Singleton v. Wulff (1976)
Under a Missouri statute (subsequently repealed and replaced
with another statute), only the costs of "medically indicated"
abortions were reimbursable under the State's Medicaid
program. Two physicians brought a lawsuit in federal district
court against the Chief of the Bureau of Medical Services,
Department of Health and Welfare, alleging that the statute
violated the constitutional rights of the physicians, as well as
those of their patients. The physicians claimed that the
statute was vague, deprived them of their right to practice
medicine "according to the highest standards of medical practice,"
deprived their patients of their "fundamental right" to choose an
abortion, interfered with the physicians "right to render and their
patients' right to receive safe and adequate medical advice and
treatment," and denied both the physicians and their patients the
equal protection of the laws. Singleton, 428 U.S. at 110
(reciting plaintiffs' claims).
The district court dismissed plaintiffs' action "for lack of
standing," i.e., the physicians were not the proper
parties to challenge the funding restriction. The court of
appeals reversed, determined that the physicians had standing to
challenge the statute and went on to hold that the statute violated
the Equal Protection Clause of the Fourteenth Amendment.
The Statute Under Review
The Missouri Medicaid plan includes a list of twelve categories
of medical services that are eligible for Medicaid funding.
The final category, the subject of the litigation, provided:
services defined by federal rules and regulations; provided,
however, that such family planning services shall not include
abortions unless such abortions are medically indicated.
Mo. Rev. Stat. § 208.152(12).
The Court's Holding
All of the justices agreed that the physicians had standing to
raise their own financial interests in seeking reimbursement for
abortions that were not "medically indicated" under the
statute. The justices were sharply divided, however, on
whether the physicians had standing to represent the interests of
their Medicaid-eligible patients. Four justices expressed the view
that the physicians had standing to represent their patients'
interests, four justices disagreed and one justice
expressed no view on whether the physicians would have had
standing to represent their patients' interests if they had not had
any interests of their own to raise. All of the justices
agreed that the court of appeals had erred in reaching the merits
of the plaintiffs' constitutional challenge. Once the court
of appeals had determined that the physicians had standing, it
should have remanded the case to the district court for further
proceedings on the merits of their underlying claim.
The Court's Reasoning
The Court quickly disposed of the issue of the physicians'
standing to represent their own financial interests. To
maintain their standing, they needed to allege an "injury-in-fact,"
that is "a sufficiently concrete interest in the outcome of their
suit to make it a case or controversy subject a federal court's
Article III jurisdiction." Singleton, 428 U.S. at
112. That requirement was easily met because, if the
physicians prevailed in their lawsuit, they would benefit
financially "for they will then receive payment for the abortions"
they perform on indigent women. Id. at 113.
The Court expressed no opinion on whether the physicians had a
constitutional right "to practice medicine," but added that, if
they do, they could assert them in the underlying litigation.
The more difficult issue, and the one on which the Court was
divided, was whether the physicians had standing to represent the
interests of third parties, specifically, their women patients who
were Medicaid-eligible and sought abortions that were not
Justice Blackmun's plurality opinion on this aspect of the case,
which was joined by Justices Brennan, White and Marshall, began by
noting that third party standing involves prudential considerations
as to whether a given plaintiff is the proper proponent of the
legal rights of others. Third party standing is not favored
for two reasons: First, the rights of third parties who are
not before the court should not be adjudicated unnecessarily.
"It may be," the plurality said, that "the holders of those rights
either do not wish to assert them, or will be able to enjoy them
regardless of whether the in-court litigant is successful or
not." Singleton, 428 U.S. at 113-14. Second,
"third parties themselves usually will be the best proponents of
their own rights." Id. at 114. "The courts
depend on effective advocacy, and therefore should prefer to
construe legal rights only when the most effective advocates of
those rights are before them." Id.
Notwithstanding these considerations, the plurality noted that
in certain situations there may be countervailing considerations
that allow for third party standing. Two factors that the
courts have looked at are the relationship of the litigant to the
person whose right he seeks to assert and, the ability of the third
party to assert his own rights. Singleton, 428 U.S.
at 114-16. With respect to the former factor, "[i]f the
enjoyment of the right is inextricably bound up with the activity
the litigant wishes to pursue, the court at least can be sure that
its construction of the right is not unnecessary in the sense that
the right's enjoyment will be unaffected by the outcome of the
case." Id. at 114-15. With respect to the
latter factor, third party standing may be appropriate where "there
is some genuine obstacle to [the] assertion [of the third party's
rights]." Id. at 115.
Applying these factors, the plurality concluded that the
physicians could assert the rights of their patients. First,
the relationship between the physician and the patient is close
because "[a] woman cannot safely secure an abortion without the aid
of a physician, and an impecunious woman cannot easily secure an
abortion without the physician's being paid by the State."
Id. at 117. Accordingly, "[t]he woman's exercise of
her right to an abortion . . . is therefore necessarily at
stake." Id. "Aside from the woman herself, . . . the
physician is uniquely qualified to litigate the constitutionality
of the State's interference with, or discrimination against, that
Second, for reasons of privacy, the woman might not want to
bring her own lawsuit. Moreover, her case may become moot
during the course of litigation once she is no longer
The plurality recognized that a pregnant woman may file her suit
under a pseudonym and also recognized that the mootness of her
lawsuit (by giving birth or obtaining an abortion) would not
prevent her from pursuing it to a final judgment. And,
certainly, a class may be assembled whose membership always
included some women with "live claims." Id. But if
the assertion of her rights is representative to such an extent,
"there seems little loss in terms of effective advocacy from
allowing the its assertion by a physician." Id. at
117-18. The plurality concluded that "it generally is
appropriate to allow a physician to assert the rights of women
patients as against governmental interference with the abortion
decision . . . ." Id. at 118. Finally,
as, previously noted, the Court unanimously decided that the court
of appeals had erred in reaching the merits of the physicians'
constitutional claims once it determined that they had standing to
pursue their own interests and to represent the interests of their
women patients. Id. at 119-21. The court of
appeals should have remanded the case to the district court for
The Concurring And Dissenting Opinions
In a short, two-paragraph opinion concurring in part, Justice
Stevens agreed that the physicians had standing to sue to vindicate
their own interests. As a consequence, they also had standing
to represent the interests of their patients.
Singleton, 428 U.S. at 121-22 (Stevens, J., concurring in
part). Justice Stevens, however, was not sure that, apart
from their own asserted interests, the physicians would have
standing to represent the interests of their patients.
Accordingly, he did not join the key part of the plurality opinion
(Part II-B). Id. at 122. Nevertheless, because
he agreed that, under the circumstances of the case, the physicians
could assert the interests of their pregnant, Medicaid-eligible
patients, his opinion provided the fifth vote needed to allow them
to represent their patients in the subsequent proceedings in the
Justice Powell, joined by Chief Justice Burger, Justice Stewart
and Justice Rehnquist, dissented from the plurality's analysis of
third party standing. Justice Powell expressed the view that
third party standing should be allowed only when litigation by the
actual holders of the rights involved "is in all practicable terms
impossible." Singleton, 428 U.S. at 126 (Powell, J.,
concurring in part and dissenting in part). No such
impossibility was shown, however. Moreover, even under the
plurality's more expansive view of third party standing, the
physicians should have been denied standing to represent the
interests of their women patients. The alleged "obstacles" to
the patients' assertion of their own rights, Justice Powell
concluded, were more apparent than real. The women patients
could have brought suit using pseudonyms and the "mootness" of
their claims would not bar judicial review so long as the claims
existed at the time they filed suit. Id. Insofar as
the "confidential relationship" between the holder of the right and
the party seeking to assert her rights is concerned, Justice Powell
emphasized that third party standing had been allowed only where
"the State directly interdicted the normal functioning of the
physician-patient relationship by criminalizing certain
procedures." Id. at 128. In those circumstances,
"one party to the relationship should be permitted to assert the
constitutional rights of the other, for a judicial rule of
self-restraint should not preclude an attack on a State's
proscription of constitutionally protected activity."
Id. But the statute at issue in
Singleton-restricting public funding of abortions-did not
directly interfere with the physician-patient relationship and
imposed no criminal penalties. Id. Finally,
Justice Powell expressed concern that the plurality's analysis of
third party standing would open the door to allowing any provider
of services to assert his client's or his customer's constitutional
rights, if any, in an attack on a welfare statute that excludes
from coverage his particular transaction." Id. at
129-30. "The Court's holding invites litigation by those who
perhaps have the least legitimate ground for seeking to assert the
rights of third parties." Id. at 130.