Bragdon v. Abbott
524 U.S. 624 (1998)
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Rule of Law:
An individual with asymptomatic Human Immunodeficiency Virus (HIV) has a 'disability' under the Americans with Disabilities Act of 1990 because the infection is a physical impairment that substantially limits the major life activity of reproduction. A healthcare provider's refusal to treat such an individual is not justified as a 'direct threat' unless the assessment of risk is based on objective, scientific evidence, not subjective belief.
Facts:
- Sidney Abbott had been infected with the Human Immunodeficiency Virus (HIV) since 1986, but at the time of the events, her infection was asymptomatic.
- On September 16, 1994, Abbott visited the dental office of Dr. Randon Bragdon for a check-up.
- On the patient registration form, Abbott disclosed that she was HIV-positive.
- Dr. Bragdon completed a dental examination and discovered a cavity in one of Abbott's teeth.
- Bragdon informed Abbott that he would not fill her cavity in his office due to his policy regarding HIV-infected patients.
- Bragdon offered to perform the procedure at a local hospital, but specified that Abbott would be responsible for the additional costs of using the hospital's facilities.
- Abbott declined Bragdon's offer to be treated at a hospital.
Procedural Posture:
- Sidney Abbott sued Dr. Randon Bragdon in the U.S. District Court for the District of Maine, alleging discrimination in violation of the ADA.
- The United States and the Maine Human Rights Commission intervened as plaintiffs.
- On cross-motions for summary judgment, the District Court (trial court) ruled in favor of Abbott.
- The District Court held that Abbott's asymptomatic HIV infection was a disability under the ADA and that Bragdon had not raised a genuine issue of material fact regarding a 'direct threat'.
- Bragdon, as appellant, appealed the decision to the U.S. Court of Appeals for the First Circuit.
- The Court of Appeals (intermediate appellate court) affirmed the District Court's judgment.
- Bragdon, as petitioner, successfully petitioned the U.S. Supreme Court for a writ of certiorari.
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Issue:
Does asymptomatic HIV infection constitute a 'disability' under the Americans with Disabilities Act of 1990 because it substantially limits the major life activity of reproduction?
Opinions:
Majority - Justice Kennedy
Yes, asymptomatic HIV infection is a disability under the ADA. To determine if an individual has a disability, the Court employs a three-part analysis: (1) is there a physical impairment, (2) does it affect a major life activity, and (3) does it substantially limit that activity. First, HIV is a physical impairment from the moment of infection because it immediately begins to damage the hemic and lymphatic systems. Second, reproduction is a 'major life activity' under the ADA, as it is central to the life process; the statute does not limit such activities to those of a public or economic character. Third, HIV substantially limits reproduction in two ways: the significant risk of transmitting the virus to a sexual partner, and the significant risk of transmitting it to a child during gestation and birth. Even an 8% risk of perinatal transmission with treatment constitutes a substantial limitation, as the ADA addresses 'substantial limitations,' not 'utter inabilities.' On the 'direct threat' issue, a healthcare provider’s assessment must be based on objective scientific evidence available at the time, not subjective beliefs. The views of public health authorities carry special weight but are not conclusive. The case is remanded for the Court of Appeals to re-evaluate the evidence regarding whether Bragdon's refusal was based on an objective, medically reasonable assessment of risk.
Concurring - Justice Stevens
Agrees with the majority's conclusion that asymptomatic HIV is a disability under the ADA. However, he would have affirmed the Court of Appeals' judgment outright, believing that Bragdon had failed to present sufficient evidence to create a triable issue of fact on the 'direct threat' defense. He joins the majority opinion only to ensure there is a majority supporting the judgment to remand the case.
Concurring - Justice Ginsburg
Agrees that HIV infection is a disability under the ADA, noting that the disease pervades all of an individual's life choices and affects their ability to obtain healthcare. She agrees with the decision to remand the 'direct threat' issue, viewing it as a cautious approach that ensures a fully informed determination on whether treating Abbott posed a significant risk to Bragdon.
Concurring-in-part-and-dissenting-in-part - Chief Justice Rehnquist
No, asymptomatic HIV is not a disability under the ADA based on the facts presented. The disability inquiry must be individualized, and there is no evidence that reproduction was a major life activity for Abbott personally before her diagnosis. Furthermore, reproduction is not a 'major life activity' in the same sense as the daily functions listed in the regulations (e.g., walking, working). Even if it were, Abbott's ability to reproduce is not 'substantially limited,' as she is physically capable of conception and childbirth; her decision not to do so is a voluntary choice based on risk, not a physical limitation imposed by the impairment. He concurs in the judgment to remand, but disagrees that courts should give 'special weight' to the views of public health authorities in private litigation, arguing their scientific claims must stand on their own merit.
Concurring-in-part-and-dissenting-in-part - Justice O’Connor
Agrees with the dissent that Abbott failed to prove her asymptomatic HIV status substantially limited a major life activity on an individualized basis. She argues that the act of giving birth is not comparable to the representative major life activities listed in the ADA's regulations, such as walking, seeing, and working. She joins the part of Chief Justice Rehnquist's opinion that concludes the 'direct threat' issue was not properly decided and requires a remand.
Analysis:
This landmark decision was the Supreme Court's first interpretation of the definition of 'disability' under the ADA. The ruling significantly broadened the scope of the Act by establishing that an asymptomatic condition, such as HIV, can constitute a disability. By recognizing reproduction as a major life activity, the Court clarified that such activities need not be public, economic, or performed daily to be protected. The decision also set a crucial precedent for the 'direct threat' defense, requiring an individualized assessment based on objective medical evidence, thus limiting the ability of providers to deny services based on stereotype or unsubstantiated fear. This framework has since been applied to a wide range of disability claims and has shaped how courts and employers evaluate both disabilities and safety risks.
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