Rust v. Sullivan

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Rust v. Sullivan
Seal of the United States Supreme Court.svg
Argued October 30, 1990
Decided May 23, 1991
Full case name Irving Rust, et al., Petitioners v. Louis W. Sullivan, Secretary of Health and Human Services; New York, et al., Petitioners v. Louis W. Sullivan, Secretary of Health and Human Services
Citations 500 U.S. 173 (more)
111 S. Ct. 1759; 114 L. Ed. 2d 233; 1991 U.S. LEXIS 2908; 59 U.S.L.W. 4451; 91 Cal. Daily Op. Service 3713; 91 Daily Journal DAR 6006
Prior history Summary judgment for defendant, 690 F. Supp. 1261 (S.D.N.Y. 1988); affirmed, 889 F.3d 401 (2d Cir. 1989).
Health and Human Services regulations prohibiting recipients of government funds from advocating, counseling, or referring patients for abortion were a permissible construction of Title X of the Act, nor did they violate the First or Fifth Amendments.
Court membership
Case opinions
Majority Rehnquist, joined by White, Scalia, Kennedy, Souter
Dissent Blackmun, joined by Marshall; Stevens (parts II, III); O'Connor (part I)
Dissent Stevens
Dissent O'Connor
Laws applied
U.S. Const. amends. I, V; Public Health Service Act, 42 U.S.C. §§ 300300a-8

Rust v. Sullivan, 500 U.S. 173 (1991), was a United States Supreme Court case that found restrictions on funding with regard to abortion counseling to be constitutionally permissible.


The case concerned the legality and constitutionality of Department of Health and Human Services regulations on the use of funds spent by the U.S. federal government to promote family planning (Title X). With Title X of the Public Health Service Act, Congress prohibited the funds from being "used in programs where abortion is a method of family planning." In 1988, the Republican-appointed Secretary of Health and Human Services issued new regulations that prohibited projects receiving these funds from not only providing abortions, but also counseling, advising, or promoting the idea that a woman seek an abortion. These regulations were challenged on the grounds that they were not permissibly within the scope of the statute and that they violated the First and Fifth Amendments.

Opinion of the Court[edit]

In its decision, the Court ruled that the regulations did not violate the legislation in question or the Constitution. Chief Justice William Rehnquist wrote for the majority in finding that the regulations were a permissible construction of statutory law, that they did not violate the First Amendment free speech rights of the recipients, and that they did not violate the Fifth Amendment right of women to choose whether to terminate a pregnancy as established in Roe v. Wade (1973).


Section 1008 of the Public Health Service Act specified that none of the federal funds appropriated under the Act's Title X for family-planning services "shall be used in programs where abortion is a method of family planning." In 1988, respondent Secretary of Health and Human Services issued new regulations requiring, inter alia, that recipients of the federal funding (1) not engage in any counseling regarding abortion as a method for family planning; and (2) maintain an objective integrity and independence from abortion activities by the use of separate facilities, personnel, and accounting records.

The Court held that the regulations were a permissible construction of the statute and consistent with the First and Fifth Amendments.

(1) The regulations were a permissible construction of Title X. The regulations did not violate the First Amendment free-speech rights of private Title X fund recipients, their staffs, or their patients by impermissibly imposing viewpoint-discriminatory conditions on government subsidies. Section 1008's abortion prohibition was constitutional because the government might make a value judgment favoring childbirth over abortion and implement that judgment by using subsidies of public funds. Maher v. Roe, 432 U.S. 464, 474 (1977). The use of public subsidies by the government was not rendered “discrimination” simply by the government's favoring one viewpoint over another.

(2) The Secretary's construction of Title X must be accorded substantial deference by this Court because: (a) HHS was the agency charged with administering Title X, and (b) the Court could not look to § 1008 of Title X for interpretation. Section 1008 was ambiguous because it did not speak directly to abortion issues regarding counseling, and did not provide any guidance as to what was meant by “program integrity”. Moreover, the title neither defined § 1008's "method of family planning" phrase, nor enumerated what types of medical and counseling services were entitled to funding. The Secretary’s construction of § 1008 would not be disturbed since (a) it was a plausible construction of the statute's plain language, (b) it did not conflict with Congress' expressed intent, and (c) the legislative history either was ambiguous as to Congress' intent on those issues or supported the Secretary’s interpretation. The legislative history demonstrated that Congress had intended that Title X funds be kept separate and distinct from abortion-related activities. An agency must be given ample latitude to adapt its rules to changing circumstances. Thus, an interpretation that was different from previous interpretations deserved deference if it complimented the changes in circumstances. The Secretary's change of interpretation was amply supported by a "reasoned analysis" as the new regulations were more in keeping with Title X’s original intent, which was supported by the testimony of client experience under the prior policy.

(3) The Doctors' argument, that if the Government chooses to subsidize one viewpoint over a subject (here, abortion), then it must also balance that viewpoint by subsidizing its opposite, had clearly been rejected by the Court. Comparing, e.g., Regan v. Taxation with Representation of Washington, 461 U.S. 540 (1983). The regulations do not force the Title X grantee, or its employees, to give up abortion-related speech; they merely require that such activities be kept separate and distinct from the activities of the Title X project. F.C.C. v. League of Women Voters of California, 468 U.S. 364, 400 (1984); Regan, 461 U.S. at 546, distinguished.

(4) Although it could be argued that the traditional doctor-patient relationship should enjoy First Amendment protection from government regulation, even when subsidized by the government (comparing, e.g., United States v. Kokinda, 497 U.S. 720, 726 (1990)), that question need not be resolved, since the Title X program's regulations did not significantly impinge on the doctor-patient relationship.

(5) The regulations did not violate a woman's Fifth Amendment right to choose whether to terminate her pregnancy. The government had no constitutional duty to subsidize an activity merely because it was constitutionally protected, and might validly choose to allocate public funds for medical services relating to childbirth but not to abortion. Webster v. Reproductive Health Services, 492 U.S. 490, 510 (1989). Such allocation placed no governmental obstacle in the path of a woman wishing to terminate her pregnancy, and left her with the same choices as if the Government had chosen not to fund family planning services at all. See Harris v. McRae (1980). Nor did the regulations place restrictions on the patient/doctor dialogue which violated a woman's right to make an informed and voluntary choice under City of Akron v. Akron Center for Reproductive Health (1983) and Thornburgh v. American College of Obstetricians and Gynecologists (1986). A doctor's ability to provide abortion-related information and a woman's right to receive such information remained unfettered outside the context of the Title X project.

See also[edit]

Further reading[edit]

  • Fitzpatrick, Michael (1992). "Rust Corrodes: The First Amendment Implications of Rust v. Sullivan". Stanford Law Review. Stanford Law Review, Vol. 45, No. 1. 45 (1): 185–227. doi:10.2307/1228987. JSTOR 1228987. 
  • Kagan, Elena (1992). "The Changing Faces of First Amendment Neutrality: R.A.V. v St. Paul, Rust v Sullivan, and the Problem of Content-Based Underinclusion". The Supreme Court Review. The Supreme Court Review, Vol. 1992. 1992: 29–77. JSTOR 3109667. 
  • Leedes, G. C. (1991). "The discourse ethics alternative to Rust v. Sullivan". University of Richmond Law Review. 26 (1): 87–143. PMID 11659547. 

External links[edit]