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Abortion - Roe V. Wade And Its Aftermath

health fetus life requirement

New York's was the only state abortion law that came close to surviving the Supreme Court's decision in Roe v. Wade, 410 U.S. 113 (1973). Roe held unconstitutional a Texas statute, dating from 1857, which prohibited all abortions except those procured on medical advice for the purpose of saving the mother's life. A companion case, Doe v. Bolton, 410 U.S. 179 (1973), struck down a Georgia law adopted in 1968 and based on the Model Penal Code's abortion provisions. The effect of these two decisions was to render invalid practically every abortion restriction on the books in the United States.

The decision in Roe was premised on a woman's constitutional right to control (in consultation with her physician) the use of her own body for reproductive purposes. This right was held to follow from the Court's previous decisions recognizing a fundamental right to "privacy" or personal autonomy. Because a "fundamental" right was involved, a state could not simply prohibit abortion on any terms it chose; it would have to adduce "compelling" reasons for overriding a woman's right to procreative choice. Since early abortion is safer than normal childbirth, concern for the mother's health would not provide a sufficiently compelling reason for restrictions on abortion during the first trimester, other than a requirement that it be performed by a licensed physician. Concern for the fetus could not be used to preempt a woman's right to elect abortion before "viability"—the point near the beginning of the third trimester at which a fetus is capable of surviving outside the womb, albeit only with artificial aid. After viability, concern for the fetus as "potential life" was held to be sufficiently compelling to permit a state to regulate or even prohibit abortion, unless continued pregnancy threatened the mother's life or health. In other words, Roe invalidated almost all restrictions on abortion during the first six months of pregnancy except for those designed to protect maternal health in the second trimester, but permitted any and all restrictions during the third trimester except where abortion was necessary to preserve maternal health or life.

The Roe decision sparked enormous controversy. Opposition to Roe turned abortion into a central issue in national politics. Efforts to over-rule Roe by constitutional amendment, or by packing the Supreme Court, so far have failed. The Court did depart from Roe and nearly over-ruled it in Webster v. Reproductive Health Services, 492 U.S. 490 (1989). Subsequently, however, the controlling opinion in Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S. 833 (1992), jointly delivered by Justices Sandra Day O'Connor, Anthony Kennedy, and David Souter, reaffirmed Roe's "essential holding," although it significantly qualified Roe by allowing states to invoke both maternal health and concern for the life of the fetus as bases for restrictions that inhibit access to abortion at any stage of pregnancy, so long as those restrictions do not amount to an "undue burden" posing a "substantial obstacle" to the abortion of a nonviable fetus.

Since 1973 about two-thirds of the states have enacted new abortion laws designed to test the limits of Roe. These statutes curtail the availability of abortion in various ways: by denying the use of public funds or facilities for abortion; by requiring special precautions to prevent the abortion of a possibly viable fetus; by banning particular methods of abortion; and by imposing waiting periods and notification and consent requirements designed to discourage the choice of abortion.

  1. Laws denying the use of public funds or facilities for abortion consistently have been upheld by the Supreme Court (e.g., Maher v. Roe, 432 U.S. 464 (1977); Harris v. McRae, 448 U.S. 297 (1980)), as was a Bush administration rule forbidding clinics that receive federal funds from counseling or even mentioning abortion (Rust v. Sullivan, 500 U.S. 173 (1991)). Indeed, it was in the abortionfunding cases that the distinction first emerged between "undue burdens" on procreative choice and constitutionally permissible expressions of a legislative policy favoring maternity.
  2. Laws prohibiting the abortion of a viable fetus are common and generally valid, provided they make exception for abortions necessary to preserve the mother's life or health. Planned Parenthood Association of Kansas City v. Ashcroft, 462 U.S. 476 (1983), narrowly upheld a Missouri statute mandating that a second doctor be present to look out for the fetus during post-viability abortions; Thornburg v. American College of Obstetricians and Gynecologists, 476 U.S. 747 (1986), struck down a similar Pennsylvania requirement that did not except situations where waiting for the second doctor would put the mother's life or health at risk. Thornburg also invalidated a requirement that post-viability abortions be performed in a way that would allow the unborn child to survive the procedure, if it could be done without significantly greater risk to the mother; this was read as impermissibly demanding that the mother bear an increased medical risk in order to save the fetus. Webster v. Reproductive Health Services, supra, upheld another Missouri statute prohibiting doctors from performing abortions on any woman believed to be twenty weeks pregnant or more without first undertaking tests to determine fetal viability.
  3. Laws banning particular methods of abortion generally have been found to be invalid. Planned Parenthood of Central Missouri v. Danforth, 428 U.S. 52 (1976), struck down a prohibition of saline amniocentesis, at the time the usual and safest method for second trimester abortions. Most of the lower courts that passed on the spate of state laws prohibiting so-called partial-birth abortions found them to be invalid, as did the Supreme Court in Stenberg v. Carhart, 120 S. Ct. 2597 (2000). These laws criminalize abortions where "the person performing the abortion partially delivers vaginally a living unborn child before killing the unborn child and completing the delivery." This appears to refer to the procedure known as "intact dilation and extraction," in which, in order to minimize damage to the uterus and cervix, the fetus is partly moved into the birth canal before being destroyed. But no exception for maternal health is made in these laws; it is not required that the fetus be viable; and the statutory language is said to be vague enough to cover other permissible abortion procedures as well.
  4. Laws imposing relatively minor impediments to abortion such as record-keeping requirements and a requirement of the patient's written consent generally have been upheld. Requirements that doctors make certain specified statements to a woman seeking abortion, so that her consent will be "informed," and mandatory twenty-four-hour waiting periods before the abortion can be performed, were struck down in City of Akron v. Akron Center for Reproductive Health, 462 U.S. 416 (1983), and in Thornburg, supra, on the ground that they were designed to intimidate women into forgoing abortion; such requirements were upheld, however, under the new standard adopted by the plurality opinion in Planned Parenthood of Southeastern Pennsylvania v. Casey, supra. A requirement of spousal consent was invalidated in Danforth, supra, on the ground that it effectively gave the husband a veto over his wife's exercise of a constitutional right; Casey similarly found that, for many women, even a requirement of spousal notification would pose a substantial obstacle to abortion and therefore was impermissible. A requirement of parental consent when an unmarried pregnant minor seeks an abortion was invalidated in Danforth; but such requirements generally have been upheld in subsequent cases, including Casey, when accompanied by alternative provision for a judge to approve the abortion in lieu of a parent. A law requiring that both of a minor's parents be notified of the abortion would be invalid without a similar provision for so-called judicial bypass (Hodgson v. Minnesota, 497 U.S. 417 (1990)); the validity of a requirement that only one parent be notified, without provision for judicial bypass, was left open in Ohio v. Akron Center for Reproductive Health, 497 U.S. 502 (1990), which upheld a law requiring notification to at least one parent, with a judicial bypass option.

Efforts to limit the availability of abortion have been relentless, an indication of the intensity of opposition to Roe. The anti-abortion "pro-life" position is rooted partly in the belief that the fetus is already a human person whose destruction constitutes a form of homicide and should be punished as such. But it is not based exclusively on this belief. There are different strands of "pro-life" sentiment. Willingness to make exceptions for cases of medical necessity or of rape, and reluctance to classify abortion as first degree murder, suggest varying degrees of commitment to the premise that abortion is in no way different from any other form of homicide. In any event, opposition to abortion appears to be bound up as well with views about sexual morality and the nature of the relationship between men and women. Roe v. Wade is the outstanding symbol of the prevalence of an antithetical set of views that have, since the 1960s, subverted "traditional" family and religious values; taking up arms (in some cases quite literally) against abortion serves to reassert the importance of those values in an increasingly secular world. For the "pro-choice" side, Roe also has considerable symbolic significance, as well as the practical and liberating effect of giving women control over their fertility. For both sides, every millimeter of ground gained or lost in the struggle to preserve or curtail the right to abortion established in Roe is a signal victory or defeat in a continuing clash between deeply-held beliefs about the proper role and responsibility of women in the family and in society.

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