The College points out that Dr. Carhart does not reposition the fetus thereby avoiding any risks stemming from conversion to breech presentation, and that, as compared with D&X, D&E involves the same, if not greater, "blind" use of sharp instruments in the uterine cavity. App. App. Id., at 877. The Court’s holding contradicts Casey’s assurance that the State’s constitutional position in the realm of promoting respect for life is more than marginal. The participants, Nebraska has determined, cannot be indifferent to the procedure used and must refrain from using the natural delivery process to kill the fetus. He noted that government had no right to force doctors to perform any procedure other than what they felt would be the safest. Approximately 10% of all abortions are performed during the second trimester of pregnancy (12 to 24 weeks). Stat.

There is no other abortion procedure which could be confused with that description.” AMA Factsheet 3 (internal quotation marks omitted).

Compare Henshaw, Abortion Incidence and Services in the United States, 1995-1996, 30 Family Planning Perspectives 263, 268 (1998), with Joint Hearing on S. 6 and H. R. 929 before the Senate Committee on the Judiciary and the Subcommittee on the Constitution of the House Committee on the Judiciary, 105th Cong., 1st Sess., 46 (1997). 4. 495, 496; Medical and Surgical Abortion 139, 142; Lawson, 171 Am. The lower courts also blocked enforcement of another portion of the law that required the disposal of aborted fetuses through burial or cremation. It is quite wrong for the Court to conclude, as it seems to have done here, that Dr. Carhart conforms his practice to the proper standard of care because he has incorporated the procedure into his practice.

We again consider the right to an abortion. Dr. Carhart testified he attempts to use the intact D&E procedure during weeks 16 to 20 because (1) it reduces the dangers from sharp bone fragments passing through the cervix, (2) minimizes the number of instrument passes needed for extraction and lessens the likelihood of uterine perforations caused by those instruments, (3) reduces the likelihood of leaving infection-causing fetal and placental tissue in the uterus, and (4) could help to prevent potentially fatal absorption of fetal tissue into the maternal circulation. It "rarely reviews a construction of state law agreed upon by the two lower federal courts." Medical descriptions of the abortion procedures confirm the point, for it is only the description of the D&X that invokes the word “delivery.” App. See 11 F. Supp. Nebraska responds that the law does not require a health exception unless there is a need for such an exception. The statute defines “partial birth abortion” as. See 11 F. Supp. Chief Justice William Rehnquist, along with Antonin Scalia, and Thomas had consistently said that they did not believe abortion is a protected right, and had pointed out that "privacy" is not explicitly mentioned in the Constitution. Id., at 877. Especially for women with particular health conditions, there is medical evidence that D&X may be safer than available alternatives." That D&X procedures usually take less time than other abortion methods used at a comparable stage of pregnancy can also have health advantages. Dr. Carhart wanted to use a modified version of this called "D&X" (Dilation and Extraction), which, rather than commencing curettage inside the uterus, extracts part of the fetus first and then begins the process of dismemberment. For the reasons stated, it is not reasonable to replace the term "substantial portion" with the Attorney General's phrase "body up to the head." If the fetus presents head first (a vertex presentation), the doctor collapses the skull; and the doctor then extracts the entire fetus through the cervix. Gynecol. 2d, at 1108. It was not compelled to commit a matter involving the public health and safety to the final decision of a court or jury. Brief for Petitioners 32. Id., at 1105. Today, however, the medical profession has switched from medical induction of labor to surgical procedures for most second trimester abortions. Because fetal tissue is friable and easily broken, the fetus may not be removed intact. It found that the D&X procedure permits the fetus to pass through the cervix with a minimum of instrumentation. In a free country, where government is by the people, through their chosen representatives, practical legislation admits of no other standard of action.’ ” Id., at 35 (quoting Viemester v. White, 179 N. Y. The Court’s holding stems from misunderstanding the record, misinterpretation of Casey, outright refusal to respect the law of a State, and statutory construction in conflict with settled rules. The test, first developed in the late 19th century, is widely used in American constitutional law. §28-326(9). Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833 (1992). 2d ed. Casey banished this doctrine from our jurisprudence; yet the Court today reinvigorates it and, in the process, ignores its obligation to interpret the law in a manner to validate it, not render it void. Stenberg v. Carhart Opinion of the Court by Stephen Breyer. "deliberately and intentionally delivering into the vagina a living unborn child, or a substantial portion thereof, for the purpose of performing a procedure that the person performing such procedure knows will kill the unborn child and does kill the unborn child."

5. Other states with similar laws may also be impacted. Of the two described procedures, Nebraska seeks only to ban the D&X.

Id., at 61. The State's interest in regulating abortion previability is considerably weaker than postviability. It nonetheless concluded that the Attorney General's interpretation would "twist the words of the law and give them a meaning they cannot reasonably bear." Rather, the uncertainty means a significant likelihood that those who believe that D&X is a safer abortion method in certain circumstances may turn out to be right. The Jacobson Court quoted with approval a recent state-court decision which observed, in words having full application today: “The fact that the belief is not universal [in the medical community] is not controlling, for there is scarcely any belief that is accepted by everyone. The statute defines "partial birth abortion" as: "an abortion procedure in which the person performing the abortion partially delivers vaginally a living unborn child before killing the unborn child and completing the delivery." At trial, Dr. Carhart and Dr. Stubblefield described a variation of the D&E procedure, which they referred to as an "intact D&E." Nebraska does not deny that the statute imposes an "undue burden" if it applies to the more commonly used D&E procedure as well as to D&X. 492 ("'Intact D&X may be preferred by some physicians, particularly when the fetus has been diagnosed with hydrocephaly or other anomalies incompatible with life outside the womb'")); see also Grimes, The Continuing Need for Late Abortions, 280 JAMA 747, 748 (Aug. 26, 1998) (D&X "may be especially useful in the presence of fetal anomalies, such as hydrocephalus," because its reduction of the cranium allows "a smaller diameter to pass through the cervix, thus reducing risk of cervical injury"). In a D&E, forcing the fetus into the vagina (the pulling of extremities off the body in the process of extracting the body parts from the uterus into the vagina) is also the procedure that kills the fetus. Of all the definitions of “delivery” provided by the Court, ante, at 25—26, not one supports (or, more important for statutory construction purposes, requires), the conclusion that the statutory term “completing the delivery” refers to the placement of dismembered body parts on a tray rather than the removal of an intact fetus from the woman’s body.

Rec.

in Nos. The decision in Gonzales v. Carhart has narrowed the holding in this case; the cases are largely indistinguishable and can be explained only by the replacement of Justice O'Connor with Justice Samuel Alito, who voted to uphold the law. Ibid. Abortion Surveillance 41. The abortionist then inserts a suction tube and vacuums out the developing brain and other matter found within the skull. Id., at 1126.

Id., at 82, 83. Dr. Carhart uses the traction created by the opening between the uterus and vagina to dismember the fetus, tearing the grasped portion away from the remainder of the body. This is the method used by Dr. Carhart. §28-326(9) (Supp. The Attorney General, again echoed by the dissents, further argues that the statute "distinguishes between the overall 'abortion procedure' itself and the separate 'procedure' used to kill the unborn child."

Casey disavows strict scrutiny review; and Nebraska must be afforded leeway when attempting to regulate the medical profession. States also have an interest in forbidding medical procedures which, in the State’s reasonable determination, might cause the medical profession or society as a whole to become insensitive, even disdainful, to life, including life in the human fetus. With one exception, the federal trial courts that have heard expert evidence on the matter have reached similar factual conclusions. 125, at the end of the procedure. Brief for American College of Obstetricians and Gynecologists et al. All those who perform abortion procedures using that method must fear prosecution, conviction, and imprisonment. Since the majority concludes this is indeed the case, that should have been the end of the matter. We understand the controversial nature of the problem. City of Lakewood v. Plain Dealer Publishing Co., 486 U.S. 750, 770, n. 11 (1988). The majority and, even more so, the concurring opinion by Justice O’Connor, ignore the settled rule against deciding unnecessary constitutional questions. It is used after 16 weeks at the earliest, as vacuum aspiration becomes ineffective and the fetal skull becomes too large to pass through the cervix.