randon bragdon sidney abbott et argued march decided june held even though respondent hiv infection progressed symptomatic phase disability physical impairment substantially limits one individual major life activities pp ada definition drawn almost verbatim definitions applicable rehabilitation act another federal statute ada expressly provides nothing herein shall construed apply lesser standard rehabilitation act regulations issued pursuant must construe ada grant least much protection regulations implementing rehabilitation act pp moment infection throughout every stage disease hiv infection satisfies statutory regulatory definition physical impairment applicable rehabilitation act regulations define physical mental impairment mean physiological disorder condition affecting body hemic lymphatic systems hiv infection falls well within definition medical literature reveals disease follows predictable unalterable course infection inevitable death causes immediate abnormalities person blood infected person white cell count continues drop throughout course disease even intermediate stage attack concentrated lymph nodes thus hiv infection must regarded physiological disorder immediate constant detrimental effect hemic lymphatic systems pp life activity upon respondent relies ability reproduce bear children constitutes major life activity ada plain meaning word major denotes comparative importance suggests touchstone activity significance reproduction sexual dynamics surrounding central life process petitioner claim congress intended ada cover aspects person life public economic daily character founders statutory language nothing definition suggests activities without dimension may somehow regarded unimportant insignificant major interpretation confirmed rehabilitation act regulations provide illustrative nonexhaustive list major life activities inclusion list activities caring one self performing manual tasks working learning belies suggestion task must public economic character contrary regulations support inclusion reproduction regarded less important working learning pp respondent hiv infection substantially limits major life activity within ada meaning although rehabilitation act regulations provide little guidance regard evaluation medical evidence demonstrates hivinfected woman ability reproduce substantially limited two independent ways tries conceive child imposes male partner statistically significant risk becoming infected risks infecting child gestation childbirth perinatal transmission evidence suggesting antiretroviral therapy lower risk perinatal transmission even relevant avail petitioner said matter law risk transmitting dread fatal disease one child represent substantial limitation reproduction decision reproduce carries economic legal consequences well added costs antiretroviral therapy supplemental insurance health care child must examined treated state laws moreover forbid persons sex others regardless consent context reviewing summary judgment must take true respondent unchallenged testimony hiv infection controlled decision child pp uniform body administrative judicial precedent interpreting similar language rehabilitation act confirms holding every agency consider issue rehabilitation act found statutory coverage persons asymptomatic hiv uniformity precedent significant administrative judicial interpretations settled meaning existing statutory provision repetition language new statute indicates general matter congress intent incorporate interpretations well see lorillard pons pp holding reinforced guidance issued justice department agencies authorized administer ada supports conclusion persons asymptomatic hiv fall within ada definition disability views agencies charged implementing statute entitled deference see chevron natural resources defense council pp affirming summary judgment first circuit cite sufficient material record determine matter law respondent hiv infection posed direct threat health safety others ada direct threat provision stems school bd nassau cty arline reconciled competing interests prohibiting discrimination preventing spread disease construing rehabilitation act require hiring person posed significant risk communicating infectious disease others existence significant risk determined standpoint health care professional refuses treatment accommodation risk assessment based medical objective scientific evidence available profession simply belief significant risk existed see distinguished part first circuit followed proper standard conducted thorough review evidence however might mistakenly relied cdc dentistry guidelines recommend certain universal precautions combat risk hiv transmission dental environment actually assess level risk american dental association policy hiv work professional organization public health authority reveal extent based association assessment dentists ethical professional duties rather scientific assessments evidence record might support affirmance trial ruling reasons doubt whether petitioner advanced evidence sufficient raise triable issue fact significance risk evaluation constrained fact briefs arguments directed entire record remand permit full exploration issues adversary process pp vacated remanded kennedy delivered opinion stevens souter ginsburg breyer joined stevens filed concurring opinion breyer joined ginsburg filed concurring opinion rehnquist filed opinion concurring judgment part dissenting part scalia thomas joined part ii joined filed opinion concurring judgment part dissenting part notice opinion subject formal revision publication preliminary print reports readers requested notify reporter decisions washington typographical formal errors order corrections may made preliminary print goes press randon bragdon petitioner sidneyabbott et al writ certiorari appeals first circuit june justice kennedy delivered opinion address case application americans disabilities act ada stat et persons infected human immunodeficiency virus hiv granted certiorari review first whether hiv infection disability ada infection yet progressed symptomatic phase second whether appeals affirming grant summary judgment cited sufficient material record determine matter law respondent infection hiv posed direct threat health safety treating dentist respondent sidney abbott infected hiv since incidents recite occurred infection manifested serious symptoms september went office petitioner randon bragdon bangor maine dental appointment disclosed hiv infection patient reg istration form petitioner completed dental examination discovered cavity informed respondent policy filling cavities patients offered perform work hospital added fee services though respondent responsible cost using hospital facilities respondent declined respondent sued petitioner state law ada stat alleging discrimination basis disability state law claims us section ada provides individual shall discriminated basis disability full equal enjoyment goods services facilities privileges advantages accommodations place public accommodation person operates place public accommodation term public accommodation defined include professional office health care provider later subsection qualifies mandate discriminate provides nothing subchapter shall require entity permit individual participate benefit goods services facilities privileges advantages accommodations entity individual poses direct threat health safety others maine human rights commission intervened plaintiffs discovery parties filed summary judgment district ruled favor plaintiffs holding respondent hiv infection satisfied ada definition disability supp held petitioner raised genuine issue material fact whether respondent hiv infection posed direct threat health safety others course dental treatment relied affidavits submitted donald wayne marianos director division oral health centers disease control prevention cdc marianos affidavits asserted safe dentists treat patients infected hiv dental offices dentist follows universal precautions described recommended practices dentistry issued cdc cdc dentistry guidelines appeals affirmed held respondent hiv infection disability ada even though infection yet progressed symptomatic stage appeals also agreed treating respondent petitioner office posed direct threat health safety others unlike district however appeals declined rely marianos affidavits instead relied cdc dentistry guidelines well policy aids hiv infection practice dentistry promulgated american dental association american dental association policy hiv ii first review ruling respondent hiv infection constituted disability ada statute defines disability physical mental impairment substantially limits one major life activities individual record impairment regarded impairment hold respondent hiv infection disability subsection definitional section statute light conclusion need consider applicability subsections consideration subsection definition proceeds three steps first consider whether respondent hiv infection physical impairment second identify life activity upon respondent relies reproduction child bearing determine whether constitutes major life activity ada third tying two statutory phrases together ask whether impairment substantially limited major life activity construing statute informed interpretations parallel definitions previous statutes views various administrative agencies faced interpretive question ada definition disability drawn almost verbatim definition handicapped individual included rehabilitation act ed definition handicap contained fair housing amendments act congress repetition term carries implication congress intended term construed accordance regulatory interpretations see fdic philadelphia gear commissioner estate noel icc parker case congress suggest construction adopted specific statutory provision ada directing follows except otherwise provided chapter nothing chapter shall construed apply lesser standard standards applied title rehabilitation act et seq regulations issued federal agencies pursuant title directive requires us construe ada grant least much protection provided regulations implementing rehabilitation act first step inquiry subsection requires us determine whether respondent condition constituted physical impairment department health education welfare hew issued first regulations interpreting rehabilitation act regulations particular significance time hew agency responsible coordinating implementation enforcement consolidated rail corporation darrone citing exec order cfr hew regulations appear without change current regulations issued department health human services define physical mental impairment mean physiological disorder condition cosmetic disfigurement anatomical loss affecting one following body systems neurological musculoskeletal special sense organs respiratory including speech organs cardiovascular reproductive digestive hemic lymphatic skin endocrine mental psychological disorder mental retardation organic brain syndrome emotional mental illness specific learning disabilities issuing regulations hew decided including list disorders constituting physical mental impairments concern specific enumeration might comprehensive fed reg reprinted cfr pt app commentary accompanying regulations however contains representative list disorders conditions constituting physical impairments including diseases conditions orthopedic visual speech hearing impairments cerebral palsy epilepsy muscular dystrophy multiple sclerosis cancer heart disease diabetes mental retardation emotional illness drug addiction alcoholism ibid president transferred responsibility implementation enforcement attorney general see exec order cfr regulations issued justice department remain force day adopted verbatim hew definition physical impairment quoted cfr addition representative list diseases conditions originally relegated commentary accompanying hew regulations incorporated text regulations ibid hiv infection included list specific disorders constituting physical impairments part hiv identified cause aids see barr et isolation retrovirus patient risk acquired immune deficiency syndrome aids science gallo et frequent detection isolation cytopathic retroviruses patients aids risk aids science levy et isolation lymphocytopathic retroviruses san francisco patients aids science hiv infection fall well within general definition set forth regulations however disease follows predictable today unalterable course person infected hiv virus invades different cells blood body tissues certain white blood cells known helper tlymphocytes cells particularly vulnerable hiv virus attaches receptor site target cell fuses membrane cell membrane hiv retrovirus means uses enzyme convert genetic material form indistinguishable genetic material target cell virus genetic material migrates cell nucleus becomes integrated cell chromosomes integrated virus use cell genetic machinery replicate additional copies virus released body infect cells turn young replication cycle aids knowledge base pp cohen sande volberding ed hereinafter aids knowledge base folks hart life cycle human immunodeficiency virus type aids etiology diagnosis treatment prevention devita et al ed hereinafter aids etiology greene molecular insights infection medical management aids sande volberding ed hereinafter medical management aids although body produce antibodies combat hiv infection antibodies effective eliminating virus pantaleo et immunopathogenesis human immunodeficiency virus infection aids etiology garner hiv vaccine development aids knowledge base haynes immune responses human immunodeficiency virus infection aids etiology virus eventually kills infected host cell cells play critical role coordinating body immune response system decline number causes corresponding deterioration body ability fight infections many sources tracking infected individual cell count one accurate measures course disease greene medical management aids osmond classification staging hiv disease aids knowledge base saag clinical spectrum human immunodeficiency virus diseases aids etiology initial stage hiv infection known acute primary hiv infection typical case stage lasts three months virus concentrates blood assault immune system immediate victim suffers sudden serious decline number white blood cells latency period symptoms often emerge six days six weeks infection times accompanied fever headache enlargement lymph nodes lymphadenopathy muscle pain myalgia rash lethargy gastrointestinal disorders neurological disorders usually symptoms abate within days hiv antibodies appear bloodstream within weeks circulating hiv detected within weeks carr cooper primary hiv infection medical management aids cohen volberding clinical spectrum hiv disease aids knowledge base crowe mcgrath acute hiv infection aids knowledge base saag aids etiology symptoms associated initial stage subside disease enters referred sometimes asymptomatic phase term misnomer respects clinical features persist throughout including lymphadenopathy dermatological disorders oral lesions bacterial infections although varies individual instances stage lasts years virus tends concentrate lymph nodes though low levels virus continue appear blood cohen volberding aids knowledge saag aids etiology strapans feinberg natural history immunopathogenesis disease medical management aids thought virus became inactive period known relative lack symptoms attributable virus migration circulatory system lymph nodes cohen volberding aids knowledge base migration reduces viral presence parts body corresponding diminution physical manifestations disease virus however thrives lymph nodes vital point body immune response system represents ideal environment infection cells strapans feinberg medical management aids studies shown viral production continues high rate cohen volberding aids knowledge base strapans feinberg medical management aids cells continue decline average per year throughout phase saag aids etiology person regarded aids count drops blood cells comprise less total lymphocytes dept health human services public health service cdc revised classification system hiv infection expanded surveillance case definition aids among adolescents adults morbidity mortality weekly osmond aids knowledge base saag aids etiology ward petersen jaffe current trends epidemiology medical management aids stage clinical conditions often associated hiv pneumocystis carninii pneumonia kaposi sarcoma lym phoma tend appear addition general systemic disorders present stages disease fever weight loss fatigue lesions nausea diarrhea tend worsen cases patient count drops death soon follows cohen volberding aids knowledge base saag aids etiology light immediacy virus begins damage infected person white blood cells severity disease hold impairment moment infection noted earlier infection hiv causes immediate abnormalities person blood infected person white cell count continues drop throughout course disease even attack concentrated lymph nodes light facts hiv infection must regarded physiological disorder constant detrimental effect infected person hemic lymphatic systems moment infection hiv infection satisfies statutory regulatory definition physical impairment every stage disease statute operative definition satisfied unless impairment affects major life activity respondent claim throughout case hiv infection placed substantial limitation ability reproduce bear children app given pervasive invariably fatal course disease effect major life activities many sorts might relevant inquiry respondent number amici make arguments hiv profound impact almost every phase infected person life see brief respondent sidney abbott brief american medical association amicus curiae brief infectious diseases society america et al amici curiae light submissions may seem legalistic circumscribe discussion activity reproduction little doubt different parties brought suit maintained hiv infection imposes substantial limitations major life activities outset however case treated one reproduction major life activity limited impairment practice decide cases grounds raised considered appeals included question granted certiorari see blessing freestone citing rule capitol square review advisory bd pinette ask whether reproduction major life activity little difficulty concluding appeals held plain meaning word denotes comparative importance suggest touchstone determining activity inclusion statutory rubric significance reproduction falls well within phrase major life activity reproduction sexual dynamics surrounding central life process petitioner concedes importance reproduction claims congress intended ada cover aspects person life public economic daily character brief petitioner see also citing krauel iowa methodist medical center argument founders statutory language nothing definition suggests activities without public economic daily dimension may somehow regarded unimportant insignificant fall outside meaning word major breadth term confounds attempt limit construction manner noted ada must construed consistent regulations issued implement rehabilitation act see rather enunciating general principle determining major life activity rehabilitation act regulations instead provide representative list defining term include functions caring one self performing manual tasks walking seeing hearing speaking breathing learning working cfr ii cfr use term confirms list illustrative exhaustive regulations contrary petitioner attempt limit meaning term major public activities inclusion activities caring one self performing manual tasks belies suggestion task must public economic character order major life activity purposes ada contrary rehabilitation act regulations support inclusion reproduction major life activity since reproduction regarded less important working learning petitioner advances credible basis confining major life activities public economic daily aspect absence reason reach contrary conclusion agree appeals determination reproduction major life activity purposes ada final element disability definition subsection whether respondent physical impairment substantial limit major life activity asserts rehabilitation act regulations provide additional guidance cfr pt app evaluation medical evidence leads us con clude respondent infection substantially limited ability reproduce two independent ways first woman infected hiv tries conceive child imposes man significant risk becoming infected cumulative results studies collected textbook aids indicates male partners women hiv became majority studies finding statistically significant risk infection osmond padian sexual transmission hiv aids knowledge base tbl see also haverkos battjes transmission hiv jama tbl cumulative results studies indicated risk transmission studies report similar severe risk transmission see osmond padian aids knowledge base tbl second infected woman risks infecting child gestation childbirth perinatal transmission petitioner concedes women infected hiv face risk transmitting virus children published reports available confirm accuracy statistic report consensus workshop maternal factors involved transmission acquired immune deficiency syndromes collecting studies placing risk studies falling within range connor et reduction transmission human immunodeficiency virus type zidovudine treatment new eng med placing risk see also strapans feinberg medical management aids studies report risk infection average approximately petitioner points evidence record suggesting antiretroviral therapy lower risk perinatal transmission app see also connor supra sperling et maternal viral load zidovudine treatment risk transmission human immunodeficiency virus type mother infant new eng med solicitor general questions relevance figure pointing regulatory language requiring substantiality limitation assessed without regard available mitigating measures brief amicus curiae citing cfr pt app cfr pt need resolve dispute order decide case however said matter law risk transmitting dread fatal disease one child represent substantial limitation reproduction act addresses substantial limitations major life activities utter inabilities conception childbirth impossible hiv victim without doubt dangerous public health meets definition substantial limitation decision reproduce carries economic legal consequences well added costs antiretroviral therapy supplemental insurance health care child must examined tragic think treated infection laws moreover forbid persons infected hiv sex others regardless consent iowa code md health code ann mont code ann utah code ann supp rev code supp see also cent code end disability definition turn personal choice significant limitations result impairment definition met even difficulties insurmountable statistical reasons cited course limitations reproduction may insurmountable testimony respondent hiv infection controlled decision child unchallenged app context reviewing summary judgment must take true fed rule civ proc agree district appeals triable issue fact impedes ruling question statutory coverage respondent hiv infection physical impairment substantially limits major life activity ada defines view holding need address second question presented whether hiv infection per se disability ada holding confirmed consistent course agency interpretation enactment ada every agency consider issue rehabilitation act found statutory coverage persons asymptomatic hiv responsibility administering rehabilitation act delegated single agency need pause inquire whether causes us withhold deference agency interpretations chevron natural resources defense council enough observe views agencies implementing statute constitute body experience informed judgment courts litigants may properly resort guidance skidmore swift one comprehensive significant administrative precedent opinion issued office legal counsel department justice olc concluding rehabilitation act protects symptomatic asymptomatic individuals discrimination covered program application section rehabilitation act individuals op legal counsel preliminary print omitted relying letter surgeon general everett koop stating purely scientific perspective persons hiv clearly impaired even asymptomatic phase olc determined asymptomatic hiv physical impairment rehabilitation act constituted physiological disorder condition affecting hemic lymphatic systems internal quotation marks omitted olc determined asymptomatic hiv imposed substantial limit major life activity reproduction opinion said based medical knowledge available us believe reasonable conclude life activity procreation substantially limited asymptomatic individual light significant risk aids virus may transmitted baby pregnancy individuals whether male female engage act procreation normal expectation bringing forth healthy child addition olc indicated life activity engaging sexual relations threatened probably substantially limited contagiousness virus either consideration sufficient render asymptomatic hiv infection handicap purposes rehabilitation act course opinion olc considered rejected contention limitation discounted voluntary response infection limitation reasoned infection manifest physical effect without exception agencies address problem enactment ada reached result federal contract compliance manual app fep manual david ritter wl eeoc see also comptroller general task force aids workplace coping aids gao workplace task force report report presidential commission human immunodeficiency virus epidemic june agencies adhered conclusion since enactment ada well see cfr cfr cfr cfr cfr cfr westchester county medical center transfer binder cch employment practices guide pp apr aff pp dept health human servs departmental appeals rosebud sioux tribe wl dept health human servs departmental appeals july david martin wl eeoc mar every addressed issue ada enacted july moreover concluded asymptomatic hiv infection satisfied rehabilitation act definition handicap see doe garrett cert denied ray school dist desoto county supp md thomas atascadero unified school supp cd cal district community school bd board ed new york misc sup queens cty cf baxter belleville supp sd fair housing amendments act cain hyatt supp ed pennsylvania human relations act cases finding infection hiv handicap without distinguishing symptomatic asymptomatic hiv see martinez ex rel martinez school bd hillsborough chalk dist doe dolton elementary school dist supp nd robertson granite city community unit school dist supp sd local afge dept state supp dc cf association relatives friends aids patients regulations permits supp pr fair housing amendments act aware instance prior enactment ada agency ruled hiv infection handicap rehabilitation act congress done nothing copy rehabilitation act definition ada action indicate new statute construed light unwavering line administrative judicial interpretation indications congress well aware position taken olc enacting ada intended give position active endorsement pt endorsing analysis conclusion olc opinion pt pp noted earlier congress also incorporated definition fair housing amendments act see find significant implementing regulations issued department housing urban development hud construed definition include infection hiv fed reg codified cfr see also willie williams fair lending pp hud admin law judges mar adhering interpretation elroy dorothy burns trust fair lending hud admin law judges june legislative record indicates congress intended ratify hud interpretation reiterated definition ada pt pt pt find uniformity administrative judicial precedent construing definition significant administrative judicial interpretations settled meaning existing statutory provision repetition language new statute indicates general matter intent incorporate administrative judicial interpretations well see lorillard pons uniform body administrative judicial precedent confirms conclusion reach today faithful way effect congressional design conclusion reinforced administrative guidance issued justice department implement public accommodation provisions title iii ada agency directed congress issue implementing regulations see render technical assistance explaining responsibilities covered individuals institutions enforce title iii department views entitled deference see chevron justice department interpretation definition disability consistent analysis regulations acknowledge congress intended ada definition disability given construction definition handicap rehabilitation act cfr pt app pp regulatory definition developed hew implement rehabilitation act incorporated verbatim ada regulations justice department went however added hiv infection symptomatic asymptomatic list disorders constituting physical impairment iii technical assistance department issued pursuant similarly concludes persons asymptomatic hiv infection fall within ada definition disability see dept justice civil rights division americans disabilities act title iii technical assistance manual response congressman sonny callahan nat disability lrp response laurence field nat disability lrp conclusion department reasoned contradict congress affirmative ratification administrative interpretations given previous versions definition cfr pt app citing olc opinion hud regulations fed reg notice proposed rulemaking also draw guidance views agencies authorized administer sections ada see authorizing eeoc issue regulations implementing title authorizing attorney general issue regulations implementing public services provisions title ii subtitle authorizing secretary transportation issue regulations implementing provisions titles ii iii authorizing agencies offer technical assistance provisions administer agencies concluded hiv infection physical impairment ada cfr iii cfr fed reg dept justice civil rights division americans disabilities act title ii technical assistance manual eeoc technical assistance manual employment provisions title americans disabilities act hereinafter eeoc technical assistance manual eeoc interpretive manual pp reissued mar hereinafter eeoc interpretive manual reprinted bna eeoc compliance manual categorical eeoc conclusion individual hiv infection including asymptomatic hiv infection individual disability eeoc interpretive manual accord eeoc view impairments hiv infection inherently substantially limiting cfr pt eeoc technical assistance manual eeoc interpretive manual regulatory authorities cite consistent holding hiv infection even asymptomatic phase impairment substantially limits major life activity reproduction iii petition certiorari presented three questions review questions stated deciding title iii ada whether private health care provider must perform invasive procedures infectious patient office courts defer health care provider professional judgment long reasonable light medical knowledge proper standard judicial review title iii ada private health care provider judgment performance certain invasive procedures office pose direct threat health safety others petitioner randon bragdon raise genuine issue fact trial whether warranted judgment performance certain invasive procedures patient office posed direct threat health safety others granted certiorari question three question phrased awkward way conflates two separate inquiries asking whether appropriate defer petitioner judgment assumes petitioner assessment objective facts reasonable central premise question assumption based merit separate consideration begin statute notwithstanding protection given respondent ada definition disability petitioner refused treat infectious condition pose direct threat health safety others ada defines direct threat significant risk health safety others eliminated modification policies practices procedures provision auxiliary aids services ibid parallel provisions appear employment provisions title ada direct threat provision stems recognition school bd nassau cty arline importance prohibiting discrimination individuals disabilities protecting others significant health safety risks resulting instance contagious disease arline reconciled objectives construing rehabilitation act require hiring person posed significant risk communicating infectious disease others congress amended rehabilitation act fair housing act incorporate language see excluding individuals constitute direct threat health safety individuals later relied language enacting ada see cfr pt app ada direct threat provision codifies arline activities life risk free arline ada ask whether risk exists whether significant arline supra existence nonexistence significant risk must determined standpoint person refuses treatment accommodation risk assessment must based medical objective evidence arline supra cfr pt app health care professional petitioner duty assess risk infection based objective scientific information available others profession belief significant risk existed even maintained good faith relieve liability use words question presented petitioner receives special deference simply health care professional true arline reserved question whether courts also defer reasonable medical judgments private physicians employer relied statement reserved possibility employers consult individual physicians objective experts suggest individual physician state mind excuse discrimination without regard objective reasonableness actions conclusion courts assess objective reasonableness views health care professionals without deferring individual judgments answer implicit assumption question presented whether petitioner actions reasonable light available medical evidence assessing reasonableness petitioner actions views public health authorities public health service cdc national institutes health special weight authority arline supra cfr pt app views organizations conclusive however health care professional disagrees prevailing medical consensus may refute citing credible scientific basis deviating accepted norm see keeton dobbs keeton owen prosser keeton law torts ed reviewed much record necessary illustrate application rule facts case part appeals followed proper standard evaluating petitioner position conducted thorough review evidence rejection district reliance marianos affidavits correct application principle petitioner actions must evaluated light available objective evidence record show cdc published conclusion set affidavits time petitioner refused treat respondent illustration correct application objective standard appeals refusal give weight petitioner offer treat respondent hospital petitioner testified believed hospitals safety measures air filtration ultraviolet lights respirators reduce risk hiv transmission app petitioner made showing however area hospital safeguards even hospital privileges expert also admitted lack scientific basis conclusion measures lower risk transmission petitioner failed present objective medical evidence showing treating respondent hospital safer efficient preventing hiv transmission treatment dental office concerned however appeals might placed mistaken reliance upon two sources ruling triable issue fact existed point appeals relied cdc dentistry guidelines american dental association policy hiv evidence definitive noted earlier cdc guidelines recommended certain universal precautions cdc view reduce risk disease transmission dental environment dept health human services public health service cdc recommended infection control practices dentistry morbidity mortality weekly may appeals determined hile guidelines state explicitly riskreduction measures desirable routine dental care individuals safe two conclusions seem implicit guidelines detailed delineation procedures office treatment patients view guidelines necessarily contain implicit assumptions conclusive point decided guidelines set cdc recommendation universal precautions best way combat risk hiv transmission assess level risk certain record whether american dental association policy hiv carries weight appeals attributed policy provide evidence medical community objective assessment risks posed treating people infected hiv dental offices indicates current scientific epidemiologic evidence indicates little risk transmission infectious diseases dental treatment recommended infection control procedures routinely followed patients hiv infection may safely treated private dental offices appropriate infection control procedures employed infection control procedures provide protection patients dental personnel note however association professional organization although respected source information dental profession public health authority clear extent policy based association assessment dentists ethical professional duties addition scientific assessment risk ada refers efforts clarify dentists ethical obligations encourage dentists treat patients hiv infection compassion may commendable question statute one statistical likelihood professional responsibility without information manner american dental association formulated policy unable determine policy value evaluating whether petitioner assessment risks reasonable matter law considered materials submitted parties cross motions summary judgment petitioner required establish existed genuine issue material fact evidence merely colorable significantly probative sufficient anderson liberty lobby acknowledge presence evidence record appeals subject arguments examination might support affirmance trial ruling instance record contains substantial testimony numerous health experts indicating safe treat patients infected hiv dental offices app unable determine import evidence however record disclose whether expert testimony submitted respondent turned evidence available september see expert testimony relied part materials published september reasons doubt whether petitioner advanced evidence sufficient raise triable issue fact significance risk petitioner relied two principal points first asserted use drills surface cooling water created risk airborne hiv transmission study petitioner relied inconclusive however determining urther work required determine whether risk exists johnson robinson human immunodeficiency vapors surgical power instruments medical virology petitioner expert witness conceded moreover evidence suggested spray transmit hiv opinion airborne risk based absence contrary evidence positive data app scientific evidence expert testimony must traceable analytical basis objective fact may considered summary judgment see general electric joiner slip second petitioner argues september cdc identified seven dental workers possible occupational transmission hiv see dept health human services public health service cdc surveillance report vol tbl ed june dental workers exposed hiv course employment cdc determine whether hiv infection resulted known cdc ascertain whether seven dental workers contracted disease present hiv testing appropriate time initial exposure gooch et percutaneous exposures hivinfected blood among dental workers enrolled cdc needlestick study american dental assn clear record however whether information available petitioner september seven cases might provided albeit necessarily sufficient support petitioner position standing alone doubt meet objective scientific basis finding significant risk petitioner evaluation evidence constrained fact points briefs arguments directed entire record accepting case review declined grant certiorari question five asked whether petitioner raised genuine issue fact trial pet cert result briefs arguments presented us concentrate question sufficiency light submissions summary judgment proceeding attention focused issues case comes expressed views controlling question may appropriate remand case rather deal merits question dandridge williams consideration carries particular force full briefing directed issue help place complex factual record proper perspective resolution issue importance health care workers result also precision comprehensiveness reasons given decision conclude proper course give appeals opportunity determine whether analysis studies cited parties change conclusion petitioner presented neither objective evidence triable issue fact question risk remanding case foreclose possibility appeals may reach conclusion earlier remand permit full exploration issue adversary process determination appeals respondent hiv infection disability ada affirmed judgment vacated case remanded proceedings consistent opinion ordered randon bragdon petitioner sidneyabbott et al writ certiorari appeals first circuit june justice stevens justice breyer joins concurring opinion demonstrates respondent hiv infection easily falls within statute definition disability moreover discussion part iii relevant evidence persuaded judgment appeals affirmed believe petitioner sustained burden adducing evidence sufficient raise triable issue fact significance risk posed treating respondent office appeals reached conclusion careful extensive study record analysis question perfectly consistent legal reasoning justice kennedy opinion latter opinion explains petitioner relied data inconclusive speculative best see ante cf general electric joiner however five justices agree judgment affirmed appear five justices favor remand proceedings consistent views expressed either justice kennedy opinion opinion ofthe chief justice agreement legal analysis justice kennedy opinion order provide judgment supported majority join opinion even though prefer outright affirmance cf screws rutledge concurring result randon bragdon petitioner sidneyabbott et al writ certiorari appeals first circuit june justice ginsburg concurring hiv infection description set opinion documents ante regarded disease limiting life see brief american medical association amicus curiae disease inevitably pervades life choices education employment family financial undertakings affects need case shows ability obtain health care reaction others impairment rational legislator seems apparent require nondiscrimination symptoms become visible permit discrimination disease though present yet visible therefore satisfied statutory regulatory definitions well met hiv infection physical impairment substantially limits major life activities perceived including afflicted individual family relations employment potential ability care see cfr ii cfr agree view importance issue health care workers ante wise remand erring side caution taking course ensures fully informed determination whether respondent abbott disease posed signifi cant risk health safety petitioner bragdon eliminated modification policies practices procedures opinion rehnquist abbott opinion rehnquist sufficiently clear act goes provide major life activities allegedly limited impairment must individual individualized nature inquiry particularly important case district disposed summary judgment thus disputed issues material fact must resolved respondent contends asymptomatic hiv status brings within first definition disability must therefore demonstrate inter alia cally mentally impaired impairment substantially limited one major life activities petitioner dispute asymptomatic positive status physical impairment therefore sume case proceed second third statutory requirements disability according next question whether reproduction major life activity ante however half relevant question tioned ada definition disability requires respondent alternatively urges us find disabled regarded however grant certiorari question respondent vance arguments within question presented support judgment trans world airlines thurston dandridge williams rarely addressed arguments asserted respondent asserted regarded ment appeals declined address event regarded prong requires plaintiff strate defendant regarded ment one substantially limits major life activity respondent offered evidence support assertion petitioner regarded impairment substantially limited ability reproduce opposed ing simply impaired cite opinion rehnquist major life activity issue one vidual truncates question perhaps shred record evidence indicating prior becoming infected hiv spondent major life activities included reproduction assuming moment reproduction major life activity record indicates learning hiv status respondent whatever vious inclination conclusively decided children app absolutely evidence absent hiv respondent even considering children indeed asked deposition whether hiv infection way impaired ability carry life functions respondent answered ibid telling course entire brief respondent studiously avoids asserting even reproduction major life activity trary argues major life activity inquiry turn particularized assessment cumstances case brief respondent sidney abbott even aside facts particular case simply wrong concluding general matter reproduction major life activity unfortunately ada define phrase major life activities act incorporate reference list activities contained regulations issued calling reproduction major life activity somewhat inartful production activity process one scribed breathing walking performing manual tasks man opposed copier machine gremlin never described reproducing assume using term tion respondent referring numerous discrete activities comprise reproductive process sense used term abbott opinion rehnquist bilitation act cfr ii correctly recognizes list major life activities illustrative exhaustive ante makes attempt demonstrate reproduction major life activity sense caring one self performing manual tasks walking seeing hearing speaking breathing learning ing instead argues reproduction major life activity central life process ante support reading cuses fact indicates importance ibid see also webster collegiate ary ed greater dignity rank tance interest ignoring alternative definition major greater quantity number extent ibid latter definition consistent ada illustrative list major life activities one deny reproductive decisions tant person life decisions marry live earn one living damental importance sort common thread linking statute listed activities common thread rather activities repetitively performed essential existence normally tioning individual thus quite different series activities leading birth child respondent brief respondent sidney abbott amicus curiae brief amicus curiae argue tion must major life activity regulations sued ada define term physical ment include physiological disorders affecting reproductive system cfr tion major life activity argue made little sense include reproductive cite opinion rehnquist disorders roster physical impairments gument simply wrong numerous disorders reproductive system dysmenorrhea dometriosis painful limit woman ability engage major life activities walking working obviously cancer ous reproductive organs limits one ability engage numerous activities reproduction even assume reproduction jor life activity respondent agree asymptomatic hiv infection substantially limits activity record us leaves doubt infected still entirely able engage sexual course give birth child become pregnant perform manual tasks necessary rear child turity see app individuals infected hiv may choose engage activities support language logic case law proposition voluntary choices constitute limit one life activities responds ada addresses tial limitations major life activities utter ities ante agree fail see assists cause apart unable strate utterly unable engage various activities comprise reproductive process dent even explained less able engage activities respondent contends ability reproduce limited fatal nature hiv infection means parent unlikely live long enough raise nurture child adulthood brief respondent sidney abbott ada definition disability met alleged impairment substantially limits present tense major life activity asymptomatic hiv presently limit abbott opinion rehnquist respondent ability perform tasks necessary bear raise child respondent argument taken logical extreme render every individual genetic marker debilitating disease disabled possible future effects view therefore respondent failed strate major life activities tially limited hiv concludes contrary ability issue quite correctly recognizes tioner nonetheless refused treat respondent condition posed direct threat peals affirmed judgment district granting summary judgment respondent issue vacates portion appeals sion remands case lower presumably may determine whether analysis studies cited parties change sion petitioner presented neither objective evidence triable issue fact question risk ante agree judgment vacated although sure understand cryptic direction lower health safety others eliminated modification policies practices procedures provision auxiliary aides services statutory definition direct threat consists two parts first must ask whether treating fected patient without precautionary techniques pose significant risk heath safety others ibid whether particular risk significant depends nature risk disease mitted duration risk long cite opinion ehnquist carrier infectious severity risk potential harm third parties probabilities disease transmitted cause varying degrees harm school bd nassau cty arline even significant risk exists health practitioner still required treat infected patient modification policies practices procedures case universal precautions eliminat risk agree existence nonexitence significant risk must determined standpoint person refuses treatment accommodation time decision refusing treatment made ante disagree however assessing reasonableness petitioner actions views public health authorities special weight authority ante views course entitled presumption validity actions authorities challenged even disputes private parties congress committed dispute adjudication public health authority litigation private parties originating federal courts aware provision law judicial practice require permit courts give scientific views credence others simply endorsed politically appointed public health authority surgeon general litigation latter sort face credentials scientists employed public health authority soundness studies must stand cites authority limitation upon courts function except statement school bd nassau cty arline making findings regarding risk contagion rehabilitation act courts normally defer reasonable medical judgments public health officials appended dictum following makes clear urging respect medical judgment necessarily respect official medical judgment private medical judgment case present address question whether courts also defer reasonable medical judgments private physicians employer relied id applying principles clear petitioner presented enough evidence avoid summary judgment direct threat question june centers disease control prevention published study identifying seven instances possible transmission hiv patients dental workers see ante entirely certain whether dental workers contracted hiv course providing dental treatment potential disease transmitted course dental treatment relevant evidence one need demonstrate risk certainty infection see arline supra probabilities disease transmitted factor assessing risk given severity risk involved near certain death fact public health authority outlined protocol eliminating risk context routine dental treatment seems likely petitioner establish objectively reasonable conclude treating respondent office posed direct threat safety addition petitioner offered evidence documented incidents occupational transmission hiv healthcare workers dental professionals app appeals dismissed evidence irrelevant health professionals den tists fact health care workers dentists valid basis distinguishing transmissions hiv fact health care workers practice maine minimum petitioner evidence sufficient create triable issue question summary judgment accordingly appropriate abbott opinion termine whether respondent condition posed direct threat accordingly agree remand necessary issue