Hope Clinic v. Ryan

195 F.3d 857, 1999 U.S. App. LEXIS 26925, 1999 WL 974098
CourtCourt of Appeals for the Seventh Circuit
DecidedOctober 26, 1999
DocketNos. 98-1726, 99-2528, 99-2533
StatusPublished
Cited by45 cases

This text of 195 F.3d 857 (Hope Clinic v. Ryan) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hope Clinic v. Ryan, 195 F.3d 857, 1999 U.S. App. LEXIS 26925, 1999 WL 974098 (7th Cir. 1999).

Opinions

EASTERBROOK, Circuit Judge.

We must decide whether state laws prohibiting partial-birth abortions are unconstitutionally vague or unduly burden women’s rights. Acting without an evidentiary hearing, a district court held the Illinois statute unconstitutional and entered a permanent injunction. Hope Clinic v. Ryan, 995 F.Supp. 847 (N.D.Ill.1998). But after a trial, another district court concluded that the Wisconsin statute is valid. Planned Parenthood of Wisconsin v. Doyle, 44 F.Supp.2d 975 (W.D.Wis.1999). A panel of this court earlier had ordered preliminary relief against Wisconsin’s law, see Planned Parenthood of Wisconsin v. Doyle, 162 F.3d 463 (7th Cir.1998), and plaintiffs say that this decision, applying Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S. 833, 112 S.Ct. 2791, 120 L.Ed.2d 674 (1992), justifies permanent injunctions against both states’ rules. To ensure consistency, we heard the appeals en banc. We conclude that both laws can be applied in a constitutional manner. Whether that will occur depends on state courts, which alone can settle questions about the construction of the statutes. To ensure that physicians are not deterred from performing other medical procedures while issues wend their way through state tribunals, we hold that both sets of plaintiffs are entitled to injunctive relief that will limit the statutes’ application to the medical procedure that each state insists is its sole concern.

I

Induction, suction curettage, and dilation and evacuation (d&e) are the principal methods of performing abortions in the United States. Prohibiting any one of these would conflict with the right of abortion recognized by cases such as Casey, 505 U.S. at 877, 112 S.Ct. 2791 (plurality opinion) (adopting “undue burden” as the constitutional standard), and Planned Parenthood of Central Missouri v. Danforth, 428 U.S. 52, 75-79, 96 S.Ct. 2831, 49 L.Ed.2d 788 (1976) (holding that a state may not forbid saline amniocentesis, at the time the principal means of induction). Our cases involve an uncommon procedure known to the medical community as “intact dilation and extraction” or just “dilation and extraction (d&x),” and to the public as “partial-birth abortion.”

Some medical background is essential to understanding the issues. Induction means inducing preterm labor, which causes the expulsion of the conceptus. Methotrexate or mifepristone (Ru-486, now in clinical trials), in combination with misoprostol, can be used for this purpose early in pregnancy; saline amniocentesis and injected prostaglandins serve the same function in the second trimester. Suction curettage (vacuum aspiration), the most common surgical method of abortion early in pregnancy, refers to evacuation of the uterine cavity; the embryo or fetus is separated from the placenta either by scraping or vacuum pressure, then is removed by suction. When these methods are inappropriate, or do not work, physicians employ the d&e procedure. To perform a d&e, the physician dilates the cervix and dismembers the fetus inside the uterus using forceps. Fetal parts are removed with forceps or by suction.

A d&x is a variant of a d&e in which the fetus is removed without dismemberment. The American College of Obstetricians and Gynecologists (acog) defines d&x as follows: “1. deliberate dilatation of the cervix, usually over a sequence of days; 2. instrumental conversion of the fetus to a footling breech; 3. breech extraction of the body excepting the head; and 4. partial evacuation of the intracranial contents of a living fetus to effect vaginal delivery of a dead but otherwise intact fetus.” Martin Haskell, the physician who developed the d&x procedure, see Dilation and Extraction for Late Second Trimester Abortion [862]*862(1992), reprinted in 139 Cong. Rec, e1092 (Apr. 29, 1993), believes that how the head is diminished in size so that it can pass through the cervix is not important: mechanically crushing the skull serves the same end as evacuating its contents, which causes its collapse. It is this combination of coming so close to delivering a live child with the death of the fetus by reducing the size of the skull that not only distinguishes n&x from d&e medically but also causes the adverse public (and legislative) reaction. Opponents deem the d&x procedure needlessly cruel and bordering on infanticide, and all three states in this circuit have enacted statutory restrictions.

The statute in Illinois has three sections with legal significance:

720 ILCS § 513/5. Definitions
In this Act: “Partial-birth abortion” means an abortion in which the person performing the abortion partially vaginally delivers a living human fetus or infant before killing the fetus or infant and completing the delivery. The terms “fetus” and “infant” are used interchangeably to refer to the biological offspring of human parents.
720 ILCS § 513/10. Partial-birth abortions prohibited
Any person who knowingly performs a partial-birth abortion and thereby kills a human fetus or infant is guilty of a Class 4 felony. This Section does not apply to a partial-birth abortion that is necessary to save the life of a mother because her life is endangered by a physical disorder, physical illness, or physical injury, including a life-endangering condition caused by or arising from the pregnancy itself, provided that no other medical procedure would suffice for that purpose.
720 ILCS § 513/15. Civil action
The maternal grandparents of the fetus or infant, if the mother has not attained the age of 18 years at the time of the abortion, may in a civil action obtain appropriate relief unless the pregnancy resulted from the plaintiffs criminal conduct or the plaintiff consented to the abortion. The relief shall include money damages for all injuries, psychological and physical, occasioned by the violation of this Act and statutory damages equal to 3 times the cost of the partial-birth abortion.

The Indiana statute defines “partial-birth abortion” in identical terms. Ind.Code § 16-18-2-267.5. Like Illinois it forbids partial-birth abortions unless that procedure is necessary to save the mother’s life, and no other procedure would suffice. Ind.Code § 16-34-2-l(b). The Indiana statute has never been challenged and has been in effect since July 1,1997.

Wisconsin has taken a slightly different approach. Its statutes provide:

Wis. Stat. § 895.038 Partial-birth abortions; liability.
(1) In this section:
(a) “Child” has the meaning given in § 940.16(l)(a).
(b) “Partial-birth abortion” has the meaning given in § 940.16(l)(b).
(2) (a) Except as provided in par. (b), any of the following persons has a claim for appropriate relief against a person who performs a partial-birth abortion:
1.

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Bluebook (online)
195 F.3d 857, 1999 U.S. App. LEXIS 26925, 1999 WL 974098, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hope-clinic-v-ryan-ca7-1999.