gonzales attorney general carhart et argued november decided april following stenberg carhart decision nebraska partial birth abortion statute violated federal constitution interpreted planned parenthood southeastern casey roe wade congress passed abortion ban act act proscribe particular method ending fetal life later stages pregnancy act regulate common abortion procedures used first trimester pregnancy vast majority abortions take place usual procedure dilation evacuation doctor dilates cervix inserts surgical instruments uterus maneuvers grab fetus pull back cervix vagina fetus usually ripped apart removed doctor may take passes remove entirety procedure prompted federal act various state statutes including nebraska variation standard herein referred intact main difference two procedures intact doctor extracts fetus intact largely intact passes pulling entire body instead ripping apart order allow head pass cervix doctor typically pierces crushes skull act responded stenberg two ways first congress found unlike stenberg required accept district factual findings moral medical ethical consensus abortion gruesome inhumane procedure never medically necessary prohibited second act language differs nebraska statute struck stenberg among things act prohibits knowingly perform ing abortion necessary save life mother defines abortion procedure doctor deliberately intentionally vaginally delivers living fetus case presentation entire fetal head outside mother body case breech presentation part fetal trunk past navel outside mother body purpose performing overt act person knows kill partially delivered living fetus performs overt act completion delivery kills fetus respondent abortion doctors challenged act constitutionality face federal district granted permanent injunction prohibiting petitioner attorney general enforcing act cases dispute fetus viable found act unconstitutional lacked exception allowing prohibited procedure necessary mother health covered merely intact also es affirming eighth circuit found lack consensus existed medical community banned procedure necessity thus stenberg required legislatures err side protecting women health including health exception respondent abortion advocacy groups brought suit challenging act district enjoined attorney general enforcing act concluding unconstitutional face unduly burdened woman ability choose abortion vague lacked health exception required stenberg ninth circuit agreed affirmed held respondents demonstrated act facial matter void vagueness imposes undue burden woman right abortion based overbreadth lack health exception pp casey reaffirmed termed roe essential holding first woman right choose abortion fetal viability obtain without undue interference state second state power restrict abortions viability law contains exceptions pregnancies endangering woman life health third state legitimate interests pregnancy outset protecting health woman life fetus may become child though three implicated third requires extended discussion deciding whether act furthers government legitimate interest protecting fetal life assumes inter alia undue burden previability abortion right exists regulation purpose effect place substantial obstacle woman path egulations create structural mechanism state may express profound respect life unborn permitted substantial obstacle woman exercise right choose casey struck balance central holding applies casey standard central premise casey joint opinion government legitimate substantial interest preserving promoting fetal life repudiated affirm judgments pp act face void vagueness impose undue burden overbreadth pp act text demonstrates regulates proscribes performing intact procedure first since doctor must vaginally delive living fetus act restrict abortions involving delivery expired fetus involving vaginal delivery hysterotomy hysterectomy applies previability postviability common understanding scientific terminology fetus living organism within womb whether viable outside womb second act requires living fetus delivered specific anatomical landmark depending fetus presentation abortion involving partial delivery permitted third doctor must perform overt act completion delivery kills partially delivered fetus overt act must separate delivery must also occur delivery anatomical landmark since killing partially delivered fetus read context refers fetus delivered ibid fourth given act scienter requirements delivery living fetus past anatomical landmark accident inadvertence crime deliberat intentiona delivery prohibited fetus delivered purpose performing overt act doctor knows kill ibid pp act unconstitutionally vague face satisfies requirements doctrine first provides doctors ordinary intelligence reasonable opportunity know prohibited grayned city rockford setting forth relatively clear guidelines prohibited conduct providing objective criteria evaluate whether doctor performed prohibited procedure posters things second encourage arbitrary discriminatory enforcement kolender lawson anatomical landmarks establish minimal guidelines govern law enforcement smith goguen scienter requirements narrow scope prohibition limit prosecutorial discretion see kolender supra respondents arbitrary enforcement arguments furthermore somewhat speculative since preenforcement challenge pp rejects respondents argument act imposes undue burden facial matter restrictions abortions broad pp act text discloses prohibits doctor intentionally performing intact dual prohibitions correspond steps generally undertaken procedure doctor delivers fetus head lodges cervix usually past anatomical landmark breech presentation see proceeds overt act piercing crushing fetal skull partial delivery see act scienter requirements limit reach physicians carry intact intent undertake steps outset act excludes es doctor intends remove fetus pieces outset interpretation confirmed comparing act nebraska statute stenberg concluded statute encompassed often involve physician pulling portion still living fetus say arm leg vagina prior death fetus rejected nebraska attorney general limiting interpretation statute reference procedure kill unborn child distinct procedure abortion procedure whole apparent congress responded concerns act adopts phrase delivers living fetus instead living unborn child substantial portion thereof thereby targeting extraction entire fetus rather removal fetal pieces identifies specific anatomical landmarks fetus must partially delivered thereby clarifying removal small portion fetus prohibited requires fetus delivered partially outside mother body thereby establishing delivering substantial portion fetus vagina subject doctor criminal sanctions adds requirement thereby making distinction nebraska statute failed draw nebraska attorney general advanced finally canon constitutional avoidance see edward debartolo florida gulf coast building constr trades council extinguishes lingering doubt interpreting act prohibit standard reasonable reading understanding terms pp ii respondents contrary arguments unavailing contention may result delivery living fetus beyond act anatomical landmarks doctors predict amount cervix dilate procedure take account act intent requirements preclude liability accidental intact evidence supports legislative determination intact delivery almost always conscious choice rather happenstance belying claim standard performed without intending foreseeing intact many doctors begin every objective removing fetus intact possible based belief safer prove respondents suggest every might violate act thereby imposing undue burden demonstrates doctors must adjust conduct law attempting deliver fetus anatomical landmark respondents shown requiring doctors intend dismemberment delivery prohibit vast majority abortions pp act measured text facial attack impose substantial obstacle previability abortions prohibited casey plurality pp contention act congressional purpose create obstacle rejected act stated purposes protecting innocent human life brutal inhumane procedure protecting medical community ethics reputation government undoubtedly interest protecting integrity ethics medical profession washington glucksberg moreover casey reaffirmed government may use voice regulatory authority show profound respect life within woman see act ban abortions involving partial delivery living fetus furthers government objectives congress determined abortions similar killing newborn infant confirmed validity drawing boundaries prevent practices extinguish life close actions condemned glucksberg supra act also recognizes respect human life finds ultimate expression mother love child whether abortion requires difficult painful moral decision casey women come regret decision fraught emotional consequence doctors may prefer disclose precise details abortion procedure used however precisely lack information legitimate concern state state interest respect life advanced dialogue better informs political legal systems medical profession expectant mothers society whole consequences follow decision elect abortion objection act accomplishes little standard respects brutal intact unpersuasive reasonable congress think abortion standard undermines public perception doctor appropriate role delivery perverts birth process pp act failure allow banned procedure use appropriate medical judgment preservation mother health ayotte planned parenthood northern new effect imposing unconstitutional burden abortion right assumes act prohibition unconstitutional controlling precedents subject ed women significant health risks whether act creates risks however contested factual question evidence presented trial courts congress demonstrates sides medical support positions precedents instruct act survive facial attack medical uncertainty persists see kansas hendricks traditional rule consistent casey confirms state interest promoting respect human life stages pregnancy abortion doctors treated doctors medical uncertainty foreclose exercise legislative power abortion context contexts considerations also support conclusion including fact safe alternatives prohibited procedure available addition intact truly necessary circumstances prior injection kill fetus allows doctor perform procedure given act prohibition applies delivery living fetus planned parenthood central mo danforth distinguished rejects certain parties arguments one hand attorney general contention act upheld based congressional findings alone fails act recitations factually incorrect important findings superseded also unavailing however respondents contention abortion regulation must contain health exception substantial medical authority supports proposition banning particular procedure endanger women health stenberg interpreting stenberg leaving margin legislative error face medical uncertainty exacting standard marginal safety considerations including balance risks within legislative competence regulation rational pursues legitimate ends standard safe medical options available pp facial attacks entertained first instance circumstances proper means consider exceptions challenge cf wisconsin right life federal election proper manner protect woman health shown discrete instances condition likely occur procedure prohibited act must used challenge need brought act prohibition threatens woman life act already contains life exception pp reversed kennedy delivered opinion roberts scalia thomas alito joined thomas filed concurring opinion scalia joined ginsburg filed dissenting opinion stevens souter breyer joined alberto gonzales attorney general petitioner leroy carhart et al writ certiorari appeals eighth circuit alberto gonzales attorney general petitioner planned parenthood federation america et al writ certiorari appeals ninth circuit april justice kennedy delivered opinion cases require us consider validity abortion ban act act supp iv federal statute regulating abortion procedures recitations preceding operative provisions act refers opinion stenberg carhart also addressed subject abortion procedures used later stages pregnancy compared state statute issue stenberg act specific concerning instances applies respect precise coverage conclude act sustained objections lodged broad facial attack brought carhart respondents leroy carhart william fitzhugh william knorr jill vibhakar doctors perform abortions doctors filed complaint attorney general district district nebraska challenged constitutionality act sought permanent injunction enforcement carhart ashcroft supp trial district granted permanent injunction prohibited attorney general enforcing act cases dispute fetus viable appeals eighth circuit affirmed granted certiorari planned parenthood respondents planned parenthood federation america planned parenthood golden gate city county san francisco planned parenthood entities sought enjoin enforcement act suit filed district northern district california planned parenthood federation ashcroft supp city county san francisco intervened plaintiff district held trial spanning period short three weeks enjoined attorney general enforcing act appeals ninth circuit affirmed granted certiorari act proscribes particular manner ending fetal life necessary stenberg discuss abortion procedures detail three district courts heard extensive evidence describing procedures addition two courts involved instant cases district southern district new york also considered constitutionality act nat abortion federation ashcroft supp found act unconstitutional appeals second circuit affirmed nat abortion federation gonzales three district courts relied similar medical evidence indeed much evidence submitted carhart previously submitted two courts supp refer district courts exhaustive opinions discussion abortion procedures abortion methods vary depending extent preferences physician course term pregnancy resulting stage unborn child development percent approximately million abortions performed year take place first three months pregnancy say first trimester planned parenthood supp app pp common abortion method vacuum aspiration otherwise known suction curettage physician vacuums embryonic tissue early trimester alternative use medication mifepristone commonly known terminate pregnancy nat abortion federation supra act regulate procedures remaining abortions take place year occur second trimester surgical procedure referred dilation evacuation usual abortion method trimester planned parenthood supp although individual techniques performing differ general steps doctor must first dilate cervix least extent needed insert surgical instruments uterus maneuver evacuate fetus nat abortion federation supra app steps taken cause dilation differ physician gestational age fetus see carhart supp doctor often begins dilation process inserting osmotic dilators laminaria sticks seaweed cervix dilators used combination drugs misoprostol increase dilation resulting amount dilation uniform doctor know advance individual patient respond general longer dilators remain cervix dilate yet length time doctors employ osmotic dilators varies may keep dilators cervix two days others use dilators day less nat abortion federation supra planned parenthood supra sufficient dilation surgical operation commence woman placed general anesthesia conscious sedation doctor often guided ultrasound inserts grasping forceps woman cervix uterus grab fetus doctor grips fetal part forceps pulls back cervix vagina continuing pull even meeting resistance cervix friction causes fetus tear apart example leg might ripped fetus pulled cervix woman process evacuating fetus piece piece continues completely removed doctor may make passes forceps evacuate fetus entirety though sometimes removal completed fewer passes fetus evacuated placenta remaining fetal material suctioned scraped uterus doctor examines different parts ensure entire fetal body removed see nat abortion federation supra planned parenthood supra doctors especially later second trimester may kill fetus day two performing surgical evacuation inject digoxin potassium chloride fetus umbilical cord amniotic fluid fetal demise may cause contractions make greater dilation possible dead moreover fetus body soften removal easier doctors refrain injecting chemical agents believing adds risk little medical benefit carhart supra nat abortion federation supra abortion procedure impetus numerous bans abortion including act variation standard see haskell dilation extraction late second trimester abortion appellant app hereinafter dilation extraction medical community reached unanimity appropriate name variation referred intact dilation extraction intact nat abortion federation supra see also cunningham et williams obstetrics ed identifying procedure danforth obstetrics gynecology scott gibbs karlan haney eds ed identifying procedure intact paul lichtenberg borgatta grimes stubblefield clinician guide medical surgical abortion identifying procedure intact discussion purposes variation referred intact main difference two procedures intact doctor extracts fetus intact largely intact passes comprehensive statistics indicating percentage es performed manner intact like regular begins dilation cervix sufficient dilation essential procedure achieve intact extraction doctors thus may attempt dilate cervix greater degree approach called serial dilation carhart supra planned parenthood supra doctors attempt outset perform intact may dilate two full days use osmotic dilators see dilation extraction carhart supra intact procedure doctor extracts fetus way conducive pulling entire body instead ripping apart one doctor example testified know good dilation reach fetus starts come think accomplish abortion intact delivery use forceps little bit differently close quite much gently draw tissue attempting intact delivery possible app rotating fetus pulled decreases odds dismemberment carhart supra app pp appellant app doctor also may use forceps grasp fetal part pull fetus higher level sometimes using hand forceps exert traction retrieve fetus intact head lodged cervix carhart supp intact gained public notoriety martin haskell gave presentation describing method performing operation dilation extraction usual intact fetus head lodges cervix dilation insufficient allow pass see ibid app app haskell explained next step follows point surgeon slides fingers left hand along back fetus hooks shoulders fetus index ring fingers palm maintaining tension lifting cervix applying traction shoulders fingers left hand surgeon takes pair blunt curved metzenbaum scissors right hand carefully advances tip curved along spine middle finger feels contact base skull tip middle surgeon forces scissors base skull foramen magnum safely entered skull spreads scissors enlarge surgeon removes scissors introduces suction catheter hole evacuates skull contents catheter still place applies traction fetus removing completely patient abortion doctor clinical description another description nurse witnessed method performed fetus testified senate judiciary committee haskell went forceps grabbed baby legs pulled birth canal delivered baby body arms everything head doctor kept head right inside uterus baby little fingers clasping unclasping little feet kicking doctor stuck scissors back head baby arms jerked like startle reaction like flinch like baby thinks going doctor opened scissors stuck suction tube opening sucked baby brains baby went completely limp cut umbilical cord delivered placenta threw baby pan along placenta instruments used ibid haskell approach method killing fetus head lodges cervix process evolved since presentation planned parenthood supp another doctor example squeezes skull pierced enough brain tissue exudes allow head pass app see also carhart supra still physicians reach cervix forceps crush fetus skull carhart supra others continue pull fetus woman disarticulates neck effect decapitating doctors grasp head forceps crush remove see also planned parenthood supra doctors performing intact attempt remove fetus without collapsing skull see carhart supra yet one doctor allow delivery live fetus younger weeks objective procedure perform abortion birth app doctor thus answered affirmative asked whether hold fetus head internal side cervix order collapse skull kill fetus born see also carhart supra another doctor testified crushes fetus skull reduce size also ensure fetus dead removed staff deal fetus viability movement limbs according doctor always difficult situation app see carhart supra intact abortion methods doctors also may abort fetus medical induction doctor medicates woman induce labor contractions occur deliver fetus induction unlike occur hospital last little hours take longer accounts five percent abortions weeks gestation percent weeks doctors turn two methods abortion hysterotomy hysterectomy emergency situations carry increased risk complications hysterotomy cesarean section doctor removes fetus making incision abdomen uterine wall gain access uterine cavity hysterectomy requires removal entire uterus two procedures represent abortions nat abortion federation supp planned parenthood supra haskell procedure received public attention ensuing increasing public concern bans birth proliferated time stenberg decision enacted bans designed prohibit procedure nn thomas dissenting see also congress also acted ban abortion president clinton vetoed congressional legislation senate failed override veto congress approved another bill banning procedure president clinton vetoed decision stenberg congress passed act issue november president bush signed act law take effect following day supp iv act responded stenberg two ways first congress made factual findings congress determined stenberg required accept questionable findings issued district judge stat notes following supp iv congressional findings congress bound accept factual findings congress found among things moral medical ethical consensus exists practice performing abortion gruesome inhumane procedure never medically necessary prohibited second relevant act language differs nebraska statute struck stenberg see quoting neb rev stat ann supp operative provisions act provide relevant part physician affecting interstate foreign commerce knowingly performs abortion thereby kills human fetus shall fined title imprisoned years subsection apply abortion necessary save life mother whose life endangered physical disorder physical illness physical injury including physical condition caused arising pregnancy subsection takes effect day enactment used section term abortion means abortion person performing abortion deliberately intentionally vaginally delivers living fetus case presentation entire fetal head outside body mother case breech presentation part fetal trunk past navel outside body mother purpose performing overt act person knows kill partially delivered living fetus performs overt act completion delivery kills partially delivered living fetus term means doctor medicine osteopathy legally authorized practice medicine surgery state doctor performs activity individual legally authorized state perform abortions provided however individual physician otherwise legally authorized state perform abortions nevertheless directly performs abortion shall subject provisions section defendant accused offense section may seek hearing state medical board whether physician conduct necessary save life mother whose life endangered physical disorder physical illness physical injury including physical condition caused arising pregnancy findings issue admissible issue trial defendant upon motion defendant shall delay beginning trial days permit hearing take place woman upon abortion performed may prosecuted section conspiracy violate section offense section title based violation section supp iv act also includes provision authorizing civil actions relevance district carhart concluded act unconstitutional two reasons first determined act unconstitutional lacked exception allowing procedure necessary health mother supp second district found act deficient covered merely intact also certain es appeals eighth circuit addressed lack health exception began analysis saw appropriate question whether medical authority supports medical necessity banned procedure quoting stenberg proper framework according appeals lack consensus exists medical community constitution requires legislatures err side protecting women health including health exception rejected attorney general attempt demonstrate changed evidentiary circumstances since stenberg considered bound stenberg conclusion health exception required explaining record case record stenberg similar significant respects invalidated act ibid district planned parenthood concluded act unconstitutional pose undue burden woman ability choose second trimester abortion unconstitutionally vague require health exception set forth stenberg supp appeals ninth circuit agreed like appeals eighth circuit concluded absence health exception rendered act unconstitutional interpreted stenberg require health exception unless consensus medical community banned procedure never medically necessary preserve health women even applying deferential standard review congress factual findings appeals determined substantial disagreement exists medical community regarding whether procedures prohibited act ever necessary preserve woman health appeals concluded act placed undue burden woman ability obtain abortion found textual differences act nebraska statute struck stenberg insufficient distinguish intact result according appeals act imposed undue burden prohibited finally appeals found act void vagueness abortion doctors testified uncertain procedures act made criminal thus concluded act offer physicians clear warning regulatory reach resting understanding remedial framework established ayotte planned parenthood northern new appeals held act unconstitutional face permanently enjoined ii principles set forth joint opinion planned parenthood southeastern casey find support join instant opinion see scalia joined thomas inter alios concurring judgment part dissenting part whatever one views concerning casey joint opinion evident premise central conclusion government legitimate substantial interest preserving promoting fetal life repudiated affirm judgments courts appeals casey involved challenge roe wade opinion contains summary must stated outset clarity roe essential holding holding reaffirm three parts first recognition right woman choose abortion viability obtain without undue interference state viability state interests strong enough support prohibition abortion imposition substantial obstacle woman effective right elect procedure second confirmation state power restrict abortions fetal viability law contains exceptions pregnancies endanger woman life health third principle state legitimate interests outset pregnancy protecting health woman life fetus may become child principles contradict one another adhere opinion though three holdings implicated instant cases third requires extended discussion must determine whether act furthers legitimate interest government protecting life fetus may become child implement holding casey rejected roe rigid trimester framework interpretation roe considered previability regulations abortion unwarranted plurality opinion point casey overruled holdings two cases undervalued state interest potential life see joint opinion overruling thornburgh american college obstetricians gynecologists akron akron center reproductive health assume following principles purposes opinion viability state may prohibit woman making ultimate decision terminate pregnancy plurality opinion also may impose upon right undue burden exists regulation purpose effect place substantial obstacle path woman seeking abortion fetus attains viability hand egulations create structural mechanism state parent guardian minor may express profound respect life unborn permitted substantial obstacle woman exercise right choose casey short struck balance balance central holding apply standard cases bar iii begin determination act operation effect straightforward reading act text demonstrates purpose scope provisions regulates proscribes exceptions qualifications discussed performing intact procedure respondents agree act encompasses intact contend additional reach unclear excessive respondents assert least act void vagueness scope indefinite alternative respondents argue act text proscribes es common abortion method respondents suggest act imposes undue burden litigation attorney general dispute act impose undue burden covered standard conclude act void vagueness impose undue burden overbreadth invalid face act punishes knowingly perform ing abortion supp iv defines unlawful abortion explicit terms first person performing abortion must vaginally delive living fetus act restrict abortion procedure involving delivery expired fetus act furthermore inapplicable abortions involve vaginal delivery instance hysterotomy hysterectomy act apply previability postviability common understanding scientific terminology fetus living organism within womb whether viable outside womb see planned parenthood supp understand point contested parties second act definition abortion requires fetus delivered case presentation entire fetal head outside body mother case breech presentation part fetal trunk past navel outside body mother supp iv attorney general concedes agree abortion procedure involve delivery living fetus one anatomical depending presentation either fetal head fetal trunk past navel outside body mother prohibitions act apply brief petitioner third fall within act doctor must perform overt act completion delivery kills partially delivered living fetus supp iv purposes criminal liability overt act causing fetus death must separate delivery overt act must occur delivery anatomical landmark act proscribes killing partially delivered fetus read context refers fetus delivered anatomical landmark ibid fourth act contains scienter requirements concerning actions involved prohibited abortion begin physician must deliberately intentionally delivered fetus one act anatomical landmarks living fetus delivered past critical point accident inadvertence act inapplicable addition fetus must delivered purpose performing overt act doctor knows kill ibid either intent absent crime occurred follows general principle scienter required crime committed absent requisite state mind see generally lafave substantive criminal law ed hereinafter lafave torcia wharton criminal law ed respondents contend language described indeterminate thus argue act unconstitutionally vague face generally stated doctrine requires penal statute define criminal offense sufficient definiteness ordinary people understand conduct prohibited manner encourage arbitrary discriminatory enforcement kolender lawson posters things act satisfies requirements act provides doctors ordinary intelligence reasonable opportunity know prohibited grayned city rockford indeed sets forth relatively clear guidelines prohibited conduct provides objective criteria evaluate whether doctor performed prohibited procedure posters things supra unlike statutory language stenberg prohibited delivery fetus doctor might question much fetus substantial portion act defines line potentially criminal conduct one hand lawful abortion stenberg quoting neb rev stat ann supp doctors performing know deliver living fetus anatomical landmark face criminal liability conclusion buttressed intent must proved impose liability made clear scienter requirements alleviate vagueness concerns posters things supra see also colautti franklin long recognized constitutionality vague statutory standard closely related whether standard incorporates requirement mens rea act requires doctor deliberately delivered fetus anatomical landmark supp iv doctor performing face criminal liability delivers fetus beyond prohibited point mistake act described trap act good faith colautti supra internal quotation marks omitted respondents likewise failed show act invalidated face encourages arbitrary discriminatory enforcement kolender supra act anatomical landmarks provide doctors objective standards also establish minimal guidelines govern law enforcement smith goguen scienter requirements narrow scope act prohibition limit prosecutorial discretion said act vests virtually complete discretion hands law enforcement determine whether doctor satisfied provisions kolender supra invalidating statute regulating loitering respondents arguments concerning arbitrary enforcement furthermore somewhat speculative preenforcement challenge evidence introduced indicate whether act enforced discriminatory manner aim inhibiting constitutionally protected conduct hoffman estates flipside hoffman estates act vague next determine whether act imposes undue burden facial matter restrictions abortions broad review statutory text discloses limits reach act prohibits intact notwithstanding respondents arguments prohibit procedure fetus removed parts act prohibits doctor intentionally performing intact dual prohibitions act necessary criminal liability correspond steps generally undertaken type procedure first doctor delivers fetus head lodges cervix usually past anatomical landmark breech presentation see supp iv second doctor proceeds pierce fetal skull scissors crush forceps step satisfies requirement kills fetus distinct delivery see act intent requirements however limit reach physicians carry intact intending undertake steps outset act excludes es fetus removed pieces intact doctor intends remove fetus parts outset doctor requisite intent incur criminal liability doctor performing standard procedure often tak uterus remove entire fetus planned parenthood supp removing fetus manner violate act doctor delivered living fetus one anatomical landmarks committed additional overt act kills fetus partial delivery supp iv comparison act nebraska statute struck stenberg confirms point statute stenberg prohibited intentionally delivering vagina living unborn child substantial portion thereof purpose performing procedure person performing procedure knows kill unborn child kill unborn child quoting neb rev stat ann supp concluded statute encompassed often involve physician pulling portion still living fetus say arm leg vagina prior death fetus also rejected limiting interpretation urged nebraska attorney general statute reference procedure unborn distinct procedure abortion procedure whole congress apparent responded concerns act departs material ways statute stenberg adopts phrase delivers living fetus supp iv instead living unborn child substantial portion thereof quoting neb rev stat ann supp act language unlike statute stenberg expresses usual meaning deliver used connection fetus namely extraction entire fetus rather removal fetal pieces see stedman medical dictionary ed defining deliver assist woman childbirth extract enclosed place fetus womb object foreign body see also dox melloni eisner melloni harpercollins illustrated medical dictionary ed merriam webster collegiate dictionary ed act thus displaces interpretation delivering dictated nebraska statute reference substantial portion fetus stenberg supra indicating nebraska statute specifies applies delivering intact unborn child substantial portion interpreting statutory texts courts use ordinary meaning terms unless context requires different result see singer sutherland statutes statutory construction rev ed unlike stenberg language require departure ordinary meaning involve delivery fetus requires removal fetal parts ripped fetus pulled cervix identification specific anatomical landmarks fetus must partially delivered also differentiates act statute issue stenberg supp iv stenberg interpreted fetus include arm leg act anatomical landmarks contrast clarify removal small portion fetus prohibited landmarks also require fetus delivered partially outside body mother come within ambit nebraska statute hand substantial portion fetus delivered vagina part fetus outside body mother doctor face criminal sanctions adding requirement congress sought meet objections state statute considered stenberg compare supp iv neb rev stat ann supp act makes distinction nebraska statute failed draw nebraska attorney general advanced differentiating overall abortion distinct overt act kills fetus see stenberg fatal overt act must occur delivery anatomical landmark must something completion delivery distinction matters unlike intact standard involve delivery followed fatal act canon constitutional avoidance finally extinguishes lingering doubt whether act covers prototypical elementary rule every reasonable construction must resorted order save statute unconstitutionality edward debartolo florida gulf coast building constr trades council quoting hooper california true longstanding maxim statutory interpretation past fallen wayside confronted statute regulating abortion times employed antagonistic construction cases involving abortion permissible reading statute avoided costs stenberg supra kennedy dissenting quoting thornburgh dissenting casey put novel statutory approach rest stenberg supra kennedy dissenting stenberg need interpreted revived read decision instead stand uncontroversial proposition canon constitutional avoidance apply statute genuinely susceptible two constructions see also clark martinez stenberg found statute covered contrast interpreting act prohibit standard reasonable reading understanding terms contrary arguments respondents unavailing respondents look situations might arise situations examined stenberg contend relying testimony numerous abortion doctors may result delivery living fetus beyond act anatomical landmarks significant fraction cases respondents say doctors predict amount cervix dilate abortion procedure might dilate degree fetus removed largely intact complete abortion doctors commit overt act kills partially delivered fetus respondents thus posit potential violate act physician know beforehand whether abortion proceed prohibited manner brief respondent planned parenthood et al reasoning however take account act intent requirements preclude liability attaching accidental intact doctor intent outset perform fetus delivered either act anatomical landmarks fetus nonetheless delivered past one points requisite prohibited scienter present supp iv doctor situation completes abortion performing intact doctor violate act true intent cause result may sometimes inferred person knows result practically certain follow conduct lafave yet abortion doctors intending outset perform standard procedure know prohibited abortion practically certain follow conduct ibid fetus delivered largely intact small fraction overall number abortions planned parenthood supp evidence also supports legislative determination intact delivery almost always conscious choice rather happenstance doctors example may remove fetus manner increase chances intact delivery see app intact usually described involving manner serial dilation see dilation extraction doctors seek obtain serial dilation perform intact far fewer occasions see carhart supp order intact removal occur regular basis fitzhugh dilate patients second round laminaria evidence belies claim standard performed without intending foreseeing intact many doctors testified behalf respondents objected act perform intact accident contrary begin every abortion objective removing fetus intact possible see since chasen believes intact safer dismemberment chasen goal perform intact every time see also prove respondents suggest every might violate act act therefore imposes undue burden demonstrates doctors intend perform involve delivery living fetus one act anatomical landmarks must adjust conduct law attempting deliver fetus either points respondents shown requiring doctors intend dismemberment delivery anatomical landmark prohibit vast majority abortions act held invalid face grounds iv principles accepted controlling act interpreted unconstitutional purpose effect place substantial obstacle path woman seeking abortion fetus attains viability casey plurality opinion abortions affected act regulations take place previability postviability quoted language undue burden analysis relies upon applicable question whether act measured text facial attack imposes substantial obstacle previability abortions act face impose substantial obstacle reject facial challenge validity act purposes set forth recitals preceding operative provisions description prohibited abortion procedure demonstrates rationale congressional enactment act proscribes method abortion fetus killed inches completion birth process congress stated follows implicitly approving brutal inhumane procedure choosing prohibit coarsen society humanity newborns vulnerable innocent human life making increasingly difficult protect life congressional findings notes following supp iv act expresses respect dignity human life congress concerned furthermore effects medical community reputation caused practice abortion findings act explain abortion confuses medical legal ethical duties physicians preserve promote life physician acts directly physical life child delivered head womb order end life congressional findings ibid doubt government interest protecting integrity ethics medical profession washington glucksberg see also barsky board regents univ indicating state legitimate concern maintaining high standards professional conduct practice medicine precedents clear state significant role play regulating medical profession casey reaffirmed governmental objectives government may use voice regulatory authority show profound respect life within woman central premise opinion precedents roe undervalue state interest potential life plurality opinion see also plurality opinion indicated fact law serves valid purpose one designed strike right incidental effect making difficult expensive procure abortion enough invalidate idle assertion three premises casey must coexist see opinion third premise state inception pregnancy maintains regulatory interest protecting life fetus may become child set naught interpreting casey requirement health exception becomes tantamount allowing doctor choose abortion method might prefer rational basis act impose undue burden state may use regulatory power bar certain procedures substitute others furtherance legitimate interests regulating medical profession order promote respect life including life unborn act ban abortions involve partial delivery living fetus furthers government objectives one dispute many procedure laden power devalue human life congress nonetheless conclude type abortion proscribed act requires specific regulation implicates additional ethical moral concerns justify special prohibition congress determined abortion methods proscribed disturbing similarity killing newborn infant congressional findings notes following supp iv thus concerned draw ing bright line clearly distinguishes abortion infanticide congressional findings ibid past confirmed validity drawing boundaries prevent certain practices extinguish life close actions condemned glucksberg found reasonable state fear permitting assisted suicide start path voluntary perhaps even involuntary euthanasia respect human life finds ultimate expression bond love mother child act recognizes reality well whether abortion requires difficult painful moral decision casey supra opinion find reliable data measure phenomenon seems unexceptionable conclude women come regret choice abort infant life created sustained see brief sandra cano et al amici curiae pp severe depression loss esteem follow see ibid decision fraught emotional consequence doctors may prefer disclose precise details means used confining required statement risks procedure entails one standpoint surprising number patients facing imminent surgical procedures prefer hear details lest usual anxiety preceding invasive medical procedures become intense likely case abortion procedures issue see nat abortion federation supp plaintiffs experts acknowledged describe patients intact procedures entail clear precise terms see also however precisely lack information concerning way fetus killed legitimate concern state casey supra plurality opinion free enact laws provide reasonable framework woman make decision profound lasting meaning state interest ensuring grave choice well informed mother comes regret choice abort must struggle grief anguished sorrow profound learns event know allowed doctor pierce skull vacuum brain unborn child child assuming human form reasonable inference necessary effect regulation knowledge conveys encourage women carry infant full term thus reducing absolute number abortions medical profession furthermore may find different less shocking methods abort fetus second trimester thereby accommodating legislative demand state interest respect life advanced dialogue better informs political legal systems medical profession expectant mothers society whole consequences follow decision elect abortion objected standard respects brutal intact legislation accomplishes little already said however shows ample justification regulation abortion defined act differs standard former occurs fetus partially outside mother point one act anatomical landmarks reasonable congress think abortion standard undermines public perception appropriate role physician delivery process perverts process life brought world congressional findings notes following supp iv flaw logic irony jurisprudence first conclude ban intact overbroad say irrational ban intact proscribe procedures sum reject contention congressional purpose act place substantial obstacle path woman seeking abortion plurality opinion act furtherance legitimate government interests bears upon resolve next question whether act effect imposing unconstitutional burden abortion right allow use barred procedure appropriate medical judgment preservation health mother ayotte quoting casey supra plurality opinion prohibition act unconstitutional precedents assume controlling subject ed women significant health risks ayotte supra see also casey supra opinion ayotte parties agreed health exception challenged statute necessary avert serious often irreversible damage pregnant minor health contrast whether act creates significant health risks women contested factual question evidence presented trial courts congress demonstrates sides medical support position respondents presented evidence intact may safest method abortion reasons similar adduced stenberg see abortion doctors testified example intact decreases risk cervical laceration uterine perforation requires fewer passes uterus surgical instruments require removal bony fragments dismembered fetus fragments may sharp respondents also presented evidence intact safer reduces risks fetal parts remain uterus takes less time complete respondents addition proffered evidence intact safer women certain medical conditions women fetuses certain anomalies see carhart supp nat abortion federation supra planned parenthood supp contentions contradicted doctors testified district courts congress concluded alleged health advantages based speculation without scientific studies support considered always safe alternative see carhart supra nat abortion federation supp planned parenthood supp documented medical disagreement whether act prohibition ever impose significant health risks women see continues division opinion among highly qualified experts regarding necessity safety intact see also nat abortion federation supra three district courts considered act constitutionality appeared disagreement central factual question district district nebraska concluded banned procedure sometimes safest abortion procedure preserve health women carhart supra district northern district california reached similar conclusion planned parenthood supra finding intact certain circumstances significantly safer disarticulation district southern district new york skeptical purported health benefits intact found attorney general expert witnesses reasonably effectively refuted plaintiffs proffered bases opinion intact safety advantages abortion procedures nat abortion federation supp addition believe many plaintiffs purported reasons intact medically necessary credible rather found theoretical false nonetheless invalidated act determined significant body medical opinion holds safety advantages induction intact safety advantages however hypothetical unsubstantiated scientific evidence women circumstances ibid question becomes whether act stand medical uncertainty persists precedents instruct act survive facial attack given state federal legislatures wide discretion pass legislation areas medical scientific uncertainty see kansas hendricks jones lambert yellowley collins texas jacobson massachusetts see also stenberg supra kennedy dissenting marshall congress undertakes act areas fraught medical scientific uncertainties legislative options must especially broad traditional rule consistent casey confirms state interest promoting respect human life stages pregnancy physicians entitled ignore regulations direct use reasonable alternative procedures law need give abortion doctors unfettered choice course medical practice elevate status physicians medical community casey controlling opinion held requirement abortion context different requirement doctor give certain specific information medical procedure joint opinion opinion stated relation entitled solicitude receives contexts ibid see also webster reproductive health services plurality opinion criticizing roe trimester framework inter alia left serve country ex officio medical board powers approve disapprove medical operative practices standards throughout internal quotation marks omitted mazurek armstrong per curiam upholding restriction performance abortions licensed physicians despite respondents contention health evidence contradicts claim health basis law internal quotation marks omitted medical uncertainty foreclose exercise legislative power abortion context contexts see hendricks supra medical uncertainty whether act prohibition creates significant health risks provides sufficient basis conclude facial attack act impose undue burden conclusion act impose undue burden supported considerations alternatives available prohibited procedure noted act proscribe one district found extremely low rates medical complications planned parenthood supra another indicated generally safest method abortion second trimester carhart supp see also nat abortion federation supra explaining xperts testifying sides agreed safe addition act prohibition applies delivery living fetus supp iv intact procedure truly necessary circumstances appears likely injection kills fetus alternative act allows doctor perform procedure instant cases different planned parenthood central mo danforth invalidated ban saline amniocentesis abortion method found ban danforth unreasonable arbitrary regulation designed inhibit effect inhibiting vast majority abortions first weeks act allows among means commonly used generally accepted method construct substantial obstacle abortion right reaching conclusion act require health exception reject certain arguments made parties sides cases one hand attorney general urges us uphold act basis congressional findings alone brief petitioner although review congressional factfinding deferential standard circumstances place dispositive weight congress findings retains independent constitutional duty review factual findings constitutional rights stake see crowell benson cases brought enforce constitutional rights judicial power necessarily extends independent determination questions fact law necessary performance function respondents noted district courts recognized recitations act factually incorrect see nat abortion federation supp whether accurate time important findings superseded two examples suffice congress determined medical schools provide instruction prohibited procedure congressional findings notes following supp iv testimony district courts however demonstrated intact taught medical schools nat abortion federation supra planned parenthood supp congress also found existed medical consensus prohibited procedure never medically necessary congressional findings notes following supp iv evidence presented district courts contradicts conclusion see carhart supra nat abortion federation supra planned parenthood supra uncritical deference congress factual findings cases inappropriate hand relying opinion stenberg respondents contend abortion regulation must contain health exception medical authority supports proposition banning particular procedure endanger women health brief respondents quoting see also brief respondent planned parenthood et al illustrated respondents arguments decisions courts appeals stenberg interpreted leave margin error legislatures act face medical uncertainty carhart planned parenthood see also nat abortion federation walker concurring explaining standard stenberg virtually insurmountable evidentiary hurdle zero tolerance policy strike legitimate abortion regulations like present one part medical community disinclined follow proscription exacting standard impose legislative power exercised instance commerce clause regulate medical profession considerations marginal safety including balance risks within legislative competence regulation rational pursuit legitimate ends standard medical options available mere convenience suffice displace procedures different risks others follow state altogether barred imposing reasonable regulations act invalid face uncertainty whether barred procedure ever necessary preserve woman health given availability abortion procedures considered safe alternatives considerations discussed support determination facial attacks entertained first instance circumstances proper means consider exceptions challenge government acknowledged preenforcement challenges act maintained tr oral arg pp proper manner protect health woman shown discrete instances particular condition likely occur procedure prohibited act must used challenge nature medical risk better quantified balanced facial attack latitude given facial challenges first amendment context inapplicable broad challenges type impose heavy burden upon parties maintaining suit rust sullivan burden consists specific context abortion statutes subject question compare ohio akron center reproductive health ecause appellees making facial challenge statute must show set circumstances exists act valid internal quotation marks omitted casey opinion indicating statute impose undue burden large fraction cases relevant holding statutory provision facially invalid see also janklow planned parenthood sioux falls clinic need resolve debate previous sections opinion explain respondents demonstrated act unconstitutional large fraction relevant cases casey supra opinion note statute applies instances doctor proposes use prohibited procedure merely woman suffers medical complications neither obligation within traditional institutional role resolve questions constitutionality respect potential situation might develop indeed undesirable consider every conceivable situation might possibly arise application complex comprehensive legislation raines internal quotation marks omitted reason challenges basic building blocks constitutional adjudication fallon facial challenges standing harv rev act open proper challenge discrete case cf wisconsin right life federal election per curiam challenge need brought prohibition act threatens woman life act already contains life exception supp iv respondents demonstrated act facial matter void vagueness imposes undue burden woman right abortion based overbreadth lack health exception reasons judgments courts appeals eighth ninth circuits reversed ordered alberto gonzales attorney general petitioner leroy carhart et al writ certiorari appeals eighth circuit alberto gonzales attorney general petitioner planned parenthood federation america et al writ certiorari appeals ninth circuit april justice thomas justice scalia joins concurring join opinion accurately applies current jurisprudence including planned parenthood southeastern casey write separately reiterate view abortion jurisprudence including casey roe wade basis constitution see casey supra scalia concurring judgment part dissenting part stenberg carhart thomas dissenting also note whether act constitutes permissible exercise congress power commerce clause parties raise brief issue outside question presented lower courts address see cutter wilkinson thomas concurring alberto gonzales attorney general petitioner leroy carhart et al writ certiorari appeals eighth circuit alberto gonzales attorney general petitioner planned parenthood federation america et al writ certiorari appeals ninth circuit april justice ginsburg justice stevens justice souter justice breyer join dissenting planned parenthood southeastern casey declared iberty finds refuge jurisprudence doubt said imperative need dispel doubt meaning reach judgment rendered nearly two decades earlier roe wade responsive need endeavored provide secure guidance tate federal courts well legislatures throughout union defining rights woman legitimate authority state respecting termination pregnancies abortion procedures ibid taking care speak plainly casey restated reaffirmed roe essential holding first addressed type abortion regulation permissible prior fetal viability recognized right woman choose abortion viability obtain without undue interference state second acknowledged state power restrict abortions fetal viability law contains exceptions pregnancies endanger woman life health ibid emphasis added third confirmed state legitimate interests outset pregnancy protecting health woman life fetus may become child ibid emphasis added reaffirming roe casey described centrality decision whether bear child eisenstadt baird woman dignity autonomy personhood destiny conception place society signal importance casey stated unmistakable clarity state regulation access abortion procedures even viability must protect health woman seven years ago stenberg carhart invalidated nebraska statute criminalizing performance medical procedure political arena dubbed abortion fidelity line precedent held nebraska statute unconstitutional part lacked requisite protection preservation woman health stenberg cf ayotte planned parenthood northern new today decision alarming refuses take casey stenberg seriously tolerates indeed applauds federal intervention ban nationwide procedure found necessary proper certain cases american college obstetricians gynecologists acog blurs line firmly drawn casey previability postviability abortions first time since roe blesses prohibition exception safeguarding woman health dissent disposition retreating prior rulings abortion restrictions imposed absent exception safeguarding woman health upholds act surely survive close scrutiny previously attended limitations woman reproductive choices casey comprehended stake cases challenging abortion restrictions woman control destiny plurality opinion see also majority opinion time long ago women regarded center home family life attendant special responsibilities precluded full independent legal status constitution quoting hoyt florida views made clear casey longer consistent understanding family individual constitution women acknowledged talent capacity right participate equally economic social life nation ability realize full potential recognized intimately connected ability control reproductive lives ibid thus legal challenges undue restrictions abortion procedures seek vindicate generalized notion privacy rather center woman autonomy determine life course thus enjoy equal citizenship stature see siegel reasoning body historical perspective abortion regulation questions equal protection stan rev law rethinking sex constitution rev keeping comprehension right reproductive choice consistently required laws regulating abortion stage pregnancy cases safeguard woman health see ayotte ur precedents hold state may restrict access abortions necessary appropriate medical judgment preservation life health woman quoting casey plurality opinion stenberg since law requires health exception order validate even postviability abortion regulation minimum requires respect previability see also thornburgh american college obstetricians gynecologists invalidating abortion regulation fail ure require pregnant woman health physician paramount consideration thus ruled state must avoid subjecting women health risks pregnancy creates danger also state regulation forces women resort less safe methods abortion see planned parenthood central mo danforth holding unconstitutional ban method abortion force woman terminate pregnancy methods dangerous health see also stenberg cases make clear risk women health whether happens arise regulating particular method abortion barring abortion indeed applied rule abortion regulation must safeguard woman health particular procedure issue intact dilation evacuation stenberg expressly held statute banning intact unconstitutional part lacked health exception noted existed division medical opinion relative safety intact made clear long substantial medical authority supports proposition banning particular abortion procedure endanger women health health exception required explained word casey phrase appropriate medical judgment preservation life health pregnant woman refer absolute necessity absolute proof medical treatments procedures often considered appropriate inappropriate light estimated comparative health risks health benefits particular cases neither phrase require unanimity medical opinion doctors often differ estimation comparative health risks appropriate treatment casey words medical judgment must embody judicial need tolerate responsible differences medical opinion citation omitted thus reasoned division medical opinion means uncertainty factor signals presence risk absence ibid statute altogether forbids intact consequently must contain health exception see also concurring th lack health exception necessarily renders statute years ruling stenberg congress passed abortion ban act without exception women health see supp iv congressional findings abortion ban act rests withstand inspection lower courts determined obliged concede ante see national abortion federation ashcroft supp sdny congress carefully consider evidence arriving findings aff sub nom national abortion federation gonzales see also planned parenthood federation ashcroft supp nd cal one six physicians testified congress ever performed intact several provide abortion services one even obgyn oral testimony congress unbalanced intentionally polemic aff carhart ashcroft supp neb congress arbitrarily relied upon opinions doctors claimed little recent relevant experience surgical abortions disregarded views doctors significant relevant experience procedures aff many act recitations incorrect see ante example congress determined medical schools provide instruction intact stat notes following supp iv congressional findings fact numerous leading medical schools teach procedure see planned parenthood supp national abortion federation supp see also brief acog amicus curiae among schools teach intact variant columbia cornell yale new york university northwestern university pittsburgh university pennsylvania university rochester university important congress claimed medical consensus banned procedure never necessary congressional findings notes following supp iv evidence clearly demonstrate opposite planned parenthood supp see also carhart supp evident consensus record congress compiled however substantial body medical opinion presented congress opposition anything congressional record establishes favor banned procedure national abortion federation supp congressional record undermines congress finding medical consensus intact never medically necessary prohibited internal quotation marks omitted similarly congress found credible medical evidence abortions safe safer abortion procedures congressional findings notes following supp iv congressional record includes letters numerous individual physicians stating pregnant women health jeopardized act well statements nine professional associations including acog american public health association california medical association attesting intact carries meaningful safety advantages methods see national abortion federation supp see also planned parenthood supp congress findings chose disregard statements acog medical comparable medical groups supported ban fact government witnesses disagreed many specific congressional findings contrast congress district courts made findings full trials parties opportunity present best evidence courts benefit much extensive medical scientific evidence concerning safety necessity intact es planned parenthood supp cf national abortion federation supp district heard evidence trial congress heard span eight district trials numerous extraordinarily accomplished experienced medical experts explained certain circumstances certain women intact safer alternative procedures necessary protect women health carhart supp see planned parenthood supp doctors actually perform intact es concluded opinion clinical judgment intact es remain safest option certain individual women certain individual health circumstances significantly safer women abortion techniques thus medically necessary cf ante respondents presented evidence intact may safest method abortion reasons similar adduced according expert testimony plaintiffs introduced safety advantages intact marked women certain medical conditions example uterine scarring bleeding disorders heart disease compromised immune systems see carhart supp national abortion federation supp planned parenthood supp plaintiffs experts testified intact significantly safer women certain conditions placenta previa accreta women carrying fetuses certain abnormalities severe hydrocephalus see carhart supp national abortion federation supp planned parenthood supp see also stenberg brief acog amicus curiae intact plaintiffs experts explained provides safety benefits dismemberment several reasons first intact minimizes number times physician must insert instruments cervix uterus thereby reduces risk trauma perforation cervix uterus serious complication associated nonintact see carhart supp national abortion federation supp planned parenthood supp second removing fetus intact instead dismembering utero decreases likelihood fetal tissue retained uterus condition cause infection hemorrhage infertility see carhart supp national abortion federation supp planned parenthood supp third intact diminishes chances exposing patient tissues sharp bony fragments sometimes resulting dismemberment fetus see carhart supp national abortion federation supp planned parenthood supp fourth intact takes less operating time dismemberment thus may reduce bleeding risk infection complications relating anesthesia see carhart supp national abortion federation supp planned parenthood supp see also stenberg brief acog amicus curiae based thoroughgoing review trial evidence congressional record district courts consider issue rejected congress findings unreasonable supported evidence see carhart supp national abortion federation supp planned parenthood supp trial courts concluded contrast congress findings significant medical authority supports proposition circumstances intact safest procedure quoting stenberg accord carhart supp national abortion federation supp cf stenberg record shows significant medical authority supports proposition circumstances intact safest district courts findings merit respect see fed rule civ proc salve regina college russell today opinion supplies reason reject findings nevertheless despite district courts appraisal weight evidence undisguised conflict stenberg asserts abortion ban act survive medical uncertainty persists ante assertion bewildering defy longstanding precedent affirming necessity health exception circumstances medical uncertainty see supra gives short shrift records us carefully canvassed district courts records indicate majority experts subject believe intact safest appropriate procedure certain circumstances planned parenthood supp see supra acknowledges evidence ante insists witnesses disagreed acog experts assessment risk act stand ante insistence brushes rug district courts findings physicians testified intact never necessary preserve health woman slim authority opinions training personal experience intact procedure many performed abortions rare occasions see planned parenthood supp carhart supp cf national abortion federation supp even indulging assumption government witnesses equally qualified evaluate relative risks abortion procedures testimony erase significant medical authority support ing proposition circumstances intact safest procedure stenberg ii offers flimsy transparent justifications upholding nationwide ban intact sans exception safeguard women health today ruling declares advances premise central casey conclusion government legitimate substantial interest preserving promoting fetal life ante see also ante must determine whether act furthers legitimate interest government protecting life fetus may become act scarcely furthers interest law saves single fetus destruction targets method performing abortion see stenberg surely statute designed protect lives health pregnant women ginsburg concurring cf casey recognizing along state legitimate interest life fetus legitimate interes protecting health woman emphasis added short upholds law nothing preserv fetal life ante bars woman choosing intact although doctor reasonably believes procedure best protect stenberg stevens concurring another reason upholding ban emphasizes act proscribe nonintact procedure see ante one might ask nonintact equally characterized brutal ante involving tear ing fetus apart ripp ing limbs ante notion either two equally gruesome procedures akin infanticide state furthers legitimate interest banning one simply irrational stenberg stevens concurring delivery intact albeit nonviable fetus warrants special condemnation maintains fetus dismembered resembles infant ante fetus delivered intact terminated injection day two surgical evacuation ante fetus delivered medical induction cesarean ante yet availability procedures along dismemberment says saves ban intact declaration unconstitutionality ante never mind procedures deemed acceptable might put woman health greater risk see supra cf ante ultimately admits moral concerns work concerns yield prohibitions abortion see ante congress conclude type abortion proscribed act requires specific regulation implicates additional ethical moral concerns justify special notably concerns expressed untethered ground genuinely serving government interest preserving life allowing concerns carry day case overriding fundamental rights dishonors precedent see casey us individuals find abortion offensive basic principles morality control decision obligation define liberty mandate moral code lawrence texas though many persons objections homosexual conduct trivial concerns profound deep convictions accepted ethical moral principles power state may used enforce views whole society operation criminal law citing casey revealing regard invokes antiabortion shibboleth concededly reliable evidence women abortions come regret choices consequently suffer evere depression loss esteem ante women fragile emotional state bond love mother child worries doctors may withhold information nature intact procedure ante solution approves require doctors inform women accurately adequately different procedures attendant risks cf casey plurality opinion free enact laws provide reasonable framework woman make decision profound lasting instead deprives women right make autonomous choice even expense way thinking reflects ancient notions women place family constitution ideas long since discredited compare muller oregon protective legislation imposing limitations women held permissible view women physical structure proper discharge maternal funct ion bradwell state wall bradley concurring man woman protector defender natural proper timidity delicacy belongs female sex evidently unfits many occupations civil life paramount destiny mission woman fulfil noble benign offices wife mother virginia state may rely overbroad generalizations talents capacities preferences women uch judgments impeded women progress toward full citizenship stature throughout nation history califano goldfarb social security classification rejected rested archaic overbroad generalizations assumptions women dependency internal quotation marks omitted though today majority may regard women feelings matter ante repeatedly confirmed destiny woman must shaped conception spiritual imperatives place society casey see also plurality opinion eans chosen state interest potential life must calculated inform woman free choice hinder supra cases woman liberty determine whether continue pregnancy identified viability critical consideration see casey plurality opinion line workable viability explained casey viability time realistic possibility maintaining nourishing life outside womb independent existence second life reason fairness object state protection overrides rights woman broad sense might said woman fails act viability consented state intervention behalf developing child today blurs line maintaining act legitimately appl ies previability postviability fetus living organism within womb whether viable outside womb ante instead drawing line viability refers congress purpose differentiate abortion infanticide based whether fetus survive outside womb fetus anatomically located particular medical procedure performed see ante quoting congressional findings notes following supp iv one wonders long line saves fetus destruction hold face moral concerns see supra cf ante noting litigation attorney general dispute act impose undue burden covered standard hostility right roe casey secured concealed throughout opinion refers surgeons perform abortions titles medical specialties pejorative label abortion doctor ante fetus described unborn child baby ante previability abortions referred ante reasoned medical judgments highly trained doctors dismissed preferences motivated mere convenience ante instead heightened scrutiny previously applied determines rational ground enough uphold act ante troubling casey principles confirming continuing vitality essential holding roe merely assume moment ante rather retained reaffirmed casey iii confuses jurisprudence declares facial attacks permissible circumstances medical uncertainty exists ante see ibid challenge nature medical risk better quantified balanced facial holding perplexing given materially identical circumstances held statute lacking health exception unconstitutional face stenberg see facial challenge law held unconstitutional significant body medical opinion believes procedure may bring greater safety patients emphasis added see also sabri identifying abortion one setting recognized validity facial challenges fallon making sense overbreadth yale irtually abortion cases reaching since roe wade involved facial attacks state statutes whether accepting rejecting challenges merits typically accepted framing question accord fallon facial challenges standing harv rev dorf facial challenges state federal statutes stan rev without attempting distinguish stenberg earlier decisions majority asserts act survives review respondents shown ban intact unconstitutional large fraction relevant cases ante citing casey casey makes clear determining whether restriction poses undue burden large fraction women relevant class women pregnant women even women seeking abortions rather provision restricting access abortion must judged reference women actual rather irrelevant restriction ibid thus absence health exception burdens women relevant women judgment doctors require intact procedures place health cf stenberg accepting relative rarity medically indicated intact es true highly relevant health exception question whether protecting women health requires exception infrequent occasions ayotte facial challenge entertained small percentage cases women need immediate abortions avert serious often irreversible damage health makes sense conclude facial challenge fails respondents shown health exception necessary large fraction abortions including health exception unnecessary purpose health exception protect women exceptional cases anything redemptive said today opinion willing foreclose entirely constitutional challenge act act open proper challenge discrete case ante see ante government acknowledged preenforcement challenges act offers clue proper lawsuit might look like see ante explain injunctions ordered district courts remain place trimmed exclude instances another procedure safeguard woman health least equally well surely mean suit may brought woman health immediately jeopardized ban intact woman suffer ing medical complications ante needs access medical procedure wait judicial process unfold see ayotte appears contemplate another lawsuit initiators instant actions second round suggests challengers succeed upon demonstrating discrete instances particular condition likely occur procedure prohibited act must used ante one may anticipate preenforcement challenge mounted swiftly ward serious sometimes irremediable harm women whose health endangered intact prohibition envisions challenge nature medical risk better quantified balanced ibid escape notice record already includes hundreds hundreds pages testimony identifying discrete instances recourse intact better protect health women particular conditions see supra record evidence also documents medical exigencies unpredictable advance may indicate doctor intact safest procedure see ibid light evidence unanimous decision one year ago ayotte counsels reversal see remanding reconsideration remedy absence health exception suggesting injunction prohibiting unconstitutional applications might suffice allowance challenge discrete case ante jeopardizes women health places doctors untenable position even courts able exceptions piecemeal litigation discrete instances ante women whose circumstances anticipated prior litigation well left unprotected treating women physicians risk criminal prosecution conviction imprisonment exercise best judgment safest medical procedure patients thus gravely mistaken conclude narrow challenges proper manner protect health woman cf ibid iv wrote casey overruling roe central holding reach unjustifiable result principles stare decisis seriously weaken capacity exercise judicial power function nation dedicated rule law concept rule law underlying constitution requires continuity time respect precedent definition indispensable see also overrule fire absence compelling reason reexamine watershed decision subvert legitimacy beyond serious though today opinion go far discard roe casey differently composed last considered restrictive abortion regulation hardly faithful earlier invocations rule law principles stare decisis congress imposed ban despite clear prior holdings state proscribe abortion procedure use necessary protect woman health see supra although congress findings withstand crucible trial defers legislative override rulings see supra decision odds jurisprudence staying power sum notion abortion ban act furthers legitimate governmental interest quite simply irrational defense statute provides saving explanation candor act defense understood anything effort chip away right declared increasing comprehension centrality women lives see supra supra statute burdens constitutional rights said behalf vehicle legislators chosen expressing hostility rights burden undue stenberg ginsburg concurring quoting hope clinic ryan posner dissenting reasons stated dissent disposition affirm judgments us review footnotes together gonzales attorney general planned parenthood federation america et certiorari appeals ninth circuit footnotes term abortion neither recognized medical literature used physicians perform abortions see planned parenthood federation ashcroft supp nd cal aff medical community refers procedure either dilation extraction intact dilation evacuation intact see ante stenberg carhart planned parenthood southeastern casey described precisely roe wade impact abortion restrictions women liberty roe focus considerable measure vindicat ing right physician administer medical treatment according professional judgment dilation evacuation frequently used abortion procedure second trimester pregnancy intact variant procedure see ante stenberg planned parenthood supp abortions midpregnancy previability abortions however relatively uncommon percent abortions performed take place first three months pregnancy see ante see also stenberg national abortion federation ashcroft supp sdny aff sub nom national abortion federation gonzales planned parenthood supp adolescents indigent women research suggests likely women difficulty obtaining abortion first trimester pregnancy minors may unaware pregnant relatively late pregnancy poor women financial constraints obstacle timely receipt services see finer frohwirth dauphinee singh moore timing steps reasons delays obtaining abortions contraception see also drey et risk factors associated presenting abortion second trimester obstetrics gynecology concluding women abortions typically discover relatively late pregnant severe fetal anomalies health problems confronting pregnant woman also causes abortions many conditions diagnosed develop second trimester see finer supra cunningham et williams obstetrics ed cf schechtman gray baty rothman termination pregnancies fetal anomalies analysis pregnancies obstetrics gynecology nearly women carrying fetuses serious central nervous system anomalies chose abort pregnancies act sponsors left doubt intention nullify ruling stenberg see cong rec statement santorum defended indefensible responded see also cong rec statement linder rejecting proposition congress right legislate ban horrible practice says even district southern district new york skeptical health benefits intact see ante recognized government experts disagreed almost congress factual findings significant body medical opinion holds intact safety advantages nonintact rofessional medical associations also expressed view intact may safest procedure women evidence indicates disagreement among experts found stenberg existed throughout time congress considering legislation despite congress findings contrary national abortion federation supp majority contends intact procedure truly necessary circumstances appears likely injection kills fetus alternative act allows doctor perform procedure ante significant body medical opinion believes inducing fetal death injection almost always inappropriate preservation health women undergoing abortion poses tangible risk provides benefit woman carhart ashcroft supp neb internal quotation marks omitted aff circumstances injections absolutely medically contraindicated supp see also national abortion federation supp planned parenthood supp also identifies medical induction labor alternative see ante procedure however requires hospital stay rendering inaccessible patients lack financial resources considered less safe many women impermissible others see carhart supp national abortion federation supp planned parenthood supp surely correct women abortion painfully difficult decision see ante neither weight scientific evidence date observable reality years legal abortion comports idea abortion dangerous woman mental health delivering parenting child intend cohen abortion mental health myths realities guttmacher policy rev see generally bazelon syndrome times magazine see also american psychological association apa briefing paper impact abortion rejecting theory postabortion syndrome stating ccess legal abortion terminate unwanted pregnancy vital safeguard physical mental health women schmiege russo depression unwanted first pregnancy longitudinal cohort study british medical finding credible evidence choosing terminate unwanted first pregnancy contributes risk subsequent depression gilchrist hannaford frank kay termination pregnancy psychiatric morbidity british psychiatry finding cohort women rate psychiatric disorder higher among women terminated pregnancy among carried pregnancy term stodland myth abortion trauma syndrome jama scientific studies indicate legal abortion results fewer deleterious sequelae women compared possible outcomes unwanted pregnancy evidence abortion trauma syndrome american psychological association council policy manual public interest declaring assertions widespread severe negative psychological effects abortion without fact see cougle reardon coleman generalized anxiety following unintended pregnancies resolved childbirth abortion cohort study national survey family growth anxiety disorders advancing theory postabortion syndrome acknowledging causal relationship pregnancy outcome anxiety determined study reardon et psychiatric admissions women following abortion childbirth canadian medical assn may concluding psychiatric admission rates higher women abortion compared women delivered cf major psychological implications abortion highly charged rife misleading research canadian medical assn may critiquing reardon study failing control host differences women delivery abortion samples notwithstanding bond love women often children see ante pregnancies recognized wanted even product consensual activity see casey average day nearly women severely assaulted male partners many incidents involve sexual see also glander moore michielutte parsons prevalence domestic violence among women seeking abortion obstetrics gynecology holmes resnick kilpatrick best pregnancy estimates descriptive characteristics national sample women obstetrics gynecology eliminating reducing women reproductive choices manifestly means protecting safe abortion procedures cease option many women seek means end unwanted coerced pregnancies see world health organization unsafe abortion global regional estimates incidence unsafe abortion associated mortality pp ed restrictive legislation associated high incidence unsafe abortion worldwide unsafe abortion represents maternal deaths henshaw unintended pregnancy abortion public health perspective clinician guide medical surgical abortion paul lichtenberg borgatta grimes stubblefield eds legalization large numbers women died unsafe abortions boonstra gold richards finer abortion women lives fig late illegal abortion still accounted estimated officially reported deaths eaths abortion declined dramatically legalization short fraction numerator denominator health exception reaches cases woman health risk perhaps reason mandating safeguards women health never invoked large fraction test