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A Matter of Context: Casey and the Constitutionality of Compelled Physician Speech

Published online by Cambridge University Press:  01 January 2021

Extract

The First Amendment states that “Congress shall make no law…abridging the freedom of speech.” Given the myriad ways in which freedom of speech can be implicated, the United States Supreme Court has not adopted a single standard for reviewing First Amendment speech claims. With respect to compelled speech, the Court has instructed that “context” is dispositive. When the government attempts to “prescribe what shall be orthodox in politics, nationalism, religion, or other matters of opinion or force citizens to confess by word or act their faith therein,” the Court applies strict scrutiny. When, however, “the State has a significant role to play in regulating” a particular context, government-compelled disclosures may be subject to a lower standard of review: “When a state regulation implicates First Amendment rights, the court must balance those interests against the State’s legitimate interest in regulating the activity in question.”

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Symposium
Copyright
Copyright © American Society of Law, Medicine and Ethics 2015

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References

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At first glance, this last factor – whether the compelled statements otherwise limit speech – may not seem to do much work in terms of the Court's analysis. Compelled speech does not in and of itself involve speech restrictions, so the factor would always be met in cases involving only compelled speech. The Court emphasizes this point, however, to emphasize that speech restrictions may trigger heightened scrutiny, thereby encouraging government actors not to overreach in their legislative efforts to regulate professionals, such as doctors. See also Wollschlaeger, 760 F.3d at 1219 and Locke v. Shore, 634 F.3d 1185, 1191 (11th Cir. 2011) (upholding Florida's restriction on physicians' inquiring about firearm ownership because the “the inquiry provision places no burdens whatsoever on physicians' ability to speak outside the physician-patient relationship”)Google Scholar
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Id. Zauderer applies the same analysis to Ohio's compelled disclosures regarding contingent-fee arrangements. The Court upheld the disclosures in Zauderer because there are “material differences between disclosure requirements and outright prohibitions on speech” and Ohio did “not attempt[] to prevent attorneys from conveying information to the public.” 471 U.S. at 650.Google Scholar
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Lthough the district court in Stuart characterizes Bowman as addressing only professional licensing, Stuart, 992 F. Supp.2d at 594 n.15, it directly involves the regulation of professional speech. See Bowman, 860 F.2d at 605 (“The statute in question restricts only accountants' communications with and on behalf of their clients, as a means of regulating the professional activities of non-CPAs.”).Google Scholar
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Zauderer refers to “purely factual and uncontroversial information.” 471 U.S. at 651. In the context of professional speech, “uncontroversial” cannot prohibit disclosures related to controversial topics – otherwise Casey would have been decided differently.Google Scholar
The Supreme Court has not given a precise definition of what constitutes an “undue burden” other than saying that it is a regulation that imposes a “substantial obstacle.” Casey, 505 U.S. 878. But even this definition is of limited value given that the Court has not necessarily applied the test consistently, upholding a 24-hour waiting period but striking down a spousal consent requirement.Google Scholar
See United States v. Windsor, 133 S. Ct. 2675, 2717 (2013) (noting that “in rational basis cases…‘the courts have been very reluctant, as they should be in our federal system and with our respect for the separation of powers, to closely scrutinize legislative choices as to whether, how, and to what extent those interests should be presumed.”’).Google Scholar
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Planned Parenthood Minn., North Dakota, South Dakota v. Rounds, 686 F.3d 889, 906 (8th Cir. 2012).Google Scholar
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Although the Fifth Circuit Court of Appeals has adopted a similar interpretation, some commentators disagree. See, e.g., Sawicki, N. M., “Compelling Images: The Constitutionality of Emotionally Persuasive Health Campaigns,” Maryland Law Review 73 (2014): 458522Google Scholar
and Smith, C. D., “Mandatory Ultrasound Statutes and the First Amendment, Shifting the Constitutional Perspective,” Cardozo Journal of Law and Gender 20 (2014): 844855. Some commentators contend that speech-and-display laws require the disclosure of controversial and possibly irrelevant information and that these laws are, therefore, unconstitutional. This Article takes the opposite position, but space constraints preclude a detailed analysis of these commentators' arguments.Google Scholar
Lakey, 667 F.3d at 577–78.Google Scholar
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Stuart, 992 F. Supp.2d at 609. Under North Carolina's speech-and-display legislation, a physician must show the ultrasound image to the woman and to describe the image. Contrary to the district court's suggestion, the statute does not require that “a physician attempt to persuade a woman not to have abortion.” Physicians may counsel a woman to have an abortion or not depending on the physician's assessment of what is in the patient's best medical interests.Google Scholar
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