## Facts

- Sidney Abbott, an asymptomatic HIV-positive patient, sought dental treatment from Dr. Randon Bragdon in Bangor, Maine.
- Abbott disclosed her HIV status on a patient registration form.
- After examining Abbott and diagnosing a cavity, Bragdon stated he would not fill the cavity in his office due to a policy against treating HIV-infected patients there.
- Bragdon offered to perform the procedure in a hospital without charging an additional professional fee, but Abbott would bear the hospital facility costs.
- Abbott declined and sued under Title III of the Americans with Disabilities Act (ADA), which bars disability-based discrimination in the full and equal enjoyment of services of a place of public accommodation, including a health care provider’s professional office.
- Bragdon invoked the ADA’s “direct threat” provision, asserting office treatment would endanger health or safety.

## Issues

1. Whether asymptomatic HIV infection constitutes a “disability” under the ADA because it substantially limits a “major life activity,” and whether reproduction qualifies as a major life activity.
2. Whether, on the summary-judgment record, treating Abbott in the dentist’s office posed a “direct threat” justifying refusal of in-office treatment.

## Decision

- The Court held that HIV infection is a physical impairment from the moment of infection, including when asymptomatic.
- The Court held that reproduction is a “major life activity” and that asymptomatic HIV substantially limits reproduction, making Abbott a person with a disability under the ADA.
- The Court vacated the judgment and remanded on the “direct threat” issue, concluding the record required further evaluation under the proper evidentiary standard.

## Legal Principles

- A physical impairment may qualify as an ADA disability even without current symptoms if it substantially limits a major life activity.
- Reproduction is a “major life activity” under the ADA.
- The ADA “direct threat” exception requires an objective, evidence-based assessment grounded in reasonable medical judgment using current medical knowledge or the best available objective evidence.
- A health care provider’s asserted risk assessment is not entitled to automatic deference when contradicted by objective medical evidence.

## Conclusion

The Court ruled that asymptomatic HIV is a disability under the ADA because it substantially limits reproduction, and it required that any “direct threat” defense be evaluated through an objective medical-evidence standard, remanding for further proceedings on that issue.


Bragdon v. Abbott, 524 U.S. 624 (1998)