Court Opinion

ID: 9468076
Source: CourtListenerOpinion
Date Created: 2023-08-05 02:03:40.1741+00
Date Added: 2024-06-11T17:40:40.157985
License: Public Domain

CORNELIA G. KENNEDY, Circuit Judge.
Concurring in part and dissenting in part.
I respectfully dissent from part II (standard of review), that portion of IIIA relat*1212ing to minors under 15, and a portion of IIIB of the majority’s opinion.
The District Court ruled that abortion regulations that do not absolutely prohibit or afford the power to veto a woman’s decision to have an abortion may withstand constitutional scrutiny though furthering something less than a “compelling” state interest. It held that regulations that interfere with a woman’s privacy to a lesser degree may be weighed against any valid state interests furthered by the regulation. The majority, rejecting the District Court’s standard, would apply a two-step test. First, if the provision in question causes no “legally significant” impact on the right of a pregnant woman to choose to terminate her pregnancy, it is constitutional. Second, if it causes a legally significant impact, the provision must be supported by a compelling state interest and must be sufficiently narrowly drawn so as not to unduly burden the woman’s right. Because I am less certain than the majority that the Supreme Court’s abortion decisions call for such a two-step analysis, I am not able to concur with the panel even though I do not completely agree with the District Court either.
Because there appears to have been some shift on the issue in the Supreme Court’s decisions a lengthy and detailed review of its cases is required. Language from the earliest abortion decisions supports the majority’s conclusion that only a compelling state interest will justify significant first trimester abortion regulation. In Roe v. Wade, 410 U.S. 113, 93 S.Ct. 705, 35 L.Ed.2d 147 (1973), the Court spoke broadly in invalidating a statute that absolutely prohibited abortions except to save the life of the mother:
Where certain “fundamental rights” are involved, the Court has held that regulation limiting these rights may be justified only by a “compelling state interest” . . . and that legislative enactments must be narrowly drawn to express only the legitimate state interest at stake.
Id. at 155, 93 S.Ct. at 728 (citations omitted).
[Because the interest in material health becomes compelling at the end of the first trimester], [i]t follows that, from and after this point, a State may regulate the abortion procedure to the extent that the regulation relates to the preservation and protection of maternal health. . . . This means, on the other hand, that, for the period of pregnancy prior to this “compelling” point, the attending physician, in consultation with his patient, is free to determine, without regulation by the State, that, in his medical judgment, the patient’s pregnancy should be terminated.
Id. at 163, 93 S.Ct. at 732.
Up to [this point], the abortion decision in all its aspects is inherently, and primarily, a medical decision, and basic responsibility for it must rest with the physician.1
Id. at 166, 93 S.Ct. at 733.
In the next case, Planned Parenthood of Central Missouri v. Danforth, 428 U.S. 52, 96 S.Ct. 2831, 49 L.Ed.2d 788 (1976), the Court appears to be ambivalent as to the proper standard of review, though the case signals at least some retreat from the broad language of Roe. In relevant part the Court held that Missouri could not give an absolute veto over a woman’s abortion decision to the woman’s spouse or parents. However, Missouri could impose record keeping requirements on an abortion clinic that it did not impose for other surgical procedures; the record keeping requirement did not have a “legally significant” impact on the abortion decision or the physician-patient relationship. Id. at 81, 96 S.Ct. at 2846.2 Thus far Planned Parent*1213hood is consistent with both the District Court’s and the majority’s test.
In the course of its opinion in Planned Parenthood the Court quoted language from Roe v. Wade that can be used to support the majority’s test:
“For the stage prior to approximately the end of the first trimester, the abortion decision and its effectuation must be left to the medical judgment of the pregnant woman’s attending physician,” without interference from the State.
Id. at 61, 96 S.Ct. at 2837.3
On the other hand, the Court, held that Missouri could require that the woman consent in writing to the abortion procedure, though such a requirement was not imposed for other types of surgery, because “[t]he decision to abort, indeed, is an important, and often a stressful one ....” Id. at 67, 96 S.Ct. at 2840. It is possible that such a consent requirement is “legally insignificant,” or “furthers a compelling state interest,” and the Supreme Court’s holding is therefore consistent with the standard developed by the majority. However, the Court did not analyze the requirement in this way. Indeed, in Bellotti v. Baird, 428 U.S. 132, 147, 96 S.Ct. 2857, 2866, 49 L.Ed.2d 844 (1976) (Bellotti I), the Court stated that Planned Parenthood held the consent requirement constitutional because it did not “unduly burden” the right to seek an abortion.
At issue in Bellotti I was the constitutionality of a Massachusetts statute requiring parental consent to abortions for unmarried minors. The Supreme Court remanded the case so the district court could get an authoritative construction of the statute from the Massachusetts Supreme Judicial Court. The Supreme Court stated that it did not need to determine the point at which review of a woman’s consent or of good cause for an abortion in the case of a minor becomes “unduly burdensome,” 428 U.S. at 148, 96 S.Ct. at 2866, or whether a court hearing to determine whether informed consent was given would “unduly burden” the rights of an adult. Id. at 147, 96 S.Ct. at 2866. No mention is made in Bellotti I of any compelling state interest. Again, the facts of Bellotti I do not militate against either the majority’s or the District Court’s standard. However, the Supreme Court’s language indicates that the panel’s formulation is incorrect.
Maher v. Roe, 432 U.S. 464, 97 S.Ct. 2376, 53 L.Ed.2d 484 (1977), held that the Constitution does not require states to fund non-therapeutic abortions. The Supreme Court observed that the court below had read Roe v. Wade and progeny
as establishing a fundamental right to abortion and therefore concluded that nothing less than a compelling state interest would justify Connecticut’s different treatment of abortion and childbirth. We think the District Court misconceived the nature and scope of the fundamental right recognized in Roe. . . . We held [in Roe] that only a compelling state interest would justify such a sweeping restriction on a constitutionally protected interest, and we found no such state interest during the first trimester.... In subsequent cases, we have invalidated other types of restrictions different in form but similar in effect, on the woman’s freedom *1214of choice. . . . Although a state-created obstacle need not be absolute to be impermissible ... we have held that a requirement for a lawful abortion “is not unconstitutional unless it unduly burdens the right to seek an abortion.” ... As Whalen [v. Roe, 429 U.S. 589, 599-600, 97 S.Ct. 869, 876-877, 51 L.Ed.2d 64] makes clear, the right in Roe can be understood only by considering both the woman’s interest and the nature of the State’s interference with it. Roe did not declare an unqualified “constitutional right to an abortion,” as the District Court seems to think. Rather, the right protects the woman from unduly burdensome interference with her freedom to decide to terminate her pregnancy.
Id. at 472-474, 97 S.Ct. at 2382 (citations omitted) (emphasis added).
The Court also upheld Connecticut’s requirement that a woman who sought state funding for a therapeutic abortion submit her request in writing and get the prior approval of the Connecticut Department of Social Services. Id. at 480, 97 S.Ct. at 2386. The Court found the requirement reasonable although there was no similar requirement for other forms of surgery because “such [other] procedures do not involve the termination of a potential human life.” Id.
The majority distinguishes Maher by pointing out the Supreme Court’s emphasis that the case did not involve limitations on the right to an abortion. While true, this means only that the facts of Maher, like the facts of Roe v. Wade, Planned Parenthood, and Bellotti I, do not determine the correct standard. The majority also attaches significance to language in Maher in which the Supreme Court states that its “conclusion signals no retreat from Roe or the cases applying it.” Id. at 475, 97 S.Ct. at 2383. The majority interprets this as signalling “that the [Supreme Court’s] later cases do not represent a retreat from the Roe v. Wade holding that the state’s right to regulate abortions, at each stage of pregnancy, must rest on a compelling and legitimate state interest.” However, when the Court in Maher announced that it was not retreating from Roe, it meant only that it was not retreating from Roe as it had interpreted Roe in the preceding pages of its opinion in Maher, that is, to forbid “unduly burdensome” regulation of abortions.
In Bellotti v. Baird, 443 U.S. 622, 99 S.Ct. 3035, 61 L.Ed.2d 797 (1979) (Bellotti II), the Court struck down a Massachusetts statute requiring parental consent to abortions for mature minors. The four-justice plurality framed the issue thus:
The question before us — in light of what we have said in the prior cases — is whether [the statute], as authoritatively interpreted by the Supreme Judicial Court, provides for parental notice and consent in a manner that does not unduly burden the right to seek an abortion.
Id. at 640, 99 S.Ct. at 3046 (emphasis added).
The plurality concluded that as construed the statute
would impose an undue burden upon the exercise by minors of the right to seek an abortion.... [U]nder state regulation such as that undertaken by Massachusetts, every minor must have the opportunity — if she so desires — to go directly to a court without first consulting or notifying her parents.
Id. at 647, 99 S.Ct. at 3050 (emphasis added).
The plurality added that “the constitutional right to seek an abortion may not be unduly burdened by state-imposed conditions upon initial access to court.” Id. at 648, 99 S.Ct. at 3051 (emphasis added).
The requirement of either going to court or notifying one’s parents is clearly a significant burden. Therefore, to be consistent with the panel’s analysis the Supreme Court should have found a compelling state interest before inquiring whether the statute would unduly burden the right to seek an abortion. The plurality found the state’s interest in encouraging a family resolution of a minor’s abortion decision “important.” Id. at 648, 99 S.Ct. at 3051. It never found *1215the state’s interest compelling.4 Thus, while the result in Bellotti II may be consistent with the standard of review suggested by the panel the plurality’s analysis is not.
Harris v. McRae, 448 U.S. 297, 100 S.Ct. 2671, 65 L.Ed.2d 784 (1980), upheld as constitutional the Hyde Amendment, which forbade the use of federal funds for abortions. The Court stated:
The doctrine of Roe v. Wade, the Court held in Maher, “protects the woman from unduly burdensome interference with her freedom to decide whether to terminate her pregnancy,” id. [432 U.S.], at 473-474 [97 S.Ct. at 2382-83], such as the severe criminal sanctions at issue in Roe v. Wade, supra, or the absolute requirement of spousal consent for an abortion challenged in Planned Parenthood of Central Missouri v. Danforth, 428 U.S. 52 [96 S.Ct. 2831, 49 L.Ed.2d 788].
Id. 448 U.S. at 314, 100 S.Ct. at 2686 (emphasis added).
Again, the Supreme Court’s language indicates that the panel’s formulation is incorrect.
The most recent case to deal with abortions is H. L. v. Matheson,-U.S.-, 101 S.Ct. 1164, 67 L.Ed.2d 388 (1981), where the Court held constitutional a requirement that unmarried, immature minors under the age of 15 notify their parents of their decision to seek an abortion. The Court observed that the statute did not involve an absolute veto, and that it served “important considerations” and “significant state interests.” Id. - U.S. at-, 101 S.Ct. at 1173-74. The Court did not engage in the two-step analysis suggested by the panel.
Thus, the Supreme Court has never suggested the analysis put forth by the majority. It has sometimes suggested that a compelling state interest is necessary to justify any state regulation of abortion during the first trimester, but that language has always been far broader than required by the facts before it. With the exception of the passage in Colautti, supra, and a part of Planned Parenthood, all of the cases since Roe have suggested that the proper standard is simply whether a regulation that does not effectively prohibit abortions is “unduly burdensome” to the decision whether or not to abort. The Court’s decisions are all consistent with that standard. Although this standard is very close to that applied by the District Court, it differs in that the District Court required that the prohibition or veto be absolute before it must be justified by a compelling state interest.5
My resolution of the remaining issues, however, does not depend on whether I apply the majority’s standard, that of the District Court, or what I perceive to be the Supreme Court’s position.
Section 1870.05(B) requires for a minor under the age of 15 either consent of a parent or “an order from a court having jurisdiction over her that the abortion be performed or induced” as a condition of terminating pregnancy. The District Court invalidated section 1870.05(B) because it did *1216not protect the abortion decision of a mature minor, and the majority affirms this decision. The District Court, however, made no attempt to construe section 1870.-05(B) in a constitutional fashion.
In H. L. v. Matheson the Utah statute required a minor’s physician “to notify, if possible, the parents or guardian of the woman upon whom the abortion is to be performed, if she is a minor.. .. ” -U.S. at-, 101 S.Ct. at 1166-67. In an unrelated case the federal district court in Utah had held that this statute did not apply to unemancipated minors. L. R. v. Hansen, Civil No. C-80-0078J (Feb. 8, 1980). Because the minor who brought suit in Mathe-son did not show that she was mature or emancipated, she lacked standing to challenge the statute as applied to such minors, and the Supreme Court was “unwilling to assume that the statute, when challenged in a proper case, will not be construed also to exempt demonstrably mature minors.” - U.S. at-, 101 S.Ct. at 1169.
Similarly, in Bellotti I, the Supreme Court remanded for authoritative construction a statute that required parental consent to abortions for minors. “[I]n light of our disapproval of a ‘parental veto’ today in Planned Parenthood, we must assume that the lower Massachusetts courts, if called upon to enforce the statute pending interpretation by the Supreme Judicial Court, will not impose this most serious barrier.” 428 U.S. at 151, 96 S.Ct. at 2868.
Section 1870.05(B) is capable of a construction that would render it constitutional. This would be the case if, for example, the order from “a court having jurisdiction” was based, as it constitutionally must be, first on an inquiry into the minor’s maturity. Thus, the section is not facially invalid. As the majority notes in reversing the District Court’s holding that section 1870.05(A) is unconstitutional, no minor challenges the Akron ordinance. I would not find section 1870.05(B) unconstitutional until a mature minor challenges it and until it has been construed by a lower court.
I also dissent from that portion of the panel’s opinion which reverses the holding of the District Court that § 1870.06(C) is constitutional. This section requires that the attending physician advise the patient of
the particular risks associated with her own pregnancy and the abortion technique to be employed including providing her with at least a general description of the medical instructions to be followed subsequent to the abortion in order to insure her safe recovery, and shall in addition provide her with such other information which in his own medical judgment is relevant to her decision as to whether to have an abortion or to carry her pregnancy to term.
The majority holds that this provision infringes on the medical judgment of the attending physician. The section does not, however, interfere with the patient’s right to decide whether to terminate her pregnancy. Cf. Colautti v. Franklin, 439 U.S. at 392-394, 396, 99 S.Ct. at 684-85, 686 (1979); Planned Parenthood of Central Missouri v. Danforth, 428 U.S. at 64, 96 S.Ct. at 2839; Roe v. Wade, supra. Further, the witnesses who testified at trial agreed that the information should be given to the patient. Indeed, in Planned Parenthood v. Danforth, the Court stated that “[t]he decision to abort is an important, and often a stressful one, and it is desirable and imperative that it be made with full knowledge of its nature and consequences.” 428 U.S. at 67, 96 S.Ct. at 2840. The Court considered that informed consent meant
the giving of information to the patient as to just what would be done and as to its consequences. To ascribe more meaning than this might well confine the attending physician in an undesired and uncomfortable straitjacket in the practice of his profession.
Id. n. 8. The Utah statute at issue in H. L. v. Matheson provided that no abortion could be performed
unless a “voluntary and written consent” is first obtained by the attending physician from the patient. In order for such a consent to be “voluntary and informed,” the patient must be advised at a *1217minimum about available adoption services, about fetal development, and about foreseeable complications and risks of an abortion.
-U.S. at-n. 1,101 S.Ct. at 1167 n. 1. In upholding this requirement, the Supreme Court simply noted that in Planned Parenthood v. Danforth “we rejected a constitutional attack on written consent provisions.” Id. Thus, the Supreme Court apparently does not believe that the limited information required by .06(C) imposes an undue burden on the physician. The giving of such information enhances, rather than restricts, the woman’s freedom of choice. “Informed consent” without this information would be worthless. See also Wolfe v. Schroering, 541 F.2d 523, 526 (6th Cir. 1976).
Plaintiffs’ objection is not to the giving of the information, but rather to the requirement that the information be given by a physician. The Supreme Court has repeatedly recognized the importance of the physician-patient relationship to the abortion decision. Several times the Court has stated that during the first trimester the physician, in consultation with his patient, must be free to determine that in his medical judgment the patient’s pregnancy should be terminated. Bellotti II, 443 U.S. at 641 n. 21, 643, 99 S.Ct. at 3047, n. 21, 3048; Colautti v. Franklin, 439 U.S. at 387, 99 S.Ct. at 681; Planned Parenthood of Central Missouri v. Danforth, 428 U.S. at 61, 96 S.Ct. at 2837; Roe v. Wade, 410 U.S. at 163, 164, 93 S.Ct. at 732. In Planned Parenthood the Court emphasized “participation by the attending physician [in the abortion decision] and his responsibility in that decision .... ” 428 U.S. at 61, 96 S.Ct. at 2837. In Roe, the Court would have permitted a state to require that abortions be performed by a licensed physician, which at least strongly implies the state’s interest in ensuring the existence of a physician-patient relationship. 410 U.S. at 165, 93 S.Ct. at 732-733. As the Court observed in Colautti, “Roe stressed repeatedly the central role of the physician, both in consulting with the woman about whether or not to have an abortion, and in determining how any abortion was to be carried out.” 439 U.S. at 387, 99 S.Ct. at 681.
The requirement that the information specified in .06(C) be given by a physician does no more than seek to ensure that there is in fact a true physician-patient relationship even for the woman who goes to an abortion clinic. The evidence presented at trial showed that the decision to terminate a pregnancy was made not by the woman in conjunction with her physician, but by the woman and lay employees of the abortion clinic, the income of which is dependent upon the woman’s choosing to have an abortion. The testimony disclosed that the doctors at Akron Center’s clinic did little, if any, counseling before seeing the patient in the procedure room. Akron’s ordinance simply takes into account these realities of the “physician-patient” relationship at an abortion clinic.
I concur in the majority’s conclusion that the 24-hour delay imposed by § 1870.07 is unconstitutional. However, the state has a strong interest in ensuring a carefully considered abortion decision, the 24-hour delay is substantially related to that state interest, and in many instances the delay imposes no undue burden on the right to an abortion. Nonetheless, .07 as it now stands is overbroad. For example, it would require a 24-hour delay even where the delay would impose a grave risk to the mental health of the pregnant woman, where the woman has already been counseled by a physician, or where the delay would cause such significant extra expense to an individual as to unduly burden if not effectively prohibit the decision. The Supreme Court requires closer attention to the circumstances of individual cases in the abortion context. Bellotti II, 443 U.S. at 643, n. 23, 99 S.Ct. at 3048, n. 23.
I concur in the balance of the majority’s opinion.

. The Supreme Court did not use the word “significant” to distinguish permissible and impermissible first trimester regulation in Roe v. Wade. Indeed, the Court’s language prohibited all first trimester abortion regulation. However, even in Roe the Court, without explanation, permitted a state to proscribe any abortion not performed by a physician. 410 U.S. at 165, 93 S.Ct. at 733.

. This is apparently the basis for the threshold requirement of “legal significance” in the majority’s test. However, because the term “legally significant” as used by the Supreme *1213Court did no more than state a conclusion, it is not helpful in reaching a conclusion.

. The Court recently quoted from Roe to the same effect in invalidating a statute which required a certain abortion technique where the fetus “may be viable”:
... up to the points where important state interests provide compelling justifications for intervention, “the abortion decision in all its aspects is inherently, and primarily, a medical decision” ....
Colautti v. Franklin, 439 U.S. 379, 387, 99 S.Ct. 675, 681, 58 L.Ed.2d 596 (1979). Insofar as this language suggests that no regulation of abortion is permitted before the end of the first trimester absent a compelling justification, it suppo;ts the majority’s standard. However, since the purpose of Colautti was to emphasize the central role of the physician in the abortion decision, and other Supreme Court cases, infra, indicate that Roe did not prohibit all such first trimester regulation, the quote is entitled to little weight on the issue of the standard of review.

. It may be argued that the Court simply applies a different standard of review in the case of minors. However, the Court has not said that it does, and it is not clear why the standard of review, rather than the relative weights of the parties’ interests, should change. The state’s interests in the case of minors are weightier, and thus lead to a different outcome in the balancing process.

. Charles v. Carey, 627 F.2d 772, 777-778 (7th Cir. 1980), is not persuasive support for the majority’s decision. The district court in that case he'd that a law that unduly burdens the abortion decision is subject to strict scrutiny. The Seventh Circuit held that “the term ‘undue burden’ defines the ultimate constitutional issue, not merely the threshold requirement for strict scrutiny.” Id. at 777. With this statement I agree. I do not take the additional step of subjecting all regulations of abortion that are not de minimis to the compelling state interest standard.
The Seventh Circuit’s concern that plaintiffs who must challenge abortion regulations on other than an across-the-board “compelling state interest” standard will be unable to anticipate the state’s possible justifications for the regulations simply does not ring true in the abortion context. Nor do I share the Seventh Circuit’s concern that the courts are incapable of determining when a burden on the abortion decision is “undue.”