Supreme Court Rules on Bragdon vs. Abbott

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On June 25, 1998 the United States Supreme Court ruled in favor of Sidney Abbott, a woman living with HIV disease, in her contention that asymptomatic HIV disease is a disability covered under the Americans with Disabilities Act (ADA). In so ruling, the Supreme Court gave every indication that all people with HIV disease would be covered under the ADA. Justice Kennedy wrote the decision in favor of Sidney Abbott and was joined by Justices Souter, Stephens, Ginsburg, and Breyer. In the minority were Rehnquist, Thomas, Scalia, and O'Conner.

The Supreme Court also reaffirmed that health care professionals do not have a special standard to determine risk, health care professionals cannot rely on their own individual judgement, and that objective medical evidence must be used to determine risk. However, the Supreme Court ordered the lower court of appeals to reconsider the dentist Randon Bragdon's individual assertion that he did not violate the ADA, when he refused to fill Sidney Abbott's cavity in his office. On this point Justice Kennedy states that the lower court "…may reach the same conclusion it did earlier" when it ruled in Ms. Abbott's favor that the dentist had violated the ADA by refusing treatment in his office. But, whatever the future outcome of Bragdon's individual case, it will not affect the Supreme Court's ruling regarding coverage of asymptomatic HIV disease under the ADA.

This Supreme Court decision is a major victory for people living with HIV disease and affirms that the legislative history of the ADA intended to cover asymptomatic HIV disease and AIDS. In this case, the Supreme Court affirmed that plaintiff Sidney Abbott's ability to reproduce was hindered by her HIV disease. The Court also emphasized that given the pervasive nature of HIV disease many other life activities might also be relevant (e.g., procreation/intimate sexual relations, caring for one's self, or planning for one's future.)

The Court's majority decision, written by Justice Kennedy, in determining Sidney Abbott's protection by the ADA answers three questions:

1. Does asymptomatic HIV disease constitute a physical impairment? Writing for the majority, Justice Kennedy stated, "In light of the immediacy with which the virus begins to damage the infected person's white blood cells and the severity of the disease, we hold it is an impairment from the moment of infection." He also stated, "HIV infection satisfies the statutory and regulatory definition of a physical impairment during every stage of the disease."

2. Is reproduction considered a major life activity under the ADA? Deciding this question, Justice Kennedy, wrote, "…we agree with the Court of Appeals' determination that reproduction is a major life activity for the purposes of the ADA."

3. Does HIV disease substantially limit Sidney Abbott's ability to reproduce? Justice Kennedy, wrote, "Our evaluation of the medical evidence leads us to conclude that the respondent's infection substantially limited her ability to reproduce…"

AIDS Action Talking Points

The Supreme Court decision ensures that individuals living with HIV disease are covered under the Americans With Disabilities Act (ADA) and that they should have access to non-discriminatory and high quality health care -- through Ryan White programs, private providers identified by AIDS service organizations and local health departments.

This decision sends a strong message to private health care providers that there is a no tolerance policy for discrimination in health care.

The nation's Medicaid policy should be reinvented in light of the Supreme Court's decision which states "HIV infection satisfies the statutory and regulatory definition of a physical impairment during every stage of the disease." Current Medicaid eligibility provides access to new treatments for HIV only after a person has a full-blown AIDS diagnosis. This policy should be reinvented to provide eligibility to HIV-positive individuals who would otherwise meet income eligibility for the program.

Public health officials and AIDS service organizations should use the decision to send a message to individuals at-risk for HIV that there are protections for people with HIV. These protections should be used to launch a campaign to encourage individuals at risk to be tested so that they can learn their status. These campaigns should also emphasize the availability of new effective treatments to treat HIV disease.

Federal and state officials (especially attorneys general) should be encouraged to make strong statements about the enforcement of the ADA and state anti-discrimination laws on behalf of individuals with HIV disease.