No. 130-1 Emergency Motion To Stay Pending Appeal

Case: 20-5969 Document: 130-1 Filed: 06/24/2022 Page: 1
No. 20-5969
IN THE UNITED STATES COURT OF APPEALS

FOR THE SIXTH CIRCUIT
______________
MEMPHIS CENTER FOR REPRODUCTIVE HEALTH; PLANNED

PARENTHOOD OF TENNESSEE AND NORTH MISSISSIPPI; KNOXVILLE
CENTER FOR REPRODUCTIVE HEALTH; FEMHEALTH USA, INC.; DR.
KIMBERLY LOONEY; DR. NIKKI ZITE,
Plaintiffs-Appellees
v.
HERBERT H. SLATERY III; MORGAN McDONALD, M.D.; RENE

SAUNDERS, M.D.; HONORABLE AMY P. WEIRICH; GLENN R. FUNK;
CHARME P. ALLEN; MELANIE BLAKE, M.D.; JASON LAWSON,
Defendants-Appellants
______________
On Appeal from the United States District Court for the

Middle District of Tennessee
(No. 3:20-cv-00501)
EMERGENCY MOTION FOR STAY OF

PRELIMINARY INJUNCTION PENDING APPEAL
HERBERT H. SLATERY III CLARK L. HILDABRAND

Attorney General and Reporter Assistant Solicitor General
of the State of Tennessee Counsel of Record
ANDRÉE S. BLUMSTEIN TRAVIS J. ROYER
Solicitor General Honors Fellow
P.O. Box 20207

Nashville, TN 37202
(615) 253-5642
[email protected]
TABLE OF CONTENTS
TABLE OF AUTHORITIES ................................................................................... ii
EMERGENCY MOTION FOR STAY OF PRELIMINARY

INJUNCTION PENDING APPEAL ........................................................................1
INTRODUCTION .....................................................................................................2
BACKGROUND .......................................................................................................3
I. Statutory Background ................................................................................3
II. Procedural Background ..............................................................................6
STANDARD OF REVIEW ......................................................................................8
ARGUMENT ...........................................................................................................10
I. Defendants Are Likely to Succeed on Appeal ........................................11
A. Section 216 satisfies rational-basis review ......................................11
B. The medical-emergency affirmative defense is not

unconstitutionally vague..................................................................15
II. The Equities Weigh Strongly in Favor of a Stay ....................................20
CONCLUSION ........................................................................................................23
i
TABLE OF AUTHORITIES
Page(s)
Cases
Ayotte v. Planned Parenthood of N. New England,

546 U.S. 320 (2006) .............................................................................................19
Box v. Planned Parenthood of Ind. & Ky., Inc.,

139 S. Ct. 1780 (2019) .........................................................................................15
Bristol Reg’l Women’s Ctr., P.C. v. Slatery,

7 F.4th 478 (6th Cir. 2021) ..................................................................... 12, 13, 14
Byrd v. Tenn. Wine & Spirits Retailers Ass’n,

883 F.3d 608 (6th Cir. 2018) ...............................................................................19
Cameron v. EMW Women’s Surgical Ctr., P.S.C.,

142 S. Ct. 1002 (2022) .........................................................................................21
City of Pontiac Retired Emps. Ass’n v. Schimmel,

751 F.3d 427 (6th Cir. 2014) ...............................................................................10
Colautti v. Franklin,
439 U.S. 379 (1979) ................................................................................ 16, 17, 18
Daunt v. Benson,
956 F.3d 396 (6th Cir. 2020) .................................................................................9
Dobbs v. Jackson Women’s Health Org.,

597 U.S. ___ No. 19-1392 (June 24, 2022) ........................ 1, 2, 11, 12, 13, 14, 18
FCC v. Beach Commc’ns, Inc.,

508 U.S. 307 (1993) ...................................................................................... 12, 13
Fowler v. Benson,
924 F.3d 247 (6th Cir. 2019) ...................................................................... 8, 9, 10
Gibson Cnty. Special Sch. Dist. v. Palmer,

691 S.W.2d 544 (Tenn. 1985) ..............................................................................20
ii
Gonzales v. Carhart,
550 U.S. 124 (2007) ...................................................................................... 15, 19
Heller v. Doe by Doe,

509 U.S. 312 (1993) .............................................................................................14
Hope Clinic v. Ryan,

195 F.3d 857 (7th Cir. 1999) (en banc) ...............................................................17
June Medical Services L.L.C. v. Russo,

140 S. Ct. 2103 (2020) .........................................................................................11
Karlin v. Foust,
188 F.3d 446 (7th Cir. 1999) ...............................................................................17
Kolender v. Lawson,
461 U.S. 352 (1983) .............................................................................................18
Leavitt v. Jane L.,

518 U.S. 137 (1996) .............................................................................................20
Maryland v. King,
567 U.S. 1301 (2012) ...........................................................................................21
Mich. State AFL-CIO v. Miller,

103 F.3d 1240 (6th Cir. 1997) ...............................................................................9
Munaf v. Geren,
553 U.S. 674 (2008) ...............................................................................................8
New Motor Vehicle Bd. of Cal. v. Orrin W. Fox Co.,

434 U.S. 1345 (1977) ...........................................................................................21
Nken v. Holder,
556 U.S. 418 (2009) ...............................................................................................9
Planned Parenthood of Se. Pa. v. Casey,

505 U.S. 833 (1992) ...........................................................................................2, 7
iii
Preterm-Cleveland v. McCloud,
994 F.3d 513 (6th Cir. 2021) (en banc) ........................................................ 12, 19
Roe v. Wade,
410 U.S. 113 (1973) ........................................................................................ 2, 11
S. Glazer’s Distribs. of Ohio, LLC v. Great Lakes Brewing Co.,

860 F.3d 844 (6th Cir. 2017) ...............................................................................10
Serv. Emps. Int’l Union Loc. 1 v. Husted,

698 F.3d 341 (6th Cir. 2012) .................................................................................9
State v. Tester,
879 S.W.2d 823 (Tenn. 1994) ..............................................................................19
TriHealth, Inc. v. Bd. of Comm’rs, Hamilton Cnty.,

430 F.3d 783 (6th Cir. 2005) ...............................................................................13
United States v. Christie,

825 F.3d 1048 (9th Cir. 2016) .............................................................................19
United States v. Lopez,

929 F.3d 783 (6th Cir. 2019) ...............................................................................18
Voinovich v. Women’s Med. Pro. Corp.,

523 U.S. 1036 (1998) ...........................................................................................17
Winter v. Nat. Res. Def. Council, Inc.,

555 U.S. 7 (2008) ...................................................................................................9
Women’s Med. Pro. Corp. v. Voinovich,

130 F.3d 187 (6th Cir. 1997) .................................................................... 7, 16, 17
Statutes and Constitutional Provisions
Miss. Code Ann. § 41-41-191 ....................................................................................2
Ohio Rev. Code Ann. § 2919.17(A)(1) (2010) ........................................................18
Tenn. Code Ann. § 39-11-204 .................................................................................18

iv
Tenn. Code Ann. § 39-15-202(f)(1).........................................................................20
Tenn. Code Ann. § 39-15-214(a)(43)-(44) ....................................................... 14, 15
Tenn. Code Ann. § 39-15-211 ...................................................................................5
Tenn. Code Ann. § 39-15-211(a)(3) ................................................................... 5, 20
Tenn. Code Ann. § 39-15-213 .................................................................................22
Tenn. Code Ann. § 39-15-214(a)(7) ......................................................................4, 5
Tenn. Code Ann. § 39-15-214(a)(7), (15) ...............................................................14
Tenn. Code Ann. § 39-15-214(a)(24) ........................................................................4
Tenn. Code Ann. § 39-15-214(a)(36) ........................................................................4
Tenn. Code Ann. § 39-15-214(a)(43)-(44) ................................................... 4, 14, 15
Tenn. Code Ann. § 39-15-214(a)(53)-(63) ......................................................... 4, 15
Tenn. Code Ann. § 39-15-214(a)(64)-(69) ................................................................4
Tenn. Code Ann. § 39-15-214(a)(70)-(77) ......................................................... 4, 13
Tenn. Code Ann. § 39-15-216(a)(4) ..........................................................................5
Tenn. Code Ann. § 39-15-216(c)(1) ......................................................................2, 4
Tenn. Code Ann. § 39-15-216(c)(2) ......................................................................2, 5
Tenn. Code Ann. § 39-15-216(c)(3)-(12) ..............................................................3, 5
Tenn. Code Ann. § 39-15-216(e)(1) ..........................................................................5
Tenn. Code Ann. § 39-15-216(h) .............................................................................20
Tenn. Code Ann. § 39-15-217(e)(1) ..........................................................................5

v
Tenn. Code Ann. § 39-15-217(i)..............................................................................20
Tenn. Const. art. I, § 36............................................................................................22
Other
Emily West, Tennessee Planned Parenthood Reacts to Potential Overturn of Roe

v. Wade, NewsChannel5 Nashville (May 3, 2022), https://bit.ly/3HoiHb4............21
Nikki McGee, What Happens to TN Planned Parenthood Locations if Roe v. Wade

Overturned?, WKRN (May 3, 2022), https://bit.ly/3O1SJg8.................................22
vi
EMERGENCY MOTION FOR STAY OF

PRELIMINARY INJUNCTION PENDING APPEAL
The State respectfully requests that this Court fully stay the district court’s
preliminary injunction pending appeal so that the State can enforce both the Timing
Provisions of Section 216 and the Antidiscrimination Provision of Section 217. The
en banc Court has already stayed the preliminary injunction regarding Section 217.
And Dobbs v. Jackson Women’s Health Organization, 597 U.S. ___, No. 19-1392
(June 24, 2022), now makes clear that Section 216 constitutionally prohibits the
abortion of unborn children at 6 weeks gestational age when a fetal heartbeat is
detected and of unborn children at 8 weeks gestational age or older.
Because any delay costs the lives of Tennessee children, the State asks the
Court to grant this emergency motion as soon as possible. To that end, the State
proposes that Plaintiffs, who publicly stated a month ago that they anticipated this
motion, file their response by 2:30 PM Eastern Time today. If the Court does not
act by 4 PM Eastern Time today, the State plans to file a reply.
1
INTRODUCTION
Today the U.S. Supreme Court held that the U.S. Constitution “does not
prohibit the citizens of each State from regulating or prohibiting abortion.” Dobbs,
slip op. at 79. The Supreme Court expressly overruled Roe v. Wade, 410 U.S. 113
(1973), and Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S.
833 (1992), returning the authority to regulate or prohibit abortion “to the people
and their elected representatives.” Dobbs, slip op. at 69. Rejecting Casey’s “undue
burden” test, which “has proved to be unworkable,” id. at 62, the Supreme Court
applied rational-basis review and upheld Mississippi’s prohibition of abortion of
unborn children who have reached 15 weeks probable gestational age, id. at 78
(citing Miss. Code Ann. § 41-41-191).
In 2020, for many of the same reasons that justified Mississippi’s law, the
Tennessee legislature enacted Timing Provisions making it a crime to “perform or
induce, or attempt to perform or induce, an abortion upon a pregnant woman” at
certain stages of an unborn child’s development. Tenn. Code Ann. § 39-15-
216(c)(1). When the unborn child’s gestational age is 6 weeks or older, the physician
must “affirmatively determine[] and record[] in the pregnant woman’s medical
record that, in the physician’s good faith medical judgment, the unborn child does
not have a fetal heartbeat at the time of the abortion.” Id. § 39-15-216(c)(2).
2
Additional restrictions apply at 8, 10, 12, 15, 18, 20, 21, 22, 23, and 24 or more
weeks. Id. § 39-15-216(c)(3)-(12).
The district court held that Section 216 violated Casey by “prohibit[ing]
abortions based solely on gestational age rather than viability” and thus preliminarily
enjoined the enforcement of the Timing Provisions. PI Opinion, R. 41,
PageID# 756. After this Court granted rehearing en banc, the full Court granted the
State’s motion for a partial stay of the preliminary injunction pending appeal to the
extent that it enjoined Section 217 (the Antidiscrimination Provision). En Banc
Order, Dkt. No. 122-2. Because the Supreme Court has now expressly overruled
Roe and Casey, the State is also likely to prevail on appeal regarding Section 216
(the Timing Provisions). Accordingly, this Court should fully stay the preliminary
injunction pending appeal so that Tennessee can enforce both Section 216 and
Section 217. As the Supreme Court recognized in Dobbs, the State has a valid
interest in protecting the lives of unborn Tennesseans. Those lives are at risk each
day the preliminary injunction remains in place, so this Court should grant the State’s
motion as soon as possible.
BACKGROUND
I. Statutory Background
The Tennessee legislature enacted the Timing Provisions based on extensive
legislative findings that additional abortion restrictions were necessary to further the
3
State’s interests. Among other things, the legislature determined that the “presence
of a fetal heartbeat is medically significant because the heartbeat is a discernible sign
of life at every stage of human existence,” Tenn. Code Ann. § 39-15-214(a)(7); that
a “growing body of medical evidence and literature supports the conclusion that an
unborn child may feel pain from around eleven (11) to twelve (12) weeks gestational
age, or even as early as five and a half (5 ½) weeks,” id. § 39-15-214(a)(24); that
advances in science and neonatal care have “lowered the gestational limits of
survivability well into the second trimester,” id. § 39-15-214(a)(36); that
“[a]bortions performed later in pregnancy pose an even higher medical risk to the
health and life of women, with the relative risk increasing exponentially at later
gestational ages after eight (8) weeks gestational age,” id. § 39-15-214(a)(44); that
abortion has been used for discriminatory and eugenic purposes in Tennessee and
elsewhere, id. § 39-15-214(a)(53)-(63); and that physician involvement in abortion
undermines the integrity and public respect of the medical profession, id. § 39-15-
214(a)(64)-(69). Section 216 was intended to address those harms and to further
Tennessee’s compelling interests. See id. § 39-15-214(a)(70)-(77).
Section 216 makes it a crime for a person to “perform or induce, or attempt to
perform or induce, an abortion upon a pregnant woman” at certain stages of an
unborn child’s development. Id. § 39-15-216(c)(1). When the gestational age of the
unborn child is six weeks or older, the physician must “affirmatively determine[]
4
and record[] in the pregnant woman’s medical record that, in the physician’s good
faith medical judgment, the unborn child does not have a fetal heartbeat at the time
of the abortion.” Id. § 39-15-216(c)(2). In making that determination, the physician
“shall utilize generally accepted standards of medical practice using current medical
technology and methodology applicable to the gestational age of the unborn child
and reasonably calculated to determine the existence or non-existence of a fetal
heartbeat.” Id. Additional restrictions apply at 8, 10, 12, 15, 18, 20, 21, 22, 23, and
24 or more weeks. Id. § 39-15-216(c)(3)-(12).
It is an affirmative defense to prosecution under Section 216 “that, in the
physician’s reasonable medical judgment, a medical emergency prevented
compliance with the provision.” Id. § 39-15-216(e)(1). The term “medical
emergency” is defined as “a condition that, in the physician’s good faith medical
judgment, based upon the facts known to the physician at the time, so complicates
the woman’s pregnancy as to necessitate the immediate performance or inducement
of an abortion in order to prevent the death of the pregnant woman or to avoid a
serious risk of the substantial and irreversible impairment of a major bodily function
of the pregnant woman.” Id. § 39-15-211(a)(3); see also id. § 39-15-216(a)(4)
(“‘Medical emergency’ has the same meaning as defined in § 39-15-211.”). This is
the same affirmative defense used in the Antidiscrimination Provision that this Court
has allowed to go into effect while the appeal is pending. See id. § 39-15-217(e)(1).
5
II. Procedural Background
Plaintiffs—four abortion facilities and two physicians—immediately
challenged the Timing Provisions in Section 216 and the Antidiscrimination
Provision in Section 217 and sought a preliminary injunction. Compl., R. 1,
PageID# 1-34; PI Mot., R. 6, PageID# 87-91; PI Mem., R. 7, PageID# 95-129.
Plaintiffs alleged that both Section 216 and Section 217: (1) violate the abortion
rights of their patients by “prohibiting pre-viability abortions,” Compl. ¶¶ 121, 123,
R. 1, PageID# 30-31; and (2) violate the void-for-vagueness doctrine because their
medical-emergency affirmative defenses contain both objective and subjective
standards, id. ¶ 127, PageID# 31-32.1
Once Sections 216 and 217 became law, the district court issued a temporary
restraining order, TRO Order, R. 33, PageID# 591-97, followed by a preliminary
injunction, PI Opinion, R. 41, PageID# 727-68; PI Order, R. 42, PageID# 769. The
district court held that Plaintiffs have standing both “to assert the constitutional
rights of their patients and to challenge a law that subjects [abortion providers] to
potential criminal sanctions.” PI Opinion, R. 41, PageID#752.
As relevant here, the district court then held that Plaintiffs were likely to
succeed on their substantive due process challenge to Section 216 because “Casey
1
Plaintiffs also alleged that the Antidiscrimination Provision violates the void-for-
vagueness doctrine because it “fail[s] to give Plaintiffs fair notice of how to comply
with [its] mandates.” Compl. ¶ 125, R. 1, PageID# 31.
6
has established” that “a state may not prohibit abortions before viability.” Id. at
PageID#756. Because the court concluded that the Supreme Court had forbidden
legislatures from “defin[ing] viability by gestational age alone,” it did not consider
the State’s interests or determine to what extent the Timing Provisions burden a
woman’s ability to obtain a previability abortion. Id.
The district court further held the medical-emergency affirmative defense in
Sections 216 and 217 unconstitutionally vague under Women’s Medical
Professional Corp. v. Voinovich, 130 F.3d 187, 205 (6th Cir. 1997), because “a
physician acting in ‘good faith’ may still be held criminally liable if, after the fact,
other physicians disagree about the ‘reasonableness’ of his or her medical
judgment.” PI Opinion, R. 41, PageID# 763. But the court did not consider whether
any vagueness in the affirmative defense could be cured by severing the term
“reasonable” from that provision.2
With those rulings in hand, the district court determined that the “threatened
harm” from enforcement of an unconstitutional statute outweighed any potential
harm to the State or the public because they lack “a strong interest in enforcing an
unconstitutional statute.” Id. at PageID# 767.
2
The district court also concluded that Section 217 is unconstitutionally vague
because a physician “must determine what it means to ‘know’ that his or her patient
is seeking an abortion ‘because of’” the sex, race, or Down syndrome diagnosis of
the unborn child.” PI Opinion, R. 41, PageID# 759.
7
The State appealed and simultaneously asked the district court for a stay
pending appeal, which the court denied. See Notice of Appeal, R. 46, PageID# 793-
94; Mot. for Stay Pending Appeal, R. 47, PageID# 797-802; Mem. Mot. for Stay
Pending Appeal, R. 48, PageID# 803-23; Order Denying Stay, R. 58, PageID# 893.
The State then sought and received a partial stay from this Court allowing the State
to enforce the Antidiscrimination Provision in Section 217. Mot. For Partial Stay,
Dkt. 14; Stay Op., Dkt. 33-2. (The State asked the district court but not this Court
to stay the district court’s ruling on the Timing Provisions in Section 216.)
The Court’s partial stay remained in effect until a divided panel of this Court
affirmed the preliminary injunction on the merits. Panel Op., Dkt. 97-2; Judgment,
97-3. The Court granted the State’s petition for rehearing en banc and then granted
the State’s renewed motion for partial stay of the preliminary injunction regarding
the Antidiscrimination Provision. Order Granting Rehearing En Banc, Dkt. 110-2;
Order Granting Renewed Mot. for Partial Stay, Dkt. 122-2.
The U.S. Supreme Court issued its opinion in Dobbs this morning. In that
opinion, the Supreme Court upheld Mississippi’s prohibition of abortion at 15 weeks
probable gestational age and expressly overruled Roe and Casey.
STANDARD OF REVIEW
A preliminary injunction is an “extraordinary and drastic remedy,” Fowler v.
Benson, 924 F.3d 247, 256 (6th Cir. 2019) (quoting Munaf v. Geren, 553 U.S. 674,
8
689 (2008)), that “may only be awarded upon a clear showing that the plaintiff is
entitled to such relief,” id. (quoting Winter v. Nat. Res. Def. Council, Inc., 555 U.S.
7, 22 (2008)). Courts consider four factors in determining whether that heavy burden
has been satisfied: “(1) whether the plaintiffs are likely to succeed on the merits,
(2) whether the plaintiffs will suffer irreparable injury in the absence of an
injunction, (3) whether granting the injunction will cause substantial harm to others,
and (4) whether the issuance of the injunction is in the public interest.” Mich. State
AFL-CIO v. Miller, 103 F.3d 1240, 1249 (6th Cir. 1997).
A plaintiff’s failure to demonstrate a likelihood of success on the merits is
fatal to his request for preliminary relief. See id.; Daunt v. Benson, 956 F.3d 396,
421 (6th Cir. 2020). And when, as here, the government is the defendant, “the
public-interest factor ‘merges’ with the substantial-harm factor,” and “neither of
these factors can be satisfied when the challenged provisions are constitutional.”
Daunt, 956 F.3d at 422 (quoting Nken v. Holder, 556 U.S. 418, 435 (2009)).
This Court considers similar factors in deciding whether to grant a stay
pending appeal: (1) “the likelihood that the party seeking the stay will prevail on the
merits of appeal,” (2) “the likelihood that the moving party will be irreparably
harmed absent a stay,” (3) “the prospect that others will be harmed if the court grants
the stay,” and (4) “the public interest in granting the stay.” Serv. Emps. Int’l Union
Loc. 1 v. Husted, 698 F.3d 341, 343 (6th Cir. 2012) (internal quotations omitted).
9
A party seeking reversal of a preliminary injunction must show that the district
court’s “ultimate determination as to whether the four preliminary injunction factors
weigh in favor of granting” relief is an abuse of discretion. City of Pontiac Retired
Emps. Ass’n v. Schimmel, 751 F.3d 427, 430 (6th Cir. 2014) (en banc) (quotations
omitted). A district court “necessarily abuses its discretion when it commits an error
of law.” S. Glazer’s Distribs. of Ohio, LLC v. Great Lakes Brewing Co., 860 F.3d
844, 854 (6th Cir. 2017). And the court’s determination as to likelihood of success
is a legal conclusion that is reviewed de novo. Fowler, 924 F.3d at 256.
ARGUMENT
This Court should fully stay the preliminary injunction so that the State can
enforce both Section 216 and Section 217 pending the en banc Court’s review on the
merits. Plaintiffs are unlikely to prevail on the merits of their constitutional
challenges to Section 216 because the Supreme Court has expressly overruled Roe
and Casey and returned the power to regulate or prohibit abortion back to the States.
The equities also weigh strongly in favor of a stay because the State and the public
are unquestionably harmed when a valid law is enjoined. That is particularly true
here because the State has a profound interest in protecting the lives of unborn
Tennesseans. Plaintiffs face no legally recognizable harm from a stay because,
under Dobbs, they have no right to violate Section 216.
10
I. Defendants Are Likely to Succeed on Appeal.
The district court concluded that Plaintiffs are likely to prevail on their claims
that Section 216 (1) violated Casey by prohibiting pre-viability abortions, and
(2) included an unconstitutionally vague medical-emergency affirmative defense.
Those conclusions are untenable because (1) the Supreme Court today overruled
Casey, and (2) the en banc Court is likely to rule that the medical-emergency
affirmative defense is not unconstitutionally vague for the same reasons that the full
Court has allowed Section 217, which has the same affirmative defense, to come
into effect pending resolution of the appeal. The State is likely to prevail on appeal.3
A. Section 216 satisfies rational-basis review.
For the past forty-nine years, the U.S. Supreme Court barred states from
enforcing abortion laws that are squarely within their power to enact. Cf. Roe, 410
U.S. at 222 (White, J., dissenting) (labeling this “an exercise of raw judicial power”).
That changed today. The district court had held that Plaintiffs were likely to succeed
on their substantive due process challenge to Section 216 because “Casey has
established” that “a state may not prohibit abortions before viability” such as by
3
The State is also likely to prevail if the Plaintiff abortionists lacked third-party
standing to bring their lawsuit on behalf of patients. Dobbs cast serious doubt on
June Medical Services L.L.C. v. Russo, 140 S. Ct. 2103 (2020): the Dobbs majority
noted that “Roe and Casey have led to the distortion of many important but unrelated
legal doctrines,” and listed June Medical as one of the cases that “ignored the Court’s
third-party standing doctrine.” Dobbs, slip op. at 63 & n.61.
11
prohibiting abortions after with Timing Provisions based on “gestational age alone,”
PI Opinion, R. 41, PageID#756. But Casey is no more. Expressly rejecting Casey’s
undue-burden standard, the Supreme Court has instructed lower courts to apply
rational-basis review to state abortion laws and upheld Mississippi’s prohibition of
abortions after the child reaches 15 weeks gestational age. Dobbs, slip op. at 77-78.
The Timing Provisions of Section 216 easily satisfy rational-basis review.
Rational-basis review is a “highly deferential” standard “designed to respect the
constitutional prerogatives of democratically accountable legislatures.” Bristol
Reg’l Women’s Ctr., P.C. v. Slatery, 7 F.4th 478, 483 (6th Cir. 2021) (en banc)
(quotation marks omitted). “All that matters” under this standard “is whether the
state conceivably had a rational basis to enact the legislation.” Id. The State’s
rationales need not be supported with evidence and are not “subject to courtroom
fact-finding.” Id. at 484 (quoting FCC v. Beach Commc’ns, Inc., 508 U.S. 307, 315
(1993)). “Courts may not second-guess a state’s ‘medical and scientific
judgments.’” Id. at 483 (quoting Preterm-Cleveland v. McCloud, 994 F.3d 513, 525
(6th Cir. 2021) (en banc)). “And they must defer to a state’s judgment that there is
a problem that merits correction.” Id.
The Timing Provisions of Section 216 advance Tennessee’s compelling
interests in protecting unborn children, protecting the physical and mental health of
the mother, promoting human dignity, encouraging childbirth over abortion,
12
safeguarding unborn children from pain, resolving inconsistencies in the treatment
of unborn children under Tennessee law, protecting the integrity and ethics of the
medical profession, and preventing discrimination. See Tenn. Code Ann. § 39-15-
214(a)(70)-(77).
Dobbs expressly held that many of the same reasons the Tennessee legislature
provided for enacting Section 216 justified Mississippi’s 15-week gestational age
law. “[L]egitimate interests” for abortion regulations and prohibitions “include
respect for and preservation of prenatal life at all stages of development; the
protection of maternal health and safety; the elimination of particularly gruesome or
barbaric medical procedures; the preservation of the integrity of the medical
profession; the mitigation of fetal pain; and the prevention of discrimination on the
basis of race, sex, or disability.” Dobbs, slip op. at 78 (citations omitted).
Plaintiffs no doubt might “argue that the factual record does not support
Tennessee’s rationale[s]. But that turns the rational basis standard on its head.”
Bristol Reg’l Med. Ctr., 7 F.4th at 484. The State “has no obligation to produce
evidence to sustain the rationality of its action.” Id. (quoting TriHealth, Inc. v. Bd.
of Comm’rs, Hamilton Cnty., 430 F.3d 783, 790 (6th Cir. 2005)). Under this highly
deferential standard, the Tennessee General Assembly’s legislative choice simply
“is not subject to courtroom fact-finding.” Id. at 483 (quoting Beach Commc’ns,
Inc., 508 U.S. at 315). Plaintiffs cannot carry their burden “to negative every
13
conceivable basis which might support” Section 216, so their substantive due
process challenge cannot succeed under rational-basis review. Id. at 484 (quoting
Heller v. Doe by Doe, 509 U.S. 312, 320-21 (1993)).
Even if some would prefer to ignore the Supreme Court’s instructions in
Dobbs and apply a unique, abortion-specific version of rational-basis review rather
than the ordinary version that applies to “other health and welfare laws,” Dobbs, slip
op. at 77, the State has already provided ample evidence in this case that the Timing
Provisions of Section 216 advance the State’s interests. Each of the restrictions,
from fetal heartbeat to 24 weeks, furthers the State’s interests in protecting unborn
life, the integrity of the medical profession, maternal health, and preventing
discrimination.
As the legislature found, the “presence of a fetal heartbeat is medically
significant” because it is a “discernible sign of life” and a “strong predictor of
survivability to term.” Tenn. Code Ann. § 39-15-214(a)(7), (15). Abortions
performed at any gestational age are inconsistent with a physician’s ethical
obligation to heal rather than harm. See Curlin Decl. ¶ 11, R. 27-2, PageID#383.
And abortions “pose a risk” to the mother’s health at any gestational age, with the
“relative risk increasing exponentially after” 8 weeks. Tenn. Code Ann. § 39-15-
214(a)(43)-(44). While the Antidiscrimination Provision of Section 217 also helps
the State further its interest in preventing discrimination, abortion has long served
14
eugenic ends even when an aborted child’s mother does not have that intent. See id.
§ 39-15-214(a)(53)-(63) (“[T]he use of abortion to achieve eugenic goals is not
merely hypothetical.” (quoting Box v. Planned Parenthood of Ind. & Ky., Inc., 139
S. Ct. 1780, 1783 (2019) (Thomas, J., concurring)).
Other evidence supports the State’s prohibition of abortion at each time
period. For fetal pain, an unborn child “develops neural circuitry capable of
detecting and responding to pain” around 10 to 12 weeks, and additional
development from 14 to 20 weeks supports a “conscious awareness of pain.” Condic
Decl. ¶ 8, R. 27-7, PageID#500. The brutal dilation and evacuation method of
abortion commonly used after 15 weeks involves grabbing the child with forceps in
the uterus, pulling it back through the cervix and vagina, tearing the child apart, and
“evacuating” the dead child’s body “piece by piece . . . until it has been completely
removed.” Gonzales v. Carhart, 550 U.S. 124, 135-36 (2007).
Some may disagree with Tennessee’s policy judgment, but the Timing
Provisions of Section 216 satisfy rational-basis review by a country mile.
B. The medical-emergency affirmative defense is not

unconstitutionally vague.
The district court also enjoined Sections 216 and 217 based on its conclusion
that the provisions’ medical-emergency affirmative defense is unconstitutionally
vague under Voinovich. But Voinovich was wrongly decided and should be
overruled by the en banc Court. In any event, Voinovich provides no basis to

15
preliminarily enjoin the Timing Provisions of Section 216, just as this Court has
allowed the Antidiscrimination Provision of Section 217 to come into effect with the
same medical-emergency affirmative defense. Dobbs has only weakened Plaintiffs’
odds of success on this claim.
In Voinovich, this Court held that the medical-emergency exception to an
Ohio abortion law was unconstitutionally vague because it required physicians to
determine “in good faith and in the exercise of reasonable medical judgment whether
an emergency exists.” 130 F.3d at 204 (quotations omitted). This Court concluded
that the “combination of objective and subjective standards” in the exception
“without a scienter requirement render[ed] the[] exception[] unconstitutionally
vague, because physicians cannot know under which their conduct will ultimately
be judged.” Id. at 205.
Voinovich relied heavily on the Supreme Court’s decision in Colautti v.
Franklin, 439 U.S. 379 (1979). Id. at 204. Colautti held that a law requiring a
physician to make a viability determination was unconstitutionally vague because it
was “unclear whether the statute import[ed] a purely subjective standard” or instead
a “mixed subjective and objective standard.” 439 U.S. at 391. That the law lacked
a scienter requirement and imposed strict liability for erroneous viability
determinations “compounded” its vagueness. Id. at 394. Voinovich acknowledged
that Colautti “did not consider whether a mixed standard would be unconstitutional,”
16
but nevertheless “f[ound] Colautti strongly indicative of the [Supreme] Court’s view
that in this area of the law, scienter requirements are particularly important.” 130
F.3d at 204-05.
Voinovich has been rightly and roundly criticized. Judge Boggs called the
panel’s reliance on Colautti “misplaced” since the Supreme Court had “specifically
declined” to consider whether a scienter requirement was constitutionally required.
Id. at 216 (Boggs, J., dissenting). And he explained that there is “nothing vague, or
even novel, about a statute prescribing a standard including components of good
faith and reasonableness.” Id. Justice Thomas, joined by Chief Justice Rehnquist
and Justice Scalia, similarly criticized Voinovich for imposing a “constitutional
scienter requirement . . . under the guise of the void-for-vagueness doctrine” and
found the challenged Ohio law, which “plainly impose[d] both a subjective and
objective mental requirement,” easily distinguishable from the “ambiguous” statute
in Colautti. Voinovich v. Women’s Med. Pro. Corp., 523 U.S. 1036, 1348-49 (1998)
(Thomas, J., dissenting from the denial of certiorari). The Seventh Circuit has
expressly disagreed with Voinovich, refusing to read Colautti to require the
invalidation of an abortion statute containing an objective standard but no scienter
requirement. Karlin v. Foust, 188 F.3d 446, 462-63 (7th Cir. 1999); see also Hope
Clinic v. Ryan, 195 F.3d 857, 866 (7th Cir. 1999) (en banc) (Easterbrook, J.).
17
Before the Supreme Court’s decision in Dobbs, the en banc Court had ample
reason to overrule Voinovich’s vagueness holding with respect to the medical-
emergency exception. But even if the Court were reluctant to overrule Voinovich
due to Colautti, the Dobbs majority now expressly disagrees with the portions of
Colautti that Voinovich relied upon. Dobbs, slip op. at 54 (negatively citing Colautti,
439 U.S. at 390-97).
Further, regardless of whether this Court overrules Voinovich, that decision
still provided no basis for the district court to facially enjoin the Timing Provisions
on vagueness grounds for three reasons.
First, there is a material distinction between the medical-emergency provision
at issue in Voinovich and the one here. The one at issue in Voinovich was an
exception to the definition of the crime. See Ohio Rev. Code Ann. § 2919.17(A)(1)
(2010). The medical-emergency provision at issue here, by contrast, is an
affirmative defense that the defendant must prove by a preponderance of the
evidence. See Tenn. Code Ann. § 39-11-204.
That distinction is significant in the context of the void-for-vagueness
doctrine. The void-for-vagueness doctrine is concerned with whether a “penal
statute defin[es] the criminal offense with sufficient definiteness.” United States v.
Lopez, 929 F.3d 783, 784 (6th Cir. 2019) (quoting Kolender v. Lawson, 461 U.S.
352, 357 (1983)). An affirmative defense is not part of the definition of the crime,
18
so any vagueness in the medical-emergency affirmative defense does not implicate
the void-for-vagueness doctrine. See United States v. Christie, 825 F.3d 1048, 1065
(9th Cir. 2016) (O’Scannlain, J.).
Second, this Court made clear in Preterm-Cleveland that “facial attacks are
not the proper procedure for challenging the lack of a health exception.” 994 F.3d
at 529. If Plaintiffs are right that the medical-emergency affirmative defense is
vague, they must rely on as-applied challenges to “‘protect the health of the woman
if it can be shown in discrete and well-defined instances’ her health or life is at risk.”
Id. (quoting Gonzales, 550 U.S. at 167).
Third, at the very least, the district court should have “sever[ed] the
problematic portions” of the medical-emergency affirmative defense for Sections
216 and 217 while leaving “the remainder intact.” Ayotte v. Planned Parenthood of
N. New England, 546 U.S. 320, 328-29 (2006). In Tennessee,4 the “doctrine of
elision allows a court, under appropriate circumstances when consistent with the
expressed legislative intent, to elide an unconstitutional portion of a statute and find
the remaining provision to be constitutional and effective.” State v. Tester, 879
S.W.2d 823, 830 (Tenn. 1994). The Tennessee legislature undoubtedly would have
preferred omission of the term “reasonable” from the affirmative defense to
4
“Whether a portion of a state’s statute is severable is determined by the law of that
state.” Byrd v. Tenn. Wine & Spirits Retailers Ass’n, 883 F.3d 608, 626 (6th Cir.
2018) (internal quotations omitted).
19
complete invalidation of Sections 216 and 217. Both sections contain broad
severability provisions, see Tenn. Code Ann. § 39-15-216(h); id. § 39-15-217(i),
which “evidence an intent on the part of the legislature to have the valid parts of the
statute[s] in force if some other portion of the statute has been declared
unconstitutional,” Gibson Cnty. Special Sch. Dist. v. Palmer, 691 S.W.2d 544, 551
(Tenn. 1985).
Moreover, elision of the term “reasonable” would leave intact “a complete
law capable of enforcement and fairly answering the object of its passage.” Id. The
definition of prohibited conduct would remain unchanged, and the affirmative
defense would require only a good-faith determination of a medical emergency,
which is the standard already employed in other Tennessee abortion regulations. See
Tenn. Code Ann. § 39-15-202(f)(1) (defining “medical emergency” in abortion
waiting-period law by reference to “the physician’s good faith medical judgment”);
id. § 39-15-211(a)(3) (same for law prohibiting post-viability abortions).
The district court never considered whether severance was appropriate. That
failure was an abuse of discretion and is yet another reason that the State is likely to
succeed on appeal. See Leavitt v. Jane L., 518 U.S. 137, 143-46 (1996).
II. The Equities Weigh Strongly in Favor of a Stay.
The district court’s erroneous conclusions about Plaintiffs’ likelihood of
success infected its weighing of the equities, leading it to conclude that enforcement
20
of the Timing Provisions would harm Plaintiffs and the public interest by violating
the Constitution. See PI Opinion, R. 41, PageID # 766-67. But Section 216 is not
unconstitutional, as Dobbs has made clear, so allowing the law to remain enjoined
harms the State and the public interest by preventing the State “from effectuating
statutes enacted by representatives of its people.” Maryland v. King, 567 U.S. 1301
(2012) (Roberts, C.J., in chambers) (quoting New Motor Vehicle Bd. of Cal. v. Orrin
W. Fox Co., 434 U.S. 1345, 1351 (1977) (Rehnquist, J., in chambers)); see also
Cameron v. EMW Women’s Surgical Ctr., P.S.C., 142 S. Ct. 1002, 1011 (2022)
(“Paramount among the States’ retained sovereign powers is the power to enact and
enforce any laws that do not conflict with federal law.”).
The reason for this emergency motion is clear: Each day this Court allows
the injunction to remain in place is another day that the lives of unborn Tennesseans
are at risk. The CEO and president of one Plaintiff has publicly stated that they “will
continue to provide abortion care up to the very minute when we can no longer do
so legally.” Emily West, Tennessee Planned Parenthood Reacts to Potential
Overturn of Roe v. Wade, NewsChannel5 Nashville (May 3, 2022),
https://bit.ly/3HoiHb4. Plaintiffs will not suffer imminent harm from a stay because,
under Dobbs, they have no right to violate Section 216. And Plaintiffs are not
unfairly inconvenienced by the emergency nature of this motion; indeed, they
publicly stated early last month that they anticipated this motion to stay the
21
injunction of Section 216. Nikki McGee, What Happens to TN Planned Parenthood
Locations if Roe v. Wade Overturned?, WKRN (May 3, 2022),
https://bit.ly/3O1SJg8 (quoting the previously mentioned Plaintiff’s CEO and
president as saying “we have a six-week ban also and the Sixth Circuit could lift that
injunction immediately after the Supreme Court releases its final decision”).
It is true that change is imminent. With the overruling of Roe and Casey,
Tennessee has another law that will come into effect 30 days from now. See Tenn.
Code Ann. § 39-15-213. But under Tennessee law, which specifically provides that
there is no constitutional right to abortion, Tenn. Const. art. I, § 36, Section 216 is
already supposed to prohibit abortion after the detection of an unborn child’s
heartbeat. The State requests that this Court allow Section 216 to come into effect
pending resolution of the appeal so that the State may begin the important work of
protecting the lives of the most vulnerable Tennesseans.
22
CONCLUSION
Defendants respectfully request that this Court fully stay the preliminary
injunction so that the State can enforce both Section 216 and Section 217. Dobbs
makes clear that Section 216 is constitutional. The State proposes that Plaintiffs,
who publicly stated a month ago that they anticipated this motion, file their
response by 2:30 PM Eastern Time today. Because any delay costs the lives of
Tennessee children, the State asks the Court to grant the motion as soon as
possible. If the Court does not act by 4 PM Eastern Time today, the State plans to
file a reply to any response that Plaintiffs have filed.
Respectfully submitted,
HERBERT H. SLATERY III

Attorney General and Reporter
ANDRÉE S. BLUMSTEIN
Solicitor General
/s/ Clark L. Hildabrand

CLARK L. HILDABRAND
Assistant Solicitor General
P.O. Box 20207
Nashville, TN 37202
(615) 253-5642
TRAVIS J. ROYER
Honors Fellow
Counsel for Defendants-Appellants
June 24, 2022
23
CERTIFICATE OF COMPLIANCE
I certify that this motion complies with the type-volume limitation of Fed. R.
App. P. 27(d) because it contains 5,186 words, excluding the parts exempted by Fed.
R. App. P. 32(f).
This brief also complies with the typeface and type style requirements of Fed.
R. App. P. 27(d)(1)(E) because it has been prepared in proportionally spaced
typeface using Times New Roman 14-point font.

CLARK L. HILDABRAND
June 24, 2022

CERTIFICATE OF SERVICE
I, Clark L. Hildabrand, counsel for Defendants-Appellants and a member of
the Bar of this Court, certify that, on June 24, 2022, a copy of the Motion for Stay
of Preliminary Injunction Pending Appeal was filed electronically through the
appellate CM/ECF system. I further certify that all parties required to be served
have been served.

CLARK L. HILDABRAND
25

No. 130-1 Emergency Motion To Stay Pending Appeal

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Case: 20-5969 Document: 130-1 Filed: 06/24/2022 Page: 1

IN THE UNITED STATES COURT OF APPEALS

MEMPHIS CENTER FOR REPRODUCTIVE HEALTH; PLANNED

HERBERT H. SLATERY III; MORGAN McDONALD, M.D.; RENE

On Appeal from the United States District Court for the

EMERGENCY MOTION FOR STAY OF

HERBERT H. SLATERY III CLARK L. HILDABRAND

P.O. Box 20207

TABLE OF AUTHORITIES ................................................................................... ii

EMERGENCY MOTION FOR STAY OF PRELIMINARY

I. Statutory Background ................................................................................3

II. Procedural Background ..............................................................................6

STANDARD OF REVIEW ......................................................................................8

I. Defendants Are Likely to Succeed on Appeal ........................................11

A. Section 216 satisfies rational-basis review ......................................11

B. The medical-emergency affirmative defense is not

II. The Equities Weigh Strongly in Favor of a Stay ....................................20

Ayotte v. Planned Parenthood of N. New England,

Box v. Planned Parenthood of Ind. & Ky., Inc.,

Bristol Reg’l Women’s Ctr., P.C. v. Slatery,

Byrd v. Tenn. Wine & Spirits Retailers Ass’n,

Cameron v. EMW Women’s Surgical Ctr., P.S.C.,

City of Pontiac Retired Emps. Ass’n v. Schimmel,

Dobbs v. Jackson Women’s Health Org.,

FCC v. Beach Commc’ns, Inc.,

Gibson Cnty. Special Sch. Dist. v. Palmer,

Heller v. Doe by Doe,

Hope Clinic v. Ryan,

June Medical Services L.L.C. v. Russo,

Leavitt v. Jane L.,

Mich. State AFL-CIO v. Miller,

New Motor Vehicle Bd. of Cal. v. Orrin W. Fox Co.,

Planned Parenthood of Se. Pa. v. Casey,

S. Glazer’s Distribs. of Ohio, LLC v. Great Lakes Brewing Co.,

Serv. Emps. Int’l Union Loc. 1 v. Husted,

TriHealth, Inc. v. Bd. of Comm’rs, Hamilton Cnty.,

United States v. Christie,

United States v. Lopez,

Voinovich v. Women’s Med. Pro. Corp.,

Winter v. Nat. Res. Def. Council, Inc.,

Women’s Med. Pro. Corp. v. Voinovich,

Statutes and Constitutional Provisions

Miss. Code Ann. § 41-41-191 ....................................................................................2

Ohio Rev. Code Ann. § 2919.17(A)(1) (2010) ........................................................18

Tenn. Code Ann. § 39-11-204 .................................................................................18

Tenn. Code Ann. § 39-15-202(f)(1).........................................................................20

Tenn. Code Ann. § 39-15-214(a)(43)-(44) ....................................................... 14, 15

Tenn. Code Ann. § 39-15-211 ...................................................................................5

Tenn. Code Ann. § 39-15-211(a)(3) ................................................................... 5, 20

Tenn. Code Ann. § 39-15-213 .................................................................................22

Tenn. Code Ann. § 39-15-214(a)(7) ......................................................................4, 5

Tenn. Code Ann. § 39-15-214(a)(7), (15) ...............................................................14

Tenn. Code Ann. § 39-15-214(a)(24) ........................................................................4

Tenn. Code Ann. § 39-15-214(a)(36) ........................................................................4

Tenn. Code Ann. § 39-15-214(a)(43)-(44) ................................................... 4, 14, 15

Tenn. Code Ann. § 39-15-214(a)(53)-(63) ......................................................... 4, 15

Tenn. Code Ann. § 39-15-214(a)(64)-(69) ................................................................4

Tenn. Code Ann. § 39-15-214(a)(70)-(77) ......................................................... 4, 13