Poelker v. Doe

The ruling specified that a hospital was allowed to refuse the performance of abortions based on hospital policy that was not influenced by city officials. However, this ruling also brought to light a certain form of discrimination caused by policies of this type that affected indigent mothers who wished to have 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 such Supreme 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 of St. 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 the Court of Appeals for the Eight Circuit. The court of appeals determined that Doe'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 the obstetrics-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 accreditation problems; St. Louis University and Washington University offered to staff the city-run Starkloff and Homer G. Phillips Hospitals. As a result the doctors and 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 of indigent 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 so coerced." Other factors taken into consideration by the court of appeals included a previous decision in Wulff v. Singleton (1976) that had found a state 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 the Fourteenth Amendment."