Planned Parenthood of Southeastern Pa. v. Casey

The joint opinion located the abortion right in the liberty protected by the Fourteenth Amendment's Due Process Clause. Decisions about whether to bear a child implicate bodily integrity, family life, personal dignity, and autonomy; the State therefore may not make the choice for a woman before viability.

Stare decisis strongly supported retaining Roe's core. Roe had proven workable, remained consistent with the Court's broader substantive-due-process precedents, and had not been undermined by factual developments. Although medical advances could shift the precise point of viability, they did not undermine viability as the constitutional line.

The Court also emphasized reliance. For two decades, women and families had organized intimate relationships, educational plans, employment, and economic lives on the assumption that abortion would remain available if contraception failed. The Court regarded that reliance as real even though it was not the ordinary commercial form of reliance.

Finally, overruling Roe solely because the Court's membership had changed would damage the Court's legitimacy. Roe had addressed an intensely divisive national controversy, and abandoning it without a special justification beyond disagreement with the original decision would appear to be a surrender to political pressure rather than a principled constitutional judgment.

The Court rejected Roe's rigid trimester framework and the strict-scrutiny approach applied in some later abortion cases. The trimester system gave too little weight to the State's legitimate interest in potential life throughout pregnancy and incorrectly treated every regulation that made abortion more difficult as unconstitutional.

Under the new standard, an undue burden exists when a regulation has either the purpose or the effect of placing a substantial obstacle in the path of a woman seeking a previability abortion. A law intended to hinder rather than inform a woman's free choice is invalid, as is a law that substantially obstructs access even while serving an otherwise legitimate interest.

The State may regulate to protect maternal health and may use truthful, nonmisleading measures to ensure that a woman's decision is informed. It may also express a preference for childbirth over abortion, but it may not prohibit a woman from making the ultimate previability decision or impose an undue burden on that decision.

The Court retained viability as the point at which the State's interest in potential life may support a prohibition. After viability, the State may regulate and even proscribe abortion, provided it preserves exceptions necessary, in appropriate medical judgment, to protect the woman's life or health.

The Act excused compliance with its consent and notice requirements when immediate abortion was necessary to avert death or when delay created a serious risk of substantial and irreversible impairment of a major bodily function. The challengers argued that the language failed to cover several serious pregnancy complications.

The Third Circuit construed the statute to ensure that compliance with the Act would not pose a significant threat to a woman's life or health. The Supreme Court deferred to that construction of state law and concluded that, so understood, the medical-emergency exception was constitutionally adequate.

The State could require disclosure of truthful, nonmisleading information about the nature of the procedure, its risks, the risks of childbirth, and probable gestational age. It could also require that women be told about the availability of state materials concerning fetal development, adoption, public assistance, and child support. These disclosures could promote informed choice and reflect the State's legitimate interest in potential life without creating a substantial obstacle.

The Court partially overruled Akron v. Akron Center for Reproductive Health and Thornburgh v. American College of Obstetricians and Gynecologists insofar as those cases barred truthful, nonmisleading information designed to encourage childbirth. The physician-patient relationship did not give physicians a constitutional right to withhold information that a State could reasonably require as part of medical informed consent.

Pennsylvania could require a physician, rather than a nonphysician counselor, to provide the specified medical information. States have broad authority to require that licensed professionals perform particular medical functions, and the record did not show that this requirement substantially obstructed abortion access.

The 24-hour waiting period could reasonably give women time to reflect after receiving relevant information. Although the requirement could increase costs, travel, delays, and exposure to clinic protesters for some women, the District Court had not found that it created a substantial obstacle even for the women most burdened. The Court therefore rejected the facial challenge on the record presented.

The Court focused on the women for whom the statute actually operated as a restriction: married women seeking abortions who did not wish to notify their husbands and did not fall within an exception. Constitutional review could not be defeated by showing that most married women voluntarily notify their husbands or that relatively few women would be affected.

The record showed that many women reasonably feared domestic violence, coercion, psychological abuse, financial retaliation, harm to their children, or disclosure of private information if they notified their husbands. The statutory exceptions did not adequately protect many of these women, particularly victims of abuse who could not safely report it or who feared harms other than bodily injury.

For a substantial fraction of women to whom the requirement mattered, notice would operate as a practical veto. It could prevent them from obtaining an abortion as surely as an outright ban, because a husband could use force, threats, or economic coercion to stop the procedure.

The Court distinguished parental-involvement requirements for minors. The State may ordinarily assume that parents act in their children's interests, but it may not make a comparable assumption about an adult woman's husband. A married woman retains her own constitutional liberty; the State cannot give her husband dominion over her reproductive decision.

The Court reaffirmed that a State may require an unemancipated minor to obtain parental consent if it offers an adequate alternative procedure. Pennsylvania allowed a court to authorize an abortion when the minor was mature and capable of informed consent or when abortion was in her best interests.

That bypass protected a minor who could not or would not seek parental approval while preserving the State's legitimate interest in encouraging parental involvement. The Court also concluded that the informed-consent features were permissible for the reasons applicable to adults, and could be especially useful in facilitating family consultation.

Confidential reporting of medical and demographic information could serve legitimate interests in maternal-health research, public-health knowledge, enforcement, and oversight. The reports did not identify individual patients by name, and the record did not show that their modest administrative costs substantially obstructed abortion access.

Public disclosure of limited facility information was also permissible when a facility received state funds. The State had a legitimate interest in informing taxpayers about the recipients and uses of public money.

The separate reporting requirement concerning a married woman's reason for not notifying her husband could not stand. It compelled disclosure of the very private information that made the spousal-notice rule unconstitutional, and thus independently imposed an undue burden.