Legal Document

432 U.S. 464 97 Supreme Court Reporter 2376 53 United States Reports Lawyer’s Edition 2d Series KF101.8 U54 484 Edward W. MAHER, Commissioner of Social Services Connecticut, Appellant,v.Susan ROE et al. Number 75-1440. Argued Jan. 11, 1977. Decided June 20, Syllabus Appellees, two indigent women who were unable to obtain a physician's certificate medical necessity, brought this action attacking the validity Connecticut Welfare Department regulation that limits state Medicaid benefits for first trimester abortions those are "medically necessary." A three-judge District held Equal Protection Clause Fourteenth Amendment forbids exclusion nontherapeutic from welfare program generally subsidizes expenses incident pregnancy and childbirth. The court found implicit in Roe versus Wade, 410 113, 93 705, 35 147, Doe Bolton, 179, 739, 201, view "abortion childbirth . simply alternative methods dealing with pregnancy. ." Held: 1. does not require State participating pay because it has made policy choice Pp. 469-480. (a) Financial need alone identify suspect class purposes equal protection analysis. See San Antonio School Rodriguez, 411 1, 29, 1278, 1294, 36 16; Dandridge Williams, 397 471, 90 1153, 25 491. 470-471. (b) regulation, impinge upon fundamental right privacy recognized Roe, supra, protects woman unduly burdensome interference her freedom decide whether or terminate That implies no limitation on State's authority make value judgment favoring over abortion implement by allocation public funds. An desiring an is disadvantaged Connecticut's decision fund childbirth; she continues as before be dependent private services. 471-474. (c) required show compelling interest its favor normal 475-477. (d) rationally related furthers "strong legitimate encouraging childbirth," Beal Doe, 438, 446, 2366, 2372, 464. subsidizing costs rational means States, moreover, have wide latitude choosing among competing demands limited 478-480. 2. Since unreasonable insist prior showing necessity insure money being spent only authorized purposes, erred invalidating requirements written request pregnant authorization abortions. Although similar imposed other procedures, such procedures do involve termination potential human life. Pacific KF135 P2 480. D.C., 408 F.Supp. 660, reversed remanded. Edmund C. Walsh, Hartford, Conn., appellant. Lucy V. Katz, Stamford, appellees. Mr. Justice POWELL delivered opinion Court. 1 In 464, we hold today Title XIX Security Act funding condition participation joint federal-state medicaid established statute. case, result our Beal, must Constitution requires when pays 2 * abortions1 necessary," term defined include psychiatric necessity. Department, Public Assistance Program Manual, Vol. 3, chapter III, § 275 (1975).2 enforces through system Services. order abortion, hospital clinic where performed submit, things, patient's attending physician stating medically necessary. 3 This attack was against appellant Maher, Services, appellees Poe necessity.3 complaint filed they challenged both inconsistent Act, added 79 Statutes-at-Large 343, amended, 42 Code KF62 1396 seq. (1970 ed. Supp. V), violative their constitutional rights, including Amendment's guarantees due process protection. originally defended theory prohibited After certifying assistance allowed but also it. Norton, 380 726 (1974). On appeal, Appeals Second Circuit read allow, require, 522 Federal Reporter, 2nd 928 (1975). Upon remand consideration issues raised complaint, convened. invalidated regulation. 660 4 independent state-financed 147 (1973), 201 childbirth, stripped sensitive moral arguments surrounding controversy, .." F.Supp., at 663 n. 3. Relying Shapiro Thompson, 394 618, 89 1322, 22 600 (1969), Memorial Hospital Maricopa County, 415 250, 94 1076, 39 306 (1974), "weights mother exercise constitutionally protected right" "thus infringes interest." 663-664. justify infringement. fiscal "wholly chimerical least expensive response pregnancy." Id., 664 (footnote omitted). And any objection deemed irrelevant: 5 "The may refusal one type expense arising basis morally opposes expenditure money. To sanction justification would permit discrimination seeking approve right." Ibid. 6 enjoined requiring Medicaid-funded abortions.4 struck down holding could impose payments "equally applicable if conditions tend discourage delay occurrence asked perform." 665. We noted probable jurisdiction consider constitutionality 428 908, 96 3219, 49 1216 (1976). II 7 (1) imposes obligation pregnancy-related women, indeed indigents.5 But decides alleviate some hardships poverty providing care, manner which dispenses subject limitations. Appellees' claim accord treatment evidence preference challenge classifications presents question under Amendment. basic framework analysis well settled: 8 "We decide, first, (state legislation) operates disadvantage impinges explicitly implicitly Constitution, thereby strict judicial scrutiny. If not, (legislative) scheme still examined determine legitimate, articulated purpose therefore constitute invidious 17, 1288, 16 (1973). 9 Accord, Massachusetts Board Retirement Murgia, 427 307, 312, 314, 2562, 2566, 2567, 520 Applying here, think violated Atlantic 10 (2) case involves class. come within category classes so cases. Nor fact impact falls cannot lead different conclusion. sense, every denial creates wealth classification compared nonindigents able desired goods never financial identifies S.Ct., 1294; 491 (1970).6 Accordingly, central "impinges Constitution." decisions subsequent cases applying it, establishing concluded nothing less than misconceived nature scope Roe. B 11 (3) At issue Texas law making crime procure attempt except advice saving life mother. Drawing group disparate restricting governmental intrusion, physical coercion, criminal prohibition certain activities, concept personal liberty affords aspects individual's "privacy," woman's pregnancy.7 153, 727. 12 statute severe sanctions physicians personnel abortions, thus drastically limiting availability safety service. As Stewart observed, "it difficult imagine more complete abridgment 170, 735 (concurring opinion). sweeping restriction interest, during trimester. Even judged demanding standard, however, dual health fetus sufficient substantial second third trimesters. "These interests separate distinct. Each grows substantiality approaches and, point pregnancy, each becomes 'compelling.' " 162-163, 731. trimester, justifies reasonably concern. 163, 731-732. viability, usually penalties, threatened. 163-164, 732. 13 stark example impermissible cases, types restrictions, form effect, choice. Thus, Planned Parenthood Central Missouri Danforth, 52, 70-71, 2831, 2841-2842, 788 (1976), Missouri's requirement spousal consent unconstitutional "granted (the husband) prevent unilaterally, whatever reason, effectuation his wife's had interposed "absolute obstacle interference." (Emphasis added.) state-created absolute impermissible, see (1973); Carey Population International, 431 678, 2010, 52 675 (1977), lawful "is unless burdens seek abortion." Bellotti Baird, 132, 2857, 2866, 844 "not all distinction between forbidden" "(t)he will depend degree it." 149-150, 2867. declined rule regulating minor's access until courts opportunity parental veto consultation. 14 These recognize "in kinds important decisions" free compulsion. Whalen 429 589, 599-600, nn. 24 26, 869, 876, 51 64 (1977). makes clear, Wade can understood considering did declare unqualified "constitutional abortion," seemed think. Rather, It 15 us kind laws previous decisions. places obstacles otherwise path abortion. desires suffers consequence sources service desires. attractive alternative, influencing decision, already there. indigency perhaps, impossible neither created nor way affected conclude Roe.8 Contract (4) Our conclusion signals retreat There difference direct activity encouragement consonant legislative policy.9 Constitutional concerns greatest attempts force law; power encourage actions necessarily far broader. 17 cited support Meyer Nebraska, 262 390, 43 625, 67 L.Ed. 1042 (1923), involved Nebraska teach foreign languages children passed eighth grade. 396-397, 626. Nebraska's imposition providers services closely analogous sustaining teacher convicted law, teacher's "right parents engage him instruct children" "within Amendment." U.S., 400, 627. Pierce Society Sisters, 268 510, 45 571, 69 1070 (1925), relied invalidate Oregon parent guardian child send school, precluding school. Reasoning "excludes general standardize forcing them accept instruction teachers only," "unreasonably interfere(d) guardians upbringing education control." 534-535, 573. 18 (5) Both restrictions interests: Meyer, parent's taught particular language; Pierce, choose rather school education. denied preferred course action. Indeed, careful "to prescribe curriculum" included English excluded German schools questioned." 402, 628. Similarly, casts shadow pursued century. Brown Education, 347 483, 489 4, 74 686, 689, 98 873 (1954). Norwood Harrison, 413 455, 462, 2804, 2809, 37 723 rejected argument parochial share largesse," noting "(i)t thing say prohibit maintenance quite another must, matter protection, receive aid." Yet, appellees' argument, schools, preferring German, grounds identical principle advanced here. abundantly clear election education.10 Defendant 19 remains sustained test rationality applies absence impingement right. drawn "rationally related" "constitutionally permissible" purpose. Lindsey Normet, 405 56, 74, 92 862, 874, 31 (1972); 2567. satisfies standard. 20 itself acknowledged strong protecting fetus. exists throughout "grow(ing) term." Because carries "cannot isolated privacy. (Her) longer sole possesses measured accordingly." 159, 730. unquestionably honored centuries.11 there interest. associated substantial, increased significantly recent years. greater normally elective 21 (6) certainly unsympathetic plight "the provide remedies social economic ill," 874. uniformly accorded wider funds.12 485, 1162, despite recognition regulations allocating funds most needs impoverished beings," survive "reasonable basis" shown. preceding discussion exceeds minimal level. expend fraught judgments opinions sharply divided. based weighing wisdom desirability, strike "because unwise, improvident, out harmony thought." Williamson Lee Optical Co., 348 488, 75 461, 99 563 (1955), quoted 484, 1161. choices implicated appropriate forum resolution democracy legislature. should forget "legislatures ultimate liberties people great courts." Missouri, K. & T. R. company May, 194 267, 270, 638, 639, 48 971 (1904) (Holmes, J.).13 23 conclusion, emphasize proscribe government open Congress provision program. Also, construed democratic processes provided. judicially these issues. III (7) above rejects premise prompted invalidation procedural requirements. purposes. simple answer burden controlling reversed, remanded further proceedings consistent opinion. 26 ordered. 27 Chief BURGER, concurring. 28 N Dec. Immigration Nationality Decisions join Court's Like Court, finance holdings create barrier precedents suggest assist procuring 29 From time time, legislature determines that, sound policy, ought citizens. Encouragement care novel undertaking regard. Various governments, country others, determination centuries. times, similarly provided educational Constitution. federal another. 30 Here, determined expenses. concur judgment. BRENNAN, whom MARSHALL BLACKMUN join, dissenting. held: 32 "When refuses while therapeutic prenatal postnatal weights Her payment chooses When assert 663-664 33 reverses ground (v. (1973))," ante, meet "compelling interest" right," 477, 478. holding, insists, "places abortion"; "private sources." Ante, 474. True, (by childbirth) there." also, "may perhaps abortions," regrettable regulation." 34 distressing insensitivity inherent realty too many, just "some," competent licensed merely "difficult" "impossible." practical matter, many feel carry pregnancies services, even though chosen procedure, procedure. disparity clearly coerce bear have, clearly, coercion operate poor, uniquely victims pressure. Frankfurter's words apt: "To ruthless consequence, inevitably resulting hurdle erected State, latter-day Anatole France add item ironic comments 'majestic equality' law. 'The majestic equality, rich poor sleep bridges, beg streets, steal bread' Griffin Illinois, 351 12, 23, 76 585, 593, 100 891 (1956) None take seriously assurance "conclusion ) it," 475. statement occasion surprise Courts relying carried term. Rose, 499 1112 (CA10 1974); Wulff Singleton, 508 1211 (CA8 1974), rev'd grounds, 106, 2868, 826 (1976); Westby, 383 1143 (WDSD vacated (in light Hagans Lavine, 528, 1372, 577 (1974)), 420 968, 95 1385, 648, remand, 402 140 (1975); Wohlgemuth, 376 173 (WD Pa. aff'd statutory sub nom. 523 611 (CA3 1975), (1977); Rampton, 366 189 (D.C. Utah 1973); Klein Nassau County Medical Center, 496 (EDNY 1972), 412 925, 2747, 152 (1973)), 409 731 gainsaid today's erodes principles announced guide what constitutes infringement presented Claims enjoyment rights occupied protean position jurisprudence. Whether proceed Clause, plainly errs ignoring, does, unanswerable appellees, unconstitutionally derived Due Process Clause. 38 following area invulnerable intrusion surrounds bringing pressures have. obvious impairment Wade. Yet concludes (that) perceived distinction, hand, penalties procurement present Bolton other, assertedly lesser inhibition scheme. 472-474. last Brother espoused "(t)here policy," 475, refused adopt Singleton Wulff, 122, explicit Part Blackmun's four Stevens' essential agreement II-B. 121-122, 2877 part). II-B stated: 40 "Mr. Powell limit cited, explaining 'directly interfered decision' interdicted functioning physician-patient relationship criminalizing procedures,' (428 U.S.,) 128, 2880-2881. language Moreover, 'direct interference' 'interdiction' appear supported precedent. For doctor afford work nothing, him, effective ever Furthermore, since nondiscriminatorily funded, exist." 118 7, 2876. 41 approach companion addition striking Georgia certification hospitals, approval committee, concurrence doctors own doctor. operated bar prohibitions aspect save unconstitutionality. Parenthood, characterizes obstacle" obtaining 473. "absolute" sense persuade spouse agree prevented one. Any whose husband agreed, persuaded agree, directly own. qualitatively statutes says comparable, nevertheless unconstitutional. Most recently, squarely reaffirmed fundamental, justified entirety New York forbidding sale contraceptives minors years old, persons sell pharmacists, advertisement display contraceptives. use anyone, 16, Nevertheless declared apply fully statute, hardly explicit, 'Compelling' key word; beget involved, imposing interests, narrowly express interests." 2017. specifically interpreted flatly interpretation today: significance establish same applied conception substantially effectuating entirely." 688, 2018. Finally, involving new repeatedly infringements outright denials rights. First consistently variety contexts compelling-state-interest restraints difficult. See, e. g., Sherbert Verner, 374 398, 83 1790, 965 (1963) (free religion); NAACP Button, 371 415, 328, (freedom expression association), Linmark Associates Township Willingboro, 85, 1614, 155 (1977) expression). been voting relatively small power, dilution strength caused malapportionment, involved. Reynolds Sims, 377 533, 562, 566, 84 1362, 1382, 1384, 506 (1964); Chapman Meier, 751, 766 Connor Finch, U.S 407, 1828, 465 travel penalizing pass muster test, irrespective actually deter travel. 257-258, 1081-1082, (1974); Dunn Blumstein, 330, 339-341, 995, 1001-1002, 274 (1969). indigents asserting excused entry without access. (1956); Douglas California, 372 353, 814, 811 (1963); Boddie 401 371, 91 780, 113 (1971). 44 Until today, thought question, let susceptible preventing having critical. What critical inhibited interference. burdened freely distinguished grants withholdings South Carolina unemployment compensation religious reasons Saturday, stemmed number nonreligious causes. proof pressure forgo (her religious) practice (was) unmistakable," 404, 1799, effect fine Saturday worship. religion Free Exercise Amendment, governing same, withholds discourages application stronger Verner vulnerable 46 held, agrees, 473, "unduly "unduly" 47 argue justification, fetus" suffices, 478.* totally foreclosed overruling "(w)ith respect life, 'compelling' viability," occurring about end argues namely, control amount allocated budget." Brief Appellant 22. correctly asserted chimerical" "state's assertion saves declines cost mother's contrary undisputed facts." 664. render invalid, my view, submit Request Authorization Professional "statement indicating Appellees 2-3. reasons, beyond Section provides relevant part: (Title XIX) met: "1. 'Medically Necessary' includes "2. accredited patient "3. submitted patient, minor, guardian. "4. Prior secured Division Health Services." infra. filed, Mary Poe, 16-year-old high junior, obtained hospital. Apparently Poe's inability reimbursement result, pressed bill $244. Susan unwed three children, certify procedure By consent, temporary restraining entered enjoining officials refusing Roe's Appeals, issued orders covering additional women. order, January 1976, stayed. revised allow consent. revision retroactive suggests interim compliance date. No suggestion mootness parties, appeal taken reinstate Under circumstances, moot. event, remain situated members class, prerevision 730 Eleventh defense relief sought represents. (1971), contrary. "certain commencement litigation, fees process," ability bring divorce. 372, 783. "(G)iven marriage society's hierarchy values concomitant monopolization legally dissolving relationship, denying, solely pay, individuals dissolution marriages." 374, 784. monopolize terminating easily Boddie. Kras, 434, 631, 626 Ortwein Schwab, 656, 1172, 572 (1963), appellate review convictions defendants trial transcripts counsel. grounded justice system, monopoly compelled. Cf. 5, supra. underlying extend generally. abort procreation long "one civil man very existence survival race." Skinner Oklahoma, ex rel. Williamson, 316 535, 541, 62 1110, 1113, 86 1655 (1942). rely durational residence receipt "penalized" interstate. reliance penalty misplaced. semantic interferes penalizes Penalties familiar proscribed conduct. recently exercised across lines sufficiently entitled benefits, close analogy facts Shapiro, scrutiny might either here "penalizes" penalize interstate bus fares travelers. find right-to-travel inapplicable addition, decided context "governmental neutrality" originating Establishment Freedom Religion Clauses 409, 1797. Buckley Valeo, 424 612, 659 drew financing Election Campaign 1971. candidates others. American Party White, 767, 1296, 744 electoral process: dealt primarily candidate satisfy name ballot. were, course, candidate's run office voter's voice preferences regarding representative contemporary contrast, Presidential restrictive voters' candidates'. Subtitle H getting ballot voter casting vote choice; inability, any, minority party wage campaigns derive lack raise contributions. suffered operation eligibility formulae claimed enhancement communicate electorate eligible candidates." 94-95, 670-671 (emphasis added; footnote dissenting opinion, Brennan decision. stated above, placed differs contraceptives, asserts Wade." Post, 484-485. suggested source purportedly "obvious" quotation Blackmun note beginning "issues (of standing) going merits dispute." 108, 2871. Significantly, effort distinguish explain much fetus, demographic rate population growth. Such future circumstances reason departure neutrality Wilkinson, Three Faces Equality, 61 Va.L.Rev. 945, 998-1017 Much rhetoric equally elected none dissents goes suggests, 478 "State growth" live births While conceivable factor considered part "compelling" contends

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