RECOMMENDED FOR PUBLICATION Pursuant to Sixth Circuit I.O.P. 32.1(b) File Name: 20a0169p.06 UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT EMW WOMEN’S SURGICAL CENTER, P.S.C., on behalf ┐ of itself, its staff, and its patients; ASHLEE BERGIN, │ M.D., M.P.H. and TANYA FRANKLIN, M.D., M.S.P.H., │ on behalf of themselves and their patients, │ Plaintiffs-Appellees, │ > No. 19-5516 │ v. │ │ │ ERIC FRIEDLANDER, in his official capacity as Acting │ Secretary of Kentucky’s Cabinet for Health and │ Family Services, │ Defendant-Appellant. │ ┘ Appeal from the United States District Court for the Western District of Kentucky at Louisville. No. 3:18-cv-00224—Joseph H. McKinley, Jr., District Judge. Argued: January 29, 2020 Decided and Filed: June 2, 2020 Before: MERRITT, CLAY, and BUSH, Circuit Judges. _________________ COUNSEL ARGUED: Matthew F. Kuhn, OFFICE OF THE GOVERNOR, Frankfort, Kentucky, for Appellant. Andrew D. Beck, AMERICAN CIVIL LIBERTIES UNION OF NEW YORK, New York, New York, for Appellees. ON BRIEF: Matthew F. Kuhn, M. Stephen Pitt, S. Chad Meredith, Brett R. Nolan, OFFICE OF THE GOVERNOR, Frankfort, Kentucky, for Appellant. Andrew D. Beck, Alexa Kolbi-Molinas, Meagan M. Burrow, Elizabeth Watson, AMERICAN CIVIL LIBERTIES UNION OF NEW YORK, New York, New York, Amy D. Cubbage, ACKERSON & YANN, Louisville, Kentucky, Heather Lynn Gatnarek, AMERICAN CIVIL LIBERTIES UNION OF KENTUCKY, Louisville, Kentucky, for Appellees. Benjamin M. Flowers, OFFICE OF THE OHIO ATTORNEY GENERAL, Columbus, Ohio, Ester Murdukhayeva, OFFICE OF THE NEW YORK ATTORNEY GENERAL, New York, New No. 19-5516 EMW Women’s Surgical Center, et al. v. Friedlander, et al. Page 2 York, Alexandria Preece, MORRISON & FOERSTER LLP, San Diego, California, Roxann E. Henry, MORRISON & FOERSTER LLP, Washington, D.C., Kimberly A. Parker, WILMER CUTLER PICKERING HALE AND DORR LLP, Washington, D.C., for Amici Curiae. CLAY, J., delivered the opinion of the court in which MERRITT, J., joined. BUSH, J. (pp. 33–43), delivered a separate dissenting opinion. _________________ OPINION _________________ CLAY, Circuit Judge. This case asks whether a state can require patients to undergo a procedure to end potential fetal life before they may receive an abortion performed through the method most common in the second trimester of pregnancy—dilation and evacuation. Kentucky House Bill 454 does just that. Plaintiffs, Kentucky’s sole abortion clinic and two of its doctors, argue that House Bill 454 violates patients’ constitutional right to abortion access prior to fetal viability because the burdens the law imposes significantly outweigh its benefits. Defendant Eric Friedlander, the Acting Secretary of Kentucky’s Cabinet for Health and Family Services, disagrees. He contends that Kentucky may constitutionally require patients to undergo such a procedure because it is a reasonable alternative to the standard dilation and evacuation abortion. The district court agreed with Plaintiffs and permanently enjoined Kentucky from enforcing House Bill 454. For the reasons set forth below, we AFFIRM the district court’s judgment. BACKGROUND Factual Background In the first trimester of pregnancy, a physician may perform an abortion through two methods. She may offer medication to induce a process like miscarriage, or she may ...
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