Doe v. Bolton

Mary Doe, under a pseudonym, was a married, twenty-two year old mother living in Georgia. At the time of this case, she already had three children, two in foster care and the third given up for adoption due to her inability to provide for them. She sought an abortion from the Grady Memorial Hospital Abortion Committee in Atlanta and was denied because she did not meet one of the exceptions in Georgia law, which only allowed an abortion when the mother’s life was in danger, the fetus would likely be born with “a grave, permanent, and irremediable mental or physical defect,” or the pregnancy was a consequence of “forcible or statutory rape.”

Even if Doe met one of the exceptions, the Georgia statute listed a series of requirements that had to be met before the procedure could be authorized. The requirements included writing of her physician’s medical judgment, two concurring judgments of other Georgia-licensed physicians, performance of the procedure in a “hospital licensed by the State Board of Health and also accredited by the Joint Commission on the Accreditation of Hospitals,” approval in advance by a hospital’s abortion committee, proof of certification if rape occurred, and “maintenance and confidentiality of records.”

Doe, along with twenty-three other physicians, nurses, clergymen, social workers, and non-profits brought this action against the State’s attorney general, the district attorney of Fulton County, and the chief of police of Atlanta. The relief sought was to declare the statutes unconstitutional and prevent the defendants from enforcing the statutes through an injunction. The basis of the claim was that the statutes violated Doe’s rights to privacy and family matters as they denied “her right to decide when and how many children she will bear.”

The district court heard Doe’s claim, but rejected the claims of the other plaintiffs, and struck down the statute only allowing three exceptions, the certification of rape a provision allowing a court review of the legality of the procedure. Despite this decision, the district court additionally held that the state had a valid interest in protecting health and potential human life. Thus, it refused to strike down any other parts of the statute and denied the injunction request.

The plaintiffs directly appealed to the Court. Although the defendants appealed also, their appeal is proceeding through the United States Court of Appeals for the Fifth Circuit. The issue before the Court regarded whether four additional provisions in the statute are unconstitutional and whether an injunction should be granted. The Court did not review the aspects of the district court decision that were adverse to the defendants.

The Court held that four different provisions were invalid and violated the 14^th amendment. This included the requirement for the procedure to be down in a hospital accredited by the Joint Commission on the Accreditation of Hospitals (JCAH), the requirements for a hospital abortion committee’s approval, the corresponding confirming of two other physicians, and the residency requirement in Georgia. The Court granted standing to the physician-appellants due to their possibility of being prosecuted but noted that who exactly had standing in this case was not significant. Before analyzing the three different provisions, the Supreme Court addressed the appellants’ argument that basing an abortion on a physician’s “best clinical judgment” is unconstitutionally vague. Relying on a precedent case, United States v. Vuitch, the court decided the provision was not vague because physicians commonly have to make similar judgments in the course of their work and that this judgment can be exercised upon all factors “relevant to the wellbeing of the patient.”

The Court next considered the provision requiring the abortion to be performed in a JCAH accredited hospital. It held the provision constitutionally invalid because another licensed facility could foreseeably perform the abortion other than a hospital, and JCAH is intended toward overall hospital quality standards, not abortions. In regards to the hospital abortion committee, the Court acknowledged that hospitals have an interest in ensuring activities “are in accord with legal requirements.” However, it noted that no other surgical procedure required committee approval and decided that the committee requirement “substantially limited” the woman’s right to receive medical care and the physician’s right to administer her treatment. The hospital is sufficiently legally protected by 26-1202(e), which permits a hospital to refuse to provide an abortion.

Next, the Court examined the provision requiring the concurrences of two physicians and decided one licensed physician’s judgment was adequate. Physicians should utilize their own judgment, and a licensed physician “is recognized by the State as capable of exercising acceptable clinical judgment.” No other surgical procedure required confirmation by two other physicians.

For the fourth provision, the Court held the residency requirement was unconstitutional because the state of Georgia does not limit its medical facilities to Georgia residents, and a contrary decision would mean that Georgia could restrict its medical care to only those within its borders.

Finally, the Court denied injunctive relief to the appellants because the court relied on Georgia’s authorities respecting its opinion.

Justice Douglas concurred with the majority’s view that the standards for exceptions were too narrow and violated the woman’s right to privacy. The language of the statute in question favoured the interests of Georgia over the rights of the woman to privacy and her relationship with her doctor.

The dissent  of Justice White and Justice Rehnquist was concerned that the majority’s decision could enable women to obtain abortions without any danger to life or health. The justices viewed this decision as extending beyond the power of judicial review of the Court.

“We agree with the District Court, 319 F. Supp., at 1058, that the medical judgment may be exercised in the light of all factors – physical, emotional, psychological, familial, and the woman’s age – relevant to the wellbeing of the patient. All these factors may relate to health. This allows the attending physician the room he needs to make his best medical judgment. And it is room that operates for the benefit, not the disadvantage, of the pregnant woman.” (p. 7)

“Appellants and various amici have presented us with a mass of data purporting to demonstrate that some facilities other than hospitals are entirely adequate to perform abortions if they possess these qualifications. The State, on the other hand, has not presented persuasive data to show that only hospitals meet its acknowledged interest in insuring the quality of the operation and the full protection of the patient. We feel compelled to agree with appellants that the State must show more than it has in order to prove that only the full resources of a licensed hospital, rather than those of some other appropriately licensed institution, satisfy these health interests.” (p. 8)

“Viewing the Georgia statute as a whole, we see no constitutionally justifiable pertinence in the structure for the advance approval by the abortion committee. With regard to the protection of potential life, the medical judgment is already completed prior to the committee stage, and review by a committee once removed from diagnosis is basically redundant. We are not cited to any other surgical procedure made subject to committee approval as a matter of state criminal law. The woman's right to receive medical care in accordance with her licensed physician's best judgment and the physician's right to administer it are substantially limited by this statutorily imposed overview.” (p. 9)

“The Georgia statute is at war with the clear message of these cases - that a woman is free to make the basic decision whether to bear an unwanted child. Elaborate argument is hardly necessary to demonstrate that childbirth may deprive a woman of her preferred lifestyle and force upon her a radically different and undesired future. For example, rejected applicants under the Georgia statute are required to endure the [410 U.S. 179, 215] discomforts of pregnancy; to incur the pain, higher mortality rate, and aftereffects of childbirth; to abandon educational plans; to sustain loss of income; to forgo the satisfactions of careers; to tax further mental and physical health in providing child care; and, in some cases, to bear the lifelong stigma of unwed motherhood, a badge which may haunt, if not deter, later legitimate family relationships.” (p. 21) (Justice Douglas, concurring).