0461S.18F
SENATE SUBSTITUTE
FOR
SENATE COMMITTEE SUBSTITUTE
FOR
HOUSE BILL NO. 126
AN ACT
To repeal sections 135.630, 188.010, 188.015, 188.027,
188.028, 188.043, and 188.052, RSMo, and to enact in
lieu thereof seventeen new sections relating to
abortion, with penalty provisions, a contingent
effective date for a certain section, and an emergency
clause for a certain section.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF MISSOURI,
AS FOLLOWS:
1

Section A.

Sections 135.630, 188.010, 188.015, 188.027,

2

188.028, 188.043, and 188.052, RSMo, are repealed and seventeen

3

new sections enacted in lieu thereof, to be known as sections

4

135.630, 188.010, 188.015, 188.017, 188.018, 188.026, 188.027,

5

188.028, 188.033, 188.038, 188.043, 188.044, 188.052, 188.056,

6

188.057, 188.058, and 188.375, to read as follows:

7
8
9
10
11
12
13
14
15

135.630.

1.

As used in this section, the following terms

mean:
(1)

"Contribution", a donation of cash, stock, bonds, or

other marketable securities, or real property;
(2)

"Director", the director of the department of social

services;
(3)

"Pregnancy resource center", a nonresidential facility

located in this state:
(a)

Established and operating primarily to provide
1

 1

assistance to women and families with crisis pregnancies or

2

unplanned pregnancies by offering pregnancy testing, counseling,

3

emotional and material support, and other similar services or by

4

offering services as described under subsection 2 of section

5

188.325, to encourage and assist such women and families in

6

carrying their pregnancies to term; and

7

(b)

Where childbirths are not performed; and

8

(c)

Which does not perform, induce, or refer for abortions

9
10

and which does not hold itself out as performing, inducing, or
referring for abortions; and

11

(d)

Which provides direct client services at the facility,

12

as opposed to merely providing counseling or referral services by

13

telephone; and

14

(e)

Which provides its services at no cost to its clients;

(f)

When providing medical services, such medical services

15
16
17
18
19
20

and

must be performed in accordance with Missouri statute; and
(g)

Which is exempt from income taxation pursuant to the

Internal Revenue Code of 1986, as amended;
(4)

"State tax liability", in the case of a business

21

taxpayer, any liability incurred by such taxpayer pursuant to the

22

provisions of chapters 143, 147, 148, and 153, excluding sections

23

143.191 to 143.265 and related provisions, and in the case of an

24

individual taxpayer, any liability incurred by such taxpayer

25

pursuant to the provisions of chapter 143, excluding sections

26

143.191 to 143.265 and related provisions;

27
28

(5)

"Taxpayer", a person, firm, a partner in a firm,

corporation, or a shareholder in an S corporation doing business

2

 1

in the state of Missouri and subject to the state income tax

2

imposed by the provisions of chapter 143, or a corporation

3

subject to the annual corporation franchise tax imposed by the

4

provisions of chapter 147, or an insurance company paying an

5

annual tax on its gross premium receipts in this state, or other

6

financial institution paying taxes to the state of Missouri or

7

any political subdivision of this state pursuant to the

8

provisions of chapter 148, or an express company which pays an

9

annual tax on its gross receipts in this state pursuant to

10

chapter 153, or an individual subject to the state income tax

11

imposed by the provisions of chapter 143, or any charitable

12

organization which is exempt from federal income tax and whose

13

Missouri unrelated business taxable income, if any, would be

14

subject to the state income tax imposed under chapter 143.

15

2.

(1)

Beginning on March 29, 2013, any contribution to a

16

pregnancy resource center made on or after January 1, 2013, shall

17

be eligible for tax credits as provided by this section.

18

(2)

For all tax years beginning on or after January 1,

19

2007, and ending on or before December 31, 2020, a taxpayer shall

20

be allowed to claim a tax credit against the taxpayer's state tax

21

liability in an amount equal to fifty percent of the amount such

22

taxpayer contributed to a pregnancy resource center.

23

years beginning on or after January 1, 2021, a taxpayer shall be

24

allowed to claim a tax credit against the taxpayer's state tax

25

liability in an amount equal to seventy percent of the amount

26

such taxpayer contributed to a pregnancy resource center.

27
28

3.

For all tax

The amount of the tax credit claimed shall not exceed

the amount of the taxpayer's state tax liability for the tax year

3

 1

for which the credit is claimed, and such taxpayer shall not be

2

allowed to claim a tax credit in excess of fifty thousand dollars

3

per tax year.

4

the tax year the contribution was made may be carried over only

5

to the next succeeding tax year.

6

section shall be assigned, transferred, or sold.

7

4.

However, any tax credit that cannot be claimed in

No tax credit issued under this

Except for any excess credit which is carried over

8

pursuant to subsection 3 of this section, a taxpayer shall not be

9

allowed to claim a tax credit unless the total amount of such

10

taxpayer's contribution or contributions to a pregnancy resource

11

center or centers in such taxpayer's tax year has a value of at

12

least one hundred dollars.

13

5.

The director shall determine, at least annually, which

14

facilities in this state may be classified as pregnancy resource

15

centers.

16

classified as a pregnancy resource center whatever information

17

which is reasonably necessary to make such a determination.

18

director shall classify a facility as a pregnancy resource center

19

if such facility meets the definition set forth in subsection 1

20

of this section.

21

6.

The director may require of a facility seeking to be

The

The director shall establish a procedure by which a

22

taxpayer can determine if a facility has been classified as a

23

pregnancy resource center.

24

permitted to decline a contribution from a taxpayer.

25

cumulative amount of tax credits which may be claimed by all the

26

taxpayers contributing to pregnancy resource centers in any one

27

fiscal year shall not exceed two million dollars for all fiscal

28

years ending on or before June 30, 2014, and two million five

Pregnancy resource centers shall be

4

The

 1

hundred thousand dollars for all fiscal years beginning on or

2

after July 1, 2014, and ending on or before June 30, 2019, and

3

three million five hundred thousand dollars for all fiscal years

4

beginning on or after July 1, 2019, and ending on or before June

5

30, 2021.

6

2021, there shall be no limit imposed on the cumulative amount of

7

tax credits that may be claimed by all taxpayers contributing to

8

pregnancy resource centers under the provisions of this section.

9

Tax credits shall be issued in the order contributions are

For all fiscal years beginning on or after July 1,

10

received.

11

is less than the cumulative amount authorized under this

12

subsection, the difference shall be carried over to a subsequent

13

fiscal year or years and shall be added to the cumulative amount

14

of tax credits that may be authorized in that fiscal year or

15

years.

16

7.

If the amount of tax credits redeemed in a fiscal year

For all fiscal years ending on or before June 30, 2021,

17

the director shall establish a procedure by which, from the

18

beginning of the fiscal year until some point in time later in

19

the fiscal year to be determined by the director, the cumulative

20

amount of tax credits are equally apportioned among all

21

facilities classified as pregnancy resource centers.

22

pregnancy resource center fails to use all, or some percentage to

23

be determined by the director, of its apportioned tax credits

24

during this predetermined period of time, the director may

25

reapportion these unused tax credits to those pregnancy resource

26

centers that have used all, or some percentage to be determined

27

by the director, of their apportioned tax credits during this

28

predetermined period of time.

If a

The director may establish more

5

 1

than one period of time and reapportion more than once during

2

each fiscal year.

3

shall establish the procedure described in this subsection in

4

such a manner as to ensure that taxpayers can claim all the tax

5

credits possible up to the cumulative amount of tax credits

6

available for the fiscal year.

7

8.

To the maximum extent possible, the director

Each pregnancy resource center shall provide information

8

to the director concerning the identity of each taxpayer making a

9

contribution to the pregnancy resource center who is claiming a

10

tax credit pursuant to this section and the amount of the

11

contribution.

12

director of revenue.

13

confidentiality and penalty provisions of section 32.057 relating

14

to the disclosure of tax information.

15

9.

16

(1)

The director shall provide the information to the
The director shall be subject to the

[Under section 23.253 of the Missouri sunset act:
The provisions of the program authorized under this

17

section shall automatically sunset on December thirty-first six

18

years after August 28, 2018, unless reauthorized by an act of the

19

general assembly;

20

(2)

If such program is reauthorized, the program authorized

21

under this section shall automatically sunset on December

22

thirty-first six years after the effective date of the

23

reauthorization of this section;

24

(3)

This section shall terminate on September first of the

25

calendar year immediately following the calendar year in which a

26

program authorized under this section is sunset; and

27
28

(4)

The provisions of this subsection shall not be

construed to limit or in any way impair the department's ability

6

 1

to issue tax credits authorized on or before the date the program

2

authorized under this section expires or a taxpayer's ability to

3

redeem such tax credits.] The provisions of section 23.253 shall

4

not apply to this section.

5

188.010.

In recognition that Almighty God is the author of

6

life, that all men and women are "endowed by their Creator with

7

certain unalienable Rights, that among these are Life", and that

8

article I, section 2 of the Constitution of Missouri provides

9

that all persons have a natural right to life, it is the

10

intention of the general assembly of the state of Missouri to

11

[grant]:

12

(1)

13
14

Defend the right to life [to] of all humans, born and

unborn[, and to];
(2)

Declare that the state and all of its political

15

subdivisions are a "sanctuary of life" that protects pregnant

16

women and their unborn children; and

17

(3)

Regulate abortion to the full extent permitted by the

18

Constitution of the United States, decisions of the United States

19

Supreme Court, and federal statutes.

20

188.015.

As used in this chapter, the following terms mean:

21

(1)

"Abortion":

22

(a)

The act of using or prescribing any instrument, device,

23

medicine, drug, or any other means or substance with the intent

24

to destroy the life of an embryo or fetus in his or her mother's

25

womb; or

26

(b)

The intentional termination of the pregnancy of a

27

mother by using or prescribing any instrument, device, medicine,

28

drug, or other means or substance with an intention other than to

7

 1

increase the probability of a live birth or to remove a dead [or

2

dying] unborn child;

3

(2)

"Abortion facility", a clinic, physician's office, or

4

any other place or facility in which abortions are performed or

5

induced other than a hospital;

6
7
8
9

(3)

by a sperm of a male;
(4)

(5)

11

191.923;

12

(6)

14

"Department", the department of health and senior

services;

10

13

"Conception", the fertilization of the ovum of a female

"Down Syndrome", the same meaning as defined in section

"Gestational age", length of pregnancy as measured from

the first day of the woman's last menstrual period;
[(6)] (7)

"Medical emergency", a condition which, based on

15

reasonable medical judgment, so complicates the medical condition

16

of a pregnant woman as to necessitate the immediate abortion of

17

her pregnancy to avert the death of the pregnant woman or for

18

which a delay will create a serious risk of substantial and

19

irreversible physical impairment of a major bodily function of

20

the pregnant woman;

21

[(7)] (8)

"Physician", any person licensed to practice

22

medicine in this state by the state board of registration for the

23

healing arts;

24

[(8)] (9)

"Reasonable medical judgment", a medical judgment

25

that would be made by a reasonably prudent physician,

26

knowledgeable about the case and the treatment possibilities with

27

respect to the medical conditions involved;

28

[(9)] (10)

"Unborn child", the offspring of human beings
8

 1

from the moment of conception until birth and at every stage of

2

its biological development, including the human conceptus,

3

zygote, morula, blastocyst, embryo, and fetus;

4

[(10)] (11)

"Viability" or "viable", that stage of fetal

5

development when the life of the unborn child may be continued

6

indefinitely outside the womb by natural or artificial life-

7

supportive systems;

8
9
10
11
12
13

(12)

"Viable pregnancy" or "viable intrauterine pregnancy",

in the first trimester of pregnancy, an intrauterine pregnancy
that can potentially result in a liveborn baby.
188.017.

1.

This section shall be known and may be cited

as the "Right to Life of the Unborn Child Act".
2.

Notwithstanding any other provision of law to the

14

contrary, no abortion shall be performed or induced upon a woman,

15

except in cases of medical emergency.

16

performs or induces an abortion of an unborn child in violation

17

of this subsection shall be guilty of a class B felony, as well

18

as subject to suspension or revocation of his or her professional

19

license by his or her professional licensing board.

20

whom an abortion is performed or induced in violation of this

21

subsection shall not be prosecuted for a conspiracy to violate

22

the provisions of this subsection.

23

3.

Any person who knowingly

A woman upon

It shall be an affirmative defense for any person

24

alleged to have violated the provisions of subsection 2 of this

25

section that the person performed or induced an abortion because

26

of a medical emergency.

27

persuasion that the defense is more probably true than not.

28

188.018.

The defendant shall have the burden of

If any one or more provisions, sections,

9

 1

subsections, sentences, clauses, phrases, or words of this

2

chapter or the application thereof to any person, circumstance,

3

or period of gestational age is found to be unenforceable,

4

unconstitutional, or invalid by a court of competent

5

jurisdiction, the same is hereby declared to be severable and the

6

balance of this chapter shall remain effective notwithstanding

7

such unenforceability, unconstitutionality, or invalidity.

8

general assembly hereby declares that it would have passed each

9

provision, section, subsection, sentence, clause, phrase, or word

The

10

thereof, irrespective of the fact that any one or more

11

provisions, sections, subsections, sentences, clauses, phrases,

12

or words of this chapter, or the application of this chapter to

13

any person, circumstance, or period of gestational age, would be

14

declared unenforceable, unconstitutional, or invalid.

15

188.026.

1.

This section and sections 188.056, 188.057,

16

and 188.058 shall be known and may be cited as the "Missouri

17

Stands for the Unborn Act".

18

2.

In Roe v. Wade, 410 U.S. 113 (1973), certain information

19

about the development of the unborn child, human pregnancy, and

20

the effects of abortion was either not part of the record or was

21

not available at the time.

22

scientific technology have greatly expanded our knowledge of

23

prenatal life and the effects of abortion on women.

24

assembly of this state finds:

25
26
27
28

(1)

Since 1973, advances in medical and

The general

At conception, a new genetically distinct human being

is formed;
(2)

The fact that the life of an individual human being

begins at conception has long been recognized in Missouri law:

10

 1

"[T]he child is, in truth, alive from the moment of conception".

2

State v. Emerich, 13 Mo. App. 492, 495 (1883), affirmed, 87 Mo.

3

110 (1885).

4

recognized that the life of each human being begins at conception

5

and that unborn children have protectable interests in life,

6

health, and well-being;

7

(3)

Under section 1.205, the general assembly has

The first prohibition of abortion in Missouri was

8

enacted in 1825.

Since then, the repeal and reenactment of

9

prohibitions of abortion have made distinctions with respect to

10

penalties for performing or inducing abortion on the basis of

11

"quickening"; however, the unborn child was still protected from

12

conception onward;

13

(4)

In ruling that Missouri's prohibition on abortion was

14

constitutional in 1972, the Missouri supreme court accepted as a

15

stipulation of the parties that "'[i]nfant Doe, Intervenor

16

Defendant in this case, and all other unborn children have all

17

the qualities and attributes of adult human persons differing

18

only in age or maturity.

19

from conception to death.'"

20

259 (1972);

21

(5)

Medically, human life is a continuum
Rodgers v. Danforth, 486 S.W.2d 258,

In Webster v. Reproductive Health Services, 492 U.S.

22

490 (1989), the Supreme Court, while considering the "preamble"

23

that set forth "findings" in section 1.205, stated:

24

the extent to which the preamble's language might be used to

25

interpret other state statutes or regulations is something that

26

only the courts of Missouri can definitively decide.

27

has offered protections to unborn children in tort and probate

28

law". Id. at 506.

"We think

State law

Since Webster, Missouri courts have construed

11

 1

section 1.205 and have consistently found that an unborn child is

2

a person for purposes of Missouri's homicide and assault laws

3

when the unborn child's mother was killed or assaulted by another

4

person.

5

manslaughter of an unborn child who was eight weeks gestational

6

age or earlier.

7

2013);

8
9

(6)

Section 1.205 has even been found applicable to the

State v. Harrison, 390 S.W.3d 927 (Mo. Ct. App.

In medicine, a special emphasis is placed on the

heartbeat.

The heartbeat is a discernible sign of life at every

10

stage of human existence.

11

age, an unborn child's heart begins to beat and blood flow begins

12

during the sixth week;

13

(7)

During the fifth week of gestational

Depending on the ultrasound equipment being used, the

14

unborn child's heartbeat can be visually detected as early as six

15

to eight weeks gestational age.

16

gestational age, the unborn child's heartbeat can consistently be

17

made audible through the use of a handheld Doppler fetal heart

18

rate device;

19

(8)

By about twelve weeks

Confirmation of a pregnancy can be indicated through

20

the detection of the unborn child's heartbeat, while the absence

21

of a heartbeat can be an indicator of the death of the unborn

22

child if the child has reached the point of development when a

23

heartbeat should be detectable;

24

(9)

Heart rate monitoring during pregnancy and labor is

25

utilized to measure the heart rate and rhythm of the unborn

26

child, at an average rate between one hundred ten and one hundred

27

sixty beats per minute, and helps determine the health of the

28

unborn child;

12

 1

(10)

The Supreme Court in Roe discussed "the difficult

2

question of when life begins" and wrote: "[p]hysicians and their

3

scientific colleagues have regarded [quickening] with less

4

interest and have tended to focus either upon conception, upon

5

live birth, or upon the interim point at which the fetus becomes

6

'viable', that is, potentially able to live outside the mother's

7

womb, albeit with artificial aid".

8

however, physicians' and scientists' interests on life in the

9

womb also focus on other markers of development in the unborn

Roe, 410 U.S. at 160.

Today,

10

child, including, but not limited to, presence of a heartbeat,

11

brain development, a viable pregnancy or viable intrauterine

12

pregnancy during the first trimester of pregnancy, and the

13

ability to experience pain;

14

(11)

In Planned Parenthood of Central Missouri v. Danforth,

15

428 U.S. 52 (1976), the Supreme Court noted that "we recognized

16

in Roe that viability was a matter of medical judgment, skill,

17

and technical ability, and we preserved the flexibility of the

18

term". Id. at 64.

19

diagnoses, present-day physicians and scientists now describe the

20

viability of an unborn child in an additional manner, by

21

determining whether there is a viable pregnancy or viable

22

intrauterine pregnancy during the first trimester of pregnancy;

23

(12)

Due to advances in medical technology and

While the overall risk of miscarriage after clinical

24

recognition of pregnancy is twelve to fifteen percent, the

25

incidence decreases significantly if cardiac activity in the

26

unborn child has been confirmed.

27

an unborn child is a reliable indicator of a viable pregnancy and

28

that the unborn child will likely survive to birth, especially if

13

The detection of a heartbeat in

 1

presenting for a prenatal visit at eight weeks gestational age or

2

later.

3

between six and eleven weeks gestational age where a heartbeat

4

was confirmed through an ultrasound, the subsequent risk of

5

miscarriage is one and six-tenths percent.

6

higher at six weeks gestational age at nine and four-tenths

7

percent, it declines rapidly to one and five-tenths percent at

8

eight weeks gestational age, and less than one percent at nine

9

weeks gestational age or later;

10

For asymptomatic women attending a first prenatal visit

(13)

Although the risk is

The presence of a heartbeat in an unborn child

11

represents a more definable point of ascertaining survivability

12

than the ambiguous concept of viability that has been adopted by

13

the Supreme Court, especially since if a heartbeat is detected at

14

eight weeks gestational age or later in a normal pregnancy, there

15

is likely to be a viable pregnancy and there is a high

16

probability that the unborn child will survive to birth;

17

(14)

The placenta begins developing during the early first

18

trimester of pregnancy and performs a respiratory function by

19

making oxygen supply to and carbon dioxide removal from the

20

unborn child possible later in the first trimester and throughout

21

the second and third trimesters of pregnancy;

22

(15)

By the fifth week of gestation, the development of the

23

brain of the unborn child is underway.

Brain waves have been

24

measured and recorded as early as the eighth week of gestational

25

age in children who were removed during an ectopic pregnancy or

26

hysterectomy.

27

unborn child's brain is used during the second and third

28

trimesters of pregnancy and brain activity has been observed

Fetal magnetic resonance imaging (MRI) of an

14

 1
2

using MRI;
(16)

Missouri law identifies the presence of circulation,

3

respiration, and brain function as indicia of life under section

4

194.005, as the presence of circulation, respiration, and brain

5

function indicates that such person is not legally dead, but is

6

legally alive;

7

(17)

Unborn children at eight weeks gestational age show

8

spontaneous movements, such as a twitching of the trunk and

9

developing limbs.

It has been reported that unborn children at

10

this stage show reflex responses to touch.

11

the first part of the unborn child's body to respond to touch at

12

about eight weeks gestational age and by fourteen weeks

13

gestational age most of the unborn child's body is responsive to

14

touch;

15

(18)

The perioral area is

Peripheral cutaneous sensory receptors, the receptors

16

that feel pain, develop early in the unborn child.

17

in the perioral cutaneous area at around seven to eight weeks

18

gestational age, in the palmar regions at ten to ten and a half

19

weeks gestational age, the abdominal wall at fifteen weeks

20

gestational age, and over all of the unborn child's body at

21

sixteen weeks gestational age;

22

(19)

They appear

Substance P, a peptide that functions as a

23

neurotransmitter, especially in the transmission of pain, is

24

present in the dorsal horn of the spinal cord of the unborn child

25

at eight to ten weeks gestational age.

26

that play a role in neurotransmission and pain modulation, are

27

present in the dorsal horn at twelve to fourteen weeks

28

gestational age;

15

Enkephalins, peptides

 1

(20)

When intrauterine needling is performed on an unborn

2

child at sixteen weeks gestational age or later, the reaction to

3

this invasive stimulus is blood flow redistribution to the brain.

4

Increased blood flow to the brain is the same type of stress

5

response seen in a born child and an adult;

6

(21)

By sixteen weeks gestational age, pain transmission

7

from a peripheral receptor to the cortex is possible in the

8

unborn child;

9

(22)

Physicians provide anesthesia during in utero

10

treatment of unborn children as early as sixteen weeks

11

gestational age for certain procedures, including those to

12

correct fetal urinary tract obstruction.

13

administered by ultrasound-guided injection into the arm or leg

14

of the unborn child;

15

(23)

Anesthesia is

A leading textbook on prenatal development of the

16

human brain states, "It may be concluded that, although

17

nociperception (the actual perception of pain) awaits the

18

appearance of consciousness, nociception (the experience of pain)

19

is present some time before birth.

20

it is merely prudent to assume that pain can be experienced even

21

early in prenatal life (Dr. J. Wisser, Zürich): the fetus should

22

be given the benefit of the doubt".

Ronan O'Rahilly & Fabiola

23

Müller.

An Atlas of Developmental

24

Stages (3d ed. 2005);

25

(24)

The Embryonic Human Brain:

In the absence of disproof,

By fourteen or fifteen weeks gestational age or later,

26

the predominant abortion method in Missouri is dilation and

27

evacuation (D & E).

28

dismemberment, disarticulation, and exsanguination of the unborn

The D & E abortion method includes the

16

 1
2

child, causing the unborn child's death;
(25)

The Supreme Court acknowledged in Gonzales v. Carhart,

3

550 U.S. 124, 160 (2007), that "the standard D & E is in some

4

respects as brutal, if not more, than the intact D & E" partial

5

birth abortion method banned by Congress and upheld as facially

6

constitutional by the Supreme Court, even though the federal ban

7

was applicable both before and after viability and had no

8

exception for the health of the mother;

9

(26)

Missouri's ban on the partial birth abortion method,

10

section 565.300, is in effect because of Gonzales v. Carhart and

11

the Supreme Court's subsequent decision in Nixon v. Reproductive

12

Health Services of Planned Parenthood of the St. Louis Region,

13

Inc., 550 U.S. 901 (2007), to vacate and remand to the appellate

14

court the prior invalidation of section 565.300.

15

565.300, like Congress' ban on partial birth abortion, is

16

applicable both before and after viability, there is ample

17

precedent for the general assembly to constitutionally prohibit

18

the brutal D & E abortion method at fourteen weeks gestational

19

age or later, even before the unborn child is viable, with a

20

medical emergency exception;

21

(27)

Since section

In Roper v. Simmons, 543 U.S. 551 (2005), the Supreme

22

Court determined that "evolving standards of decency" dictated

23

that a Missouri statute allowing the death penalty for a

24

conviction of murder in the first degree for a person under

25

eighteen years of age when the crime was committed was

26

unconstitutional under the Eighth and Fourteenth Amendments to

27

the United States Constitution because it violated the

28

prohibition against "cruel and unusual punishments";

17

 1

(28)

In Bucklew v. Precythe, 139 S. Ct. 1112, 1123 (2019),

2

the Supreme Court noted that "'[d]isgusting' practices" like

3

disemboweling and quartering "readily qualified as 'cruel and

4

unusual', as a reader at the time of the Eighth Amendment's

5

adoption would have understood those words";

6

(29)

Evolving standards of decency dictate that Missouri

7

should prohibit the brutal and painful D & E abortion method at

8

fourteen weeks gestational age or later, with a medical emergency

9

exception, because if a comparable method of killing was used on:

10
11
12

(a)

A person convicted of murder in the first degree, it

would be cruel and unusual punishment; or
(b)

An animal, it would be unlawful under state law because

13

it would not be a humane method, humane euthanasia, or humane

14

killing of certain animals under chapters 273 and 578;

15

(30)

In Roper, the Supreme Court also found that "[i]t is

16

proper that we acknowledge the overwhelming weight of

17

international opinion against the juvenile death penalty....

18

opinion of the world community, while not controlling our

19

outcome, does provide respected and significant confirmation for

20

our own conclusions".

21

the Supreme Court was instructed by "international covenants

22

prohibiting the juvenile death penalty", such as the

23

International Covenant on Civil and Political Rights, 999

24

U.N.T.S. 171. Id. at 577;

25

(31)

Roper, 543 U.S. at 578.

The

In its opinion,

The opinion of the world community, reflected in the

26

laws of the United Nation's 193-member states and six other

27

entities, is that in most countries, most abortions are

28

prohibited after twelve weeks gestational age or later;

18

 1

(32)

The opinion of the world community is also shared by

2

most Americans, who believe that most abortions in the second and

3

third trimesters of pregnancy should be illegal, based on polling

4

that has remained consistent since 1996;

5

(33)

Abortion procedures performed later in pregnancy have

6

a higher medical risk for women.

7

eight weeks gestational age or earlier, the relative risk

8

increases exponentially at later gestational ages.

9

risk of death for a pregnant woman who had an abortion performed

10
11

Compared to an abortion at

The relative

or induced upon her at:
(a)

Eleven to twelve weeks gestational age is between three

12

and four times higher than an abortion at eight weeks gestational

13

age or earlier;

14

(b)

Thirteen to fifteen weeks gestational age is almost

15

fifteen times higher than an abortion at eight weeks gestational

16

age or earlier;

17

(c)

Sixteen to twenty weeks gestational age is almost

18

thirty times higher than an abortion at eight weeks gestational

19

age or earlier; and

20

(d)

Twenty-one weeks gestational age or later is more than

21

seventy-five times higher than an abortion at eight weeks

22

gestational age or earlier;

23

(34)

In addition to the short-term risks of an abortion,

24

studies have found that the long-term physical and psychological

25

consequences of abortion for women include, but are not limited

26

to, an increased risk of preterm birth, low birthweight babies,

27

and placenta previa in subsequent pregnancies, as well as serious

28

behavioral health issues.

These risks increase as abortions are

19

 1

performed or induced at later gestational ages.

2

consequences of an abortion have a detrimental effect not only on

3

women, their children, and their families, but also on an already

4

burdened health care system, taxpayers, and the workforce;

5

(35)

These

A large percentage of women who have an abortion

6

performed or induced upon them in Missouri each year are at less

7

than eight weeks gestational age, a large majority are at less

8

than fourteen weeks gestational age, a larger majority are at

9

less than eighteen weeks gestational age, and an even larger

10

majority are at less than twenty weeks gestational age.

11

prohibition on performing or inducing an abortion at eight weeks

12

gestational age or later, with a medical emergency exception,

13

does not amount to a substantial obstacle to a large fraction of

14

women for whom the prohibition is relevant, which is pregnant

15

women in Missouri who are seeking an abortion while not

16

experiencing a medical emergency.

17

on performing or inducing an abortion at eight, fourteen,

18

eighteen, or twenty weeks gestational age or later, with a

19

medical emergency exception, might impose on abortion access, is

20

outweighed by the benefits conferred upon the following:

21
22

(a)

A

The burden that a prohibition

Women more advanced in pregnancy who are at greater

risk of harm from abortion;

23

(b)

Unborn children at later stages of development;

24

(c)

The medical profession, by preserving its integrity and

25
26

fulfilling its commitment to do no harm; and
(d)

Society, by fostering respect for human life, born and

27

unborn, at all stages of development, and by lessening societal

28

tolerance of violence against innocent human life;

20

 1

(36)

In Webster, the Supreme Court noted, in upholding a

2

Missouri statute, "that there may be a 4-week error in estimating

3

gestational age".

4

child thought to be eight weeks gestational age might in fact be

5

twelve weeks gestational age, when an abortion poses a greater

6

risk to the woman and the unborn child is considerably more

7

developed.

8

might be eighteen weeks gestational age and an unborn child at

9

eighteen weeks gestational age might be twenty-two weeks

Webster, 492 U.S. at 516.

Thus, an unborn

An unborn child at fourteen weeks gestational age

10

gestational age, when an abortion poses a greater risk to the

11

woman, the unborn child is considerably more developed, the

12

abortion method likely to be employed is more brutal, and the

13

risk of pain experienced by the unborn child is greater.

14

unborn child at twenty weeks gestational age might be twenty-four

15

weeks gestational age, when an abortion poses a greater risk to

16

the woman, the unborn child is considerably more developed, the

17

abortion method likely to be employed is more brutal, the risk of

18

pain experienced by the unborn child is greater, and the unborn

19

child may be viable.

20

3.

An

The state of Missouri is bound by Article VI, Clause 2

21

of the Constitution of the United States that "all treaties made,

22

or which shall be made, under the authority of the United States,

23

shall be the supreme law of the land".

24

International Covenant on Civil and Political Rights, entered

25

into force on March 23, 1976, and adopted by the United States on

26

September 8, 1992.

27

declared that while the provisions of Articles 1 through 27 of

28

the Covenant are not self-executing, the United States'

One such treaty is the

In ratifying the Covenant, the United States

21

 1

understanding is that state governments share responsibility with

2

the federal government in implementing the Covenant.

3

4.

Article 6, Paragraph 1, U.N.T.S. at 174, of the

4

International Covenant on Civil and Political Rights states,

5

"Every human being has the inherent right to life.

6

shall be protected by law.

7

of his life".

8

obligation to comply with the Covenant and to implement this

9

paragraph as it relates to the inherent right to life of unborn

This right

No one shall be arbitrarily deprived

The state of Missouri takes seriously its

10

human beings, protecting the rights of unborn human beings by

11

law, and ensuring that such unborn human beings are not

12

arbitrarily deprived of life.

13

implements Article 6, Paragraph 1 of the Covenant by the

14

regulation of abortion in this state.

15
16
17
18

5.

The state of Missouri hereby

The state of Missouri has interests that include, but

are not limited to:
(1)

Protecting unborn children throughout pregnancy and

preserving and promoting their lives from conception to birth;

19

(2)

Encouraging childbirth over abortion;

20

(3)

Ensuring respect for all human life from conception to

21

natural death;

22

(4)

Safeguarding an unborn child from the serious harm of

23

pain by an abortion method that would cause the unborn child to

24

experience pain while she or he is being killed;

25

(5)

Preserving the integrity of the medical profession and

26

regulating and restricting practices that might cause the medical

27

profession or society as a whole to become insensitive, even

28

disdainful, to life.

This includes regulating and restricting

22

 1

abortion methods that are not only brutal and painful, but if

2

allowed to continue, will further coarsen society to the humanity

3

of not only unborn children, but all vulnerable and innocent

4

human life, making it increasingly difficult to protect such

5

life;

6

(6)

Ending the incongruities in state law by permitting

7

some unborn children to be killed by abortion, while requiring

8

that unborn children be protected in non-abortion circumstances

9

through, including, but not limited to, homicide, assault, self-

10

defense, and defense of another statutes; laws guaranteeing

11

prenatal health care, emergency care, and testing; state-

12

sponsored health insurance for unborn children; the prohibition

13

of restraints in correctional institutions to protect pregnant

14

offenders and their unborn children; and protecting the interests

15

of unborn children by the appointment of conservators, guardians,

16

and representatives;

17
18
19

(7)

Reducing the risks of harm to pregnant women who obtain

abortions later in pregnancy; and
(8)

Avoiding burdens on the health care system, taxpayers,

20

and the workforce because of increased preterm births, low

21

birthweight babies, compromised pregnancies, extended postpartum

22

recoveries, and behavioral health problems caused by the long-

23

term effects of abortions performed or induced later in the

24

pregnancy.

25

188.027.

1.

Except in [the case] cases of medical

26

emergency, no abortion shall be performed or induced on a woman

27

without her voluntary and informed consent, given freely and

28

without coercion.

Consent to an abortion is voluntary and

23

 1

informed and given freely and without coercion if, and only if,

2

at least seventy-two hours prior to the abortion:

3

(1)

The physician who is to perform or induce the abortion,

4

a qualified professional, or the referring physician has informed

5

the woman orally, reduced to writing, and in person, of the

6

following:

7

(a)

The name of the physician who will perform or induce

8

the abortion;

9

(b)

Medically accurate information that a reasonable

10

patient would consider material to the decision of whether or not

11

to undergo the abortion, including:

12

a.

A description of the proposed abortion method;

13

b.

The immediate and long-term medical risks to the woman

14

associated with the proposed abortion method including, but not

15

limited to, infection, hemorrhage, cervical tear or uterine

16

perforation, harm to subsequent pregnancies or the ability to

17

carry a subsequent child to term, and possible adverse

18

psychological effects associated with the abortion; and

19

c.

The immediate and long-term medical risks to the woman,

20

in light of the anesthesia and medication that is to be

21

administered, the unborn child's gestational age, and the woman's

22

medical history and medical condition;

23

(c)

Alternatives to the abortion which shall include making

24

the woman aware that information and materials shall be provided

25

to her detailing such alternatives to the abortion;

26

(d)

A statement that the physician performing or inducing

27

the abortion is available for any questions concerning the

28

abortion, together with the telephone number that the physician

24

 1

may be later reached to answer any questions that the woman may

2

have;

3

(e)

The location of the hospital that offers obstetrical or

4

gynecological care located within thirty miles of the location

5

where the abortion is performed or induced and at which the

6

physician performing or inducing the abortion has clinical

7

privileges and where the woman may receive follow-up care by the

8

physician if complications arise;

9
10
11

(f)

The gestational age of the unborn child at the time the

abortion is to be performed or induced; and
(g)

The anatomical and physiological characteristics of the

12

unborn child at the time the abortion is to be performed or

13

induced;

14

(2)

The physician who is to perform or induce the abortion

15

or a qualified professional has presented the woman, in person,

16

printed materials provided by the department, which describe the

17

probable anatomical and physiological characteristics of the

18

unborn child at two-week gestational increments from conception

19

to full term, including color photographs or images of the

20

developing unborn child at two-week gestational increments.

21

descriptions shall include information about brain and heart

22

functions, the presence of external members and internal organs

23

during the applicable stages of development and information on

24

when the unborn child is viable.

25

prominently display the following statement:

26

human being begins at conception.

27

life of a separate, unique, living human being.";

28

(3)

Such

The printed materials shall
"The life of each

Abortion will terminate the

The physician who is to perform or induce the abortion,

25

 1

a qualified professional, or the referring physician has

2

presented the woman, in person, printed materials provided by the

3

department, which describe the various surgical and drug-induced

4

methods of abortion relevant to the stage of pregnancy, as well

5

as the immediate and long-term medical risks commonly associated

6

with each abortion method including, but not limited to,

7

infection, hemorrhage, cervical tear or uterine perforation, harm

8

to subsequent pregnancies or the ability to carry a subsequent

9

child to term, and the possible adverse psychological effects

10
11

associated with an abortion;
(4)

The physician who is to perform or induce the abortion

12

or a qualified professional shall provide the woman with the

13

opportunity to view at least seventy-two hours prior to the

14

abortion an active ultrasound of the unborn child and hear the

15

heartbeat of the unborn child if the heartbeat is audible.

16

woman shall be provided with a geographically indexed list

17

maintained by the department of health care providers,

18

facilities, and clinics that perform ultrasounds, including those

19

that offer ultrasound services free of charge.

20

shall provide contact information for each provider, facility, or

21

clinic including telephone numbers and, if available, website

22

addresses.

23

a provider, facility, or clinic other than the abortion facility,

24

the woman shall be offered a reasonable time to obtain the

25

ultrasound examination before the date and time set for

26

performing or inducing an abortion.

27

ultrasound shall ensure that the active ultrasound image is of a

28

quality consistent with standard medical practice in the

The

Such materials

Should the woman decide to obtain an ultrasound from

26

The person conducting the

 1

community, contains the dimensions of the unborn child, and

2

accurately portrays the presence of external members and internal

3

organs, if present or viewable, of the unborn child.

4

auscultation of fetal heart tone must also be of a quality

5

consistent with standard medical practice in the community.

6

the woman chooses to view the ultrasound or hear the heartbeat or

7

both at the abortion facility, the viewing or hearing or both

8

shall be provided to her at the abortion facility at least

9

seventy-two hours prior to the abortion being performed or

10

induced;

11

(5)

The

If

[Prior to an abortion being performed or induced on an

12

unborn child of twenty-two weeks gestational age or older, the

13

physician who is to perform or induce the abortion or a qualified

14

professional has presented the woman, in person, printed

15

materials provided by the department that offer information on

16

the possibility of the abortion causing pain to the unborn child.

17

This information shall include, but need not be limited to, the

18

following:

19

(a)

At least by twenty-two weeks of gestational age, the

20

unborn child possesses all the anatomical structures, including

21

pain receptors, spinal cord, nerve tracts, thalamus, and cortex,

22

that are necessary in order to feel pain;

23

(b)

A description of the actual steps in the abortion

24

procedure to be performed or induced, and at which steps the

25

abortion procedure could be painful to the unborn child;

26

(c)

There is evidence that by twenty-two weeks of

27

gestational age, unborn children seek to evade certain stimuli in

28

a manner that in an infant or an adult would be interpreted as a

27

 1
2

response to pain;
(d)

Anesthesia is given to unborn children who are

3

twenty-two weeks or more gestational age who undergo prenatal

4

surgery;

5

(e)

6
7

Anesthesia is given to premature children who are

twenty-two weeks or more gestational age who undergo surgery;
(f)

Anesthesia or an analgesic is available in order to

8

minimize or alleviate the pain to the unborn child] The printed

9

materials provided by the department shall include information on

10

the possibility of an abortion causing pain in the unborn child.

11

This information shall include, but need not be limited to, the

12

following:

13

(a)

Unborn children as early at eight weeks gestational age

14

start to show spontaneous movements and unborn children at this

15

stage in pregnancy show reflex responses to touch;

16

(b)

In the unborn child, the area around his or her mouth

17

and lips is the first part of the unborn child's body to respond

18

to touch and by fourteen weeks gestational age most of the unborn

19

child's body is responsive to touch;

20

(c)

Pain receptors on the unborn child's skin develop

21

around his or her mouth at around seven to eight weeks

22

gestational age, around the palms of his or her hands at ten to

23

ten and a half weeks, on the abdominal wall at fifteen weeks, and

24

over all of his or her body at sixteen weeks gestational age;

25

(d)

Beginning at sixteen weeks gestational age and later,

26

it is possible for pain to be transmitted from receptors to the

27

cortex of the unborn child's brain, where thinking and perceiving

28

occur;

28

 1

(e)

When a physician performs a life-saving surgery, he or

2

she provides anesthesia to unborn children as young as sixteen

3

weeks gestational age in order to alleviate the unborn child's

4

pain; and

5

(f)

A description of the actual steps in the abortion

6

procedure to be performed or induced and at which steps the

7

abortion procedure could be painful to the unborn child;

8
9

(6)

The physician who is to perform or induce the abortion

or a qualified professional has presented the woman, in person,

10

printed materials provided by the department explaining to the

11

woman alternatives to abortion she may wish to consider.

12

materials shall:

13

(a)

Such

Identify on a geographical basis public and private

14

agencies available to assist a woman in carrying her unborn child

15

to term, and to assist her in caring for her dependent child or

16

placing her child for adoption, including agencies commonly known

17

and generally referred to as pregnancy resource centers, crisis

18

pregnancy centers, maternity homes, and adoption agencies.

19

materials shall provide a comprehensive list by geographical area

20

of the agencies, a description of the services they offer, and

21

the telephone numbers and addresses of the agencies; provided

22

that such materials shall not include any programs, services,

23

organizations, or affiliates of organizations that perform or

24

induce, or assist in the performing or inducing of, abortions or

25

that refer for abortions;

26

(b)

Such

Explain the Missouri alternatives to abortion services

27

program under section 188.325, and any other programs and

28

services available to pregnant women and mothers of newborn

29

 1

children offered by public or private agencies which assist a

2

woman in carrying her unborn child to term and assist her in

3

caring for her dependent child or placing her child for adoption,

4

including but not limited to prenatal care; maternal health care;

5

newborn or infant care; mental health services; professional

6

counseling services; housing programs; utility assistance;

7

transportation services; food, clothing, and supplies related to

8

pregnancy; parenting skills; educational programs; job training

9

and placement services; drug and alcohol testing and treatment;

10
11

and adoption assistance;
(c)

Identify the state website for the Missouri

12

alternatives to abortion services program under section 188.325,

13

and any toll-free number established by the state operated in

14

conjunction with the program;

15

(d)

Prominently display the statement:

"There are public

16

and private agencies willing and able to help you carry your

17

child to term, and to assist you and your child after your child

18

is born, whether you choose to keep your child or place him or

19

her for adoption.

20

contact those agencies before making a final decision about

21

abortion.

22

professional give you the opportunity to call agencies like these

23

before you undergo an abortion.";

24

(7)

The state of Missouri encourages you to

State law requires that your physician or a qualified

The physician who is to perform or induce the abortion

25

or a qualified professional has presented the woman, in person,

26

printed materials provided by the department explaining that the

27

father of the unborn child is liable to assist in the support of

28

the child, even in instances where he has offered to pay for the

30

 1

abortion.

2

duties and support obligations of the father of a child,

3

including, but not limited to, child support payments, and the

4

fact that paternity may be established by the father's name on a

5

birth certificate or statement of paternity, or by court action.

6

Such printed materials shall also state that more information

7

concerning paternity establishment and child support services and

8

enforcement may be obtained by calling the family support

9

division within the Missouri department of social services; and

10

(8)

Such materials shall include information on the legal

The physician who is to perform or induce the abortion

11

or a qualified professional shall inform the woman that she is

12

free to withhold or withdraw her consent to the abortion at any

13

time without affecting her right to future care or treatment and

14

without the loss of any state or federally funded benefits to

15

which she might otherwise be entitled.

16

2.

All information required to be provided to a woman

17

considering abortion by subsection 1 of this section shall be

18

presented to the woman individually, in the physical presence of

19

the woman and in a private room, to protect her privacy, to

20

maintain the confidentiality of her decision, to ensure that the

21

information focuses on her individual circumstances, to ensure

22

she has an adequate opportunity to ask questions, and to ensure

23

that she is not a victim of coerced abortion.

24

unable to read materials provided to her, they shall be read to

25

her.

26

information presented in the written materials, an interpreter

27

shall be provided to her.

28

concerning any of the information or materials, answers shall be

Should a woman be

Should a woman need an interpreter to understand the

Should a woman ask questions

31

 1
2

provided in a language she can understand.
3.

No abortion shall be performed or induced unless and

3

until the woman upon whom the abortion is to be performed or

4

induced certifies in writing on a checklist form provided by the

5

department that she has been presented all the information

6

required in subsection 1 of this section, that she has been

7

provided the opportunity to view an active ultrasound image of

8

the unborn child and hear the heartbeat of the unborn child if it

9

is audible, and that she further certifies that she gives her

10

voluntary and informed consent, freely and without coercion, to

11

the abortion procedure.

12

4.

[No abortion shall be performed or induced on an unborn

13

child of twenty-two weeks gestational age or older unless and

14

until the woman upon whom the abortion is to be performed or

15

induced has been provided the opportunity to choose to have an

16

anesthetic or analgesic administered to eliminate or alleviate

17

pain to the unborn child caused by the particular method of

18

abortion to be performed or induced.

19

anesthesia or analgesics shall be performed in a manner

20

consistent with standard medical practice in the community.

21

5.]

The administration of

No physician shall perform or induce an abortion unless

22

and until the physician has obtained from the woman her voluntary

23

and informed consent given freely and without coercion.

24

physician has reason to believe that the woman is being coerced

25

into having an abortion, the physician or qualified professional

26

shall inform the woman that services are available for her and

27

shall provide her with private access to a telephone and

28

information about such services, including but not limited to the

32

If the

 1

following:

2

(1)

Rape crisis centers, as defined in section 455.003;

3

(2)

Shelters for victims of domestic violence, as defined

4

in section 455.200; and

5

(3)

Orders of protection, pursuant to chapter 455.

6

[6.] 5.

The physician who is to perform or induce the

7

abortion shall, at least seventy-two hours prior to such

8

procedure, inform the woman orally and in person of:

9

(1)

The immediate and long-term medical risks to the woman

10

associated with the proposed abortion method including, but not

11

limited to, infection, hemorrhage, cervical tear or uterine

12

perforation, harm to subsequent pregnancies or the ability to

13

carry a subsequent child to term, and possible adverse

14

psychological effects associated with the abortion; and

15

(2)

The immediate and long-term medical risks to the woman,

16

in light of the anesthesia and medication that is to be

17

administered, the unborn child's gestational age, and the woman's

18

medical history and medical conditions.

19

[7.] 6.

No physician shall perform or induce an abortion

20

unless and until the physician has received and signed a copy of

21

the form prescribed in subsection 3 of this section.

22

physician shall retain a copy of the form in the patient's

23

medical record.

24

[8.] 7.

The

In the event of a medical emergency [as provided by

25

section 188.039], the physician who performed or induced the

26

abortion shall clearly certify in writing the nature and

27

circumstances of the medical emergency.

28

be signed by the physician who performed or induced the abortion,

33

This certification shall

 1
2

and shall be maintained under section 188.060.
[9.] 8.

No person or entity shall require, obtain, or

3

accept payment for an abortion from or on behalf of a patient

4

until at least seventy-two hours have passed since the time that

5

the information required by subsection 1 of this section has been

6

provided to the patient.

7

prohibit a person or entity from notifying the patient that

8

payment for the abortion will be required after the

9

seventy-two-hour period has expired if she voluntarily chooses to

10

have the abortion.

11

[10.] 9.

Nothing in this subsection shall

The term "qualified professional" as used in this

12

section shall refer to a physician, physician assistant,

13

registered nurse, licensed practical nurse, psychologist,

14

licensed professional counselor, or licensed social worker,

15

licensed or registered under chapter 334, 335, or 337, acting

16

under the supervision of the physician performing or inducing the

17

abortion, and acting within the course and scope of his or her

18

authority provided by law.

19

not be construed to in any way expand the authority otherwise

20

provided by law relating to the licensure, registration, or scope

21

of practice of any such qualified professional.

22

[11.] 10.

The provisions of this section shall

By November 30, 2010, the department shall

23

produce the written materials and forms described in this

24

section.

25

typeface large enough to be clearly legible.

26

shall be presented in an objective, unbiased manner designed to

27

convey only accurate scientific and medical information.

28

department shall furnish the written materials and forms at no

Any written materials produced shall be printed in a

34

All information

The

 1

cost and in sufficient quantity to any person who performs or

2

induces abortions, or to any hospital or facility that provides

3

abortions.

4

subsection 1 of this section available to the public through its

5

department website.

6

twenty-four-hour hotline telephone number where a caller can

7

obtain information on a regional basis concerning the agencies

8

and services described in subsection 1 of this section.

9

identifying information regarding persons who use the website

The department shall make all information required by

The department shall maintain a toll-free,

No

10

shall be collected or maintained.

11

the website on a regular basis to prevent tampering and correct

12

any operational deficiencies.

13

[12.] 11.

The department shall monitor

In order to preserve the compelling interest of

14

the state to ensure that the choice to consent to an abortion is

15

voluntary and informed, and given freely and without coercion,

16

the department shall use the procedures for adoption of emergency

17

rules under section 536.025 in order to promulgate all necessary

18

rules, forms, and other necessary material to implement this

19

section by November 30, 2010.

20

[13.] 12.

If the provisions in subsections 1 and [9] 8 of

21

this section requiring a seventy-two-hour waiting period for an

22

abortion are ever temporarily or permanently restrained or

23

enjoined by judicial order, then the waiting period for an

24

abortion shall be twenty-four hours; provided, however, that if

25

such temporary or permanent restraining order or injunction is

26

stayed or dissolved, or otherwise ceases to have effect, the

27

waiting period for an abortion shall be seventy-two hours.

28

188.028.

1.

Except in the case of a medical emergency, no

35

 1

person shall knowingly perform or induce an abortion upon a

2

pregnant woman under the age of eighteen years unless:

3

(1)

The attending physician has secured the informed

4

written consent of the minor and one parent or guardian, and the

5

consenting parent or guardian of the minor has notified any other

6

custodial parent in writing prior to the securing of the informed

7

written consent of the minor and one parent or guardian.

8

purposes of this subdivision, "custodial parent" shall only mean

9

a parent of a minor who has been awarded joint legal custody or

For

10

joint physical custody of such minor by a court of competent

11

jurisdiction.

12

(a)

Notice shall not be required for any parent:

Who has been found guilty of any offense in violation

13

of chapter 565, relating to offenses against the person; chapter

14

566, relating to sexual offenses; chapter 567, relating to

15

prostitution; chapter 568, relating to offenses against the

16

family; or chapter 573, related to pornography and related

17

offenses, if a child was a victim;

18

(b)

Who has been found guilty of any offense in any other

19

state or foreign country, or under federal, tribal, or military

20

jurisdiction if a child was a victim, which would be a violation

21

of chapters 565, 566, 567, 568, or 573 if committed in this

22

state;

23
24
25

(c)

Who is listed on the sexual offender registry under

sections 589.400 to 589.425;
(d)

Against whom an order of protection has been issued,

26

including a foreign order of protection given full faith and

27

credit in this state under section 455.067;

28

(e)

Whose custodial, parental, or guardianship rights have

36

 1
2

been terminated by a court of competent jurisdiction; or
(f)

Whose whereabouts are unknown after reasonable inquiry,

3

who is a fugitive from justice, who is habitually in an

4

intoxicated or drugged condition, or who has been declared

5

mentally incompetent or incapacitated by a court of competent

6

jurisdiction; [or]

7
8
9

(2)

The minor is emancipated and the attending physician

has received the informed written consent of the minor; [or]
(3)

The minor has been granted the right to self-consent to

10

the abortion by court order pursuant to subsection 2 of this

11

section, and the attending physician has received the informed

12

written consent of the minor; or

13

(4)

The minor has been granted consent to the abortion by

14

court order, and the court has given its informed written consent

15

in accordance with subsection 2 of this section, and the minor is

16

having the abortion willingly, in compliance with subsection 3 of

17

this section.

18

2.

The right of a minor to self-consent to an abortion

19

under subdivision (3) of subsection 1 of this section or court

20

consent under subdivision (4) of subsection 1 of this section may

21

be granted by a court pursuant to the following procedures:

22

(1)

The minor or next friend shall make an application to

23

the juvenile court which shall assist the minor or next friend in

24

preparing the petition and notices required pursuant to this

25

section.

26

thereafter file a petition setting forth the initials of the

27

minor; the age of the minor; the names and addresses of each

28

parent, guardian, or, if the minor's parents are deceased and no

The minor or the next friend of the minor shall

37

 1

guardian has been appointed, any other person standing in loco

2

parentis of the minor; that the minor has been fully informed of

3

the risks and consequences of the abortion; that the minor is of

4

sound mind and has sufficient intellectual capacity to consent to

5

the abortion; that, if the court does not grant the minor

6

majority rights for the purpose of consent to the abortion, the

7

court should find that the abortion is in the best interest of

8

the minor and give judicial consent to the abortion; that the

9

court should appoint a guardian ad litem of the child; and if the

10

minor does not have private counsel, that the court should

11

appoint counsel.

12

the next friend;

13

(2)

The petition shall be signed by the minor or

A hearing on the merits of the petition, to be held on

14

the record, shall be held as soon as possible within five days of

15

the filing of the petition.

16

counsel, the court shall appoint counsel at least twenty-four

17

hours before the time of the hearing.

18

shall hear evidence relating to the emotional development,

19

maturity, intellect and understanding of the minor; the nature,

20

possible consequences, and alternatives to the abortion; and any

21

other evidence that the court may find useful in determining

22

whether the minor should be granted majority rights for the

23

purpose of consenting to the abortion or whether the abortion is

24

in the best interests of the minor;

If any party is unable to afford

At the hearing, the court

25

(3)

In the decree, the court shall for good cause:

26

(a)

Grant the petition for majority rights for the purpose

27
28

of consenting to the abortion; [or]
(b)

Find the abortion to be in the best interests of the

38

 1

minor and give judicial consent to the abortion, setting forth

2

the grounds for so finding; or

3
4
5

(c)

Deny the petition, setting forth the grounds on which

the petition is denied;
(4)

If the petition is allowed, the informed consent of the

6

minor, pursuant to a court grant of majority rights, or the

7

judicial consent, shall bar an action by the parents or guardian

8

of the minor on the grounds of battery of the minor by those

9

performing or inducing the abortion.

The immunity granted shall

10

only extend to the performance or induction of the abortion in

11

accordance herewith and any necessary accompanying services which

12

are performed in a competent manner.

13

shall be borne by the parties;

14

(5)

The costs of the action

An appeal from an order issued under the provisions of

15

this section may be taken to the court of appeals of this state

16

by the minor or by a parent or guardian of the minor.

17

of intent to appeal shall be given within twenty-four hours from

18

the date of issuance of the order.

19

completed and the appeal shall be perfected within five days from

20

the filing of notice to appeal.

21

essence regarding the performance or induction of the abortion,

22

the supreme court of this state shall, by court rule, provide for

23

expedited appellate review of cases appealed under this section.

24

3.

The notice

The record on appeal shall be

Because time may be of the

If a minor desires an abortion, then she shall be orally

25

informed of and, if possible, sign the written consent required

26

[by section 188.039] under this chapter in the same manner as an

27

adult person.

28

minor against her will, except that an abortion may be performed

No abortion shall be performed or induced on any

39

 1

or induced against the will of a minor pursuant to a court order

2

described in subdivision (4) of subsection 1 of this section that

3

the abortion is necessary to preserve the life of the minor.

4

188.033.

Whenever an abortion facility or a family planning

5

agency located in this state, or any of its agents or employees

6

acting within the scope of his or her authority or employment,

7

provides to a woman considering an abortion the name, address,

8

telephone number, or website of an abortion provider that is

9

located outside of the state, such abortion facility or family

10

planning agency or its agents or employees shall also provide to

11

such woman the printed materials produced by the department under

12

section 188.027.

13

website of such abortion provider is not provided to such woman

14

in person, such printed materials shall be offered to her, and if

15

she chooses, sent to such woman at no cost to her the same day or

16

as soon as possible either electronically or by U.S. mail

17

overnight delivery service or by other overnight or same-day

18

delivery service to an address of such woman's choosing.

19

department shall furnish such printed materials at no cost and in

20

sufficient quantities to abortion facilities and family planning

21

agencies located within the state.

22

188.038.

23

(1)

1.

If the name, address, telephone number, or

The

The general assembly of this state finds that:

Removing vestiges of any past bias or discrimination

24

against pregnant women, their partners, and their family members,

25

including their unborn children, is an important task for those

26

in the legal, medical, social services, and human services

27

professions;

28

(2)

Ending any current bias or discrimination against

40

 1

pregnant women, their partners, and their family members,

2

including their unborn children, is a legitimate purpose of

3

government in order to guarantee that those who "are endowed by

4

their Creator with certain unalienable Rights" can enjoy "Life,

5

Liberty and the pursuit of Happiness";

6

(3)

The historical relationship of bias or discrimination

7

by some family planning programs and policies towards poor and

8

minority populations, including, but not limited to, the

9

nonconsensual sterilization of mentally ill, poor, minority, and

10

immigrant women and other coercive family planning programs and

11

policies, must be rejected;

12

(4)

Among Missouri residents, the rate of black or African-

13

American women who undergo abortions is significantly higher,

14

about three and a half times higher, than the rate of white women

15

who undergo abortions.

16

black or African-American women who undergo repeat abortions is

17

significantly higher, about one and a half times higher, than the

18

rate of white women who undergo repeat abortions;

19

(5)

Among Missouri residents, the rate of

Performing or inducing an abortion because of the sex

20

of the unborn child is repugnant to the values of equality of

21

females and males and the same opportunities for girls and boys,

22

and furthers a false mindset of female inferiority;

23

(6)

Government has a legitimate interest in preventing the

24

abortion of unborn children with Down Syndrome because it is a

25

form of bias or disability discrimination and victimizes the

26

disabled unborn child at his or her most vulnerable stage.

27

Eliminating unborn children with Down Syndrome raises grave

28

concerns for the lives of those who do live with disabilities.

41

 1

It sends a message of dwindling support for their unique

2

challenges, fosters a false sense that disability is something

3

that could have been avoidable, and is likely to increase the

4

stigma associated with disability.

5

2.

No person shall perform or induce an abortion on a woman

6

if the person knows that the woman is seeking the abortion solely

7

because of a prenatal diagnosis, test, or screening indicating

8

Down Syndrome or the potential of Down Syndrome in an unborn

9

child.

10

3.

No person shall perform or induce an abortion on a woman

11

if the person knows that the woman is seeking the abortion solely

12

because of the sex or race of the unborn child.

13

4.

Any physician or other person who performs or induces or

14

attempts to perform or induce an abortion prohibited by this

15

section shall be subject to all applicable civil penalties under

16

this chapter including, but not limited to, sections 188.065 and

17

188.085.

18

188.043.

1.

No person shall perform or induce [a surgical

19

or medical] an abortion on another unless such person has [proof

20

of] medical malpractice insurance with coverage amounts of at

21

least [five hundred thousand dollars] one million dollars per

22

occurrence and three million dollars in the annual aggregate.

23

2.

For the purpose of this section, "medical malpractice

24

insurance" means insurance coverage against the legal liability

25

of the insured and against loss, damage, or expense incident to a

26

claim arising out of the death or injury of any person as a

27

result of the negligence or malpractice in rendering professional

28

service by any health care provider.

42

 1

3.

No abortion facility or hospital shall employ or engage

2

the services of a person to perform [one or more abortions] or

3

induce an abortion on another if the person does not have [proof

4

of] medical malpractice insurance pursuant to this section,

5

except that the abortion facility or hospital may provide medical

6

malpractice insurance for the services of persons employed or

7

engaged by such facility or hospital which is no less than the

8

coverage amounts set forth in this section.

9

4.

Notwithstanding the provisions of section 334.100,

10

failure of a person to maintain the medical malpractice insurance

11

required by this section shall be an additional ground for

12

sanctioning of a person's license, certificate, or permit.

13

188.044.

1.

When a drug or chemical, or combination

14

thereof, used by a person to induce an abortion carries a warning

15

from its manufacturer or distributor, a peer-reviewed medical

16

journal article, or a Food and Drug Administration label that its

17

use may cause birth defects, disability, or other injury in a

18

child who survives the abortion, then in addition to the

19

requirements of section 188.043, such person shall also carry

20

tail insurance with coverage amounts of at least one million

21

dollars per occurrence and three million dollars in the annual

22

aggregate for personal injury to or death of a child who survives

23

such abortion.

24

effect for a period of twenty-one years after the person used the

25

drug or chemical, or combination thereof, to induce the abortion.

26

2.

Such policy shall be maintained in force or be in

For the purpose of this section, "tail insurance" means

27

insurance which covers the legal liability of the insured once a

28

medical malpractice insurance policy is cancelled, not renewed,

43

 1

or terminated, and covers claims made after such cancellation or

2

termination for acts occurring during the period the prior

3

medical malpractice insurance was in effect.

4

3.

No abortion facility or hospital shall employ or engage

5

the services of a person to induce an abortion on another using

6

any drug or chemical, or combination thereof, which may cause

7

birth defects, disability, or other injury in a child who

8

survives the abortion, if the person does not have tail insurance

9

pursuant to this section, except that the abortion facility or

10

hospital may provide tail insurance for the services of persons

11

employed or engaged by such facility or hospital which is no less

12

than the coverage amounts and duration set forth in this section.

13

4.

Notwithstanding the provisions of section 334.100 to the

14

contrary, failure of a person to maintain the tail insurance

15

required by this section shall be an additional ground for

16

sanctioning of a person's license, certificate, or permit.

17

188.052.

1.

An individual abortion report for each

18

abortion performed or induced upon a woman shall be completed by

19

[her attending] the physician who performed or induced the

20

abortion.

21

a certification that the physician does not have any knowledge

22

that the woman sought the abortion solely because of a prenatal

23

diagnosis, test, or screening indicating Down Syndrome or the

24

potential of Down Syndrome in the unborn child and a

25

certification that the physician does not have any knowledge that

26

the woman sought the abortion solely because of the sex or race

27

of the unborn child.

28

2.

Abortion reports shall include, but not be limited to,

An individual complication report for any post-abortion

44

 1

care performed upon a woman shall be completed by the physician

2

providing such post-abortion care.

This report shall include:

3

(1)

The date of the abortion;

4

(2)

The name and address of the abortion facility or

5

hospital where the abortion was performed or induced;

6

(3)

7

treated.

8

3.

The nature of the abortion complication diagnosed or

All abortion reports shall be signed by the attending

9

physician[,] who performed or induced the abortion and submitted

10

to the [state] department [of health and senior services] within

11

forty-five days from the date of the abortion.

12

reports shall be signed by the physician providing the

13

post-abortion care and submitted to the department [of health and

14

senior services] within forty-five days from the date of the

15

post-abortion care.

16

4.

All complication

A copy of the abortion report shall be made a part of

17

the medical record of the patient of the abortion facility or

18

hospital in which the abortion was performed or induced.

19

5.

The [state] department [of health and senior services]

20

shall be responsible for collecting all abortion reports and

21

complication reports and collating and evaluating all data

22

gathered therefrom and shall annually publish a statistical

23

report based on such data from abortions performed or induced in

24

the previous calendar year.

25

188.056.

1.

Notwithstanding any other provision of law to

26

the contrary, no abortion shall be performed or induced upon a

27

woman at eight weeks gestational age or later, except in cases of

28

medical emergency.

Any person who knowingly performs or induces

45

 1

an abortion of an unborn child in violation of this subsection

2

shall be guilty of a class B felony, as well as subject to

3

suspension or revocation of his or her professional license by

4

his or her professional licensing board.

5

abortion is performed or induced in violation of this subsection

6

shall not be prosecuted for a conspiracy to violate the

7

provisions of this section.

8
9

2.

A woman upon whom an

It shall be an affirmative defense for any person

alleged to have violated the provisions of subsection 1 of this

10

section that the person performed or induced an abortion because

11

of a medical emergency.

12

persuasion that the defense is more probably true than not.

13

3.

The defendant shall have the burden of

Prosecution under this section shall bar prosecution

14

under sections 188.057, 188.058, or 188.375 if prosecution under

15

such sections would violate the provisions of Amendment V to the

16

Constitution of the United States or article I, section 19 of the

17

Constitution of Missouri.

18

4.

If any one or more provisions, subsections, sentences,

19

clauses, phrases, or words of this section or the application

20

thereof to any person, circumstance, or period of gestational age

21

is found to be unenforceable, unconstitutional, or invalid by a

22

court of competent jurisdiction, the same is hereby declared to

23

be severable and the balance of the section shall remain

24

effective notwithstanding such unenforceability,

25

unconstitutionality, or invalidity.

26

declares that it would have passed this section, and each

27

provision, subsection, sentence, clause, phrase, or word thereof,

28

irrespective of the fact that any one or more provisions,

46

The general assembly hereby

 1

subsections, sentences, clauses, phrases, or words of the

2

section, or the application of the section to any person,

3

circumstance, or period of gestational age, would be declared

4

unenforceable, unconstitutional, or invalid.

5

188.057.

1.

Notwithstanding any other provision of law to

6

the contrary, no abortion shall be performed or induced upon a

7

woman at fourteen weeks gestational age or later, except in cases

8

of medical emergency.

9

induces an abortion of an unborn child in violation of this

Any person who knowingly performs or

10

subsection shall be guilty of a class B felony, as well as

11

subject to suspension or revocation of his or her professional

12

license by his or her professional licensing board.

13

whom an abortion is performed or induced in violation of this

14

subsection shall not be prosecuted for a conspiracy to violate

15

the provisions of this section.

16

2.

A woman upon

It shall be an affirmative defense for any person

17

alleged to have violated the provisions of subsection 1 of this

18

section that the person performed or induced an abortion because

19

of a medical emergency.

20

persuasion that the defense is more probably true than not.

21

3.

The defendant shall have the burden of

Prosecution under this section shall bar prosecution

22

under sections 188.056, 188.058, or 188.375 if prosecution under

23

such sections would violate the provisions of Amendment V to the

24

Constitution of the United States or article I, section 19 of the

25

Constitution of Missouri.

26

4.

If any one or more provisions, subsections, sentences,

27

clauses, phrases, or words of this section or the application

28

thereof to any person, circumstance, or period of gestational age

47

 1

is found to be unenforceable, unconstitutional, or invalid by a

2

court of competent jurisdiction, the same is hereby declared to

3

be severable and the balance of the section shall remain

4

effective notwithstanding such unenforceability,

5

unconstitutionality, or invalidity.

6

declares that it would have passed this section, and each

7

provision, subsection, sentence, clause, phrase, or word thereof,

8

irrespective of the fact that any one or more provisions,

9

subsections, sentences, clauses, phrases, or words of the

10

section, or the application of the section to any person,

11

circumstance, or period of gestational age, would be declared

12

unenforceable, unconstitutional, or invalid.

13

188.058.

1.

The general assembly hereby

Notwithstanding any other provision of law to

14

the contrary, no abortion shall be performed or induced upon a

15

woman at eighteen weeks gestational age or later, except in cases

16

of medical emergency.

17

induces an abortion of an unborn child in violation of this

18

subsection shall be guilty of a class B felony, as well as

19

subject to suspension or revocation of his or her professional

20

license by his or her professional licensing board.

21

whom an abortion is performed or induced in violation of this

22

section shall not be prosecuted for a conspiracy to violate the

23

provisions of this section.

24

2.

Any person who knowingly performs or

A woman upon

It shall be an affirmative defense for any person

25

alleged to have violated the provisions of subsection 1 of this

26

section that the person performed or induced an abortion because

27

of a medical emergency.

28

persuasion that the defense is more probably true than not.

The defendant shall have the burden of

48

 1

3.

Prosecution under this section shall bar prosecution

2

under sections 188.056, 188.057, or 188.375 if prosecution under

3

such sections would violate the provisions of Amendment V to the

4

Constitution of the United States or article I, section 19 of the

5

Constitution of Missouri.

6

4.

If any one or more provisions, subsections, sentences,

7

clauses, phrases, or words of this section or the application

8

thereof to any person, circumstance, or period of gestational age

9

is found to be unenforceable, unconstitutional, or invalid by a

10

court of competent jurisdiction, the same is hereby declared to

11

be severable and the balance of the section shall remain

12

effective notwithstanding such unenforceability,

13

unconstitutionality, or invalidity.

14

declares that it would have passed this section, and each

15

provision, subsection, sentence, clause, phrase, or word thereof,

16

irrespective of the fact that any one or more provisions,

17

subsections, sentences, clauses, phrases, or words of the

18

section, or the application of the section to any person,

19

circumstance, or period of gestational age, would be declared

20

unenforceable, unconstitutional, or invalid.

21
22
23

188.375.

1.

The general assembly hereby

This section shall be known and may be cited

as the "Late-Term Pain-Capable Unborn Child Protection Act".
2.

As used in this section, the phrase "late-term pain-

24

capable unborn child" shall mean an unborn child at twenty weeks

25

gestational age or later.

26

3.

Notwithstanding any other provision of law to the

27

contrary, no abortion shall be performed or induced upon a woman

28

carrying a late-term pain-capable unborn child, except in cases

49

 1

of medical emergency.

2

induces an abortion of a late-term pain-capable unborn child in

3

violation of this subsection shall be guilty of a class B felony,

4

as well as subject to suspension or revocation of his or her

5

professional license by his or her professional licensing board.

6

A woman upon whom an abortion is performed or induced in

7

violation of this subsection shall not be prosecuted for a

8

conspiracy to violate the provisions of this subsection.

9

4.

Any person who knowingly performs or

It shall be an affirmative defense for any person

10

alleged to have violated the provisions of subsection 3 of this

11

section that the person performed or induced an abortion because

12

of a medical emergency.

13

persuasion that the defense is more probably true than not.

14

5.

The defendant shall have the burden of

Prosecution under subsection 3 of this section shall bar

15

prosecution under sections 188.056, 188.057, or 188.058 if

16

prosecution under such sections would violate the provisions of

17

Amendment V to the Constitution of the United States or article

18

I, section 19 of the Constitution of Missouri.

19

6.

When in cases of medical emergency a physician performs

20

or induces an abortion upon a woman in her third trimester

21

carrying a late-term pain-capable unborn child, the physician

22

shall utilize the available method or technique of abortion most

23

likely to preserve the life or health of the unborn child.

24

cases where the method or technique of abortion most likely to

25

preserve the life or health of the unborn child would present a

26

greater risk to the life or health of the woman than another

27

legally permitted and available method or technique, the

28

physician may utilize such other method or technique.

50

In

In all

 1

cases where the physician performs or induces an abortion upon a

2

woman during her third trimester carrying a late-term pain-

3

capable unborn child, the physician shall certify in writing the

4

available method or techniques considered and the reasons for

5

choosing the method or technique employed.

6

7.

When in cases of medical emergency a physician performs

7

or induces an abortion upon a woman during her third trimester

8

carrying a late-term pain-capable unborn child, there shall be in

9

attendance a physician other than the physician performing or

10

inducing the abortion who shall take control of and provide

11

immediate medical care for a child born as a result of the

12

abortion.

13

8.

Any physician who knowingly violates any of the

14

provisions of subsections 6 or 7 of this section shall be guilty

15

of a class D felony, as well as subject to suspension or

16

revocation of his or her professional license by his or her

17

professional licensing board.

18

performed or induced in violation of subsections 6 or 7 of this

19

section shall not be prosecuted for a conspiracy to violate the

20

provisions of those subsections.

21

9.

A woman upon whom an abortion is

If any one or more provisions, subsections, sentences,

22

clauses, phrases, or words of this section or the application

23

thereof to any person, circumstance, or period of gestational age

24

is found to be unenforceable, unconstitutional, or invalid by a

25

court of competent jurisdiction, the same is hereby declared to

26

be severable and the balance of the section shall remain

27

effective notwithstanding such unenforceability,

28

unconstitutionality, or invalidity.

51

The general assembly hereby

 1

declares that it would have passed this section, and each

2

provision, subsection, sentence, clause, phrase, or word thereof,

3

irrespective of the fact that any one or more provisions,

4

subsections, sentences, clauses, phrases, or words of the

5

section, or the application of the section to any person,

6

circumstance, or period of gestational age, would be declared

7

unenforceable, unconstitutional, or invalid.

8
9

Section B.

The enactment of section 188.017 of this act

shall only become effective upon notification to the revisor of

10

statutes by an opinion by the attorney general of Missouri, a

11

proclamation by the governor of Missouri, or the adoption of a

12

concurrent resolution by the Missouri general assembly that:

13

(1)

The United States Supreme Court has overruled, in whole

14

or in part, Roe v. Wade, 410 U.S. 113 (1973), restoring or

15

granting to the state of Missouri the authority to regulate

16

abortion to the extent set forth in section 188.017, and that as

17

a result, it is reasonably probable that section 188.017 of this

18

act would be upheld by the court as constitutional;

19

(2)

An amendment to the Constitution of the United States

20

has been adopted that has the effect of restoring or granting to

21

the state of Missouri the authority to regulate abortion to the

22

extent set forth in section 188.017; or

23

(3)

The United States Congress has enacted a law that has

24

the effect of restoring or granting to the state of Missouri the

25

authority to regulate abortion to the extent set forth in section

26

188.017.

27
28

Section C.

Because of the need to protect the health and

safety of women and their children, both unborn and born, the

52

 1

repeal and reenactment of section 188.028 of this act is deemed

2

necessary for the immediate preservation of the public health,

3

welfare, peace and safety, and is hereby declared to be an

4

emergency act within the meaning of the constitution, and the

5

repeal and reenactment of section 188.028 of this act shall be in

6

full force and effect upon its passage and approval.

53