potential unborn child so proscribe altogether, "except when necessary preserve mother." 164, 732. Second, women undergo "a properly assert safeguarding [and] maintaining standards." however, become "approximately trimester" pregnancy.11 Until permitted, consultation physician, effectuate "free interference State."12 This enact touching weeks Certain significant impact justified objectives. supra, unanimously Missouri statutory applicable written keep records, even though comparable most procedures. 65-67, 79-81, 2839-2840, 2845-2846. decisive factor met demonstrating health-related concerns.13 interfere physician-patient id., 81, 2846. 20 From "may extent relates preservation protection maternal health."14 basis not, permit depart practice. rejected attempt ban would increased costs promoting benefits. 77-78, 2844-2845. licensing undertakes standards adopted "legitimately related objective seeks accomplish." 195, 749. III 21 "upon subsequent pregnancy"15 "performed hospital." "hospital" devoted gynecology obstetrics accredited Joint Commission Accreditation Hospitals American Osteopathic Association." 1870.1(B). organizations compliance comprehensive wide variety surgical services.16 thus prevents outpatient facilities acute-care, full-service hospital.17 22 sought serious detrimental ability woman. did reject argument, rather "not convincing willing discard Supreme formulation Roe" line impermissible first-trimester regulation. F.Supp., 1215. similar basis. argument justification least declined "retreat 'bright line' Wade." F.2d, 1210.18 believe courts below misinterpreted prior decisions, hold 23 Wade compelling, "regulate health." noted, example, States could establish relating facility performed, is, clinic place less-than-hospital status." Ibid. companion case Bolton Georgia licensed Board Health Hospitals. 201, 752. establishing, "standards performed." found, show more than [was shown ] prove resources hospital, those appropriately institution, satisfy interests." Ibid.19 429, 11, existence health, beginning inquiry. always applies entire latitude adopting applicability sensitive area. appears "depart[s] practice," 431, B 25 can tha places obstacle seeking primary created additional cost noted there testimony twice much clinic. 1209 (in-hospital $850-$900, whereas (D & E) $350-$400).20 Moreover, indicated rarely hospitals. (only nine hospitals year trial).21 Thus, force travel find facilities, resulting financial expense risk. apparent significantly 26 contend imposes insignificant defends position had strong support recommended Public Association (APHA), 143-146, 721-722, Obstetricians Gynecologists (ACOG), Standards Obstetric-Gynecologic Services 65 (4th ed. 1974). Since then, safety dramatically.22 principal reason D E widely successfully used abortions.23 "an abundance safest method post-first today." 1209. interval techniques generally used,24 meant desiring early longer forced incur sixteenth week 27 For purposes, experience indicates safely facilities. convinced APHA abandon recommendation abortions: 28 "Current data occurring Dilatation Evacuation Requirements gestation increase inconvenience contributing procedure." Recommended Program Guide Abortion (Revised 1979), 70 Am.J. 652, 654 (1980) (hereinafter Guide). 29 Similarly, ACOG suggests hospital. recommends office hospital-based free-standing ambulatory facility, out-patient meeting criteria facility," ACOG, 54 (5th 1982). 30 developments, professional commentary supporting them, constitute impressive that—at trimester—D hospital.25 conclude, therefore, "present knowledge," 731, convincingly undercuts hospital.26 nonetheless urges "[t]he fact mid-trimester done minimally equipped invalidate regulation."27 Brief 81-1172, p. 19. true correspond perfectly asserted reasonable, 1870.03. heavy, unnecessary, procedure.28 weeks," 79, 2845, IV 32 turn next prohibiting legal guardian" induced." "[i]t avoid veto fact, informed. requires, cases, either order." 1201. basis.29 33 dispute. impose parent person loco parentis condition minor." 74, 2843. Bellotti 443 622, 3035, 61 797 (1979) (Bellotti ), sustain substitute, judicial. 640-642, 3046-3047 (plurality Justices); 656-657, 3054-3055 (WHITE, dissenting) (expressing approval absolute requirement). 102-105, 2856-2857 (STEVENS, concurring part). plurality cautioned, alternative whereby sufficiently mature herself that, despite immaturity, interests. U.S , 643-644, 3048. clear 34 expressly II. contends qualify "court jurisdiction" within meaning "it assumed construe manner consistent consent." 28. concludes face. relies 132, 2857, 844 (1976) I minors, holding instead "abstention unconstrued construction judiciary 'which might whole necessity federal adjudication, materially change nature problem.' " 146-147, 2865-2866 (quoting Harrison NAACP, 360 167, 177, 79 1025, 1030, 1152 (1959)). H.L. Matheson, 450 398, 101 1164, (1981) (refusing minors).30 do think abstention principle been here. assume, I, presented procedures consistently requirements. suit, concerns municipal creates determinations. invoke neither mentions emancipation.31 circumstances, "opportunity minors." II, 643, 23, 3048, opinion). Appeals' V 36 provides shall except "with woman, freely coercion." 1870.06(A). Furthermore, consent," "orally 1870.06(B). addition, "of own carry term." 1870.06(C). 37 unconstitutional, valid 1203-1204. concluded 1207. affirm. 38 law "certif[y] writing 85, 2848. explained: 39 "The abort important, often stressful one, desirable imperative made knowledge consequences. primarily concerned, awareness significance assured, constitutionally, 67, 2840. 40 view vague term, construing giving just To ascribe well confine undesired uncomfortable straitjacket practice profession." 8, 2840, 8. 41 "implications broader kinds treatment," 649, 3051 opinion), legitimately seek attendant circumstances—psychological physical—that well-being patient." 394, 685, (1979).32 mean, responsibility conveyed patient, depending circumstances. Danforth's recognition childbirth.33 42 Viewing city's light, limits. say persuade withhold altogether. Subsection moment conception," inconsistent theory begins 159-162, 729-731. detailed description anatomical physiological characteristics child" subsection involve speculation physician.34 (5), dubious statement "abortion major procedure"35 proceeds describe numerous pyschological abortion,36 "parade horribles" intended particularly dangerous additional, equally decisive, objection intrusion specifies litany recite each regardless decision. believes outlined nonexistent them her. warned placing "undesired straitjacket." Consistent gone "obstacles doctor whom [the is] rely advice connection decision." 604 879 (1977).37 C 44 presents different question. provision, providing instructions followed recovery, addition 46 clearly purpose determined interfered exactly way disclosures desirability doing so." misapplication Danforth. consequences." 2840 difference told particu ar used, proper post-abortion care. contrast (B), describes disclosed. amount "medical 47 held, invalid physician." plaintiff conducted persons performs abortion," 1207, personally risks. challenges contrary emphasize relationship. view, judge below, "does relationship clinic." 1217 (Kennedy, 48 Requiring discuss decision, risks, consequences add record here ethical charge adhering typical Yet "stressed repeatedly central role consulting about determining how carried out." left mandate perform Connecticut Menillo, 423 9, 170, 171, 152 (1975); 165, convinced, vital need counsel absence request. unpressured; critical qualified person, identity it.38 intervenors strongly urge nonphysician counselors trained function. findings, delegates task another individual. 50 holding, powerless vindicate "important" "stressful" imply abdicate ultimately responsible aspects abortion.39 include verification adequate informed.40 minimum qualifications people function.41 749 (State possess staffing services safely"). alternatives, invalid. VI form. 1870.07.42 ground "that careful consideration situation." 1204. reversed, "no basis," state's power require." 1208. 52 mandatory increases obtaining trips facility. Plaintiffs scheduling difficulties hours, risk denies argues brief delay—with reflection received—often beneficial fi d suggesting proceed "affor[d] accordance profession, advise defer thinks her.43 counseling, prepared demand effectuation VII "insure manner." word "humane" impermissibly definition prosecution. declining sever uphold "sanitary." 1211. 55 'to preclude mindless dumping aborted fetuses garbage piles.' Fitzpatrick, 401 554, 573 (ED Pa.1975) (three-judge court) characterization legislative purpose), aff'd mem. sub nom. Franklin 901, 3202, 1205 (1976).44 clear, intent. phrase sanitary" does, intent "mandate sort 'decent burial' embryo earliest stages formation." level uncertainty fatal liability imposed. 396, 686, Because fails "fair forbidden," United Harriss, 347 612, 617, 74 808, 811, 98 (1954), agree Clause.45 VIII 56 sections "Regulations Abortions" ordinan e deal judgment, sustaining reversed. 57 ordered. O'CONNOR, WHITE REHNQUIST join, dissenting. 59 privacy asked reexamine address it. Accordingly, re-examine previous holding. sound application neutral principles accommodate analytical framework varies according "stages" stages, concomitant review, differ technology occurs. analysis methods dealing approach areas. 60 Our recent indicate lawful 'is unduly burdens abortion.' Maher 464, 473, 2376, 2382, 484 (1977) 147, 2866, )). Harris McRae, 448 297, 314, 100 2671, 2686-2687, 784 (1980). my "unduly burdensome" standard challenged throughout reference "stage" involved. burden[ ]" Maher, then evaluation rationally purpose. Irrespective wise prudent policy difficult area, 'Platonic Guardians' vest strike down laws meet social policy, 'wisdom,' 'common sense.' Plyler 457 202, 242, 2408, 72 786 (1982) (BURGER, C.J., dissenting). "three-stage" Roe,1 and, modified form, analyze useful accommodating today graphically illustrates why completely unworkable involved context. 62 As changes changes, "depart practice." Ante, 431.2 applying standard, holds dramatically" since 1973, decided. 435-436 (footnote omitted). "had support" 1973 "as regulation," ibid, stand because, diligent research scientific literature, dilation evacuation E), abortions." Ibid Further, literature relied non-hospital setting "at ." 437. thereby invalidates 63 purported adherence "blurred" accepts technological advancement "bright line" separates regulation, free consider unit weigh posed trimester.3 continuously conscientiously study contemporary determine practice" insofar periods concerned. Assuming bodies able engage exacting task,4 prelude citizens. entrusted choices, itself inquiries revise every (ACOG) group revises views Indeed, changed 1982 trial present cases. Before 1982, 1198, today's indicates, changing, necessitate continued functioning nation's "ex officio board powers approve disapprove operative practices States." 99, 2854, Just improvements inevitably move forward reasons backward mother. unusual. fourteenth edition L. Hellman J. Pritchard, Williams Obstetrics, understanding stated "[a]ttainment [fetal] weight 1,000 g [or gestation] criterion viability." 493. However, studies demonstrated increasingly earlier etal viability.5 certainly distant future. explicitly "flexible anticipated advancements skill." "[W]e skill, technical ability, preserved flexibility 64, 2838-2839. 66 framework, collision itself. various decrease, moved actual science better back toward conception. aspiration through "sufficiently roots community continuity Cox, Role Government 114 inherently tied whenever ensues. legislatures suited factual judgments forces legislatures, law, speculate constitutes "accepted time. Without expertise pretend act boards examine judgments. adheres decisis "demands law." 420. challenged, "this [is] apply rigidly nonconstitutional cases." Glidden Company Zdanok, 370 530, 82 1459, 1469, 671 (1962). mindful "desirability const tutional questions. former error, felt constrained follow precedent. questions, correction depends amendment exercised decisions." Smith Allwright, 321 665, 757, 765, 88 987 (1944) 68 Even assuming situations, logic decisis. above, means balancing indisputably implicated. correctly realized areas standards" seeing like maximum 149, 150, 724, 725. "another 731 (emphasis original). interests, depend recognize doubted long bounds [does not] assume[ character fiat. [then] [t]he measures needful people. Purity Extract Tonic Co. Lynch, 226 204-205, 44, 47, 184 (1912). "There nothing Sendak Arnold, 968, 969, 476, 477, 579 mode diagnostic business judges." Parham J.R., 442 584, 607-608, 2493, 2507, onset "until mortality less normal childbirth." "must 732.6 71 fallacy inherent apparent: once danger childbirth, justifies possible.7 likewise extant although life, viable. difficulty clear: afterward. stage life. refused "resolve question begins," 159, 730, chose viability—when capable independent mother—to complete proscription choosing possesses measured examined strict scrutiny. understood considering declare 'constitutional abortion,' protects burdensome freedom 473-474, 2382. Justices utilized cases.8 "infringe substantially" "heavily burden" heightened scrutiny novel fundamental-rights jurisprudence, restricted San Antonio Independent School Rodriguez, 411 37, 38, 1278, 1299, observed "strict scrutiny" legislation 'deprived,' 'infringed,' 'interfered' liberty." rise scrutiny, inquiry bears "some rational purposes." 40, 1300. First Amendment context, conduct, Gibson Florida Investigation Committee, 372 539, 545, 83 889, 893, 929 (1963), encroachment liberty," Bates Little Rock, 361 516, 524, 80 412, 417, 480 (1960). Carey Population International, 431 678, 2010, 675 eschewed notion "compelling interest" test 'whenever implicates sexual freedom.' 688, 5, 2018, employed, "impose[ 689, "burden prevent conception substantially limiting effectuating 2018 added). stressed "even validated interest." 2016. Finally, 485, 1682, (1965) banning use contraceptives married destructive impact" marital follows approach. expression "undue burden," recognizes "significant obstacle" "reasonable" ante, 434, 435, 438. 77 represents threshold ourt actions standard. "[A] severe deliberate restraint accorded judgments." Carey, 2026 (POWELL, judgment). 78 context "cannot absolute." "Roe protect "drastically desired service," 472, 2381, imposition "absolute 70-71, 2841-2842, "official interference" "coercive restraint" Harris, 328, 2694 That "inhibit" degree 413, 1173, (1981). situations involving limitations Texas criminalized save prohibition saline amniocentesis weeks." 2845. acknowledges Danforth effectively represented circumstances." spousal prerequisite delegated "veto power" spouses concerned decision.9 mind extremely issues, forum resolution democracy legislature. forget 'legislatures ultimate guardians welfare quite great courts.' K. &. T. R. May, 194 267, 270 [24 638, 639, 971] (1904) (Holmes, J.)." 479-480, 2385-2386 legislatures. rather, face complex problem many hard questions few easy answers pay attention branches addressed problem." Columbia Broadcasting System, Democratic National 412 94, 103, 2080, 2087, 772 (1973).10 compel fine-tune statutes encourage facilitate contrary, 'encouraging urgent circumstances' 'rationally government life.' 325 [100 2692]. Accord supra [432 U.S.], 473-474 [97 2382]." 1173 decreased 434-435, 435 rejects offered 731-732. 435-436. restriction. undue 84 reliance misplaced. points out, Reply Br. nearby almo t allow, 437-438, 26, entails ---, upholds stringent greater scheme furthering in" preserving 2540. correct Simopoulos, inexplicably refuses case. Health-related factors go well-beyond "all factors—physical, emotional, psychological, familial, age—[are] standards, relies, "[r]egardless advances technology, midtrimester terminations likely remain hazardous, expensive, emotionally disturbing Gynecologists, Technical Bulletin 56: Methods Midtrimester (Dec. 86 burden, review. "rational relation" Williamson Lee Optical Co., 348 483, 491, 461, 466, 563 (1955).11 p rform years gives guardian, Despite yet courts, "reasonably 'opportunity minors.' opinion)). abstained declaring deciding respected well-settled "where 2866 acknowledging doctrine, 440-441, nevertheless declines Instead, speculates 'surgical care morals, being,' ante 441, Rev.Code Ann. 2151.03). interpretation filing petition notification, 89 arguendo minors,12 assume judges notify type lack operate, interact, 'scrupulous regard rightful independence governments' counsels "unnecessary validly administered concerns, balanced working system." 176, 1030 Matthews Rodgers, 284 521, 525, 217, 219, 447 (1932)). 90 ordinance.13 finds subsections (1), (2), (6), (7) "certainly objectionable," 445-446, (3), (4), "acceptable" "much, it, physician," ibid. "properly 'medical judgment,' 447, "qualified persons" work 91 approved past deliver patient. abort, indeed, 2840.14 "be advised adoption services, forseeable Utah Code 76-7-305 (1978). 65-67 [96 788] (1976), attack provisions." 400, 1167, 2866.15 conceded unconstitutionality below. 79-3757 (CA6), 35, 79-3757, 5-9. separable 1870.19 contains separability clause 'presumption divisibility' litigant escape operation." Carter Coal 298 238, 335, 855, 883, 1160 (1936) (Cardozo, severance "create program legislature actually adopted." Sloan Lemon, 413 825, 834, 2982, 2987, 939 drastic limitation attempting deems choice. such, affect Amendment.16 94 signing emergency. 1870.12. affected affirms affects "Akron period." 450. clinic, difficulties. 'discretion judgment.' Colautti, 681). 95 understand mental shows non-existent. interesting note "[p]rior explores options management unwanted examines allows sufficient inf rmed Services, 54. Therefore, significantly, wait. "fine-tune" minimize 1173. one," haste. grave whose preserve. "No [medical] involves purposeful termination 325, 2692. surely small well-considered irreparable effects own.17 "[a]ny induce void-for-vagueness. disagree. 554 court), district disposal" vagueness representation 573. implicated were, point, "expensive burial." case, statute, distinguished "sanitary" portion, 'dump[ed] 48. "decent burials" fetuses, term "sanitary," conclude void vagueness. set dissent especially argued 1971 Term, reargued—with extensive briefing—the following Term. joined Chief six Justices. decided basic highly (1976); (1977); (1979); (1980); Today, premise progeny. stops short arguing flatly overruled. adopts reasoning practical accomplish precisely result. states "[e]ven situations," "are Post, 459 turns out largely "limited" post, 465, 10, asserts cost, "[a] 'official interference' 467 2694, concurring)). unacceptable familiarity appreciate dissent's drive underground attendance sum, rational-basis test. deemed appropriate, abortion-inhibiting 474 (arguing fetus"). wholly incompatible prefaced findings: "WHEREAS, citizens highest care; WHEREAS, complications, equipment personnel woman; offering safeguards Council union sperm egg, blastocyst infant implantation, six-weeks embryo, six-month one-week-old child, adult maturation; traditionally conflict arise conflicts inducing implies adversary towards child; wishes destruction consequently continuing obligation survival viable discharged hazard Council, public hearings investigations enactment contribute pu lic safety, welfare." 160-1978. "1870.03 ABORTION IN HOSPITAL No 1870.1(B) defines "1870.05 NOTICE AND CONSENT (A) twenty-four (24) guardian intention reached him her, seventy-two (72) constructive certified mail last known computed mailing, ordered (B) fifteen (15) obtained Chapter, INFORMED induced coercion. she, orally facts, signed applicable, follows: pregnant. number elapsed probable menstrual examination laboratory described detail gestational including, to, appearance, mobility, tactile sensitivity, pain, perception response, brain heart function, presence internal organs ternal members. viable, surviving womb, twenty-two (22) conception, take steps hemorrhage, perforated uterus, infection, disturbances, sterility miscarriage prematurity pregnancies; essentially unaffected worsen existing psychological problems have, disturbances. (6) private control requests. (C) paragraph Section, shall, orally, term. (D) duplicate copy Section." "1870.07 WAITING PERIOD certifies elapsed." "1870.16 DISPOSAL REMAINS Any "1870.19 SEVERABILITY Should Chapter invalid, illegal, unenforcible, invalidity, illegality, unconstitutionality, unenforcibility Chapter." Compare Assn. 655 848 (CA8), supplemented, 664 (CA8 1981) (invalidating requirement), Commonwealth, 221 Va. 1059, 277 S.E.2d (upholding Numerous Americans Life Amicus Curiae 81-185, (listing States). unique children "significant" aimed adult." 75, 2843, 693, 2020, includes "independence decisions," 599-600, 876, adults decisions. 633-635, 3043, opinion) ); 102, 2856 encouraging involvement children's notice); 648, 3046, 3050 consent). involvement. 420, 1176 concurring); 450-451, 1192-1193 (MARSHALL, choosi identified time—according 1973—"mortality developments decade, safer infra, 435-437, extended LeBolt, Mortality Childbirth: Are Populations Comparable?, 248 J.A.M.A. 188, 191 (abortion up ages weeks). prudent, retain identification approximate restrict 1982) Standards) (uncomplicated day period); 56, Mid-Trimester 1979) ("Regardless abortions."). continues Where determinative uestion 163. comparison rates employs rationale 78-79, 2845 "safer, mortality, continuation childbirth"). Of course, retains assumption term," "holds medically conditions insuring woman." (1975) (per curiam ). basis, sanctions nonphysician. recordkeeping, "if abused overdone, female citizens, resource 443-445 (discussing "Examples area abortion; licensure person; status; facility; like." 163-164, "first trimester," 1870.06(B)(2) (physician conception); 1870.06(B)(4) conception). average lasts or, commonly measured, two-week deviation way. measurements, delineating "trimesters." Frequently, estimated draw line, Court—for purposes analysis—has point" trimester." Unless indicated, references (JCAH), established guidelines services: dietetic, emergency, home care, nuclear medicine, pharmaceutical, library, rehabilitation, work, JCAH, Manual Hospitals, 1983 Edition distinguishes "hospitals" 1870.02 facility." "Abortion facility" defined office, 1870.01(G). believed bound Gary-Northwest Indiana Women's Bowen, 496 894 Ind.1980) (t ree-judge Orr, 451 934, 2012, (1981), upheld. render skills," 901-902, rested dilatation 902-903. summary affirmance binding precedent issue. Illinois Elections Socialist Workers Party, 440 173, 180-181, 182-183, 983, 230 JCAH 'based differences Act found.' 194, 748 Morey Doud, 354 457, 1344, 1349, 1485 (1957)). event, Georgia's statistics difference. charged $284 $435. fee, ran high $300. Rosoff, Availability Second-Trimester States, published Second Trimester Abortion: Perspectives After Decade Experience (Berger, Brenner Keith eds. Abortion). situation unique. country, few, any, 687, 689 (second-trimester Missouri); Wolfe Stumbo, 519 22, (WD Ky.1980) (no elective post-first-trimester Kentucky hospitals); Margaret S. Edwards, 488 181, 192 La.1980) Louisiana trimester). death-to-case ratio country fell 14.4 deaths per 100,000 1972 7.6 1977. Tyler, Induced 17-20. decided, Instillation procedures, E, approx mately 16th amniotic sac small. Grimes Cates, Evacuation, 121. 690 Dr. Willard Surveillance Centers Disease Control, week); (out-patient in-hospital non-D revised occur trial. 51-62, manner. prescribed city. clinics, hold, may, "from 194-195, 748-749. deficiencies exist clinics' operation. sustained later instillation Abortions safer, methods. Cates Grimes, Morbidity Mortality, 166-169. 1208-1210. 82.1% 13-15 24.6% 16-20 method. Department Human Surveillance: Annual Summary Table 14, 1870.05(A)'s requirement. 1206. Matheson questioned Utah's emancipated raise alleged member class emancipated. 406, 1169. plaintiff, failure comply claims patients. 62, 2837; 188-189, 745-746; 627 3039 "alleged traffic offender, delinquent, unruly, abused, neglected, dependent." 2151.23. category argu bly "neglected" category. neglected "[w]hose parents, custodian neglects subsistence, education, being." 2151.03. permitting "proper care" makes hostile satisfaction exercising notified filed, 2151.28, 1176, 428, 3, 1181, particular, emphasized integrity deliberation. 411, (1981); 419-420, 421-424, 1177-1179 foreclosed asserting pregnancies (1980), governmental spending reimbursed indigent preferring permissible, "restriction already there." 474, include, "appearance, external members." "there impossible [these] items, 'unborn child's' sensitivity pain." 1203. 'a procedure' ., 'minor procedure.' 1870.06(B)(5) "That i disturbances." little defend 1870.06(B)(3), severable. pregnant, 1870.06(B)(1), 1870.06(B)(2), 1870.06(B)(6), 1870.06(B)(7). accurate, objectionable, probably routinely persuaded, They much, 448-449. consists recital pertinent facts. patients vary considerably. disputed desire Federation NAF Standards); Metropolitan Guidelines Operation, Maintenance, Evaluation Outpatient Facilities Such alienated separated parents. 654. patients, mere printed counseling. model competent, conscientious, 196-197, 749-750. occasion model. Cf. 91-92, 2, 2851, ("If elsewhere, verify taken place."). well-trained ("Abortion skilled trained, sympathetic supervision."); (counselors initially subjects: reproductive health; technology; contraceptive short-term skills; referrals; consent; agency policies practices."). emergency poses immediate threat allow "sufficient 1870.07's needed received. Fitzpatrick Pennsylvania's contention "mindless dumping." distinguishable liability, promulgation implement 572-573. persuaded statute. uncertain alone. free, carefully "separate distinct" grow substantiality approaches 'compelling.' 162-163, childbirth" "viability," potentially live albeit artificial aid." 160, 730 Based weeks, weeks. reached, "left [of viability] flexible young "familial integrity" purports limiting" regulatory abandons relative decides 431. "make furthered." 434 thought, 433, 18. reads alternate ignores abortions," 903 task, superior fact-finding capabilities, Courts. One infants born alive 500 1,249 grams 20% chance survival. Phillip, Neonatal Risk Eighties: Importance Birth Weight/Gestational Age Groups, Pediatrics 122 Another comparative preterm 1000 42% rate Kopelman, Smallest Preterm Infants: Reasons Optimism New Dilemmas, 132 Diseases Children 461 weighing thriving Los Angeles "95% survival." Washington March 31, 1983, A2, col. weighed 495 Recent promise success overcoming respiratory immunological neonatal viability. Beddis, Technique Servo-Control Arterial Oxygen Tension Infants, Archives Childhood 278 absolutely current era progressive improvement outlook premature infants." Stern, Intensive Care Pre-Term Infant, Danish Med.Bull. 144 Interestingly, recordkeeping 2845-2847 retreat ostensibly Standards, heavily analysis, offices prompt treatment event complications. prescribes 57. met, ) "impose open 2866.); 640, 3046-3047, (opinion POWELL) abortion"); 2686-2687 ("The 'protects pregnancy,' 2382], L.E .2d 788"); (The third interference. ."); 2026, judgment) ("In [Roe Griswold] [compelling interest] invoked frustrates (1976)."). evaluating informed-consent 2866. burdens" Roe. covered accreditation hospital-committee two-doctor concurrence disapproval apart differential invalidation regulations. 80-81, 2846-2847; 480, 2385, 2692-2693. 81-1255, Ashcroft Ass'n, 81-1623, ---. curiae Solicitor General so, "accord deference judgment" burden." General, 10. incorporates "pay attention" stage. "narrowly drawn" express mentioned enactments, 728, analysis. fully endorses call obstacle," related" 430-431, area." 434. 2539. Nevertheless, relates" signifies. fall 'depart[s] practice,' supra,." ,in 436-437. Four hardly "substantial portion" suggested directly notifying parents," 647, 3050, unemancipated lieu parents." 22. "veto." 406-407, 1169-1170. woman: pregnant; conception; characteristics; try complications; control; proposed technique, "legally trigger proscriptions 2846 (recordkeeping requirements). incorrect, inexp icably "burden" 430 732). "vital need" 448. violate communicate ideology. Wooley Maynard, 1428, 752 raised 79-3701 18-23. 26-33. waiting-period charges 421, consideration. pathology-report Parenthood, 1623, (report "comparatively cost," 2524).

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