Snapped Shot

§ 2. (c)(i) The Act’s text discloses that it prohibits a doctor from intentionally performing an intact D&E. Its dual prohibitions correspond with the steps generally undertaken in this procedure: The doctor (1) delivers the fetus until its head lodges in the cervix, usually past the anatomical landmark for a breech presentation, see §1531(b)(1)(A), and (2) proceeds to the overt act of piercing or crushing the fetal skull after the partial delivery, see §1531(b)(1)(B). The Act’s scienter requirements limit its reach to those physicians who carry out the intact D&E, with the intent to undertake both steps at the outset. The Act excludes most D&Es in which the doctor intends to remove the fetus in pieces from the outset. This interpretation is confirmed by comparing the Act with the Nebraska statute in Stenberg. There, the Court concluded that the statute encompassed D&E, which “often involve[s] a physician pulling a substantial portion’ of a still living fetus . . . , say, an arm or leg, into the vagina prior to the death of the fetus,” 530 U. S., at 939, and rejected the Nebraska Attorney General's limiting interpretation that the statute’s reference to a “procedure that “kill[s] the unborn child” was to a distinct procedure, not to the abortion procedure as a whole, id., at 943. It is apparent Congress responded to these concerns because the Act adopts the phrase delivers a living fetus,” 18 U. S. C. §1531(b)(1)(A), instead of “ ‘delivering . . . a living unborn child, or a substantial portion thereof,’ ” 530 U. S., at 938, thereby targeting extraction of an entire fetus rather than removal of fetal pieces; identifies specific anatomical landmarks to which the fetus must be partially delivered, §1531(b)(1)(A), thereby clarifying that the removal of a small portion of the fetus is not prohibited; requires the fetus to be delivered so that it is partially “outside the [mother’s] body,” §1531(b)(1)(A), thereby establishing that delivering a substantial portion of the fetus into the vagina would not subject a doctor to criminal sanctions; and adds the overt-act requirement, §1531(b)(1), thereby making the distinction the Nebraska statute failed to draw (but the Nebraska Attorney General advanced). Finally, the canon of constitutional avoidance, see, e.g., Edward J. DeBartolo Corp. v. Florida Gulf Coast Building & Constr. Trades Council, 485 U. S. 568, 575, extinguishes any lingering doubt. Interpreting the Act not to prohibit standard D&E is the most reasonable reading and understanding of its terms.

§ 3. (b) This traditional rule is consistent with Casey, which confirms both that the State has an interest in promoting respect for human life at all stages in the pregnancy, and that abortion doctors should be treated the same as other doctors. Medical uncertainty does not foreclose the exercise of legislative power in the abortion context any more than it does in other contexts. Other considerations also support the Court’s conclusion, including the fact that safe alternatives to the prohibited procedure, such as D&E, are available. In addition, if intact D&E is truly necessary in some circumstances, a prior injection to kill the fetus allows a doctor to perform the procedure, given that the Act’s prohibition only applies to the delivery of “a living fetus,” 18 U. S. C. §1531(b)(1)(A). Planned Parenthood of Central Mo. v. Danforth, 428 U. S. 52, 77–79, distinguished. [ed.: All emphasis mine.]