Bowen v. American Hosp. Association

RESPONDENT: American Hosp. Association
LOCATION: Circuit Court of Jefferson County

DOCKET NO.: 84-1529
DECIDED BY: Burger Court (1981-1986)
LOWER COURT: United States Court of Appeals for the Second Circuit

CITATION: 476 US 610 (1986)
ARGUED: Jan 15, 1986
DECIDED: Jun 09, 1986

Ben W. Heineman, Jr. - on behalf of Respondents American Medical Association, et al
Charles J. Cooper - on behalf of Petitioner
Richard L. Epstein - on behalf of respondents american hospital association, et al.
Richard A. Epstein - on behalf of Respondents American Hospital Association, et al

Facts of the case


Media for Bowen v. American Hosp. Association

Audio Transcription for Oral Argument - January 15, 1986 in Bowen v. American Hosp. Association

Warren E. Burger:

The Court will hear arguments first this morning in Bowen against American Hospital Association.

Mr. Cooper, you may proceed whenever you're ready.

Charles J. Cooper:

Thank you, Mr. Chief Justice, and may it please the Court:

The question in this case is whether Section 504 of the Rehabilitation Act of 1973 prohibits a federally assisted hospital from withholding nourishment or medically beneficial treatment from a handicapped infant solely because of that individual's handicap.

The Court of Appeals, relying on an earlier ruling in the University Hospital case, held that Section 504 has no application in this setting at all, no matter what the circumstances, and therefore invalidated on their face the interpretive guidelines and procedural regulations issued by the Secretary to explain the application of Section 504 in this setting.

In so doing, the Court of Appeals affirmed a nationwide injunction that prohibited the Secretary from taking any action whatsoever, investigatory or otherwise, in an effort to enforce Section 504's non-discriminatory mandate in this setting.

Now, there is no question presented in this case concerning the application of Section 504 to any particular set of facts or circumstances.

Rather, this case concerns only the facial validity of the Secretary's regulation.

Now, it is our submission that the Court of Appeals was clearly incorrect in concluding that all handicapped individuals who are infants are as a matter of law outside the scope of Section 504 protection insofar as furnishing nourishment and lifesaving medically beneficial treatment are concerned.

Therefore, we urge that the Court of Appeals is due to be reversed.

Now, as I shall explain, the language of Section 504 plainly prohibits a federally assisted hospital program from discriminating on the basis of handicap is this, as well as in any other context concerning a covered federally funded health services program.

And, contrary to the Respondents' claims, there is firm support for this position at every stage of Section 504's evolution, from its origins in Title 6 of the 1964 Civil Rights Act, through its enactment in 1973 and its amendments in 1974 and 1978.

The Secretary's construction of Section 504 is also supported through a consistent administrative construction.

Turning first to the text of the Act, Section 504 provides in pertinent part as follows:

"No otherwise qualified handicapped individual in the United States shall, solely by reason of his handicap, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any program or activity receiving federal financial assistance. "

Now, this language is majestic in its sweep, as one member of this Court described the almost identical language of Title 6 of the '64 Civil Rights Act, which was the model for Section 504.

And this Court also noted in the Grove City case recently that it is very reluctant to read into the largely identical language of Title 9, involved in Grove City, a limitation not apparent on the face of the language.

And it is with these principles in mind that we are met at the threshold by Respondent American Hospital Association, who argues that a handicapped infant is not a handicapped individual within the meaning of Section 504.

Now, the Court of Appeals rejected that argument and agreed with us that, of course, infants are entitled no less than adults to the protection of Section 504, that they have physical and mental impairments that limit major life activities, which is the statutory definition of what a handicapped individual is.

The court also noted, and we certainly concur, that to say otherwise defies common sense.

Indeed, this Court in Smith against Robinson stated that 504 applies to all individuals without respect to their age.

The Court of Appeals below did conclude, however, that handicapped individuals are not otherwise qualified, which is also a requirement of Section 504, and that was a requirement that this Court scrutinized very closely in Southeastern Community College against Davis, and there it held that an otherwise qualified handicapped individual is someone who is able to meet all of the requirements of the program in spite of his handicap.

Now, the requirement in Section 504 that a handicapped person be otherwise qualified simply reflects a Congressional recognition that a handicapping condition may be relevant, a relevant consideration, in some contexts, and that when it is relevant 504 doesn't require that it be ignored.

Thus, in the Davis case the ability to communicate effectively was very relevant to whether or not a person could function properly in a nursing training program, and the ability to communicate effectively was a legitimate requirement of that training program, and therefore a deaf person who could not meet that neutral requirement was not admitted and 504 did not require a different result.

In the context of medical care, the principal requirement for administering treatment is that it be medically indicated, that it be beneficial to the health or to the life of the patient.

That also is a neutral requirement.

It applies whether the patient is handicapped or whether he is not.

And the existence of a handicapping condition may well bear, and bear very importantly, on the question of whether certain treatment strategy is medically indicated.

That is, whether or not it is likely to be beneficial to the life and the health of the patient.

And when a medical professional concludes in good faith that the disabilities arising out of a handicapping condition render certain medical treatments contraindicated, that is not beneficial to the life and health of the patient, Section 504 does not require that the treatment be administered.