Poelker v. Doe (1977)

In Depth

Background

Jane Doe, an indigent woman, was denied a nontherapeutic (elective) abortion at one of the two city-owned public hospitals in St. Louis, Missouri.  She subsequently brought a lawsuit in federal district court against the Mayor of St. Louis (John Poelker) and the Director of Health and Hospitals, alleging that the hospital's refusal to provide her with the desired abortion violated her constitutional rights.

The district court ruled against Doe and she appealed.  The court of appeals reversed.  The court concluded that Doe's inability to obtain an abortion resulted from a combination of a policy directive by the Mayor and a longstanding staffing practice at the hospital.  The mayoral directive prohibited the performance of an abortion in city hospitals except when there was a threat of grave physiological injury or death to the mother.  Under the staffing practice, the physicians and medical students at the obstetrics-gynecology clinic at the hospital are drawn from the faculty and students at the St. Louis University School of Medicine, a Jesuit-operated institution opposed to abortion.  Relying upon Roe v. Wade, 410 U.S. 113 (1973), and Doe v. Bolton, 410 U.S. 179 (1973), the court of appeals held that the city's policy and the hospital's staffing practice denied the constitutional rights of indigent pregnant women. Treating the case as an equal protection issue, the court of appeals found that providing publicly financed hospital services for childbirth but not for elective abortions constituted invidious discrimination.  The court also emphasized that nonindigent women could afford to obtain abortions in private hospitals while indigent women could not.

The Policies Under Review

No statutes were challenged in Poelker.  At issue were the directive issued by the mayor prohibiting the performance of nontherapeutic abortions at city hospitals and the staffing policy of the particular city hospital where Jane Doe sought an abortion.

The Court's Holding

By a six-to-three vote, the Supreme Court upheld the mayoral directive and the hospital's staffing practice, finding "no constitutional violation by the city of St. Louis in electing, as a policy choice, to provide publicly financed hospital services for childbirth without providing corresponding services for nontherapeutic abortions."  Poelker, 432. U.S. at 521.

The Court's Reasoning

Poelker was one of a trilogy of cases decided the same day by the Supreme Court.  The other two cases were Beal v. Doe, 432 U.S. 438 (1977), and Maher v. Roe, 432 U.S. 464 (1977).  In Beal, the Court held that the States have no statutory obligation under the Medicaid program (Title XIX of the Social Security Act) to use state funds to pay for the cost of nontherapeutic (elective) abortions.  In Maher, the Court held that there was no constitutional violation in a State deciding to fund childbirth, but not nontherapeutic (elective) abortions.  The Court in Poelker agreed that "the constitutional question presented . . . is identical in principle with that presented by a State's refusal to provide Medicaid benefits for abortions while providing them for childbirth."  432 U.S. at 521.  Based on its holding in Maher, the Court upheld the policies challenged in Poelker.  Id.  The Court also rejected as irrelevant the emphasis the court of appeals and the plaintiff had placed on Mayor Poelker's personal opposition to abortion. Id. The Court noted that the mayor "is an elected official responsible to the people of St. Louis," and "[h]is policy of denying city funds for abortions . . . is subject to public debate and approval or disapproval at the polls."  Id.  Justices Brennan, Marshall and Blackmun dissented.  For an analysis of their dissents, as well as an analysis of the statutory and constitutional issues decided in Beal v. Doe and Maher v. Roe, please see the summaries for those cases.