stenberg attorney general nebraska et al carhart argued april decided june constitution offers basic protection woman right choose whether abortion roe wade planned parenthood southeastern casey fetal viability woman right terminate pregnancy joint opinion state law unconstitutional imposes woman decision undue burden purpose effect placing substantial obstacle woman path postviability state promoting interest potentiality human life may regulate even proscribe abortion except necessary appropriate medical judgment preservation mother life health nebraska law issue prohibits partial birth abortion unless procedure necessary save mother life defines partial birth abortion procedure doctor partially delivers vaginally living unborn child killing child defines latter phrase mean intentionally delivering vagina living unborn child substantial portion thereof purpose performing procedure abortionist knows kill child kill child violation law felony provides automatic revocation convicted doctor state license practice medicine respondent carhart nebraska physician performs abortions clinical setting brought suit seeking declaration statute violates federal constitution district held statute unconstitutional eighth circuit affirmed held nebraska statute criminalizing performance partial birth abortion violates federal constitution interpreted casey roe pp statute seeks ban one abortion method discusses several different abortion procedures described evidence medical literature pregnancy second trimester weeks common abortion procedure dilation evacuation involves dilation cervix removal least fetal tissue using nonvacuum surgical instruments week potential need instrumental dismemberment fetus collapse fetal parts facilitate evacuation uterus dismemberment necessary typically occurs doctor pulls portion fetus cervix birth canal risks mortality complication accompany significantly lower accompanying induced labor procedures next safest procedures variation known intact used weeks involves removing fetus uterus cervix intact one pass rather several passes intact proceeds one two ways depending whether fetus presents head first feet first method known dilation extraction ordinarily associated term partial birth abortion district concluded clear convincing evidence established carhart procedure superior safer abortion procedures used relevant gestational period cases year present carhart moreover materials presented trial emphasize potential benefits procedure certain cases pp nebraska statute lacks requisite exception preservation health mother casey supra joint opinion state may promote endanger woman health regulates methods abortion pp rejects nebraska contention need health exception safe alternatives remain available ban create risk women health parties strongly contested factual question district findings evidence support carhart pp ii nebraska supporting amici respond eight arguments district findings irrelevant wrong applicable tiny number instances pp iii eight arguments insufficient demonstrate nebraska law needs health exception one thing certain arguments beside point procedure relative rarity argument highly relevant state prohibit person obtaining treatment simply pointing people need fact handful doctors use procedure argument may reflect comparative rarity late second term abortions procedure recent development controversy surrounding nebraska suggests procedure lack utility another thing record responds nebraska amici medically based arguments argument district agreed alternatives induced labor safe found method safer circumstances used carhart argument testimony showed statutory ban increase woman risk several rare abortion complications district simply relied different expert testimony state argument assertion amici association american physicians surgeons et al elements procedure may create special risks disputed carhart amici including american college obstetricians gynecologists acog claims suggested alternative procedures involve similar greater risks cervical uterine injury nebraska argument right general medical studies documenting comparative safety various abortion procedures deny import american medical association ama recommendation argument intact used unless alternative procedures pose materially greater risk woman however read acog qualification identify circumstance option according nebraska argument denied potential need acog also asserted appropriate abortion procedure presents variety potential safety advantages pp iv upshot district finding obviates health risks certain circumstances highly plausible explanation might division medical opinion whether generally safer absence controlled medical studies help answer medical questions given circumstances believes law requires health exception one thing word necessary casey phrase necessary appropriate medical judgment health mother refer absolute proof require unanimity medical opinion doctors often differ estimation comparative health risks appropriate treatment casey words appropriate medical judgment must embody judicial need tolerate responsible differences medical opinion another thing division medical opinion signals uncertainty believe safer abortion method certain circumstances turn right absence health exception place women unnecessary risk wrong exception simply turn unnecessary pp nebraska statute imposes undue burden woman ability choose abortion see casey supra joint opinion pp nebraska deny statute imposes undue burden applies commonly used procedure well agrees eighth circuit procedure falls within statutory prohibition intentionally delivering vagina living fetus substantial portion thereof purpose performing procedure perpetrator knows kill fetus evidence makes clear often involve physician pulling arm leg substantial portion still living fetus vagina prior fetus death statutory terms distinguish statute language track medical differences covers using law statutory terms impossible distinguish foot arm drawn cervix body head drawn cervix procedures involve introduction substantial portion still living fetus cervix vagina feature abortion leads characterizing procedure involving partial birth pp ii rejects nebraska attorney general arguments state law differentiate two procedures words substantial portion mean child head law inapplicable physician introduces birth canal anything less entire fetal body must defer views case law makes clear attorney general narrowing interpretation given controlling weight one thing normally follows lower interpretations state law mcmillian monroe county rarely reviews interpretation agreed upon two lower federal courts virginia american booksellers two lower courts rejected attorney general narrowing interpretation another precedent warns accepting authoritative attorney general interpretation state law interpretation bind state courts local law enforcement nebraska elected county attorneys independent authority initiate criminal prosecutions present prosecutors future attorneys general might use law issue pursue physicians use procedures said lower courts used wrong legal standard assessing attorney general interpretation eighth circuit recognized duty give law construction avoid constitutional doubt nonetheless concluded attorney general interpretation twist law words giving meaning reasonably bear eighth circuit far alone rejecting narrowing interpretation since federal courts interpreted merits model statutory language nebraska law based found language potentially applicable abortion procedures regardless grant attorney general views substantial weight still reject interpretation conflicts statutory language statutory words substantial portion indicate statute include attorney general restriction child head nebraska legislature debates hurt attorney general argument help indicating small portion fetus foot constitute substantial portion even assuming distinction attorney general seeks draw overall abortion procedure separate procedure used kill unborn child help make distinction seeks language statute supports although adopting interpretation might avoid constitutional problem discussed lacks power narrowing construction reasonable readily apparent boos barry finally never held federal litigant must await construction development established practice bringing federal suit city lakewood plain dealer publishing authoritative construction lacking attorney general neither sought narrowing interpretation nebraska asked federal courts certify interpretive question cf arizonans official english arizona even inclined certify question certification appropriate statute fairly susceptible narrowing construction see houston hill case moreover nebraska grants certification certified question determinative cause see sum perform abortion procedures using method must fear prosecution conviction imprisonment nebraska law imposes undue burden upon woman right make abortion decision pp affirmed breyer delivered opinion stevens souter ginsburg joined stevens filed concurring opinion ginsburg joined filed concurring opinion ginsburg filed concurring opinion stevens joined rehnquist scalia filed dissenting opinions kennedy filed dissenting opinion rehnquist joined thomas filed dissenting opinion rehnquist scalia joined stenberg attorney general nebraska et petitioners leroy carhart writ certiorari appeals eighth circuit june justice breyer delivered opinion consider right abortion understand controversial nature problem millions americans believe life begins conception consequently abortion akin causing death innocent child recoil thought law permit millions fear law forbids abortion condemn many american women lives lack dignity depriving equal liberty leading least resources undergo illegal abortions attendant risks death suffering taking account virtually irreconcilable points view aware constitutional law must govern society whose different members sincerely hold directly opposing views considering matter light constitution guarantees fundamental individual liberty course generation determined redetermined constitution offers basic protection woman right choose roe wade planned parenthood southeastern casey shall revisit legal principles rather apply circumstances case three established principles determine issue us shall set forth language joint opinion casey first viability woman right choose terminate pregnancy joint opinion kennedy souter second law designed state interest fetal life imposes undue burden woman decision fetal viability unconstitutional undue burden shorthand conclusion state regulation purpose effect placing substantial obstacle path woman seeking abortion nonviable fetus ibid third subsequent viability state promoting interest potentiality human life may chooses regulate even proscribe abortion except necessary appropriate medical judgment preservation life health mother quoting roe wade supra apply principles nebraska law banning partial birth abortion statute reads follows partial birth abortion shall performed state unless procedure necessary save life mother whose life endangered physical disorder physical illness physical injury including physical condition caused arising pregnancy neb rev stat ann supp statute defines partial birth abortion abortion procedure person performing abortion partially delivers vaginally living unborn child killing unborn child completing delivery defines partially delivers vaginally living unborn child killing unborn child mean deliberately intentionally delivering vagina living unborn child substantial portion thereof purpose performing procedure person performing procedure knows kill unborn child kill unborn child ibid law classifies violation statute class iii felony carrying prison term years fine also provides automatic revocation doctor license practice medicine nebraska hold statute violates constitution leroy carhart nebraska physician performs abortions clinical setting brought lawsuit federal district seeking declaration nebraska statute violates federal constitution asking injunction forbidding enforcement trial merits sides presented several expert witnesses district held statute unconstitutional supp neb appeal eighth circuit affirmed cf hope clinic ryan en banc considering similar statute reaching different legal conclusion granted certiorari consider matter nebraska law seeks ban one method aborting pregnancy must describe discuss several different abortion procedures considering fact procedures seek terminate potential human life discussion may seem clinically cold callous perhaps horrifying others alternative way however acquaint reader technical distinctions among different abortion methods related factual matters upon outcome case depends reason drawing upon findings trial underlying testimony related medical texts shall describe relevant methods performing abortions technical detail evidence trial supported supplemented literature indicates following abortions performed take place first trimester pregnancy weeks gestational age centers disease control prevention abortion surveillance july hereinafter abortion surveillance first trimester predominant abortion method vacuum aspiration involves insertion vacuum tube cannula uterus evacuate contents abortion typically performed outpatient basis local anesthesia supp obstetrics normal problem pregnancies gabbe niebyl simpson eds ed vacuum aspiration considered particularly safe procedure mortality rates first trimester abortion example times lower associated carrying fetus term complication rates also low lawson et abortion mortality obstet gynecol paul et clinicians guide medical surgical abortion hereinafter medical surgical abortion fetus grows size however vacuum aspiration method becomes increasingly difficult use supp obstetrics normal problem pregnancies supra approximately abortions performed second trimester pregnancy weeks abortion surveillance early inducing labor injection saline uterus predominant method second trimester abortion planned parenthood central mo danforth today however medical profession switched medical induction labor surgical procedures second trimester abortions commonly used procedure called dilation evacuation procedure together modified form vacuum aspiration used early second trimester accounts abortions performed weeks gestational age abortion surveillance refers generically transcervical procedures performed weeks gestation later american medical association report board trustees abortion app hereinafter ama report ama report adopted district describes process follows weeks gestation ampe similar vacuum aspiration except cervix must dilated widely surgical instruments used remove larger pieces tissue osmotic dilators usually used intravenous fluids analgesic sedative may administered local anesthetic paracervical block may administered dilating agents used removed instruments inserted cervix uterus removal fetal placental tissue fetal tissue friable easily broken fetus may removed intact walls uterus scraped curette ensure tissue remains weeks fetus larger stage gestation particularly head bones rigid dismemberment destructive procedures likely required earlier gestational ages remove fetal placental tissue weeks physicians use intrafetal potassium chloride digoxin induce fetal demise prior late weeks facilitate evacuation variations operative strategy compare ibid hern abortion practice medical surgical abortion however common points involves dilation cervix removal least fetal tissue using nonvacuum instruments week potential need instrumental disarticulation dismemberment fetus collapse fetal parts facilitate evacuation uterus instrumental disarticulation incident necessary typically occurs doctor pulls portion fetus cervix birth canal carhart testified trial follows carhart dismemberment occurs traction instrument internal os cervix counsel dismemberment occurs pulled part fetus cervix correct carhart exactly using cervix two strictures two rings internal os external os actually dismembering counsel talked talked intention intact situation dismember fetus utero first remove portions carhart think know way one go intentionally dismember fetus uterus takes something restricts motion fetus going get dismemberment supp carhart specification location fetal disarticulation consistent sources see medical surgical abortion app nos testimony phillip stubblefield actually dismember fetus utero take pieces procedure carries certain risks use instruments within uterus creates danger accidental perforation damage neighboring organs sharp fetal bone fragments create similar dangers fetal tissue accidentally left behind cause infection various complications see supp gynecologic obstetric related surgery nichols eds ed cunningham et williams obstetrics ed nonetheless studies show risks mortality complication accompany procedure weeks gestation significantly lower accompanying induced labor procedures next safest midsecond trimester procedures see gynecologic obstetric related surgery supra ama report app medical surgical abortion lawson obstet trial carhart stubblefield described variation procedure referred intact see supp like versions technique begins induced dilation cervix procedure involves removing fetus uterus cervix intact one pass rather several passes ibid used weeks earliest vacuum aspiration becomes ineffective fetal skull becomes large pass cervix intact proceeds one two ways depending presentation fetus fetus presents head first vertex presentation doctor collapses skull doctor extracts entire fetus cervix fetus presents feet first breech presentation doctor pulls fetal body cervix collapses skull extracts fetus cervix ibid breech extraction version intact also known commonly dilation extraction late second trimester vertex breech sideways presentations occur roughly similar proportions medical surgical abortion supp intact procedure also found described certain obstetric abortion clinical textbooks two variations recognized first described calls physician adapt method extracting intact fetus depending fetal presentation see gynecologic obstetric related surgery supra medical surgical abortion method used carhart see supp slightly different version intact procedure associated martin haskell calls conversion breech presentation cases see gynecologic obstetric related surgery supra citing haskell dilation extraction late second trimester abortion cong rec american college obstetricians gynecologists describes procedure manner corresponding intact ampe including following steps deliberate dilatation cervix usually sequence days instrumental conversion fetus footling breech breech extraction body excepting head partial evacuation intracranial contents living fetus effect vaginal delivery dead otherwise intact fetus american college obstetricians gynecologists executive board statement intact dilation extraction hereinafter acog statement app despite technical differences described intact sufficiently similar us use terms interchangeably carhart testified attempts use intact procedure weeks reduces dangers sharp bone fragments passing cervix minimizes number instrument passes needed extraction lessens likelihood uterine perforations caused instruments reduces likelihood leaving fetal placental tissue uterus help prevent potentially fatal absorption fetal tissue maternal circulation see supp district made findings procedure overall safety district concluded however evidence clear convincing carhart procedure superior safer abortion procedures used relevant gestational period cases year present dr carhart materials presented trial referred potential benefits procedure circumstances involving nonviable fetuses fetuses abnormal fluid accumulation brain hydrocephaly see supp quoting ama report app intact may preferred physicians particularly fetus diagnosed hydrocephaly anomalies incompatible life outside see also grimes continuing need late abortions jama may especially useful presence fetal anomalies hydrocephalus reduction cranium allows smaller diameter pass cervix thus reducing risk cervical injury others emphasized potential women prior uterine scars women induction labor particularly dangerous see women medical professional voinovich supp sd ohio evans kelley supp ed reliable data number abortions performed annually estimates ranged per year compare henshaw abortion incidence services family planning perspectives joint hearing senate committee judiciary subcommittee constitution house committee judiciary ii question us whether nebraska statute making criminal performance partial birth abortion violates federal constitution interpreted planned parenthood southeastern casey roe wade conclude least two independent reasons first law lacks exception preservation health mother casey joint opinion kennedy souter second imposes undue burden woman ability choose abortion thereby unduly burdening right choose abortion shall discuss reasons turn casey joint opinion reiterated held roe subsequent viability state promoting interest potentiality human life may chooses regulate even proscribe abortion except necessary appropriate medical judgment preservation life health mother quoting roe supra emphasis added fact nebraska law applies postviability aggravates constitutional problem presented state interest regulating abortion previability considerably weaker postviability see casey supra since law requires health exception order validate even postviability abortion regulation minimum requires respect previability regulation see casey supra majority opinion assuming need health exception previability see also harris mcrae quoted standard also depends state regulations promoting state interest potentiality human life nebraska law course directly interest potentiality human life saving fetus question destruction regulates method performing abortion nebraska describes interests differently says law show concern life unborn prevent cruelty partially born children preserve integrity medical profession brief petitioners see differences make difference question hand namely application health requirement consequently governing standard requires exception necessary appropriate medical judgment preservation life health mother casey supra made clear state may promote endanger woman health regulates methods abortion thornburgh american college obstetricians gynecologists colautti franklin danforth justice thomas says cases cited limit principle situations pregnancy creates threat health see post wrong cited cases reaffirmed casey recognize state subject women health significant risks context also state regulations force women use riskier methods abortion cases repeatedly invalidated statutes process regulating methods abortion imposed significant health risks make clear risk women health whether happens arise regulating particular method abortion barring abortion entirely holding go beyond cases ratified casey nebraska responds law require health exception unless need exception need says argues safe alternatives remain available ban create risk health women brief petitioners problem nebraska parties strongly contested factual question trial findings evidence support carhart state fails demonstrate banning without health exception may create significant health risks women record shows significant medical authority supports proposition circumstances safest procedure shall reiterate summary form relevant findings evidence basis medical testimony district concluded carhart procedure safer tha abortion procedures used relevant gestational period cases year present dr carhart supp found procedure permits fetus pass cervix minimum instrumentation ibid thereby reduces operating time blood loss risk infection reduces complications bony fragments reduces damage uterus cervix prevents common causes maternal mortality dic amniotic fluid embolus eliminates possibility horrible complications arising retained fetal parts ibid district also noted select panel american college obstetricians gynecologists concluded may best appropriate procedure particular circumstance save life preserve health woman quoting acog statement app see important qualification infra one exception federal trial courts heard expert evidence matter reached similar factual conclusions see rhode island medical soc whitehouse supp ri choice women butterworth supp sd fla causeway medical suite foster supp ed la richmond medical center women gilmore supp ed hope clinic ryan supp nd vacated cert pending voinovich supp kelley supp see planned parenthood doyle supp wd vacated nebraska along supporting amici replies findings irrelevant wrong applicable tiny number instances says procedure handful doctors brief petitioners argues labor induction times safe alternative procedures refers testimony petitioners medical expert testified ban increase woman risk several rare abortion complications disseminated intravascular coagulopathy amniotic fluid embolus app association american physicians surgeons et amici supporting nebraska argue elements procedure may create special risks including cervical incompetence caused overdilitation injury caused conversion fetal presentation dangers arising blind use instrumentation pierce fetal skull lodged birth canal see brief association american physicians surgeons et al amici curiae see also sprang neerhof rationale banning abortions late pregnancy jama nebraska emphasizes medical studies establishing safety procedure brief petitioners medical studies comparing safety abortion procedures ibid points american medical association policy statement appear identified situation intact appropriate procedure induce abortion late term pregnancy termination techniques ama policy points american college obstetricians gynecologists qualified statement may best appropriate procedure adding panel identify circumstances procedure option save life preserve health woman app find eight arguments insufficient demonstrate nebraska law needs health exception one thing certain arguments beside point procedure relative rarity argument highly relevant infrequently used abortion procedure health exception question whether protecting women health requires exception infrequent occasions rarely used treatment might necessary treat rarely occurring disease strike anyone state prohibit person obtaining treatment simply pointing people need know whether fact handful doctors use procedure argument reflects comparative rarity late second term abortions procedure recent development gynecologic obstetric related surgery controversy surrounding nebraska suggests procedure lack utility another thing record responds nebraska amici medically based arguments respect argument example district agreed alternatives induced labor safe found method significantly safer certain circumstances supp respect argument district simply relied different expert testimony testimony stating nother advantage intact eliminates risk embolism cerebral tissue woman blood stream quoting hearing senate committee judiciary statement hern response amici argument american college obstetricians gynecologists amici brief denies generally poses risks greater alternatives says suggested alternative procedures involve similar greater risks cervical uterine injury procedures involve similar amounts dilitation course childbirth involves even greater cervical dilitation brief american college obstetricians gynecologists et al amici curiae college points carhart reposition fetus thereby avoiding risks stemming conversion breech presentation compared involves greater blind use sharp instruments uterine cavity quarrel nebraska argument nebraska right general medical studies documenting comparative safety neither deny import american medical association statement argument even though state omit remainder statement ama recommends procedure used unless alternative procedures pose materially greater risk woman late term pregnancy termination techniques ama policy emphasis added however read american college obstetricians gynecologists panel qualification identify circumstance option according nebraska argument denied potential need college writes following amici brief depending physician skill experience procedure appropriate abortion procedure women circumstances presents variety potential safety advantages abortion procedures used gestational period compared involving dismemberment involves less risk uterine perforation cervical laceration requires physician make fewer passes uterus sharp instruments reduces presence sharp fetal bone fragments injure uterus cervix also considerable evidence reduces risk retained fetal tissue serious abortion complication cause maternal death reduces incidence free floating fetal head difficult physician grasp remove thus cause maternal injury procedures usually take less time abortion methods used comparable stage pregnancy also health advantages shorter procedure less blood loss trauma exposure anesthesia intuitive safety advantages intact supported clinical experience especially women particular health conditions medical evidence may safer available alternatives brief american college obstetricians gynecologists et al amici curiae citation footnotes omitted upshot district finding significantly obviates health risks certain circumstances highly plausible explanation might division opinion among medical experts whether generally safer absence controlled medical studies help answer medical questions given medically related evidentiary circumstances believe law requires health exception word necessary casey phrase necessary appropriate medical judgment preservation life health mother internal quotation marks omitted 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 appropriate medical judgment must embody judicial need tolerate responsible differences medical opinion differences sort american medical association american college obstetricians gynecologists statements together indicate present another thing division medical opinion matter means uncertainty factor signals presence risk absence division involves highly qualified knowledgeable experts sides issue significant body medical opinion believes procedure may bring greater safety patients explains medical reasons supporting view say presence different view proves contrary rather uncertainty means significant likelihood believe safer abortion method certain circumstances may turn right absence health exception place women unnecessary risk tragic health consequences wrong exception simply turn unnecessary sum nebraska convinced us health exception never necessary preserve health women reply brief petitioners rather statute altogether forbids creates significant health risk statute consequently must contain health exception say justice thomas justice kennedy claim state prohibited proscribing abortion procedure whenever particular physician deems procedure preferable means must state grant physicians unfettered discretion selection abortion methods post kennedy dissenting substantial medical authority supports proposition banning particular abortion procedure endanger women health casey requires statute include health exception procedure necessary appropriate medical judgment preservation life health mother requiring exception case departure casey simply straightforward application holding eighth circuit found nebraska statute unconstitutional casey words effect placing substantial obstacle path woman seeking abortion nonviable fetus thereby places undue burden upon woman right terminate pregnancy viability ibid nebraska deny statute imposes undue burden applies commonly used procedure well agree eighth circuit apply earlier discussion procedure supra shows falls within statutory prohibition statute forbids deliberately intentionally delivering vagina living unborn child substantial portion thereof purpose performing procedure person performing procedure knows kill unborn child neb rev stat ann supp understand one distinguish using language foot arm drawn cervix body head drawn cervix evidence trial makes clear often involve physician pulling substantial portion still living fetus say arm leg vagina prior death fetus supp indeed involves dismemberment commonly occurs fetus meets resistance restricts motion fetus dismemberment occurs traction instrument internal os cervix events often occur portion living fetus pulled vagina see also medical surgical abortion trimester separation fetal corpus may occur fetus drawn lower uterine segment compression traction endocervix facilitates disarticulation even statute basic aim ban language makes clear also covers much broader category procedures language track medical differences though simple matter example provide exception performance abortion procedures stat ann supp statute anywhere suggest application turns whether portion fetus body drawn vagina part process extract intact fetus collapsing head opposed process dismember fetus thus dissenters argument law generally intended bar correct irrelevant relevant question whether legislature wanted ban whether law intended apply plain language covers procedures rereading pages opinion well justice thomas dissent pages make clear find difference terms statute procedure described procedure might performed particular compare post thomas dissenting post thomas dissenting procedures involve introduction substantial portion still living fetus cervix vagina feature abortion leads justice thomas characterize procedure involving partial birth nebraska state attorney general argues statute differentiate two procedures says statutory words substantial portion mean child head consequently denies statute application physician introduces birth canal fetal arm leg anything less entire fetal body brief petitioners argues must defer views meaning state statute accept attorney general narrowing interpretation nebraska statute case law makes clear give attorney general interpretative views controlling weight one thing normally follows lower interpretations state law mcmillian monroe county brockett spokane arcades rarely reviews construction state law agreed upon two lower federal courts virginia american booksellers case two lower courts rejected attorney general narrowing interpretation another precedent warns accepting authoritative attorney general interpretation state law attorney general bind state courts local law enforcement authorities nebraska law attorney general interpretative views bind state courts state coffman neb attorney general issued opinions entitled substantial weight respectfully considered controlling authority apparently bind elected county attorneys nebraska gives independent authority initiate criminal prosecutions neb rev stat ann supp cf crandon scalia concurring judgment never thought interpretation charged prosecuting criminal statutes entitled deference say lower courts used wrong legal standard assessing attorney general interpretation eighth circuit recognized duty give law construction avoid constitutional doubts nonetheless concluded attorney general interpretation twist words law give meaning reasonably bear ibid eighth circuit far alone rejecting narrowing interpretation language question based model statutory language though omit definition partial birth abortion lower federal courts considered merits courts including eighth circuit found language potentially applicable abortion procedures see planned parenthood greater iowa miller little rock family planning services jegley hope clinic imposing precautionary injunction prevent application beyond posner dissenting rhode island medical supp richmond medical center women supp choice women supp causeway medical suite supp planned parenthood central verniero supp nj eubanks stengel supp wd planned parenthood southern arizona woods supp kelley supp cf richmond medical center gilmore luttig granting stay regardless even grant attorney general views substantial weight still reject interpretation conflicts statutory language discussed page attorney general echoed dissents tries overcome language relying language statute particular words partial birth abortion term ordinarily associated procedure words partially delivers vaginally living unborn child neb rev stat ann words help attorney general subject statute explicit statutory definition specifying terms include delivering vagina living unborn child substantial portion thereof ibid statute includes explicit definition must follow definition even varies term ordinary meaning meese keene axiomatic statutory definition term excludes unstated meanings term colautti franklin fox standard oil cardozo see also singer sutherland statutes statutory construction ed collecting cases say statute read whole post thomas dissenting leads reader definition definition include attorney general restriction child head words substantial portion indicate contrary attorney general also points nebraska legislature debates term partial birth abortion appeared frequently debates hurt argument help nebraska legislators focused directly upon meaning word substantial one senator asked bill sponsor ou said small portion fetus foot constitute substantial portion opinion correct sponsoring senator replied yes believe correct app see also senator explaining substantial indicate little bit delivered vagina nough allow procedure end killing unborn child rejecting amendment limit law legislature seems wanted avoid limiting language lest become easy evade statute strictures motive justice thomas well explains post goal however exacerbates problem attorney general echoed dissents argues statute distinguishes overall abortion procedure separate procedure used kill unborn child brief petitioners post opinion thomas opinion kennedy even assuming distinction help attorney general make distinction seeks however find language statute supports wants us read procedure statute last sentence mean separate procedure killing fetus opposed whole procedure abortion critical word separate missing word procedure subsection throughout statute used refer entire abortion procedure neb rev stat ann supp cf gustafson alloyd dentical words used different parts act intended meaning internal quotation marks omitted dissenters add statutory words partially delivers read exclude post opinion thomas opinion kennedy say introduction say limb limbs vagina involve delivery obstetric textbooks even dictionaries routinely use term describe facilitated removal tissue uterus removal intact fetus obstetrics normal problem pregnancies describing delivery fetal membranes placenta umbilical cord third stage labor maloy medical dictionary lawyers ed also removal fetal part placenta oxford english dictionary ed deliver means inter alia disburden women foetus webster third new international dictionary elivery means expulsion extraction fetus membranes event statute specifies applies delivering intact unborn child substantial portion thereof dissents explain introduction substantial portion fetus vagina pursuant delivery introduction pursuant aware adopting attorney general interpretation might avoid constitutional problem discussed section without power adopt narrowing construction state statute unless construction reasonable readily apparent boos barry gooding wilson reasons stated reasonable replace term substantial portion attorney general phrase body head see statute must genuinely susceptible two interpretations finally law require us certify state law question nebraska course lack authoritative construction never held federal litigant must await construction development established practice bringing federal suit city lakewood plain dealer publishing attorney general seek narrowing interpretation nebraska ask federal courts certify interpretive question see brief state appellants nos cf arizonans official english arizona even inclined certify question certification question abstention appropriate statute fairly susceptible narrowing construction see houston hill believe moreover nebraska grants certification certified question determinative cause neb rev stat see also houston hill supra manifestly inappropriate certify question case uncertain question state law whose resolution might affect pending federal claim determinative light discussion part sum using law present prosecutors future attorneys general may choose pursue physicians use procedures commonly used method performing previability second trimester abortions perform abortion procedures using method must fear prosecution conviction imprisonment result undue burden upon woman right make abortion decision must consequently find statute unconstitutional judgment appeals affirmed stenberg attorney general nebraska et petitioners leroy carhart writ certiorari appeals eighth circuit june justice stevens justice ginsburg joins concurring although much ink spilled today describing gruesome nature abortion procedures rhetoric provide reason believe procedure nebraska claims seeks ban brutal gruesome less respectful potential life equally gruesome procedure nebraska claims still allows justice ginsburg judge posner believe correctly diagnosed underlying reason enactment legislation reason also explains much rhetoric directed objective extends well beyond narrow issue case presents rhetoric almost quite loud enough obscure quiet fact past years central holding roe wade endorsed justices addressed issue holding word liberty fourteenth amendment includes woman right make difficult extremely personal decision makes impossible understand state legitimate interest requiring doctor follow procedure one reasonably believes best protect woman exercise constitutional liberty one need even approach view today conclude nebraska law must fall notion either two equally gruesome procedures performed late stage gestation akin infanticide state furthers legitimate interest banning one simply irrational see amdt stenberg attorney general nebraska et petitioners leroy carhart writ certiorari appeals eighth circuit june justice concurring issue abortion one contentious controversial contemporary american society presents extraordinarily difficult questions recognizes involve virtually irreconcilable points view ante specific question face today whether nebraska attempt proscribe particular method abortion commonly known abortion constitutional reasons stated opinion agree nebraska statute reconciled decision planned parenthood southeastern casey therefore unconstitutional write separately emphasize following points first nebraska statute inconsistent casey lacks exception instances banned procedure necessary preserve health mother see joint opinion kennedy souter importantly nebraska statutory scheme underscores constitutional infirmity held casey prior viability woman right choose terminate pregnancy fetus become viable may substantially regulate even proscribe abortion regulation proscription must contain exception instances necessary appropriate medical judgment preservation life health mother quoting roe wade nebraska recognized constitutional limitation separate statute generally proscribing postviability abortions see neb rev stat ann supp statute provides abortion shall performed time sound medical judgment attending physician unborn child clearly appears reached viability except necessary preserve life health mother ibid emphasis added even postviability proscription abortion invalid absent health exception nebraska ban previability abortions circumstances presented must include health exception well since state interest regulating abortions viability considerably weaker viability ante statute issue however excepts procedures necessary save life mother whose life endangered physical disorder physical illness physical injury neb rev stat ann supp lack health exception necessarily renders statute unconstitutional contrary assertions justice kennedy justice thomas need health exception arise individual views carhart supporters post kennedy dissenting see also post thomas dissenting rather majority explains significant body medical opinion believes procedure may bring greater safety patients explains medical reasons supporting view ante nebraska say procedure circumstances necessary preserve life health mother accordingly precedent requires statute include health exception second nebraska statute unconstitutional alternative independent ground imposes undue burden woman right choose terminate pregnancy viability nebraska ban covers dilation extraction procedure also dilation evacuation procedure commonly used method performing previability second trimester abortions ante statute defines banned procedure deliberately intentionally delivering vagina living unborn child substantial portion thereof purpose performing procedure person performing procedure knows kill unborn child kill unborn child neb rev stat ann supp emphasis added explains medical evidence establishes procedure included definition thus possible interpret statute language applying procedure moreover significant district appeals interpreted statute prohibiting abortions performed using method well method see supp neb stated several occasions ordinarily defer construction state statute given lower federal courts unless construction amounts plain error see bishop wood accepted interpretation state law district appeals concurred even examination issue without guidance might justified different conclusion tungus skovgaard deference unique abortion context applies generally state statutes addressing areas law see unum life ins america ward rule state insurance law brockett spokane arcades moral nuisance law runyon mccrary statute limitations personal injury actions bishop wood supra city employment ordinance given construction statute impermissible indeed nebraska conceded oral argument state prohibit procedure tr oral arg proscribing commonly used method previability second trimester abortions see ante statute creates substantial obstacle woman seeking abortion casey supra therefore imposes undue burden woman right terminate pregnancy prior viability important note unlike nebraska enacted statutes narrowly tailored proscribing procedure alone statutes done specifically excluding coverage common methods abortion vacuum aspiration procedures example kansas statute ban apply uction curettage abortion procedure suction aspiration abortion procedure dilation evacuation abortion procedure involving dismemberment fetus prior removal body pregnant woman kan stat ann supp utah statute similarly provides prohibition include dilation evacuation procedure involving dismemberment prior removal suction curettage procedure suction aspiration procedure abortion utah code ann likewise montana statute defines banned procedure one living fetus removed intact uterus head remains uterus part intracranial contents fetus evacuated head fetus compressed following fetal demise fetus removed birth canal mont code ann ii supp restricting prohibitions procedure exclusively kansas utah montana statutes avoid principal defect nebraska law nebraska statute limited application procedure included exception life health mother question presented quite different one face today held casey abortion regulation constitutes undue burden purpose effect placing substantial obstacle path woman seeking abortion nonviable fetus adequate alternative methods woman safely obtain abortion viability unlikely prohibiting procedure alone amount practical terms substantial obstacle woman seeking abortion thus ban abortion proscribed method abortion included exception preserve life health mother constitutional view nebraska statute however meet criteria contains exception procedure appropriate medical judgment necessary preserve health mother proscribes procedure also procedure commonly used method previability second trimester abortions thus making undue burden woman right terminate pregnancy reasons agree nebraska law unconstitutional stenberg attorney general nebraska et petitioners leroy carhart writ certiorari appeals eighth circuit june justice ginsburg justice stevens joins concurring write separately stress amidst emotional uproar caused abortion case lose sight character nebraska partial birth abortion law observes law save fetus destruction targets method performing abortion ante statute seek protect lives health pregnant women moreover justice stevens points ante concurring opinion common method performing previability second trimester abortions less distressing susceptible gruesome description seventh circuit chief judge posner correspondingly observed regarding similar bans wisconsin illinois law prohibits procedure procedure kills fetus risks worse complications woman alternative procedures crueler painful disgusting method terminating pregnancy hope clinic ryan dissenting opinion rather chief judge posner commented law prohibits procedure state legislators seek chip away private choice shielded roe wade even modified casey state regulation purpose effect placing substantial obstacle path woman seeking abortion nonviable fetus violates constitution planned parenthood southeastern casey joint opinion kennedy souter obstacle exists state stops woman choosing procedure doctor reasonably believes best protect woman exercise constitutional liberty ante stevens concurring see casey means chosen state interest potential life must calculated inform woman free choice hinder stated chief judge posner statute burdens constitutional rights said behalf vehicle legislators chosen expressing hostility rights burden undue hope clinic stenberg attorney general nebraska et petitioners leroy carhart writ certiorari appeals eighth circuit june chief justice rehnquist dissenting join joint opinion planned parenthood southeastern casey continue believe case wrongly decided despite disagreement opinion rule laid marks casey joint opinion represents holding case believe justice kennedy justice thomas correctly applied casey principles join dissenting opinions stenberg attorney general nebraska et petitioners leroy carhart writ certiorari appeals eighth circuit june justice scalia dissenting optimistic enough believe one day stenberg carhart assigned rightful place history jurisprudence beside korematsu dred scott method killing human child one even accurately say entirely unborn human child proscribed statute horrible clinical description evokes shudder revulsion must know state legislatures banning procedure concluded demanding health exception requires abortionist assure expert medical judgment method case hand marginally safer others one prove contrary beyond reasonable doubt give abortion free rein notion constitution designed among things establish justice insure domestic tranquility secure blessings liberty posterity prohibits simply banning visibly brutal means eliminating posterity quite simply absurd even intended write separately focus separate writings including one joined gave cause fear case might taken stand error different one actually exemplifies practice publishing dissents order seniority authors writing appear reports others reader comprehend follows unless reads first two lengthy dissents case appropriately enough set establish today result follow recent pronouncement matter abortion planned parenthood southeastern casey unfortunate however disagree result induced regard merely regrettable misapplication casey casey logical entirely predictable consequence sure construction statute make include procedures abortion involves disregard fair meaning abandonment principle even ambiguous statutes interpreted fashion render valid rather void casey permit jurisprudential novelty must chalked inclination bend rules effort limit abortion even speak opposition abortion issue piece words hill colorado ante also decided today gives second independent reason invalidating humane say law fails allow exception situation abortionist believes method destroying child might safer woman pointed justice thomas elaborated upon justice kennedy good reason believe ever case knows sometime might joined justice thomas dissent agree today decision unprecedented expansio prior cases post mandated casey undue burden test post even called though pushes limit belief obviously irreconcilable casey explication standard requires post never put much stock casey explication inexplicable last analysis judgment casey support today tragic result traced fact consider undue burden different majority considers undue burden conclusion demonstrated true false factual inquiry legal reasoning value judgment dependent upon much one respects believes society respect life partially delivered fetus much one respects believes society respect freedom woman gave life kill evidently five justices today majority value former less latter four us dissent case closed cause anyone believes casey feel betrayed outcome arrived precisely process casey promised democratic vote nine lawyers question whether text constitution anything say subject obviously even question also appropriate lawyers whether legal traditions american people sustained limitation upon abortion obviously upon pure policy question whether limitation upon abortion undue goes far dissent casey wrote undue burden test made law joint opinion created standard doubtful application unprincipled origin casey hopelessly unworkable practice ultimately standardless today decision proof long debating issue necessity exception basis casey really quite impossible us dissenters contend majority wrong law said one wrong law support oppose death penalty support oppose mandatory minimum sentences honestly say disagree majority believe vote policy matter unelected lawyers overcome judgment state legislatures problem application casey existence casey must overruled mood must recall bemusement casey joint opinion expressed belief roe wade call ed contending sides national controversy end national division accepting common mandate rooted constitution casey decision casey ratify happy truce seemed quite contrary roe fanned life issue inflamed national politics general obscured smoke selection justices particular ever since keeping us business perpetuation disruption rather pax roeana new majority decrees today decision constitution prevents prohibition horrible mode abortion greeted firestorm criticism well understand acknowledge opening words justice concurrence issue abortion one contentious controversial contemporary american society ante persist belief armed neither constitutional text accepted tradition resolve contention controversy rather consumed sake preservation return matter people constitution silence subject left let decide state state whether practice allowed casey must overruled stenberg attorney general nebraska et petitioners leroy carhart writ certiorari appeals eighth circuit june justice kennedy chief justice joins dissenting close two decades roe wade gave slight weight interests separate legislatures sought address persisting concerns raised existence woman right elect abortion defined circumstances reaffirmed essential holding roe central premise retain critical legitimate role legislating subject abortion limited woman right restated guaranteed planned parenthood southeastern casey political processes state foreclosed enacting laws promote life unborn ensure respect human life potential joint opinion kennedy souter state constitutional authority vital means citizens address grave serious issues must progress knowledge understanding attainment degree consensus decision today submission repudiates understanding invalidating statute advancing critical state interests even though law denies woman right choose abortion places undue burden upon right legislation well within state competence enact concluded nebraska law survives scrutiny dictated proper understanding casey dissent judgment invalidating failure accord weight nebraska interest prohibiting abortion erroneous undermines discussion holding approach regard revealed description abortion methods issue correct describe clinically cold callous ante majority views procedures perspective abortionist rather perspective society shocked confronted new method ending human life words invoked majority transcervical procedures smotic dilators instrumental disarticulation paracervical block may accurate extent necessary ante citizens seek know laws subject enacted across nation words insufficient repeated references sources understandable trained physician may obscure matters persons trained medical terminology thus seems necessary outset set forth may happen abortion person challenging nebraska law leroy carhart physician received medical degree hahnemann hospital university app carhart performs procedures clinic nebraska also travel ohio perform abortions carhart specialty certifications field related childbirth abortion lacks admitting privileges hospital performs abortions throughout pregnancy including unsure whether fetus viable contrast physicians provided expert testimony case board certified instructors leading medical education institutions members american board obstetricians gynecologists carhart performs abortion procedure nebraska seeks ban also performs method abortion issue case described carhart procedure requires abortionist use instruments grasp portion foot hand developed living fetus drag grasped portion uterus vagina carhart uses traction created opening uterus vagina dismember fetus tearing grasped portion away remainder body ibid traction uterus vagina essential procedure attempting abort fetus without using traction described carhart pulling cat tail drag ging string across floor keep dragging something grabs end going develop traction fetus many cases dies human adult child bleeds death torn limb limb fetus alive beginning dismemberment process survive time limbs torn carhart agreed hen pull piece fetus let say arm leg remove time prior removal portion fetus fetus alive carhart observed fetal heartbeat via ultrasound extensive parts fetus removed testified mere dismemberment limb always cause death knows physician removed arm fetus fetus go born living child one arm conclusion abortion intact fetus remains carhart words abortionist left tray full pieces procedure implicated today called abortion ampx used general matter weeks gestation fetus become developed may survive intact partial delivery uterus vagina abortionist initiates woman natural delivery process causing cervix woman dilated sometimes sequence days fetus arms legs delivered outside uterus fetus alive witnesses procedure report seeing body fetus moving outside woman body brief petitioners point abortion procedure appearance live birth stated one group physicians physician manually performs breech extraction body live fetus excepting head continues apparent role obstetrician delivering child brief association american physicians surgeons et al amici curiae head fetus remaining utero abortionist tears open skull according martin haskell leading proponent procedure appropriate instrument used stage abortion pair scissors haskell dilation extraction late second trimester abortion cong rec witnesses report observing portion fetus outside woman react skull penetration brief petitioners abortionist inserts suction tube vacuums developing brain matter found within skull process making size fetus head smaller given clinically neutral term reduction procedure supp neb brain death occur skull invasion according carhart heart fetus may continue beat minutes contents skull vacuumed app abortionist next completes delivery dead fetus intact except damage head missing contents skull two described procedures nebraska seeks ban light description procedure go without saying nebraska ban abortion furthers purposes entitled pursue carhart nevertheless maintains state legitimate interest forbidding interprets controlling cases two interests state may advance regulation abortion health woman considering procedure life fetus carries brief respondent read opinion accedes views misunderstanding casey authorities confirmed casey held cases decided wake roe wade given state interests little acknowledgment implementation joint opinion kennedy souter decision turned aside contention person right decide whether abortion without interference state rejected strict scrutiny standard review incompatible recognition substantial state interest potential life throughout pregnancy notion state substantial interest potential life leads conclusion regulations must deemed unwarranted ibid held inappropriate judicial branch provide exhaustive list state interests implicated abortion casey premised important constitutional role defining interests abortion debate principle mind nebraska interests given proper weight state brief describes interests including concern life unborn preserving integrity medical profession erecting barrier infanticide brief petitioners review casey demonstrates legitimacy policies say may take sides abortion debate come side life even life unborn even earliest stages pregnancy state may enact rules regulations designed encourage woman know philosophic social arguments great weight brought bear favor continuing pregnancy full term procedures institutions allow adoption unwanted children well certain degree state assistance mother chooses raise child joint opinion kennedy souter also interest forbidding medical procedures state reasonable determination might cause medical profession society whole become insensitive even disdainful life including life human fetus abortion casey held consequences beyond woman fetus interests regulating concomitant extension casey recognized abortion fraught consequences persons perform assist procedure society must confront knowledge procedures exist procedures deem nothing short act violence innocent human life state may take measures ensure medical profession members viewed healers sustained compassionate rigorous ethic cognizant dignity value human life even life survive without assistance others ibid washington glucksberg casey demonstrates interests asserted state legitimate recognized law argued however ban interests reasoning continues method nebraska claims beyond intent regulate still used abort fetus less dehumanizing method adopting argument express terms indicates tacit approval refusing reject forthright manner rendering express implicit majority opinion justice stevens justice ginsburg forthright declaring two procedures indistinguishable nebraska acted irrationally without proper purpose enacting law issue whether members judiciary see difference two procedures whether nebraska refusal recognize nebraska right declare moral difference procedure dispiriting disclosure illogic illegitimacy approach entire case nebraska entitled find existence consequential moral difference procedures referred substantial medical authority perverts natural birth process greater degree commandeering live birth process skull pierced american medical association ama publications describe abortion method ethically wrong ama board trustees factsheet hr june app brief association american physicians surgeons et al amici curiae ama factsheet differs fetus killed outside womb fetus autonomy separates right woman choose treatments body ibid see also app brief association american physicians surgeons et al amici curiae intact aberrant troubling technique confuses disparate role physician childbirth abortion way blur medical legal ethical line infanticide abortion witnesses procedure relate fingers feet fetus moving prior piercing skull scissors inserted back head fetus body wholly outside woman body alive reacts though startled goes limp ampx stronger resemblance infanticide means nebraska conclude procedure presents greater risk disrespect life consequent greater risk profession society depend sustenance upon reciprocal recognition dignity respect without authority conclusion oppose abortion agree indeed insist procedures subject severe moral condemnation condemnation reserved repulsive human conduct inconsistent however proposition ethical moral matter distinct ampe serious concern medical ethics morality larger society medical profession must serve nebraska must obey legal regime declared right woman abortion viability yet retains power adopt regulations impose undue burden woman right regulation nebraska instructs participants abortion process including mother moral judgment life including life unborn respected participants nebraska determined indifferent procedure used must refrain using natural delivery process kill fetus differentiation procedures moral statement serving promote respect human life woman physician contemplating moral consequences prohibited procedure conclude grave moral consequences pertain permitted abortion process well choice elect elect abortion informed policy promoting respect life advanced institutional position constitutional sources seeks invoke refuse issue forthright affirmation nebraska right declare critical moral differences exist two procedures natural birth process appropriated yet refuses hear state voice defining interests law holding contradicts casey assurance state constitutional position realm promoting respect life marginal ii demonstrating basic misunderstanding casey holds ban procedure fails include exception permitting abortionist perform whenever believes best preserve health woman casting aside views distinguished physicians statements leading medical organizations awards physician veto power state judgment procedures performed carhart made medical judgment use procedure every case regardless indications weeks gestation supp requiring nebraska defer carhart judgment different forbidding nebraska enacting ban leroy carhart sets abortion policy state nebraska legislature people casey give precedence views single physician group physicians regarding relative safety particular procedure full agreement justice thomas appropriate casey inquiry whether state preventing abortionist something medical judgment believes appropriate course treatment post casey addressed question whether state resolve philosophic questions abortion definitive way woman lacks choice matter decided issue state holding woman deprived opportunity make reproductive decisions casey made quite evident however state substantial concerns childbirth life unborn may enact laws real sense depriv women ultimate decision joint opinion kennedy souter laws purpose effect placing substantial obstacle path woman seeking abortion nonviable fetus prohibited nebraska law purpose effect holding casey allowing woman elect abortion defined circumstances question nebraska however entitled conclude ban advancing important interests regarding sanctity life deprived woman safe abortion therefore impose substantial obstacle rights woman american college obstetricians gynecologists acog identify circumstances option save life preserve health woman app american medical association agrees stating ama expert panel included acog representative find identified circumstance appropriate alternative ama factsheet conclusion safest method requires replace words may word following sentence acog position statement intact however may best appropriate procedure particular circumstance app studies support contention abortion method safer abortion methods brief respondent leading proponents procedure acknowledge disadvantages versus methods requires high degree surgical skill pierce skull sharp instrument blind procedure haskell cong rec doctors point complications may arise brief american physicians surgeons et al amici curiae app leading physician frank boehm performed supervised abortions director fetal intensive care unit medicine division vanderbilt university hospital refused support use medical need procedure exists ethical concerns boehm fellow acog supports abortion rights provided sworn testimony opposition previous state attempts regulate abortion conclude part standard medical practice telling expert called carhart expert testifying favor procedure fact performed abortion medical practice testimony phillip stubblefield respect opinions courtroom conversions uncertain reliability litigation jurisdictions establishes physicians adopt procedure part standard medical practice richmond medical center women gilmore hope clinic ryan see also app quite wrong conclude seems done carhart conforms practice proper standard care incorporated procedure practice neither boehm carhart lead expert stubblefield chairman department obstetrics gynecology boston university school medicine director obstetrics gynecology boston medical center done substantial evidence supports nebraska conclusion law denies woman safe abortion said may present unquantified lower risk complication particular patient proven safe procedures remain available even patient circumstances wrong limit inquiry relative physical safety two procedures slightest potential difference requiring invalidation law justice explained earlier case state may regulate based matters beyond various medical organizations say physical safety particular procedure akron akron center reproductive health dissenting opinion difference physical safety best marginal state may take account grave moral issues presented new abortion method see casey requiring regulation impose significant threat life health woman application impose undue burden internal quotation marks omitted carhart decide use based conclusion best particular woman unsubstantiated generalized health differences best marginal amount substantial obstacle abortion right joint opinion kennedy souter also important recognize effective fetus close viable fact viable thus state regulating process point interest life nearing peak courts evaluate relative worth particular surgical procedures legislatures several superior factfinding capabilities regard earlier case justice explained general rule extends abortion cases writing suited nation ex officio medical board powers approve disapprove medical operative practices standards throughout dissenting opinion internal quotation marks omitted irrespective difficulty task legislatures superior factfinding capabilities certainly better able make necessary judgments courts nebraska judgment must stand deferring physician judgment turns back cases decided wake roe cases gave physician treatment decisions controlling weight repudiated casey approach deferring physicians reached apex akron supra held informed consent requirement unconstitutional law challenged akron required abortionist inform woman status pregnancy development fetus date possible viability physical emotional complications may result abortion availability agencies provide assistance information physician also required advise woman risks associated abortion technique employed information ibid law invalidated based physician right practice medicine way saw fit according akron remains primarily responsibility physician ensure appropriate information conveyed patient depending particular circumstances dispositive law intrusion upon discretion pregnant woman physician physician placed undesired uncomfortable straitjacket ibid internal quotation marks omitted decision today echoes akron deference physician right practice medicine way sees fit course wish cite akron yet holding indistinguishable reasoning akron casey repudiated doubt exists today holding based view finds primary support case rather exalting right physician practice medicine unfettered discretion casey recognized whatever constitutional status relation may general matter present context derivative woman position joint opinion kennedy souter casey discussed informed consent requirement struck akron held akron wrong relation entitled solicitude receives contexts standard medical practice depend individual views carhart supporters question whether substantial objective medical evidence demonstrate state considerable support conclusion ban created substantial risk woman health casey recognized point holding physician ability practice medicine subject reasonable regulation state receive solicitude receives contexts joint opinion kennedy souter contexts state entitled make judgments high medical authority disagreement fails acknowledge substantial authority allowing state take sides medical debate even fundamental liberty interests stake even leading members profession disagree conclusions drawn legislature kansas hendricks held disagreements among medical professionals tie state hands setting bounds laws fact precisely disagreement exists legislatures afforded widest latitude instead courts must exercise caution rather require deference physician treatment decision medical uncertainty present ibid hen legislature undertakes act areas fraught medical scientific uncertainties legislative options must especially broad courts cautious rewrite quoting jones see also collins texas holmes declaring right state adopt policy even upon medical matters concerning difference opinion dispute lambert yellowley rejecting claim distinguished physician igh medical authority conflict indeed strange congress lacked power act marshall recognizing agreement among members medical profession internal quotation marks omitted rutherford discussing regulatory approval process certain drugs instructive jacobson massachusetts defendant convicted refused undergo smallpox vaccination defendant claimed mandatory vaccination violated liberty care body health way seems best offered prove members medical profession took position vaccination value fact harmful rejected claim establishing beyond doubt right legislature resolve matters upon physicians disagreed offers proof defendant main seem purpose except state general theory medical profession attach little value vaccination means preventing spread smallpox think vaccination causes diseases body everybody knows must know therefore state judicially knew knows opposite theory accords common belief maintained high medical authority must assume statute question passed legislature massachusetts unaware opposing theories compelled necessity choose compelled commit matter involving public health safety final decision jury part function jury determine one two modes likely effective protection public disease legislative department determine light information obtain properly abdicate function guard public health safety ibid jacobson quoted approval recent decision observed words full application today fact belief universal medical community controlling scarcely belief accepted everyone possibility belief may wrong science may yet show wrong conclusive legislature right pass laws according common belief people adapted address medical matters free country government people chosen representatives practical legislation admits standard action quoting viemester white justice assures people nebraska free redraft law include exception permitting performed procedure appropriate medical judgment necessary preserve health mother ante assurance meaningless joined opinion accepts carhart exercises appropriate medical judgment using every patient every procedure regardless indications weeks gestation ante requiring health exception tolerate responsible differences medical opinion present ban depends appropriate medical judgment carhart ban unaffected new legislation course vice health exception resting physician discretion light divided medical opinion propriety abortion technique terms physical safety ethical practice vital interests asserted nebraska law one left ask first justice harlan asked upon sound principles relations existing different departments government review action legislature jacobson supra answer none iii next holding nebraska ban forbids procedure common procedure ruling misapplies settled doctrines statutory construction contradicts casey premise vital constitutional position abortion debate agree careful statutory analysis conducted justice thomas post like ruling requiring physician veto requiring state meet unattainable standards statutory draftsmanship order voice heard grave difficult subject different foreclosing state participation altogether nebraska statute provides partial birth abortion shall performed state unless procedure necessary save life mother whose life endangered physical disorder physical illness physical injury including physical condition caused arising pregnancy neb rev stat ann supp statute defines partial birth abortion abortion procedure person performing abortion partially delivers vaginally living unborn child killing unborn child completing delivery defines partially delivers vaginally living unborn child killing unborn child mean deliberately intentionally delivering vagina living unborn child substantial portion thereof purpose performing procedure person performing procedure knows kill unborn child kill unborn child ibid text demonstrates law applies procedure nebraska intention demonstrated three points statutory language references abortion delivery fetus requirement delivery occur performance procedure term abortion means abortion performed using method described appeals acknowledged term commonly understood refer particular procedure known intact dilation extraction little rock family planning servs jegley carhart lead expert phillip stubblefield prefaced description procedure describing procedure lay press called abortion app ama declared partial birth abortion legislation name aimed exclusively abortion procedure confused description ama factsheet commonsense understanding statute reference abortion demonstrates intended reach provides citizens fair warning required law mcboyle statute intended scope demonstrated requirement banned procedure include partial delivery fetus vagina completion delivery end procedure removal intact fetus described delivery fetus involves intact fetus portions fetus pulled vagina intention dismembering fetus using traction opening uterus vagina considered delivery portion fetus carhart words ampe leaves abortionist tray full pieces app end procedure even argued majority ante dragging portion intact fetus vagina first step delivery portion intact fetus still involve completing delivery intact fetus whatever statutory term completing delivery unborn child means mean placing fetal remains tray see planned parenthood doyle supp wd statute readily applied partial delivery intact child hardly applicable delivery dismembered body parts medical descriptions abortion procedures confirm point description invokes word delivery app amicus bring describe involving delivery instead substituting word emerges describe fetus brought vagina ampe brief amicus curiae similar admission uses words physician pulling portion fetus ante rather physician delivering portion fetus yet procedure involving delivery banned law definitions delivery provided ante one supports important statutory construction purposes requires conclusion statutory term completing delivery refers placement dismembered body parts tray rather removal intact fetus woman body operation nebraska law defined requirement fetus partially delivered vagina abortionist kills partial delivery must undertaken purpose performing procedure person knows kill unborn child neb rev stat ann supp law naturally read require death fetus take place two steps first fetus must partially delivered vagina defendant must perform procedure forcing fetus vagina pulling extremities body process extracting body parts uterus vagina also procedure kills fetus richmond medical center women gilmore order luttig fetus partially delivered vagina separate procedure reduction procedure performed order kill fetus majority rejects argument based conclusion word procedure must refer entire abortion procedure time used ante interpretation makes sense require us conclude nebraska legislature considered entire abortion procedure take place abortionist already delivered vagina living unborn child substantial portion thereof neb rev stat ann supp medical authorities agree however entire abortion procedure begins several days stage dilation cervix majority asks us effect replace words purpose performing words course performing portion quoted preceding paragraph reference procedure refers separate procedure unique light statutory text commonsense understanding must statute covers see broadrick oklahoma ama disagree writes partial birth abortion legislation name aimed exclusively procedure living fetus intentionally deliberately given partial birth delivered purpose killing abortion procedure confused description ama factsheet internal quotation marks omitted casey disavows strict scrutiny review nebraska must afforded leeway attempting regulate medical profession see kansas hendricks traditionally left legislators task defining terms medical nature legal significance hold statute covers must disagree ama disregard known intent legislature adequately expressed statute strained statutory constructions abortion cases new justice identified years ago unprecedented canon construction cases involving abortion permissible reading statute avoided costs thornburgh american college obstetricians gynecologists dissenting opinion internal quotation marks omitted casey banished doctrine jurisprudence yet today reinvigorates process ignores obligation interpret law manner validate render void johnson robison edward debartolo florida gulf coast building constr trades council avoidance unconstitutional constructions discussed two sentences analysis dismissed inapplicable statute susceptible construction offered nebraska attorney general ante reasons discussed statute susceptible construction required adopt justice seek shield criticism citing interpretations abortion statutes offered federal courts ante issue nationwide importance courts special competence appellate courts consider similar statutes majority contrast declared law interpreted cover see hope clinic richmond medical center supra order luttig thirty enacted similar laws abdication responsibility suggest hands tied decisions paid scant attention casey recognition state authority misapplied doctrine construing statutes avoid constitutional difficulty leading case describing deference argument frisby schultz declined defer lower construction state statute issue case frisby observed lower courts ran afoul principle statutes interpreted avoid constitutional difficulties see also webster reproductive health services opinion rehnquist concurring part concurring judgment majority even concurring opinion justice ignore settled rule deciding unnecessary constitutional questions state nebraska conceded understanding casey law must interpreted bar well unconstitutional since majority concludes indeed case end matter yet justice go much farther conclude statute requires health exception practical purposes certainly circumstances case allows physician make determination professional judgment immense constitutional holding unnecessary reasons sought explain incorrect clear two halves majority opinion dictum wrong district case leaped prevent law enforced granting injunction applied interpreted nebraska cf hill colorado ante excluded abortion debate nebraska legislative branch state executive judiciary well law enjoined chief law enforcement officer state attorney general opportunity interpret federal ignored representations made officer litigation like manner nebraska courts given opportunity define contours law although indications courts give statute narrow construction one eagerly adopted today stenberg moore neb thus denied branch nebraska government role interpretation enforcement statute casey meant said solicitous state attempts vindicate interests related abortion casey assume state affairs iv ignoring substantial medical ethical opinion substitutes judgment judgment nebraska sweeps law away holding stems misunderstanding record misinterpretation casey outright refusal respect law state statutory construction conflict settled rules decision nullifies law expressing people nebraska medical procedures must governed moral principles foundation intrinsic value human life including life unborn law people nebraska forthright confronting issue immense moral consequence state chose forbid procedure many decent civilized people find abhorrent among serious crimes human life state still protected woman autonomous right choice reaffirmed casey closes eyes profound concerns decision reasoning judgment dissent stenberg attorney general nebraska et petitioners leroy carhart writ certiorari appeals eighth circuit june justice thomas chief justice justice scalia join dissenting struck act texas legislature effect since thereby rendering unconstitutional abortion statutes dozens roe wade colleagues past present ably demonstrated decision grievously wrong see doe bolton white dissenting roe wade supra rehnquist dissenting abortion unique act woman exercise control body ends depending one view human life potential human life nothing federal constitution deprives people country right determine whether consequences abortion fetus society outweigh burden unwanted pregnancy mother although state may permit abortion nothing constitution dictates state must years following roe applied worse extended decision strike numerous state statutes purportedly threatened woman ability obtain abortion voided parental consent laws see planned parenthood central mo danforth legislation requiring abortions take place hospitals see akron akron center reproductive health even requirement parents minor notified child abortion see hodgson minnesota slight exaggeration described right abortion without interference state danforth supra expansive application roe period even roe fairly described unrestrained imposition extraconstitutional value preferences american people thornburgh american college obstetricians gynecologists white dissenting appeared era abortion demand come end first decision webster reproductive health services see blackmun concurring part dissenting part lamenting plurality discard ed roe finally told decision planned parenthood southeastern casey although casey separate opinions chief justice justice scalia urging overrule roe command majority seven members including six members sitting today acknowledged legitimate role regulating abortion recognized interest respecting fetal life stages development see joint opinion kennedy souter jj rehnquist joined white scalia thomas concurring judgment part dissenting part scalia joined rehnquist white thomas concurring judgment part dissenting part joint opinion authored justices kennedy souter concluded prior case law went far undervalu ing state interest potential life striking abortion regulations real sense deprived women ultimate decision roe subsequent cases according joint opinion wrongly treat ed governmental attempts influence woman decision behalf potential life within unwarranted treatment incompatible recognition substantial state interest potential life throughout pregnancy accordingly joint opinion held long state regulation abortion furthers legitimate interests interests designed strike right regulation invalid imposes undue burden woman ability obtain abortion meaning places substantial obstacle woman path views merits casey joint opinion fully articulated others rehnquist concurring judgment part dissenting part scalia concurring judgment part dissenting part restate views except note casey joint opinion constructed authors whole cloth standard set forth casey joint opinion historical doctrinal pedigree standard product authors philosophical views abortion go without saying origins relationship constitution consequently illegitimate standard purported replace even assuming however remainder dissent casey fabricated standard merits adherence today decision extraordinary today inexplicably holds constitutionally prohibit method abortion millions find hard distinguish infanticide hesitates even describe ante holding reconciled casey standard standard explained us authors joint opinion majority hardly pretends otherwise striking statute expresses profound legitimate respect fetal life leaves unimpeded several safe forms abortion majority opinion gives lie promise casey regulations express profound respect life unborn permitted substantial obstacle woman exercise right choose whether abortion today decision obviously irreconcilable casey explication standard requires let alone constitution seen reinstitution era mere invocation abortion rights trumps contrary societal interest statute unconstitutional casey casey meant nothing candidly admit reach decision majority must take series indefensible steps majority must first disregard principles follows every context abortion interpret statutes according plain meaning strike statutes susceptible narrowing construction majority also must disregard constitutional standard purports employ displace considered judgment people nebraska majority decision lamentable result majority reaches illogical steps majority takes reach portends return era thought last abandoned almost years since roe never described various methods aborting fetus reading majority sanitized description one think case involves state regulation widely accepted routine medical procedure nothing truth widely used method abortion stage pregnancy gruesome use traumatic even physicians medical staff perform see app testimony boehm hern abortion practice particular procedure issue case partial birth abortion closely borders infanticide attempted ban begin discussion methods abortion available women late pregnancies addressing statutory constitutional questions primary form abortion used weeks gestation known dilation evacuation supp neb performed stage pregnancy procedure requires physician dilate woman cervix extract fetus uterus forceps app american medical association ama report board trustees abortion fetus size stage physician generally removes fetus dismembering fetus one piece supp doctor grabs fetal extremity arm leg forceps pulls cervical os tearing fetal parts fetal body means traction see app testimony carhart words physician grasp fetal parts basically tear pieces fetus pull testimony stubblefield see also testimony hodgson ou grasp fetal parts often know try pull simply fetus die blood loss either physician separated umbilical cord prior beginning procedure fetus loses blood limbs removed testimony carhart testimony hodgson fetus limbs removed head left utero physician collapse skull pull cervical canal testimony carhart testimony stubblefield causeway medical suite foster supp ed la end procedure physician left respondent words tray full pieces app testimony carhart abortions week performed using method abortion known induction supp app ama report board trustees abortion induction procedure amniotic sac injected abortifacient saline solution solution known prostaglandin supp uterine contractions typically follow causing fetus expelled ibid third form abortion use weeks gestation referred medical professionals intact two variations method require physician dilate woman cervix gynecologic obstetric related surgery nichols ed app testimony stubblefield first variation used vertex presentations fetal head presented first perform intact doctor insert instrument fetus skull fetus still utero remove brain intracranial contents supp gynecologic obstetric related surgery supra app testimony stubblefield fetal skull collapses physician remove fetus second variation intact procedure commonly known partial birth abortion supp gynecologic obstetric related surgery supra app testimony stubblefield procedure used rarely performed sometimes although variations generally performed follows dilating cervix physician grab fetus feet pull fetal body uterus vaginal cavity supp stage development head largest part body assuming physician performed dilation procedure correctly head held inside uterus woman cervix ibid hearing fetus stuck position dangling partly woman body inches completed birth physician uses instrument pair scissors tear perforate skull supp app testimony boehm joint hearing senate committee judiciary subcommittee constitution house committee judiciary hereinafter joint hearing physician either crush skull use vacuum remove brain intracranial contents fetal skull collapse fetus head pull fetus uterus supp use partial birth abortion procedure achieved prominence national issue publicly described martin haskell paper entitled dilation extraction late second trimester abortion national abortion federation september risk management seminar paper haskell described version procedure follows lower fetal extremity vagina surgeon uses fingers deliver opposite lower extremity torso shoulders upper extremities skull lodges internal cervical os usually enough dilation pass fetus oriented dorsum spine point surgeon slides fingers left hand along back fetus hooks shoulders fetus index ring fingers palm surgeon takes pair blunt curved metzenbaum scissors right hand carefully advances tip curved along spine middle finger feels contact base skull tip middle finger surgeon forces scissors base skull foramen magnum safely entered skull spreads scissors enlarge opening surgeon removes scissors introduces suction catheter hole evacuates skull contents catheter still place applies traction fetus removing completely patient hearing cases physician inadvertently dilates woman great degree physician hold fetus inside woman perform procedure statement pamela smith procedures one basically relies cervical entrapment head along firm grip help keep baby place practitioner plunges pair scissors base baby skull see also joint hearing put dilapan four five days say procedure fetus fall really point point attempting abortion see manipulate situation get live birth instead quoting haskell ii nebraska along attempted ban partial birth abortion procedure although nebraska statute purports prohibit partial birth abortion phrase commonly used mentioned refer breech extraction version intact majority concludes statute also read future case prohibit ordinary first procedure described according majority application pose substantial obstacle women seeking abortions therefore statute unconstitutional majority errs first step think clear nebraska statute prohibit procedure nebraska partial birth abortion statute issue case reads follows abortion shall performed state unless procedure necessary save life mother whose life endangered physical disorder physical illness physical injury including physical condition caused arising pregnancy neb rev stat ann supp partial birth abortion defined statute abortion procedure person performing abortion partially delivers vaginally living unborn child killing unborn child completing delivery purposes subdivision term partially delivers vaginally living unborn child killing unborn child means deliberately intentionally delivering vagina living unborn child substantial portion thereof purpose performing procedure person performing procedure knows kill unborn child kill unborn child starting statutory definition partial birth abortion think highly doubtful statute applied ordinary first nebraska statute applies physician partially delivers vaginally living unborn child phrase defined mean deliberately intentionally delivering vagina living unborn child substantial portion thereof emphases added read context term partially delivers fairly interpreted include removing pieces unborn child uterus one time word deliver particularly delivery unborn child refers process assist ing giving birth suggests removing intact unborn child womb rather pieces child see webster ninth new collegiate dictionary defining deliver assist giving birth aid birth stedman medical dictionary ed assist woman childbirth without question one deliver child one removes child uterus piece piece rather words respondent experts one remove dismember child app testimony carhart referring act removing fetus testimony hodgson testimony stubblefield physician dismember fetus see also hearing haskell describing delivery part fetus majority cites sources using terms deliver delivery refer removal fetus placenta birth sources also presume intact fetus rather dismembered fetal parts see obstetrics normal problem pregnancies gabbe niebyl simpson eds ed delivery infant placenta placenta cord membranes examined oxford english dictionary ed disburden woman foetus bring childbirth maloy medical dictionary lawyers ed aid process childbirth bring forth deliver fetus placenta majority pointed source delivery used refer removal first fetal arm leg torso etc fact even majority describes procedure without using word deliver refer removal fetal tissue uterus see ante pulling substantial portion still living fetus emphasis added ibid portion living fetus pulled vagina emphasis added one including majority understands act pulling part fetus delivery make statute meaning even clear statute applies physician partially delivers vaginally living unborn child killing unborn child completing delivery statute defines phrase mean physician must complete delivery purpose performing procedure kill unborn child clear phrases procedure kills fetus must subsequent therefore separate partia deliver deliver vagina living unborn child substantial portion thereof words even one assumes arguendo dismemberment act grasping fetal arm leg pulling comes leaving remaining part fetal body still uterus kind delivery take place procedure purpose performing procedure procedure majority view covered statute doctor pulls fetal foot tears delivered substantial portion unborn child performed procedure known cause death significantly physician delivered child performing procedure purpose performing procedure dismemberment delivery act causes fetus moreover even removal fetal foot arm uterus incidental severing rest fetal body amount delivery purpose performing procedure delivery unborn child substantial portion thereof even supposing fetal foot arm conceivably substantial portion unborn child common understanding partial birth abortion principle statutes interpreted avoid constitutional difficulties require one read substantial otherwise see infra although think text forecloses application nebraska statute procedure even ambiguity ambiguity conclusively resolved reading definition light fact nebraska statute terms applies partial birth abortion ordinary rules statutory interpretation resolve ambiguity specific statutory definition comport common understanding partial birth abortion term less specific definition part statute morton construe statutory phrases isolation read statutes whole partial birth abortion term used majority state legislatures congress medical journals physicians reporters even judges never far aware used refer procedure number instances partial birth abortion equated breech extraction form intact otherwise known explicitly contrasted numerous limit examples first numerous medical authorities equated partial birth abortion american medical association ama done recognized procedure different destructive abortion techniques fetus killed outside womb ama board trustees factsheet june app brief association american physicians surgeons et al amici curiae medical literature also equated partial birth abortion distinguished see gynecologic obstetric related surgery sprang neerhof rationale banning abortions late pregnancy jama bopp cook partial birth abortion final frontier abortion jurisprudence issues law medicine physicians equated partial birth abortion see planned parenthood doyle supp wd citing testimony richmond medical center women gilmore supp ed citing testimony even respondent expert phillip stubblefield acknowledged breech extraction intact ampe referred lay press partial birth abortion app second lower courts repeatedly acknowledged partial birth abortion commonly understood mean ampx see little rock family planning services jegley term abortion commonly understood refer particular procedure also known intact dilation extraction planned parenthood greater iowa miller iowa act prohibits abortion term commonly understood refer procedure called dilation extraction district case noted abortions known medically intact dilation extraction supp even majority notes partial birth abortion term ordinarily associated procedure ante third term partial birth abortion used state legislation occasions congress twice term partial birth abortion adopted congress two separate pieces legislation prohibiting considering legislation congress conducted numerous hearings debates issue repeatedly described partial birth abortion procedure distinct congressional record contained numerous references haskell procedure see hearing joint hearing since time debates taken place state legislatures across country voted prohibit procedure two exceptions legislatures voted ban procedure referred partial birth abortion debates also referred haskell procedure evidence legislators legislators equated partial birth abortion fact adopted legislation banning partial birth abortion defined way similar identical nebraska repeatedly referred breech extraction form intact repeatedly distinguished ordinary makes inconceivable term partial birth abortion reasonably interpreted mean doubt remaining whether statute apply procedure doubt ground invalidating statute rather bound first consider whether construction statute fairly possible avoid constitutional question erznoznik jacksonville state statute deemed facially invalid unless readily subject narrowing construction state courts frisby schultz precise scope ban described within text ordinance view ordinance readily subject narrowing construction avoids constitutional difficulties principle justice said failure apply plain error although interpretation nebraska law course binding nebraska courts clear erznoznik frisby demonstrate absent conflicting interpretation nebraska none text permits adopt construction majority contends application nebraska statute pose constitutional difficulties eliminate common form abortions extent majority contention true doubt nebraska statute susceptible narrowing construction nebraska courts preserve physicians ability perform see state carpenter neb penal statute must construed meet constitutional requirements reasonably done example statute requires physician deliberately intentionally delive vagina living unborn child substantial portion thereof performing death causing procedure term substantial portion susceptible narrowing construction exclude procedure one definition word substantial largely wholly specified webster ninth new collegiate dictionary see pierce underwood describing different meanings term substantial words substantial mean almost thing denominated nothing else construe statute require fetus largely wholly delivered uterus physician performs procedure knows kill unborn child discussed construe purpose performing procedure mean purpose performing separate procedure iii majority justice reject plain language statutory definition refuse read definition light statutory reference partial birth abortion ignore doctrine constitutional avoidance offer scant statutory analysis see ante majority opinion cf ante majority opinion ante concurring brief analyses majority justice disregard statutory language except final definitional sentence thereby violating fundamental canon construction statutes read whole morton word known company keeps lieu analyzing statute whole majority justice offer five principal arguments interpretation statute address turn first majority appears accept obliquely argument made respondent term partial birth abortion refers breech extraction form intact nebraska legislature used medical nomenclature see ante noting nebraska legislature rejected amendment replace partial birth abortion dilation extraction brief respondent course requirement legislature use terminology accepted medical community legislature doubt draft statute using term heart attack even medical community preferred myocardial infarction legislatures fact sometimes use medical terms ways conflict clinical definitions see barber director noting medical definition pneumoconiosis subset afflictions fall within definition pneumoconiosis black lung act practice unremarkable long legal term adequately defined never today suggested legislature may use words accepted every individual physician rather traditionally left legislators task defining terms medical nature legal significance kansas hendricks noted ften definitions fit precisely definitions employed medical community ibid simply true many legislatures including nebraska prohibited partial birth abortion chose use term known vernacular place term accepted clinical meaning abortion ban act introduced congress term dilation extraction appear medical dictionary see dorland illustrated medical dictionary ed stedman medical dictionary encyclopedia dictionary medicine nursing allied health ed annotated dictionary dox melloni eisher harpercollins illustrated medical dictionary term appear descriptions abortion methods leading medical textbooks see cunningham et williams obstetrics ed obstetrics normal problem pregnancies hern abortion practice abortion reference books also omitted reference term see modern methods inducing abortion baird grimes van look eds glick surgical abortion medical meaning time term ambiguous face dilation extraction face accurately describe procedure woman dilated fetus extracted including see supra contrast partial birth abortion advantage faithfully describing procedure legislature meant address fact fetus partially born procedure indisputable term partial birth abortion completely accurate descriptive perhaps reason majority finds objectionable desire find fault cost explain willingness penalize nebraska legislature failing replace descriptive term vague one therefore nothing majority argument nebraska legislature fault declining use term dilation extraction second majority faults nebraska legislature failing track medical differences failing suggest application turns whether portion fetus body drawn vagina part process extract intact fetus collapsing head opposed process dismember fetus ante already explained nebraska statute reflects medical differences extent majority means nebraska legislature tracked medical differences adopting one informal definitions argument without merit none definitions effective accomplish state purpose preventing abortions partially born fetuses take example acog informal definition term intact according acog intact consists following four steps deliberate dilation cervix usually sequence days instrumental conversion fetus footling breach breech extraction body excepting head partial evacuation intracranial contents living fetus effect vaginal delivery dead otherwise intact fetus app acog executive board statement intact dilation extraction acog emphasizes unless four elements present sequence procedure intact nebraska adopted statute prohibiting intact defined along lines acog definition physicians attempting perform abortions partially born fetuses easily evaded statute doctor wishing perform partial birth abortion procedure simply avoid liability statute performing procedure respondent fetus presented feet first thereby avoiding necessity conversion fetus footling breech doctor convert fetus without instruments doctor cause fetus death partial evacuation intracranial contents plunging scissors fetus heart example doctor even attempt evade statute chopping two fetal toes prior completing delivery preventing state arguing fetus otherwise intact presumably however nebraska many legislative bodies adopted partial birth abortion bans concerned whether death inflicted injury brain heart whether fetus converted without instruments whether fetus died toes attached legislative bodies presume concerned whether child partially born physician caused death legislatures evident concern permitting procedure resembles infanticide threatens dehumanize fetus therefore presumably declined adopt ban intact defined acog ineffective purpose majority faulting nebraska legitimate legislative calculation third majority justice argue generally defers lower federal courts interpretations state law ante majority opinion ante concurring however decision drafted justice inexplicably fails discuss frisby schultz makes clear deference inappropriate justice explained case hile ordinarily defer lower constructions state statutes invariably particularly reluctant defer lower courts fallen plain error precisely situation presented extent endorsed broad reading ordinance lower courts ran afoul principle statutes interpreted avoid constitutional difficulties citations omitted frisby identifies exactly lower courts opinions entitled deference lower courts failed identify narrower construction consistent text avoid constitutional difficulties fourth majority speculates nebraska prosecutor may attempt stretch statute apply state statute unconstitutional face merely imagine aggressive prosecutor attempt overly aggressive application statute noted ords inevitably contain germs uncertainty broadrick oklahoma give statutes broadest definition imaginable rather ask whether ordinary person exercising ordinary common sense sufficiently understand comply statute ibid quoting civil service commission national assn letter carriers creative legal mind might able stretch plain language nebraska statute apply citizens desire obey statute difficulty understanding colten kentucky internal quotation marks omitted finally majority discusses length reasons defer interpretation statute proffered nebraska attorney general despite attorney general repeated representations state apply partial birth abortion statute see brief petitioners tr oral arg fact declines defer interpretation attorney general however reason give statute contrary representation even without according attorney general view particular respect agree interpretation undoubtedly correct one moreover justice noted adopt narrow interpretation state statute supported principle statutes interpreted avoid constitutional difficulties well representations counsel oral argument frisby schultz supra approach particularly appropriate case majority notes nebraska courts accord nebraska attorney general interpretations state statutes substantial weight see state coffman neb therefore renegade prosecutor bringing criminal charges physician performing find confronted contrary interpretation statute nebraska attorney general assume judge possessed common sense aware rule lenity see state white neb iv resolved nebraska partial birth abortion statute permits doctors perform abortions question remains whether state constitutionally prohibit partial birth abortion procedure without health exception although majority justice purport rely standard articulated casey joint opinion concluding state may fact disregard entirely though justices kennedy souter declined casey ground stare decisis reconsider whether abortion enjoys constitutional protection majority opinion joint opinion casey professed part repudiation roe progeny casey joint opinion expressly noted prior case law undervalued state interest potential life invalidated regulations abortion real sense deprived women ultimate decision see roe wade speaks clarity establishing state important legitimate interest potential life portion decision roe given little acknowledgment citation omitted joint opinion repeatedly recognized weighty interest area see state may express profound respect life unborn state profound interest potential life majority opinion profound moral spiritual implications terminating pregnancy even earliest stage joint opinion expressed repeatedly legitimate role regulating abortion procedures see notion state substantial interest potential life leads conclusion regulations must deemed unwarranted governmental intrusion abortion necessity unwarranted according joint opinion fact law serves valid purpose one designed strike right incidental effect making difficult expensive procure abortion enough invalidate casey joint opinion therefore adopted standard state regulation imposes undue burden woman ability make decision power state reach heart liberty protected due process clause ibid regulation imposes undue burden effect placing substantial obstacle path woman choice question state nebraska valid interest one designed strike right prohibiting partial birth abortion casey noted may express profound respect life unborn ibid may without doubt express profound respect prohibiting procedure approaches infanticide thereby dehumanizes fetus trivializes human life ama recognized procedure ethically different destructive abortion techniques fetus normally twenty weeks longer gestation killed outside womb partial birth gives fetus autonomy separates right woman choose treatments body ama board trustees factsheet june app brief association american physicians surgeons et al amici curiae thirty concurred view although description procedure set forth sufficient demonstrate resemblance partial birth abortion procedure infanticide testimony one nurse observed partial birth abortion procedure makes point even vividly 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 fall doctor opened scissors stuck suction tube opening sucked baby brains baby went completely limp hearing statement brenda pratt shafer question whether legitimate interest banning procedure require additional authority see ante kennedy dissenting civilized society answer obvious contrary arguments offensive merit discussion see ante stevens concurring arguing decision ban partial birth abortion procedure simply irrational forms abortion equally gruesome ante ginsburg concurring similar next question therefore whether nebraska statute unconstitutional contain exception allow use procedure whenever necessary appropriate medical judgment preservation health mother ante majority opinion quoting casey turn quoting roe emphasis omitted according majority health exception required division opinion among medical experts whether generally safer absence controlled medical studies help answer medical questions ante words unless state conclusively establish abortion procedure safer procedures state regulate procedure without including health exception justice agrees ante concurring opinion rule set forth majority justice dramatically expands prior abortion cases threatens undo state regulation abortion procedures majority justice suggest rule dictated straightforward application roe casey ante majority opinion ante concurring simply true roe casey stated state may regulate even proscribe abortion except necessary appropriate medical judgment preservation life health mother roe supra casey casey said health exception must available continuing pregnancy constitute threat woman emphasis added cases state seeks prohibit abortion even temporarily particular circumstances casey says may state must make exception cases life health mother endangered continuing pregnancy cases addressed situation woman must obtain abortion threat health continued pregnancy roe casey say nothing cases physician considers one prohibited method abortion preferable permissible methods today majority justice twist roe casey apply situation woman desires whatever reason abortion wishes obtain abortion particular method see ante majority opinion ante concurring opinion words majority justice fail distinguish cases health concerns require woman obtain abortion cases health concerns cause woman desires abortion whatever reason prefer one method another clear understanding health exception required mandated prior cases fact approved regulations methods conducting abortion despite lack health exception mazurek armstrong per curiam reversing appeals holding plaintiffs challenging requirement physicians perform abortions fair chance stevens dissenting arguing regulation designed make abortion difficult one think vast bodies law regulating abortion valid one hope despite lack health exceptions example physicians presumably prohibited using abortifacients approved food drug administration even physicians reasonably believe abortifacients safer women existing majority effectively concedes casey provides support broad health exception rule relying authority see ante including case specifically disapproved casey giving little weight state interest fetal life see casey supra overruling parts thornburgh american college obstetricians gynecologists inconsistent roe statement state legitimate interest promoting life potential life unborn relying thornburgh supra burger dissenting proposition expanding roe case indeed justice joins opinion thornburgh dissent arguing standard statute issue constitutional see arguing challenged state statute unduly burdensome majority resort case proves point holding today assumes standard set forth casey joint opinion longer governing even assume standards govern cases cited majority provide support proposition partial birth abortion ban must include health exception doctors believe partial birth abortion safer thornburgh danforth doe addressed health exceptions cases continued pregnancy pose risk woman thornburgh supra planned parenthood central mo danforth doe bolton explicitly declined address whether state constitutionally require tradeoff woman health fetus broad rule articulated majority justice unprecedented expansions already expansive jurisprudence state affairs bad enough majority expands health exception rule articulated casey one additional equally pernicious way although roe casey mandated health exception cases abortion necessary woman health majority concludes procedure necessary comparative health benefits ante words according majority long doctor point support profession woman preferred procedure necessary physician entitled perform id see also ante ginsburg concurring arguing state constitutionally sto woman choosing procedure doctor reasonably best interest health exception requirement eviscerates casey undue burden standard imposes unfettered exception entirely swallows rule effect regulation abortion procedures permitted always support procedure always doctors conclude procedure preferable nebraska reenacts partial birth abortion ban health exception state able prevent physicians like carhart using partial birth abortion routine abortion procedure expressed conclusion highly plausible support view partial birth abortion safer majority view means procedure therefore necessary ante doctor wishes perform procedure new statute able impunity therefore justice assurance constitutional failings nebraska statute easily fixed ante illusory majority insistence health exception fig leaf barely covering hostility abortion regulation hostility casey purported majority assiduously avoids addressing actual standard articulated casey whether prohibiting partial birth abortion without health exception poses substantial obstacle obtaining abortion good reason obstacle exist two essential reasons identify substantial obstacle first identify real much less substantial barrier woman ability obtain abortion second demonstrate obstacle affect sufficient number women justify invalidating statute face casey joint opinion makes clear strike state regulations abortion based fact women might face marginally higher health risk regulation casey upheld waiting period even though credited evidence women delay practice much longer hours even though undisputed delay obtaining abortion impose additional health risks blackmun concurring part concurring judgment part dissenting part district found mandatory delay lead delays excess hours thus increasing health risks although women able avoid waiting period medical emergency medical emergency exception statute limited women delay create serious risk substantial irreversible impairment major bodily function internal quotation marks omitted without question women regulation impose additional health risk fall within medical emergency exception concluded despite certainty increased risk showing burden women substantial case overturned state attempt prohibit particular form abortion also demonstrates marginal increase health risks sufficient create undue burden planned parenthood central mo danforth struck state regulation state outlawed method abortion used abortions alternative methods emphasized significantly dangerous critical prohibited method like casey waiting period contrast situation danforth increased health risk women imposed partial birth abortion ban minimal abortions occur weeks time partial birth abortion possible vast majority performed induction procedure woman vertex presentation fetus vertex presentation form intact presumably shares health benefits partial birth abortion procedure covered nebraska statute available remaining women women partial birth abortion procedure considered breech presentation fetus showing one faces significant health risk partial birth abortion ban select committee acog identify circumstances procedure option save life preserve health woman app acog executive board statement intact dilation extraction see also hope clinic ryan en banc appear identified situation intact appropriate procedure induce quoting late term pregnancy techniques ama policy planned parenthood doyle supp citing testimony haskell procedure never medically necessary preserve health woman vacated ad hoc coalition doctors including former surgeon general koop concluded medical conditions require use partial birth abortion procedure preserve mother health see app fact evidence nebraska legislature partial birth abortion increases health risks relative procedures floor debates proponent nebraska legislation read cited several articles physicians concluding partial birth abortion procedures risky app nos one doctor testifying committee nebraska legislature stated partial birth abortion involves three risky procedures dilation cervix using instruments blindly conversion fetus app quoting testimony paul hays also evidence congress partial birth abortion meet medical standards set acog adequately proven safe efficacious hearing statement nancy romer see ama supported congressional ban partial birth abortion concluding procedure medically indicated good medicine see cong rec may reprinting letter ama santorum evidence congress certainly basis upon state claim partial birth abortion safer even preferred procedure partial birth abortion truth joint hearing statement curtis cook doctor testified abortion unnecessary unsteady potentially dangerous procedure safe alternatives existence majority justifies result asserting significant body medical opinion supports view partial birth abortion may safer abortion procedure ante find assertion puzzling significant body medical opinion supporting procedure one majority identified fact uncontested although procedure used since least formal studies compared partial birth abortion procedures supp citing testimony stubblefield citing testimony boehm epner jonas seckinger abortion jama sprang neerhof rationale banning abortion late pregnancy jama cf kumho tire carmichael observing reliability scientific technique may turn whether technique tested whether subjected peer review publication whether high rate error standards controlling operation majority conclusion makes sense standard whether significant body medical opinion supports result rather justice ginsburg candidly admits whether doctor reasonably believe partial birth abortion procedure best protect woman ante moreover even assume credible evidence sides debate fact resolve question favor allowing nebraska legislate one knows whether regulation abortion poses burden burden surely amount substantial obstacle casey case defer legislative judgment said precisely disagreement exists legislatures afforded widest latitude drafting statutes hen legislature undertakes act areas fraught medical scientific uncertainty legislative options must especially broadies kansas hendricks internal quotations marks omitted justice words difficult believe without resources available bodies entrusted making legislative choices believes competent make inquiries revise standards every time american college obstetricians gynecologists acog similar group revises views appropriate medical procedure area akron akron center reproductive health dissenting opinion see irrespective difficulty task legislatures superior factfinding capabilities certainly better able make necessary judgments courts webster reproductive health services lesson drawn government may act face medical uncertainty rather courts pay particular deference reasonable legislative judgments today disregards principles clear import casey even willing assume partial birth method abortion safer small set women conclusion require invalidating act case comes us facial challenge question us whether respondent shown set circumstances exists act valid ohio akron center reproductive health quoting webster reproductive health services supra concurring part concurring judgment courts may invalidate face state statute regulating abortion based upon analysis may never occur invalidation statute improper even assuming casey rejected standard sub silentio least far abortion cases concerned favor large test see fargo women health organization schafer joined souter concurring arguing set circumstances standard incompatible casey see also janklow planned parenthood sioux falls clinic scalia dissenting denial certiorari casey presented facial challenge among provisions spousal notice requirement question according majority whether spousal notice provision operated substantial obstacle women whose conduct affects namely married women seeking abortions wish notify husbands intentions qualify one statutory exceptions notice requirement determined large fraction women category victims psychological physical abuse subset women according provision pose substantial obstacle ability obtain abortion husbands exercise effective veto decision none opinions supporting majority much mentions large fraction standard undoubtedly nebraska statute easily survives assume sake discussion category women whose conduct nebraska partial birth abortion statute might affect includes woman wishes obtain safe abortion weeks gestation also assume although doubt true women every one willing use partial birth abortion procedure advised doctor indisputably large fraction women face substantial obstacle obtaining safe abortion inability use particular procedure fact clear woman deprived safe abortion inability obtain partial birth abortion medically sophisticated minds searched failed identify single circumstance let alone large fraction partial birth abortion required matter ad hoc nullification machine back full throttle see thornburgh american college obstetricians gynecologists scalia concurring judgment part dissenting part reassured repeatedly casey regulations abortion unwarranted may express profound respect fetal life casey regulation us today easily pass constitutional muster abortion jurisprudence particularly virulent strain constitutional exegesis today told prohibited banning one rarely used form abortion believe border infanticide clear constitution compel result respectfully dissent footnotes unless otherwise noted subsequent cites planned parenthood southeastern casey joint opinion kennedy souter jj recent year abortion statistics available centers disease control prevention approximately abortions performed centers disease control prevention abortion surveillance july abortions performed week gestation middle second trimester third trimester majority apparently accepts none abortion procedures used pregnancies earlier stages gestation including dilation evacuation practiced weeks gestation compromised statute see ante concluding statute interpreted apply instrumental dismemberment procedures used later term therefore methods abortion available women later stage pregnancy issue case weeks gestation average fetus approximately six inches long weeks gestation fetus approximately eight inches long moore persaud developing human ed past week gestation respondent attempts induce fetal death injection prior beginning procedure patients supp app disagreement among parties regarding appropriate term procedure congress numerous state legislatures including nebraska described procedure partial birth abortion reflecting fact fetus born physician causes death see infra respondent prefers refer generically intact dilation evacuation intact without reference whether fetus presented head first feet first one doctors developed procedure martin haskell described dilation extraction see abortion ban act hearing senate committee judiciary hereinafter hearing executive board american college obstetricians gynecologists acog refers procedure hybrid term intact dilation extraction intact see app acog executive board statement intact dilation extraction term adopted ama see ama report board trustees abortion use term partial birth abortion describe procedure legal term preferred state legislatures including state nebraska congress discuss see infra justification majority preference terms intact desire make procedure appear medically sanctioned apparently general understanding women appropriate candidates procedure respondent uses procedure women weeks gestation supp doctor developed procedure martin haskell indicated performed procedure patients weeks certain patients weeks see hearing addition two forms abortion used rarely hysterotomy procedure resembling caesarean section requires surgical delivery fetus incision uterine wall hysterectomy supp majority argues statute explicitly require procedure separate overall abortion procedure beside point statute procedure must separate delivery moreover incorrect state statute contemplates one procedure statute clearly uses term procedure refer overall abortion procedure partial birth abortion abortion procedure well component overall abortion procedure purpose performing procedure kill unborn child certainly true undefined term must construed accordance ordinary plain meaning fdic meyer mean ordinary plain meaning term wholly irrelevant term defined noted see supra consensus regarding terms appropriate describe procedure assume majority terms purposes interchangeable congressional legislation prohibiting procedure first introduced june introduction partial birth abortion ban act measure sponsored individual house members passed houses wide margins cong rec cong rec vetoed president clinton see house voted override veto september see however senate failed override margin votes see next congress individual house cosponsors reintroduced partial birth abortion ban act later replaced house see sess house senate adopted legislation amended wide margins see cong rec president clinton vetoed bill see veto override passed house fell short senate see cong rec consistent practice haskell ohio practitioner ohio referred procedure dilation extraction defined termination human pregnancy purposely inserting suction device skull fetus remove brain ohio rev code ann missouri refers killing infant infanticide mo stat ann vernon supp part defined term partial birth abortion using language similar proposed congressional legislation abortion person performing abortion partially vaginally delivers living fetus killing fetus completing delivery see hearing see alaska stat ann rev stat ann supp ark code ann stat supp comp ch ind code ann west supp comp laws ann supp miss code ann supp code ann cum including nebraska see neb rev stat ann supp defined abortion using language similar used proposed congressional legislation retained definition partial birth abortion used bill abortion person performing abortion partially vaginally delivers living fetus killing fetus completing delivery defined phrase mean deliberately intentionally delivers vagina living fetus substantial portion purpose performing procedure physician knows kill fetus kills fetus see partial birth abortion ban act sess see idaho code supp iowa code ann supp stat ann west supp stat tit supp laws supp code ann majority argues approach supported meese keene stated statutory definition term excludes unstated meanings term case provides support approach adopted majority justice meese addressed statute used term political propaganda noted two commonly understood meanings term political propaganda surprisingly chose definition consistent statutory definition nowhere suggest political propaganda defined statute commonly understood meanings term irrelevant indeed significant portion opinion devoted describing effect congress use term colautti franklin western union telegraph lenroot support proposition two possible interpretations term one comports statutory definition term read include unstated meaning one possible interpretation partial birth abortion majority cite authority using term describe justification majority willingness entirely disregard statute use term matter terms intact dilation extraction intact dilation evacuation appear textbooks medical dictionaries see supra page fact respondent preferred term intact compound rather remedy confusion regarding statute meaning evident majority opinion consensus term means compare ante describing intact refer breech vertex presentation procedures app testimony henshaw using intact mean breech procedure testimony stubblefield using intact refer delivery fetus died utero fact statutory term partial birth abortion may express political moral judgment whereas dilation extraction irrelevant certainly true technical terms frequently empty normative content course decision use technical term normative see ante passim majority opinion long statutory terms adequately defined requirement congress state legislatures draft statutes using morally agnostic terminology see making unlawful manufacture transfer possess semiautomatic assault weapon kobayashi olson et california street legal economic analysis strict liability manufacture sale assault weapons stan rev prior term assault weapon exist lexicon firearms political term developed publicists expand category assault rifles allow attack many additional firearms possible basis undefined evil appearance see also meese majority relies justice scalia observation crandon never thought interpretation charged prosecuting criminal statutes entitled deference justice scalia commenting attorney general overly broad interpretation federal statute deference said turn normal construction criminal statutes replacing doctrine lenity doctrine severity nebraska attorney general adopted narrow view criminal statute one comports rule lenity mention statute plain meaning read majority opinion concede implicitly state legitimate interest banning dehumanizing procedure threshold question casey whether abortion regulation serves legitimate state interest statute serves legitimate state interest necessary consider whether regulation imposes substantial obstacle women seeking abortion ibid fact majority considers whether nebraska statute creates substantial obstacle suggests members majority justice stevens justice ginsburg rejected respondent threshold argument statute serves legitimate state purpose justice ginsburg seems suggest even nebraska statute impose undue burden women seeking abortions statute unconstitutional purpose imposing undue burden justice ginsburg view apparently presume unconstitutional purpose regulation designed save fetus destruction protect health pregnant women must therefore designed chip away roe ante strange claim make respect legislation enacted individual enacted nebraska vote nebraska legislative journal sess moreover support assertion nebraska legislature acted unconstitutional purpose justice ginsburg apparently unable muster single shred evidence nebraska legislation enacted prevent women obtaining abortions purpose entirely ineffective let alone kind persuasive proof require concluding legislature acted unconstitutional intent fact far tell justice ginsburg views regarding motives nebraska legislature derive views dissenting appeals judge discussing motives legislators justice ginsburg presumption addition squarely inconsistent casey stated may enact legislation express profound respect life unborn per curiam stated ven assuming legislative purpose interfere constitutionally protected right abortion without effect interfering right render montana law invalid basis finding vitiating legislative purpose assume unconstitutional legislative intent even statutes produce harmful results see washington davis much less assume results harmless emphases original discuss question casey whether ban partial birth abortion without health exception imposes undue burden woman seeking abortion meaning creates substantial obstacle woman assume discuss health risks respect undue burden instead suggests health risks relevant necessity health exception marginal increase safety risk women clearly undue burden within meaning casey bottom majority using health exception language water casey standard majority conclusion health exceptions required whenever support use procedure particularly troubling majority indicate whether exception physical health required whether exception account factors physical emotional psychological familial woman age relevant well patient doe bolton see also voinovich women medical professional thomas joined rehnquist scalia dissenting denial certiorari use procedure may increase risk complications including cervical incompetence requires greater dilation cervix forms abortion see epner jonas seckinger abortion jama physicians also suggested procedure may pose greater risk infection see planned parenthood doyle supp wd see also sprang neerhof rationale banning abortions late pregnancy jama intact poses serious medical risks mother nebraska entitled rely testimony evidence presented congress state legislatures cf erie pap slip renton playtime theatres numerous points legislative debates various members nebraska legislature made clear body aware relying evidence congress legislative bodies see app nos pp