Excerpts from the majority opinion, delivered by Justice Lewis F. Powell Jr. in City of Akron v. Akron Center for Reproductive Health Inc. (Quotation marks indicate material cited from other decisions):
These cases come to us a decade after we held in Roe v. Wade that the right of privacy, grounded in the concept of personal liberty guaranteed by the Constitution, encompasses a woman's right to decide whether to terminate her pregnancy. Legislative responses to the court's decision have required us on several occasions, and again today, to define the limits of a state's authority to regulate the performance of abortions. And arguments continue to be made, in these cases as well, that we erred in interpreting the Constitution. Nonetheless, the doctrine of stare decisis, while perhaps never entirely persuasive on a constitutional question, is a doctrine that demands respect in a society governed by the rule of the law. We respect it today, and reaffirm Roe v. Wade . . . .
From approximately the end of the first trimester of pregnancy, the state "may regulate the abortion procedure to the extent that the regulation reasonably relates to the preservation and protection of maternal health." The state's discretion to regulate on this basis does not, however, permit it to adopt abortion regulations that depart from accepted medical practice . . . .
There can be no doubt that a second-trimester hospitalization requirement places a significant obstacle in the path of women seeking an abortion. A primary burden created by the requirement is additional cost to the woman. The Court of Appeals noted that there was testimony that a second-trimester abortion costs more than twice as much in a hospital as in a clinic. Moreover, the court indicated that second-trimester abortions were rarely performed in Akron hospitals. Thus, a second-trimester hospitalization requirement may force women to travel to find available facilities, resulting in both financial expense and additional health risk. It therefore is apparent that a second-trimester hospitalization requirement may significantly limit a woman's ability to obtain an abortion . . . .
We find that Akron has failed to demonstrate that any legitimate state interest is furthered by an arbitrary and inflexible waiting period. There is no evidence suggesting that the abortion procedure will be performed more safely. Nor are we convinced that the state's legitimate concern that the woman's decision be informed is reasonably served by requiring a 24-hour delay as a matter of course.
The decision whether to proceed with an abortion is one as to which it is important to "afford the physician adequate discretion in the exercise of his medical judgment." In accordance with the ethical standards of the profession, a physician will advise the patient to defer the abortion when he thinks this will be beneficial to her. But if a woman, after appropriate counseling, is prepared to give her written informed consent and proceed with the abortion, a state may not demand that she delay the effectuation of that decision . . . .
Excerpts from the minority opinion, written by Justice Sandra Day O'Connor and joined by Justices Byron R. White and William H. Rehnquist:
The Roe framework . . . is clearly on a collision course with itself . . . . It is inherently tied to the state of medical technology that exists whenever particular litigation ensues. Although legislatures are better suited to make the necessary factual judgments in this area, the court's framework forces legislatures, as a matter of constitutional law, to speculate about what constitutes "accepted medical practice" at any given time. Without the necessary expertise or ability, courts must then pretend to act as science review boards and examine those legislative judgments . . . .
Although we must be mindful of the "desirability of continuity of decision in constitutional questions . . . when convinced of former error, this court has never felt constrained to follow precedent. In constitutional questions, when correction depends on amendment, not upon legislative action, this court throughout its history has freely exercised its power to reexamine the basis of its constitutional decisions."
Even assuming that there is a fundamental right to terminate pregnancy in some situations, there is no justification in law or logic for the trimester framework adopted in Roe and employed by the court today on the basis of stare decisis. For the reasons stated above, that framework is clearly an unworkable means of balancing the fundamental right and the compelling state interests that are indisputably implicated . . . .
In determining whether the state imposes an "undue burden," we must keep in mind that when we are concerned with extremely sensitive issues, such as the one involved here, "the appropriate forum for their resolution in a democracy is the legislature. We should not forget that 'legislatures are ultimate guardians of the liberties and welfare of the people in quite as great a degree as the courts.' " This does not mean that in determining whether a regulation imposes an "undue burden" on the Roe right that we defer to the judgments made by state legislatures. "The point is, rather, that when we face a complex problem with many hard questions and few easy answers we do well to pay careful attention to how other branches of government have addressed the same problem . . . . "