Forsythe Clark
Issues Law Med. 2014 Fall;29(2):183-230.
Too little attention has been paid over the past forty years to the complete lack of a factual record in Roe v. Wade and Doe v. Bolton, and to the Court's fundamental assumption that drove the outcome. The decision and opinions were driven by the medical claim that "abortion was safer than childbirth," which was raised for the first time in the briefs in the Supreme Court without any lower court record. This medical premise directly and profoundly shaped virtually every major aspect of Roe and Doe, including the creation of the trimester system and the prohibition of health and safety regulations in the first trimester. Because of this medical assumption, the Justices extended the right to abortion throughout pregnancy. It was key to the Court's historical rationale for a "right" to abortion. Because of this notion, the Justices gave abortion providers complete discretion to manage any issues of health and safety, and they prohibited public health officials from regulating abortion in the first trimester. This medical assumption was the most consequential factual assumption of the abortion decisions of 1973 and it has been assumed to be true in subsequent abortion decisions by the Court. The notion that "abortion is safer than childbirth" has become even less tenable for at least five reasons: (1) the dysfunctional abortion data reporting system in the United States that relies completely on voluntary reporting; (2) the incomparability of the published abortion mortality rate and the published maternal (childbirth) mortality rate; (3) medical data on the increasing rate of maternal mortality in the second trimester; (4) the growing body of international medical studies finding long-term risks to women from abortion; and (5) maternal mortality data from countries with superior abortion recordkeeping collection and reporting systems, which find a higher rate of abortion mortality than childbirth mortality. These concerns and the growth in international medical data over the past two decades should counsel the Supreme Court to give greater deference to the states in their attempt to protect maternal health.
在过去四十年里，人们对罗诉韦德案和多伊诉博尔顿案中完全缺乏事实记录，以及对推动案件结果的最高法院的基本假设关注太少。该判决和意见书是由“堕胎比分娩更安全”这一医学主张推动的，这一主张首次在最高法院的案情摘要中提出，且没有任何下级法院的记录。这一医学前提直接且深刻地塑造了罗诉韦德案和多伊诉博尔顿案几乎所有的主要方面，包括三期分类系统的创建以及对孕早期健康和安全法规的禁止。由于这一医学假设，大法官们将堕胎权扩展至整个孕期。这是最高法院关于堕胎“权利”的历史依据的关键所在。基于这一观念，大法官们赋予堕胎提供者处理任何健康和安全问题的完全酌处权，并禁止公共卫生官员在孕早期对堕胎进行监管。这一医学假设是1973年堕胎判决中最重要的事实假设，且在最高法院随后的堕胎判决中一直被假定为真。“堕胎比分娩更安全”这一观念因至少五个原因而变得更站不住脚：（1）美国功能失调的堕胎数据报告系统，该系统完全依赖自愿报告；（2）已公布的堕胎死亡率与已公布的孕产妇（分娩）死亡率不可比；（3）关于孕中期孕产妇死亡率上升速度的医学数据；（4）越来越多的国际医学研究发现堕胎对女性存在长期风险；（5）来自堕胎记录保存、收集和报告系统更完善的国家的孕产妇死亡率数据，这些数据显示堕胎死亡率高于分娩死亡率。这些担忧以及过去二十年来国际医学数据的增长，应促使最高法院在各州试图保护孕产妇健康时给予更多尊重。
