Poelker v. Doe

Petitioners
John H. Poelker, et al.
Respondents
Jane Doe, et al.
Petitioners' Claim
That the city of St. Louis, in electing as a policy choice to provide publicly financed hospital services for childbirth but not for nontherapeutic abortions, did not violate the Equal Protection Clause of the Fourteenth Amendment.
Chief Lawyer for Petitioner
Eugene P. Freeman
Chief Lawyer for Respondent
Frank Susman
Justices for the Court
Warren E. Burger, Lewis F. Powell, Jr., William H. Rehnquist, John Paul Stevens, Potter Stewart, Byron R. White
Justices Dissenting
Harry A. Blackmun, William J. Brennan, Jr., Thurgood Marshall
Place
Washington, D.C.
Date of Decision
20 June 1977
Decision
Upheld that the city of St. Louis did not violate Fourteenth Amendment equalprotection, thereby reversing the judgement of the Court of Appeals for the Eighth Circuit.
Significance
The ruling specified that a hospital was allowed to refuse the performance ofabortions based on hospital policy that was not influenced by city officials. However, this ruling also brought to light a certain form of discriminationcaused by policies of this type that affected indigent mothers who wished tohave abortions but could not afford to pay for them at private clinics.
In the Roe v. Wade case of 1973 it was decided by the U.S. Supreme Court that the Constitution of the United States embraced a woman's right to terminate her pregnancy by abortion. The Court maintained that this right to abortion fell within the right to privacy, and was protected by the Fourteenth Amendment. This was initially determined through a debate concerning the use of contraceptives in Griswold v. Connecticut (1965). The Court's decision in Roe v. Wade granted women complete autonomy over pregnancy during the first trimester and interpreted the levels of state interest for the second and third trimesters. This ruling influenced the laws of 46 states and spurred debate nationwide. Roe v. Wade acted as the precedent for suchSupreme Court cases as Poe v. Gernstein (1974), Whalen v. Roe (1975), and Connecticut v. Menill (1975). The fundamental issue of women's autonomy during pregnancy was at the heart of each of these cases. Poelker v. Doe was no exception; however, this case defined the means in which a hospital could legally refuse to perform an abortion without crossing the boundaries of personal freedom.
An indigent woman, known to the court only as Jane Doe, sought to obtain an abortion at Starkloff Hospital, a Jesuit institution run by the University ofSt. Louis. It is important to note that the abortion requested by Doe was nontherapeutic--her health was not endangered by the pregnancy. The hospital refused to perform the abortion. As a result, Doe brought a civil rights class action suit in the U.S. District Court for the Easter District of Missouri, alleging that her constitutional rights had been violated.
The initial trial ruled against Doe. However, this ruling was reversed by theCourt of Appeals for the Eight Circuit. The court of appeals determined thatDoe's rights had been violated due to a combination of two elements: a policy directive from Mayor Poelker of St. Louis to the Director of Health and Hospitals and the hospital's staffing practice. The mayor's policy directive backed his own personal belief against abortion, prohibiting their performance in city hospitals unless there was threat of extreme physiological injury or death to the mother. Under the staffing practice, doctors and students at theobstetrics-gynecology clinic of Starkloff Hospital were members of the faculty and students of the St. Louis University School of Medicine. This came about during the 1950s, when the city of St. Louis was experiencing accreditationproblems; St. Louis University and Washington University offered to staff the city-run Starkloff and Homer G. Phillips Hospitals. As a result the doctorsand students staffing Starkloff Hospital were considered city employees. However, St. Louis University was a Jesuit institution that expressed strong anti-abortion views. Because of this paradox, the court of appeals stated that the staffing policy of Starkloff Hospital denied the "constitutional rights ofindigent pregnant women . . . long after those rights had been clearly enunciated." It is interesting to note that Jane Doe never approached Homer G. Phillips Hospital for the abortion; ironically, this hospital was staffed by Washington University and was non-sectarian.
In essence, the appeals court used these facts to portray the case as an issue of equal protection. Jane Doe, as an indigent woman, could not afford to pay a private clinic for her abortion. Therefore, her only option lay in the use of a public hospital--which refused her this service. This was viewed as discrimination of indigent women, as "no other women similarly situated are socoerced." Other factors taken into consideration by the court of appeals included a previous decision in Wulff v. Singleton (1976) that had found astate Medicaid statute unconstitutional because it would not provide benefits to women seeking elective abortions but did provide them for women who carried their pregnancies to term, and the decisions made in Roe v. Wade and Doe v. Bolton. With this data, the court of appeals reversed with the opinion that Starkloff Hospital's refusal to grant Jane Doe an abortion "constituted invidious discrimination, violative of equal protection under theFourteenth Amendment."
Another Reversal
While the Supreme Court agreed that the constitutional question concerning discrimination presented in Poelker v. Doe was identical in principle tothat represented by a state's denial of Medicaid benefits for abortions while providing them for childbirth, they still found grounds to reverse the decision made by the Court of Appeals for the Eighth Circuit. Key to this decision was the manner in which the hospital refused to perform the abortion--as apolicy choice. An important aspect of arriving at this conclusion was the determination that there was no direct contact between the doctors and staff ofthe hospital and Mayor Poelker--and therefore no direct influence concerningthe mayor's personal opposition to abortion. Indeed, the Court deemed that the mayor's personal opinions concerning abortion were not relevant to the caseand declared that the policy of denying city funds for abortions such as that requested by Doe was a matter of public debate and could be decided at thepolls. The Supreme Court determined that the city of St. Louis did not violate the Equal Protection Clause of the Fourteenth Amendment. A city is well within its constitutional rights to provide, as a policy choice, publicly financed hospital services for childbirth while not offering services for nontherapeutic abortions.
Upon arriving at this decision, the Supreme Court also deemed that the courtof appeals erred in reversing the decision of the Federal District Court andthat it had wrongly awarded attorneys' fees to the prevailing party.
Complicated Issues
Justices Brennan, Marshall and Blackmun dissented, stating that the city of St. Louis infringed on the constitutional rights of indigent women by providing physicians and medical facilities for maternity care, but not offering thesame for indigent women who exercise their constitutionally protected right to abortion. This situation posed what they termed as a "significant, and in some cases insurmountable, obstacle to indigent pregnant women who cannot payfor abortions in . . . private facilities." They pointed out other problems created by the Court's holding. What of doctors working for public hospitals that were willing to perform abortions, but could not do so due to the ruling?What would happen in small communities where a public hospital was the onlymeans of medical care? Another important issue to note was that at the time of this decision only 18 percent of all public hospitals in the United Statesprovided abortion services, with ten states completely lacking public hospitals providing these services.
Drawing primarily from Roe v. Wade and the cases following it, Justices Brennan, Blackmun, and Marshall pointed out that the city policy coerced women to bear children that they did not wish to produce and that the state's anti-abortion morality preferred only "normal childbirth." They felt that St.Louis's policy preference was insufficient to justify its transgression on the constitutional right of women to choose abortion.
Related Cases

• Griswold v. Connecticut, 381 U.S. 479 (1965).
  
• Roe v. Wade, 410 U.S. 113 (1973).
  
• Doe v. Bolton, 410 U.S. 179 (1973).
  
• Wulff v. Singleton, 428 U.S. 106 (1976).
  
• Maher v. Roe, 432 U.S. 464 (1977).
  
• Bellotti v. Baird, 443 U.S. 622 (1979).