Facts
- Missouri enacted a comprehensive abortion regulation statute after Roe, including: a statutory definition of fetal viability; a requirement that a woman provide written informed consent; spousal consent for many first-trimester abortions; parental consent for unmarried minors; a physician duty to preserve fetal life enforceable by criminal and civil liability; a ban on saline amniocentesis after 12 weeks; and detailed reporting and recordkeeping obligations.
- A nonprofit provider and two Missouri physicians who performed or supervised abortions filed suit for declaratory and injunctive relief against state and local prosecutors.
- A three-judge federal district court held the physicians had standing, upheld most provisions, and invalidated the fetal-preservation duty as overbroad because it was not limited to post-viability.
- The Supreme Court noted probable jurisdiction and reviewed the challenged provisions under the Fourteenth Amendment framework governing abortion regulation at the time.
Issues
- Whether the physicians had standing to challenge the statute’s provisions and whether the Court could review the provision addressing an infant who survives an abortion.
- Whether Missouri’s statutory definition of “viability” was consistent with constitutional limits on abortion regulation.
- Whether requiring the pregnant woman’s written informed consent unconstitutionally burdened the abortion decision.
- Whether requiring spousal consent for a married woman’s first-trimester abortion was constitutional.
- Whether requiring parental consent for an unmarried minor’s first-trimester abortion, without an alternative procedure, was constitutional.
- Whether imposing a broad, criminally enforceable duty on physicians to preserve fetal life at all stages was constitutional.
- Whether a ban on the saline amniocentesis method after 12 weeks was a permissible health regulation.
- Whether the statute’s reporting and recordkeeping requirements were constitutionally permissible.
Decision
- The Court held the physicians had standing to challenge provisions affecting their practice and their patients’ rights, but it declined to rule on the provision treating an infant surviving an abortion as an “abandoned ward of the State” due to insufficiently concrete injury.
- The Court upheld the statutory definition of viability.
- The Court upheld the requirement that the woman provide written informed consent.
- The Court struck down the spousal consent requirement.
- The Court struck down the parental consent requirement for unmarried minors.
- The Court struck down the physician’s fetal-preservation duty as drafted because it was not limited to post-viability.
- The Court struck down the ban on saline amniocentesis after 12 weeks.
- The Court largely upheld reporting and recordkeeping requirements, subject to narrow limits to avoid undue interference with decisionmaking and privacy.
- The judgment was affirmed in part and reversed in part, and the case was remanded.
Legal Principles
- Physicians may assert their own interests and, in appropriate circumstances, their patients’ constitutional interests when statutes directly regulate abortion practice.
- A statutory definition of fetal viability is permissible where it is consistent with viability as a medically determined concept that may change with medical advances.
- A state may require written informed consent for an abortion when the requirement is a noncoercive, reasonable regulation that does not impose an undue burden on the abortion decision.
- The state may not give a husband veto power over a married woman’s decision to terminate a pregnancy in the first trimester.
- A blanket parental consent requirement for a minor’s first-trimester abortion is unconstitutional when it grants parents an absolute veto and provides no alternative procedure to protect the minor’s choice.
- A physician duty to preserve fetal life cannot be imposed in a manner that effectively makes fetal preservation paramount at all stages; before viability, regulation cannot override the pregnant woman’s protected decision.
- A method-specific ban during the second trimester is invalid when it is not reasonably related to maternal health and improperly intrudes on medical judgment and the abortion choice.
- Reporting and recordkeeping requirements may be upheld when they serve legitimate public health interests and do not significantly interfere with access, medical judgment, or patient privacy.
Conclusion
The Court applied the then-governing abortion framework to invalidate third-party vetoes and certain method and physician-duty restrictions while permitting written informed consent and most public-health reporting, reaffirming that pre-viability regulation could not substantially displace the pregnant woman’s decision with private or state control.