UCLA UCLA Women's Law Journal Title What is an "Undue Burden"? The Casey Standard as Applied to Informed Consent Provisions Permalink https://escholarship.org/uc/item/14f0z1hr Journal UCLA Women's Law Journal, 20(1) Author Paulk, Lauren Publication Date 2013 DOI 10.5070/L3201018047 Peer reviewed eScholarship.org Powered by the California Digital Library University of California WHAT IS AN “UnDUE Burden”? THE CASEY STANDARD AS APPLIED to INFORMED CONSENT ProVISIONS Lauren Paulk* I. Introduction .............................................................................71 II. A History of the Undue Burden Standard ...................................................................................73 III. The Scope of Constitutional Restrictions Under the Undue Burden Standard ....................................................................77 IV. Informed Consent ...................................................................87 A. Ultrasound Laws ...................................................................92 1. The Ultrasound Cases ....................................................97 2. Application of the Strengthened Undue Burden Standard to the Lakey Statute ...................................103 B. Fetal Pain Laws ...................................................................105 V. What is Next for the Undue Burden Standard? ..............................................................................109 I. Introduction The right to an abortion remains a hotly contested area of politics. However, advocates challenging laws that restrict access to abortion do not always raise all the possible challenges, which re- sults in a mixed application of standards by the courts. This article explores the so-called “undue burden” standard handed down by the United States Supreme Court and how lower federal courts use this standard to analyze legislation related to the right to choose. * CUNY School of Law, J.D. expected 2013. The author wishes to thank Professor Ruthann Robson for her comments, kind encouragement to pub- lish, and inspirational scholarship and teaching; Professor Caitlin Borgmann for early guidance, continued engagement with me about reproductive justice and the law, and for leading excellent classroom discussions that provided the impetus for this piece; UCLA Women’s Law Journal editors and staff for their thoughtful notes and edits; and my colleagues at CUNY, whose friendship and support make law school not only bearable, but enjoyable. 71 72 UCLA Women’s Law JOURNAL [Vol. 20.1 First, this article will outline the history of the standard, fol- lowed by a discussion of how the Supreme Court has applied it in three major cases. Next, this article will analyze how the lower fed- eral courts use the standard by focusing on its application to “in- formed consent” provisions of abortion regulation. Specifically, this article will analyze court decisions that rule on the constitutionality of legislative provisions related to pre-abortion ultrasounds and fe- tal pain. Finally, this article will discuss what recent applications of the undue burden standard in informed consent provisions may mean for the standard itself and for abortion rights in general. I conclude that the undue burden standard should be clarified and strengthened. Advocates should always raise the standard to help ensure courts address it. As such, challenges under the standard should run parallel to any other challenges. Specifically, in informed consent cases, advocates should argue that the analysis under the undue burden standard begins by assess- ing whether the provision is truthful and not misleading.1 If the pro- vision is found to be truthful and not misleading, advocates should argue that the next step is whether the provision has the “purpose or effect of placing a substantial obstacle in the path of a woman who seeks an abortion of a nonviable fetus.”2 In advocating under the purpose prong, advocates should cite to legislative history and statements made by politicians that could be reasonably construed to show that the provision has the “purpose” of “hinder[ing]” a wo- man’s free choice to abort a nonviable fetus.3 In advocating under the effects prong, advocates should attempt to show how the large fraction test proves that the restriction is a substantial obstacle 1 Planned Parenthood of Se. Pa.v. Casey, 505 U.S. 833, 882 (1992). 2 Id. at 877. 3 Id. However, as commentators have noted, the purpose prong of Casey has been relatively “neglected.” Note, After Ayotte: The Need to Defend Abor- tion Rights with Renewed “Purpose,” 119 Harv. L. Rev. 2552, 2566 (2006) [here- inafter After Ayotte]. Indeed, members of the Court themselves are divided in how—and whether—the purpose prong should be used. When Justice Gins- burg implied support for a disjunctive test (or the separation of “purpose” and “effect” in the Casey standard) in a concurrence, Justice Thomas argued back that Ginsburg’s notion was “squarely inconsistent” with precedent. See id. at 2566-67 (quoting Stenberg v. Carhart, 530 U.S. 914, 952 (2000)). Additionally, the Court has refused to grant certiorari to a petition attempting to clarify how to construe the purpose prong. See id. at 2567 n.87 (citing Petition for Writ of Certiorari, Wood v. Univ. of Utah Med. Ctr., 540 U.S. 946 (2003) (No. 03-82), 2003 WL 22428547 (presenting the question, “[d]oes the standard for deter- mining whether a statute has a constitutionally improper purpose under Casey require an examination of the entire legislative context”); Wood, 540 U.S. at 946 (denying certiorari)). 2013] WHAT is an “UndUE BUrden”? 73 for a large fraction of the women for which it is relevant.4 Finally, advocates should argue for the application of the standard to all informed consent provisions—both those already in operation in the State and those proposed in the legislation at issue—such that the provisions combined create a substantial obstacle. Even these stronger iterations of the standard, however, will only slow (at best) the introduction of new and more restrictive measures on abortion.5 II. A History of the Undue Burden Standard Prior to Roe v. Wade, the United States Supreme Court had not grounded the right of privacy in any one constitutional provi- sion.6 The discussion of privacy began, however, in 1965, when Gris- wold v. Connecticut affirmed the right of married couples to use contraception.7 A majority of the Court in Griswold found a “zone of privacy”8 to exist in the marital bedroom, but placed the right in the “penumbras” that are “formed by emanations” from various constitutional provisions.9 The Griswold Court did not situate this zone of privacy in any one constitutional provision; rather, Justice Douglas located it in no less than five separate constitutional amendments.10 The Court may not have intended for its holding in 4 Casey, 505 U.S. at 895. 5 Still, in the current political climate, slowing down “the other side” is sometimes the last line of defense against retrogressive policies. It is question- able whether or not the courts are the place for this, but hopefully a strength- ened standard on the Court would help withstand attacks from an increasingly virulent anti-choice legislative contingency. 6 It is contested that a specific “right to privacy” was even articulated here. See Ruthann Robson, Lesbians and Abortion, 35 N.Y.U. Rev. L. & Soc. Change 247, 249 (2011) (“The word ‘privacy’ is not in the text of the Constitution and the Court in Griswold had a difficult time grounding the right in any specific con- stitutional provision. Justice Douglas famously opined that ‘specific guarantees in the Bill of Rights have penumbras, formed by emanations from those guar- antees that help give them life and substance.’ The first case in which a majority of the United States Supreme Court agreed that ‘privacy’ was grounded in the liberty guarantee of the Due Process Clause of the Fourteenth Amendment was Roe v. Wade, [410 U.S. 113 (1973)] the case in which the Court first held that a state statute criminalizing abortion was unconstitutional.” (footnotes omit- ted)). But cf. Lackland H. Bloom, Jr., The Legacy of Griswold, 16 Ohio N.U. L. Rev. 511, 512 (1989) (“If Griswold is remembered for one thing, it is surely for having effectively given birth to the concept of an independent constitutional right of privacy.”). 7 Griswold v. Connecticut, 381 U.S. 479, 485-86 (1965). 8 Id. at 485. 9 Id. at 484. 10 See id. (finding zones of privacy in the First, Third, Fourth, Fifth, and Ninth Amendments). 74 UCLA Women’s Law JOURNAL [Vol. 20.1 Griswold to help establish a woman’s right to choose an abortion.11 Even so, after Eisenstadt v. Baird extended the right to contracep- tion to unmarried individuals,12 Roe v. Wade was not far behind.13 In establishing the right of unmarried persons to obtain con- traception, Eisenstadt expanded the “zone of privacy” outside the sphere of the marital bedroom and into the lives of individuals. One year later, Roe firmly located the individual right to privacy (in the abortion context) in the Due Process Clause of the Fourteenth 14 Amendment, establishing a woman’s right to have a pre-viability abortion if she chose.15 Roe provided the governing standard for abortion rights until 1992, when Planned Parenthood v. Casey artic- ulated a new standard by which abortion rights are now measured.16 Since the Court in Roe found that abortion fell under the fundamental right to privacy,17 it applied a strict scrutiny analysis,18 requiring that regulations be narrowly tailored to achieve a com- pelling state interest.19 The Roe court decided that the government had two compelling interests: “preserving and protecting the health of the pregnant woman” and “protecting the potentiality of human life.”20 These interests, however, became compelling at different times during a woman’s pregnancy. While the first trimester was to remain free of government interference,21 a woman’s health became a compelling state interest in the second trimester, and potential life became a compelling state interest at viability.22 The Court gave 11 See Robert M. Godzeno, Note, The Role of Ultrasound Imaging in In- formed Consent Legislation Post-Gonzales v.