Lead Opinion
The issue in this case is whether the trial court properly applied strict scrutiny when reviewing the Mandatory Delay Law, which imposes an additional twenty-four hour waiting period on women seeking to terminate their pregnancies. See ch. 2015-118 § 1, Laws of Fla. (codified at § 390.0111(3), Fla. Stat. (2015)) (“Mandatory Delay Law”). The Mandatory Delay Law implicates the Florida Constitution’s express right of privacy. In Florida, any law that implicates the fundamental right of privacy, regardless of the activity, is subject to strict scrutiny and, therefore, presumptively unconstitutional. Accordingly, we hold that the trial court correctly applied strict scrutiny in reviewing the Mandatory Delay Law’s constitutionality.
We conclude that the First District Court of Appeal misapplied and misconstrued our precedent by placing the initial evidentiary burden on Petitioners to prove a “significant restriction” on Florida’s constitutional right of privacy before subjecting the Mandatory Delay Law to strict scrutiny. State v. Gainesville Woman Care, LLC,
Florida’s constitutional right of privacy contained in article I, section 23, establishes the right of every person to “be let alone and free from governmental intrusion into [one’s] private life.” Art. I, § 28, Fla. Const. Because the right of privacy is a fundamental right within Florida’s constitution, this Court consistently has required that any law intruding on this right is presumptively unconstitutional and must be justified by a “compelling state interest” which the law serves or protects through the “least restrictive means.” Winfield v. Div. of Pari-Mutuel Wagering, Dep’t of Bus. Regulation,
Because the Mandatory Delay Law infringes on a woman’s right of privacy, the State bore the burden at the temporary injunction hearing to prove that the Mandatory Delay Law survives strict scrutiny. The State, however, presented no evidence of a compelling state interest, much less that the law served such an interest through the least restrictive means. In addition, the First District disregarded the fact that the challengers did present evidence, which the trial court properly relied on, that the Mandatory Delay Law would result in additional costs and additional trips to the physician and that any delay could affect the type of procedure being performed.
Beyond placing an additional initial evi-dentiary burden on Petitioners, the First District also misinterpreted and misconstrued our precedent concerning the right of privacy by requiring, on remand, that the trial court consider a list of speculative state interests, none of which this Court has ever recognized as compelling. Gainesville Woman Care,
Such delays may push women past the gestational limit when medication abortion is available. This will force women for whom a medication abortion is clinically indicated to undergo a procedure that is less safe for them. It will also force a woman who prefers a medication abortion for psychological reasons to undergo a surgical abortion, which may harm her emotional and psychological state, and this pertains especially to victims of sexual trauma. In other cases, delays may push women past the gestational limit of the nearest abortion provider, forcing them to travel farther. This, in turn, is very likely to create further delay, increasing the risks of the procedure.
Some may disagree and argue that the State should force women to endure an additional twenty-four hour waiting period after they have chosen to terminate their pregnancy, regardless of the fact that such a waiting period is not required of any other medical procedure including those gynecological procedures that are far more risky than termination of pregnancy. Whether it is a good idea to mandate that women seeking to terminate their pregnancies wait a minimum of an additional
We recognize that a woman’s right to choose remains a highly emotional issue that still divides our country many decades after the United States Supreme Court’s decision in Roe v. Wade,
We agree with the trial court that, based on this Court’s precedent, Petitioners have established a substantial likelihood of success on the merits, one of the requirements of granting a temporary injunction, as well as all other grounds for the entry of a temporary injunction. For reasons more fully explained below, we quash the First District’s decision with instructions that the temporary injunction and accompanying stay of the Mandatory Delay Law remain in effect pending a hearing on Petitioners’ request for a permanent injunction.
FLORIDA’S MANDATORY DELAY LAW
Florida’s general informed consent law requires that, for a patient to give valid, informed consent to any medical treatment in Florida, the health care professional must conform to “an accepted standard of medical practice among members of the medical profession” and provide information conveying three things: (1) the nature of the procedure, (2) the medically acceptable alternatives to the procedure, and (3) the procedure’s substantial risks. § 766.103(3)(a)1.-2., Fla. Stat. (2016). In addition, in 1997, the Florida Legislature passed the ‘Woman’s Right to Know Act,” an informed consent statute specific to procedures involving the termination of pregnancies. Ch. 97-151, Laws of Fla. This Court upheld the Woman’s Right to Know Act in 2006, only after the State conceded to a limiting interpretation of the law and this Court interpreted the law to require physicians to discuss only medical risks of either terminating or continuing the pregnancy and that the scope of the advice was patient-driven. See State v. Presidential Women’s Ctr.,
The Woman’s Right to Know Act requires the physician to inform the patient of “[t]he nature and risks of undergoing or not undergoing” the termination of pregnancy procedure, “[t]he probable gestational age of the fetus,” and some other, additional information. See § 390.0111(3)(a), Fla. Stat. (2015). In 2015, the Florida Legislature amended the Woman’s Right to Know Act to require that a woman be given the statutorily re
The Mandatory Delay Law does not require a woman to receive any new information beyond what the Woman’s Right to Know Act requires. As amended, section 390,0111(3)(a) states:
(3) CONSENTS REQUIRED.—A termination of pregnancy may not be performed or induced except with the voluntary and informed written consent of the pregnant woman or, in the case of a mental incompetent, the voluntary and informed written consent of her court-appointed guardian.
(a) Except in the ease of a medical emergency, consent to a termination of pregnancy is voluntary and informed only if:
1. The physician who is to perform the procedure, or the referring physician, has, at a minimum, orally, while physically present in the same room, and at least 24 hours before the procedure fe ■person, informed the woman of:
a. The nature and risks of undergoing or not undergoing the proposed procedure that a reasonable patient would consider material to making a knowing and willful decision of whether to terminate a pregnancy.
b. The probable gestational age of the fetus, verified by an ultrasound, at the time the termination of pregnancy is to be performed.
(I) The ultrasound must be performed by the physician who is to perform the abortion or by a person having documented evidence that he or she has completed a course in the operation of ultrasound equipment as prescribed by rule and who is working in conjunction with the physician.
(II) The person performing the ultrasound must offer the woman the opportunity to view the live ultrasound images and hear an explanation of them....
(III) The woman has a right to decline to view and hear the explanation of the live ultrasound images after she is informed of her right and offered an opportunity to view the images and hear the explanation. If the woman declines, the woman shall complete a form acknowledging that she was offered an opportunity to view and hear the explanation of the images but that she declined that opportunity. The form must*1249 also indicate that the woman’s decision was not based on any undue influence from any person to discourage her from viewing the images or hearing the explanation and that she declined of her own free will.
(IV) [Exceptions to the ultrasound when the] woman is obtaining the abortion because the woman is a victim of rape, incest, domestic violence, or human trafficking or that the woman has been diagnosed as having a condition that, on the basis of a physician’s good faith clinical judgment, would create a serious risk of substantial and irreversible impairment of a major bodily function if the woman delayed terminating her pregnancy.
c. The medical risks to the woman and fetus of carrying the pregnancy to term. The physician may provide the information required in this subparagraph within 24 hours before the procedure if requested by the woman at the time she schedules or arrives for her appointment to obtain an abortion and if she presents to the physician a copy of a restraining order, police report, medical record, or other court order or documentation evidencing that she is obtaining the abortion because she is a victim of rape, incest, domestic violence, or human trafficking.
2. Printed materials prepared and provided by the department have been provided to the pregnant woman, if she chooses to view these materials, including:
a. A description of the fetus, including a description of the various stages of development.
b. A list of entities that offer alternatives to terminating the pregnancy.
c. Detailed information on the availability of medical assistance benefits for prenatal care, childbirth, and neonatal care.
8. The woman acknowledges in writing, before the termination of pregnancy, that the information required to be provided under this subsection has been provided.
Nothing in this paragraph is intended to prohibit a physician from providing any additional information which the physician deems material to the woman’s informed decision to terminate her pregnancy.
Ch. 2015-118, § 1, Laws of Fla. (deletions indicated by strike-through type and additions indicated by underline) (codified at § 390.0111(3)(a), Fla. Stat. (2015)).
THE TEMPORARY INJUNCTION AND THE FIRST DISTRICT OPINION
Shortly after the Mandatory Delay Law’s enactment, on June 11, 2015, Petitioners, Gainesville Woman Care, LLC, and Medical Students for Choice (collectively referred to as “GWC”), filed a complaint in the Second Judicial Circuit challenging the validity of the Mandatory Delay Law as a violation of the privacy rights of Florida women under article I, section 23, of the Florida Constitution, and as a violation of GWC’s and its patients’ rights of equal protection of the laws of the State of Florida under article I, section 2, of the Florida Constitution. The same day, GWC filed a Motion for an Emergency Temporary Injunction and/or Temporary Injunction grounded solely on the right of privacy challenge set forth in their complaint. The trial court held an evidentiary hearing relating to GWC’s request for a temporaiy injunction on June 25, 2015. The parties agreed that the trial court would consider the pleadings, together with the declarations filed with GWC’s motion and supplemental reply, and that the parties would be authorized, but not required, to
At the evidentiary hearing, both parties presented legal arguments. Additionally, GWC submitted the verified affidavit of Dr. Christine L. Curry as supplemental evidence that the Mandatory Delay Law was unconstitutional. The State did not present any evidence to counter Dr. Curry’s assertions. In her affidavit, Dr. Curry stated that abortion is one of the safest medical procedures in the United States. Indeed, Dr. Curry asserted that a woman is approximately fourteen times more likely to die from childbirth than diming an abortion. Dr. Curry also opined that, in her experience, “whatever a woman’s reasons for terminating a pregnancy, she makes the decision thoughtfully after much consideration and deliberation with those she includes in her process: her family, friends, and/or physician.” Finally, Dr. Curry stated:
14. The [Mandatory Delay Law] singles out abortion procedures from all other medical procedures to impose a twenty-four-hour delay and an additional-trip requirement, with no medical benefit to the patient.... It is my opinion that by forcing women seeking abortions—but not patients seeking any other medical procedure, including those riskier than abortion—to wait twenty-four hours and to make an additional visit to the medical provider before they can obtain the treatment, the [Mandatory Delay Law] will harm Florida women seeking abortion and undermine the physician-patient relationship. It will prevent physicians from administering the care they believe will protect their patients’ well-being.
15. By forcing women to delay the procedure at least twenty-four hours and to make arrange [sic] for an additional trip to a provider, the [Mandatory Delay Law] will cause women to delay their abortion by at least one day, and in some cases, even longer. Such delays may push women past the gestational limit when medication abortion is available. This will force women for whom a medication abortion is clinically indicated to undergo a procedure that is less safe for them. It will also force a woman who prefers a medication abortion for psychological reasons to undergo a surgical abortion, which may harm her emotional and psychological state, and this pertains especially to victims of sexual trauma. In other cases, delays may push women past the gestational limit of the nearest abortion provider, forcing them to travel farther. This, in turn, is very likely to create further delay, increasing the risks of the procedure.
On July 1, 2015, the trial court issued its order granting GWC’s request for a temporary injunction. In its order, the trial court explained:
Defendants concede the unavailability of an adequate remedy at law if the law goes into effect and is found to be unconstitutional. This Court’s decision on whether Plaintiffs have carried their burden to show that they are likely to succeed on their position that the constitutional right to privacy is implicated by [the Mandatory Delay Law], and if so, whether the Defendants have sufficiently shown that [the Mandatory Delay Law] meets the “strict” scrutiny standards required will provide the answers to whether there is irreparable harm and determine the public interest issue. In simple terms, the question presented to this Court is whether Plaintiffs have sufficiently shown that the requirements of [the Mandatory Delay Law] impose a “significant burden,” as opposed to an insignificant burden, on a woman’s right to an abortion.
Defendants are clearly basing their defense of the legislation to [sic] the ruling of the Florida Supreme Court in State v. Presidential Women’s Center,937 So.2d 114 (Fla. 2006). Their logic is simplistic, but not necessarily incorrect. The legislature’s right to require informed consent has been upheld as being grounded in the common law. Id at 118. The Defendants’ pleading clearly establishes that a number of states have a waiting period, although it is also clear that most, if not all, were established under the “undue burden” standard. See cases cited in Defendants’ Response in Opposition, pp 10-11. What the Defendants have failed in any way to provide this Court is any evidence that there is a compelling state interest to be protected in enhancing the informed consent already required of women and approved by the Supreme Court of Florida in Presidential Women’s Center, supra. There are no findings of fact or statements of legislative intent set forth in [the Mandatory Delay Law]. After an evidentiary hearing, the Court has no evidence in front of it in which to make any factual determination that a 24-hour waiting period with the accompanying second trip necessitated by the same is not an additional burden on a woman’s right of privacy under the Florida’s Right of Privacy Clause.
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In this proceeding, the only evidence before the Court is that “Florida law does not require a twenty-four-hour waiting period for other gynecological procedures with comparable risk, or any other procedure I perform in my practice.” Declaration of Christine Curry, M.D., Ph.D., p 4. This is a major issue in the case that the Defendants fail to address. Defendants simply state that thirteen other states have a waiting period and the United States Supreme Court has ruled it is not unconstitutional under federal law. However, our Supreme Court has clearly stated that federal law has no bearing on Florida’s more extensive right of privacy.
The State appealed. See Gainesville Woman Care,
The trial court did not address the State’s arguments, such as whether, in passing the privacy amendment in 1980, voters intended to deprive Florida and its citizens of the benefits of advances in medical knowledge and evolutions in federal law recognizing increasingly compelling state interests arising from, among other factors, the potentiality of life uniquely represented by the human fetus. Likewise, the trial court did not address the evidence of intent reflected in the State’s many post-1980 laws and*1252 regulations specific to abortion; nor the evidence of voter intent reflected in the 2004 adoption of article X, section 22, of the Florida Constitution, which in effect overruled North Florida Women’s and authorized a requirement of parental notice of termination of a minor’s pregnancy-
id. at 282.
The First District concluded that the trial court erred by failing to consider the compelling state interests advanced by the State, including:
[Providing women a short time to reflect privately after receiving required relevant information, in maintaining the integrity of the medical profession by making that post-informed reflective time free from influence by a physician or clinic personnel, in protecting the unique potentiality of human life, in protecting the organic law of Florida from interpretations and impacts never contemplated or approved by Floridians or their elected representatives, and in protecting the viability of a duly-enacted state law.
Id. Finally, the First District held that the trial court’s order was also deficient for “failing to address the legal requirements for a facial constitutional challenge to a statute.” Id.
GWC petitioned this Court for review based on the First District having misapplied our precedent concerning the right of privacy in article I, section 23, of the Florida Constitution and, in so doing, specifically construing that provision of the Florida Constitution, Because the First District lifted the stay of the Mandatory Delay Law that had been in effect since the law was enacted, GWC also filed a motion to stay, which this Court granted.
ANALYSIS
Fundamental Right of Privacy
Article I, section 23, of the Florida Constitution, added by Florida voters in 1980, has remained unchanged since it was adopted. See art. I, § 23, Fla. Const. (1980). This Court has broadly interpreted that right, stating:
The citizens of Florida opted for more protection from governmental intrusion when they approved article I, section 23, of the Florida Constitution. This amendment is an independent, freestanding constitutional provision which declares the fundamental right to privacy. Article I, section 23, was intentionally phrased in strong terms. The drafters of the amendment rejected the use of the words “unreasonable” or “unwarranted” before the phrase “governmental intrusion” in order to make the privacy right as strong as possible. Since the people of this state exercised their prerogative and enacted an amendment to the Florida Constitution which expressly and succinctly provides for a strong right of privacy not found in the United States Constitution, it can only be concluded that the right is much broader in scope than that of the Federal Constitution.
Winfield,
The right of privacy is a fundamental right which we believe demands the compelling state interest standard. This test shifts the burden of proof to the state to justify an intrusion on privacy.*1253 The burden can be met by demonstrating that the challenged regulation serves a compelling state interest and accomplishes its goal through the use of the least intrusive means.
Id. at 547; see State v. J.P.,
This Court applies strict scrutiny to any law that implicates the fundamental right of privacy. State v. J.P.,
Florida courts first addressed Florida’s constitutional right of privacy in the termination of pregnancy context in In re T.W.,
Florida’s privacy provision is clearly implicated in a woman’s decision of whether or not to continue her pregnancy. We can conceive of few more personal or private decisions concerning one’s body that one can make in the course of a lifetime, except perhaps the decision of the terminally ill in their- choice of whether to discontinue necessary medical treatment.
Id. at 1192.
Following T.W., this Court reviewed the constitutionality of a similar statute in North Florida Women’s Health & Counseling Services, Inc. v. State,
The Court ultimately held [in T.W.] that (a) if a legislative act imposes a significant restriction on a woman’s (or minor’s) right to seek an abortion, the act must further a compelling State interest through the least intrusive means; (b) the Parental Consent Act imposed a significant restriction on a minor’s right to seek an abortion; and (c) in light of the Legislature’s less restrictive treatment of minors in other comparable procedures and practices, the Act failed to “further” a compelling State interest.
Id. at 621. The Court ultimately determined that the act was unconstitutional and in so doing, reaffirmed the strict scrutiny standard applied in T.W. N. Fla. Women’s,
Importantly, also in North Florida Women’s, this Court rejected the use of the federal “undue burden” standard announced by the United States Supreme Court in Planned Parenthood of Southeastern Pennsylvania v. Casey,
First, any comparison between the federal and Florida rights of privacy is inapposite in light of the fact that there is no express federal right of privacy clause....
And second, it is settled in Florida that each of the personal liberties enumerated in the Declaration of Rights is a fundamental right. Legislation intruding on a fundamental right is presumptively invalid and, where the right of privacy is concerned, must meet the “strict” scrutiny standard. Florida courts have consistently applied the “strict” scrutiny standard whenever the Right of Privacy Clause was implicated, regardless of the nature of the activity. The “undue burden” standard, on the other hand, is an inherently ambiguous standard and has no basis in Florida’s Right of Privacy Clause.
N. Fla. Women’s,
The above cases make clear that any law that implicates Florida’s right of privacy will be subject to strict scrutiny review. Florida’s constitutional right of privacy encompasses a woman’s right to choose to end her pregnancy. This right would have little substance if it did not also include the woman’s right to effectuate her decision to end her pregnancy. As this Court demonstrated in T.W. and North Florida Women’s, laws that place the State between a woman, or minor, and her choice to end her pregnancy clearly implicate the right of privacy. For instance, the law at issue in T.W. prevented a minor from tei'minating her pregnancy without either parental consent or satisfying a judicial bypass procedure.
Whether Strict Scrutiny Review Requires that the Challenger Establish a Significant Restriction
Although this Court has made clear that those who challenge laws implicating the fundamental right of privacy are not first required to establish an undue burden or significant restriction, the parties dispute whether there is a threshold requirement applicable only to challenges to laws involving the decision to termínate a pregnancy that the law operate as a “significant restriction” on that right before strict scrutiny applies. The First District held and the State maintains that the trial court must “make sufficient factually-supported findings about the existence of a significant restriction on a woman’s right to seek an abortion.” Gainesville Woman Care,
To support its argument, the First District and the State primarily rely on language from a discussion in T.W. regarding when the State’s interest in maternal health becomes compelling. In that discussion, this Court stated:
We nevertheless adopt the end of the first trimester as the time at which the state’s interest in maternal health becomes compelling under Florida law because it is clear that prior to this point no interest in maternal health could be served by significantly restricting the manner in which abortions are performed by qualified doctors, whereas after this point the matter becomes a genuine concern. Under Florida law, prior to the end of the first trimester, the abortion decision must be left to the woman and may not be significantly restricted by the state. Following this point, the state may impose significant restrictions only in the least intrusive manner designed to safeguard the health of the mother. Insignificant burdens during either period must substantially further important state interests.
T.W.,
Likewise, the Court has not required an additional evidentiary prerequisite before strict scrutiny applies in other cases implicating the right, of privacy, or any other context where strict scrutiny is appropriate. To single out the instance in which a woman chooses to end her pregnancy to apply this additional evidentiary burden would contradict our precedent emphasizing the importance of Florida’s fundamental right of privacy. .
Finally, the significant restriction requirement that the State maintains is appropriate would equate the Florida constitutional inquiry in the termination of pregnancy context to the federal “undue burden” test. See Casey,
To the extent there is any doubt or confusion regarding our precedent, we clarify that there is no threshold requirement that a petitioner must show by “sufficient factual findings” that a law imposes a significant restriction on a woman’s right of privacy before strict scrutiny applies to laws that implicate the right of privacy. Any law that implicates the right of privacy is presumptively unconstitutional, and the burden falls on the State to prove both the existence of a compelling state interest and that the law serves that compelling state interest through the least restrictive means. Winfield,
The Effect of Presidential Women’s Center on Florida’s Constitutional Right of Privacy
The State, before the trial court, the First District, and this Court has argued that because this Court did not discuss the right of privacy or strict scrutiny when upholding the Woman’s Right to Know Act in 2006, we implicitly determined that the right of privacy was not implicated by the Woman’s Right to Know Act. However, that contention ignores that the Court upheld the Woman’s Right to Know Act only after the State made clear that the law required the physician to discuss only medical risks of either terminating or continuing the pregnancy and that the scope of the advice was patient-driven:
As this litigation developed, and during oral argument, the State has agreed and conceded that this subsection applies solely and exclusively to information with regard to medical risks—not information with regard to social, economic, or any other risks. The doctrine of medical informed consent is rooted in the concepts of bodily autonomy and integrity» see Chambers [v. Nottebaum], 96 So.2d [716,][ ]719 [ (Fla. 3d DCA 1957) ], and it is logical that physicians be required to inform the patient only and exclusively of the medical risks of terminating or not terminating a pregnancy. Physicians are not sociologists, economists, theologians, or philosophers, and it is implausible to conclude that the Legislature intended that physicians be*1257 required to venture far beyond their professional specialty and expertise to advise patients of nonmedical matters merely because the word “medical” is not specifically utilized in subsection (3)(a)(l)(a).
Presidential Women’s Center,
As Justice Lewis, writing for the majority of the Court, explained in Presidential Women’s Center, “[ujnder the doctrine of informed consent, a physician has an obligation to advise his or her patient of the material risks of undergoing a medical procedure.”
Under a free government, at least, the free citizen’s first and greatest right, which underlies all others—the right to the inviolability of his person; in other words, the right to himself—is the subject of universal acquiescence, and this right necessarily forbids a physician or surgeon, however skillful or eminent, who has been asked to examine, diagnose, advise, and prescribe (which are at least necessary first steps in treatment and care), to violate, without permission, the bodily integrity of his patient by a major or capital operation, placing him under an anesthetic for that purpose, and operating upon him without his consent or knowledge. 1 Kinkead on Torts, § 375, states that general rule on this subject as follows: The patient must be the final arbiter as to whether he will take his chances with the operation, or take his chances of living without it.
Id. at 116-17 (quoting Chambers,
As Justice Pariente’s concurrence, which was joined by Justice Quince and Justice Anstead, made clear, it was because of this Court’s interpretation of the law as a neutral informed consent law, which the State conceded was appropriate, that the law avoided any constitutional infirmity:
The majority has construed section 390.0111(3)(a)(l), Florida Statutes (2005), to be a neutral informed consent statute that is comparable to other informed consent statutes and the common law from which they are derived. With the statute so limited, I concur in upholding its constitutionality. I write to emphasize that it is only because of two significant limitations placed on this provision by the majority that the Act is not facially unconstitutional, and that it was the State at oral argument that made these two substantial concessions limiting the interpretation of this statute. The first is that the “reasonable patient” is not a hypothetical patient but rather is the patient presenting herself for the procedure. The second is that subsection (3)(a)(l)(a) requires physicians to inform patients of only medical risks and not other types of risks such as social or economic risks.
If the State had advanced these substantial limiting constructions from the outset, this case could have been resolved expeditiously either before the trial court or the Fourth District Court of Appeal. Without the benefit of these clear concessions from the State, I cannot fault the Fourth District for concluding that the plain language of the statute is unconstitutionally vague.
Id. at 121 (Pariente, J., concurring) (emphasis added).
The Woman’s Right to Know Act does not prevent a woman from effectuating her decision to end her pregnancy, but, instead, merely requires that a physician provide her with all of the information the physician and patient, together, deem necessary to help that specific patient make an informed decision. The important dis
Therefore, we reject as unfounded any interpretation of Presidential Women’s Center to stand for a broader proposition that the State may impose additional burdens over the existing medically centered, patient-specific, informed consent law before allowing a patient to undergo a procedure to terminate her pregnancy. The Mandatory Delay Law, as opposed to the Woman’s Right to Know Act, turns informed consent on its head, placing the State squarely between a woman who has already made her decision to terminate her pregnancy and her doctor who has decided that the procedure is appropriate for his or her patient.
This Case
' Having clarified that any law implicating the right of privacy is subject to strict scrutiny review, we now turn to whether the trial court properly applied our precedent in granting a temporary injunction in this case. To obtain a temporary injunction, the petitioner must satisfy a “four-part test under Florida law: a substantial likelihood of success on the merits; lack of an adequate remedy at law; irreparable harm absent the entry of an injunction; and that injunctive relief will serve the public interest.” Reform Party of Fla. v. Black,
Additionally, Florida Rule of Civil Procedure 1.610(c) states: “Every injunction shall specify the reasons for entry, shall describe in reasonable detail the act or acts restrained without reference to a pleading or another document, and shall be binding on the parties to the action, their officers, agents, servants, employees, and attorneys and on those persons in active concert or participation with them who receive actual notice of the injunction.” We discuss each of the prongs of the test in turn below.
Substantial Likelihood of Success on the Merits
In light of the discussion above, we conclude that the First District ex-red in several respects. First, the First District erred in admonishing the trial court for its failure to “make sufficient factually-supported findings about the existence of a significant restriction on a woman’s right to seek an abortion.” Gainesville Woman Care,
Further, notwithstanding the First District’s assertions that the trial court made no findings with respect to the Mandatory Delay Law’s effect on a woman’s right of privacy, the trial court order states:
Plaintiffs allege in the motion for temporary injunctive relief that:
Absent injunctive relief from this Court, a sweeping restriction on Florida women’s ability to access abortion services, unprecedented in this state, will take effect on July 1, 2015. Section one of Florida House Bill 633, signed by Governor Scott last night (June 10, 2015) would require a woman seeking an abortion to make an additional, unnecessary trip to her health care provider at least twenty-four hours before obtaining an abortion, in order to receive the same information she may currently receive on the day of the procedure, (citation omitted) The Act’s unnecessary and burdensome requirements are imposed regardless of the distance the woman must travel to reach her provider, her own medical needs, her judgment, her doctor’s judgment, or her individual life circumstances. By subjecting no other medical procedure in Florida, much less a medical procedure protected by the state Constitution as a fundamental right—the Act can only serve to deter women from seeking abortions, and to punish and discriminate against ... those who do.
Based upon the above information alleged by GWC and one additional affidavit submitted from Dr. Christine L. Curry, detailing the harm that the Mandatory Delay Law will cause to her patients, and in light of the absence of evidence presented to the contrary by the State, the trial court concluded: “The Court has no evidence in front of it in which to make any factual determination that a 24-hour waiting period with the accompanying second trip necessitated by the same is not an additional burden on a woman’s right of privacy under the Florida’s Right of Privacy Clause,” and thus impedes all Florida women from exercising their fundamental right of privacy. (Emphasis added.)
Having concluded that the trial court was correct that the law implicated the right of privacy, we turn to review whether the trial court erred in finding that the Mandatory Delay Law would be unlikely to survive strict scrutiny review. The First District faulted the trial court, stating:
The trial court did not address the State’s arguments, such as whether, in passing the privacy amendment in 1980, voters intended to deprive Florida and its citizens of the benefits of advances in medical knowledge and evolutions in federal law recognizing increasingly compelling state interests arising from, among other factors, the potentiality of life uniquely represented by the human fetus. Likewise, the trial court did not address the evidence of intent reflected in the State’s many post-1980 laws and regulations specific to abortion; nor the evidence of voter intent reflected in the 2004 adoption of article X, section 22, of the Florida Constitution, which in effect overruled North Florida Women’s and authorized a requirement of parental notice of termination of a minor’s pregnancy.
Gainesville Woman Care,
Because the Mandatory Delay Law, which impedes Florida women’s exercise of their fundamental rights, implicates the right of privacy, the trial court was correct to conclude that strict scrutiny applies to this challenge. The case law is clear: “A legislative act impinging on [the right of privacy] is presumptively unconstitutional unless proved valid by the State.” N. Fla. Women’s,
Contrary to the claims of the First District, the trial court made two findings critical to the strict scrutiny analysis in this case: (1) the State failed to provide any evidence that there is a compelling state interest to be protected by enhancing the informed consent provision; and (2) Florida law does not require a parallel restriction on medical procedures of comparable risk.
In its order, the trial court found, based upon the verified declaration of Dr. Christine Curry, that Florida law does not require enhanced informed consent for any other gynecological procedure. Specifically, the trial court found that the State failed to provide any compelling reason to enhance the informed consent provision or how the current informed consent provision was failing in some way. These findings make it clear that the trial court concluded the selective approach employed by the Legislature was evidence of the State’s limited interest in this matter.
Similarly, in T.W., this Court reasoned that the State’s selective approach in only requiring parental consent for termination of pregnancy procedures was evidence that the State lacked any compelling interest in enacting the law.
As stated above, the trial court properly placed the burden on the State in this case to prove that the Mandatory Delay Law furthered a compelling state interest through the least restrictive means. The trial court stated numerous times that the State failed to provide any evidence of a compelling state interest that would be furthered by enhancing the informed consent statute. The First District’s statement that the trial court faded “to make any findings regarding the State’s compelling interests in support of this statute” is clearly in error. Gainesville Woman Care,
The Mandatory Delay Law impacts only those women who have already made the choice to end their pregnancies. Indeed, under Florida’s pre-existing informed consent law, a woman can already take all of the time she needs to decide whether to terminate her pregnancy, both before she arrives at the clinic and after she receives the required counseling information. The State presented no evidence to indicate that the prior, neutral informed consent statute that this Court approved in Presidential Women’s Center is inadequate and requires the revisions enacted by the Legislature. Nor are there any legislative findings explaining the compelling state interests at stake or indicating why the Legislature was compelled to amend the statute in order to support those interests.
Moreover, despite the State’s contention that women will not be required to make two trips to the clinic by the new law because they can receive the information from their referring physician, the law, in fact, requires women to make a second trip to their health care provider at least twenty-four hours after their first visit. See § 390.0111, Fla. Stat. Even if the woman receives the required information from her referring doctor, as the State contends, she must still make two trips: one to the referring physician and one to the abortion clinic at least twenty-four hours later. The challengers presented evidence that requiring a woman to make a second trip increases the likelihood that her choice to terminate her pregnancy will not remain confidential, which is particularly important, as amici assert, in the domestic violence and human trafficking context. Further, the delay is, at a minimum,.twenty-four hours, but it may be considerably more if the doctor is not available or the date falls on a weekend. No other medical procedure, even those with greater health consequences, requires a twenty-four hour waiting period in the informed consent process.
Next, we also conclude that the First District erred when it admonished the trial court for failing to make findings regarding the State’s compelling interests. The First District stated:
The court failed to make any findings regarding the State’s compelling interests in support of this statute, which the State has argued include compelling interests in providing women a short time to reflect privately after receiving required relevant information, in maintaining the integrity of the medical profession by making that post-informed reflective time free from influence by a physician or clinic personnel, in protecting the unique potentiality of human life, in protecting the organic law of Florida from interpretations and impacts never contemplated or approved by Floridians or their elected representatives, and in protecting the viability of a duly-enacted state law,
Gainesville Woman Care,
The First District compounded this error by requiring that the trial court first consider what it referred to as the State’s compelling interests in “providing women a short time to reflect privately after receiving required relevant information, in maintaining the integrity of the medical profession by making that post-informed reflective time free from influence by a physician or clinic personnel” and in “protecting the viability of a duly-enacted state law.” The Mandatory Delay Law does not differentiate between stages of pregnancy in its application. Instead, it broadly operates any time that a woman is intending to terminate a pregnancy after conception. As to the “unique potentiality of human life,” and the concern regarding the integrity of the medical profession, this law is part of the medical informed consent law that this Court has already held was a statute designed to inform the patient of only the medical risks of continuing or not continuing the pregnancy. This Court made clear in Presidential Women’s Center that “[t]he doctrine of medical informed consent is rooted in the concepts of bodily autonomy and integrity ... and it is logical that physicians be required to inform the patient only and exclusively of the medical risks of terminating or not terminating a pregnancy.”
Finally, in light of the discussion above, it was also error for the First District to insinuate that the voters in any way overruled our decision in North Florida Women’s when they added article X, section 22, to the Florida Constitution in 2004. Gainesville Woman Care,
We conclude that the trial court’s order correctly found, based on the evidence presented at the temporary injunction hearing, that there is a substantial likelihood that the Mandatory Delay Law is unconstitutional as a violation of Florida’s fundamental right of privacy and consequently that Petitioners established a substantial likelihood of success on the merits in this case. Because the State conceded the lack of an adequate remedy at law,
Irreparable Harm Absent the Entry of an Injunction and That Injunctive Relief Will Serve the Public Interest
The First District noted in its decision that the trial court’s injunction was in error because:
The trial court failed to set forth clear, definite, and unequivocally sufficient factual findings supporting the three disputed elements of an injunction (after the State essentially conceded inadequacy of any legal remedy). Indeed, the trial court here could not set forth the requisite evidence-supported factual findings because it had no legally sufficient evidentiary basis to do so. Without such clear and sufficient factual findings, supported by record evidence, the order is defective and meaningful review is not possible.
Gainesville Woman Care,
In its order, the trial court stated:
Defendants concede the unavailability of an adequate remedy at law if the law goes into effect and is found to be unconstitutional. This Court’s decision on whether Plaintiffs have carried their burden to show that they are likely to succeed on their position that the constitutional right of privacy is implicated by [the Mandatory Delay Law], and if so, whether the Defendants have sufficiently shown that [the Mandatory Delay Law] meets the “strict” scrutiny standards requfred will provide the answers to whether there is irreparable harm and determine the public interest issue. In simple terms, the question presented to this Court is whether Plaintiffs have sufficiently shown that the requirements of [the Mandatory Delay Law] impose a “significant burden,” as opposed to insignificant burden, on a woman’s right to an abortion.
Thus, the trial court determined that a decision that the Mandatory Delay Law is unconstitutional would presume that there would be irreparable harm absent the entry of an injunction and that the public interest would be served by enjoining enforcement of the Mandatory Delay Law.
This Court has not previously addressed this question. However, the United States Supreme Court has stated that the “loss of First Amendment freedoms, for even minimal periods of time, unquestionably constitutes irreparable injury.” Elrod v. Burns,
In light of finding that the Mandatory Delay Law is likely unconstitutional, there is no adequate legal remedy at law for the improper enforcement of the Mandatory Delay Law. Thus, the Mandatory Delay Law’s enactment would lead to irreparable harm, and it would be specious to require, as the First District suggests, that the trial court make additional factual findings that enjoining the law would also be in the public interest. Notwithstanding, the trial court found that women seeking to terminate their pregnancies in Florida would be haimed by the enforcement of the Mandatory Delay Law, noting that GWC’s pleadings and the declaration presented make clear that the law would require women seeking to terminate their pregnancies to make an additional, unnecessary trip to their health care provider and could impose additional harms by requiring a woman to delay the procedure or force her past the time limit for the procedure of her choice. The State presented no evidence in rebuttal. Clearly, enjoining the Mandatory Delay Law and thus preventing women from enduring the additional and unnecessary burdens it would impose upon them in violation of the Florida Constitution, would serve the public interest.
Injunctive Relief Based on Facial Constitutional Challenge
Finally, we turn to the issue of whether the trial court was correct to provide injunctive relief based on the likelihood that the Mandatory Delay Law is facially unconstitutional. The First District held:
The order is also deficient in failing to address the legal requirements for a facial constitutional challenge to a statute, an issue the parties disputed below. The State advocated a “no-set-of-circumstances” test.
Appellees argued that the “no circumstances” test does not apply in Florida abortion cases. Neither the record nor the order reflects whether the trial court applied the appropriate facial challenge analysis, and this omission thwarts meaningful appellate review of the injunction order.
Gainesville Woman Care,
The State concedes that the United States Supreme Court has yet to rule on whether the “no-set-of-cireumstances” test applies to facial challenges to restrictions on a woman’s right to choose to terminate her pregnancy. However, the State notes that the United States Supreme Court has stated that, at the least, a facial challenge fails when plaintiffs “have not demonstrated that the Act would be unconstitutional in a large fraction of relevant cases.” Id. Moreover, this Court has never applied the “no-set-of-circumstances” test to a facial constitutional challenge in the termination of pregnancy context.
The trial court’s finding that the Mandar tory Delay Law imposes a significant restriction on all women’s fundamental right of privacy, by its plain terms, is sufficient to support an injunction barring the application of the law in its entirety. The trial court did not talk in terms of hypotheti-cals, nor did it look to the effect of the law on just some women. Rather, the trial
CONCLUSION
The trial court’s findings with respect to all four of the prongs of the temporary injunction test were supported by competent, substantial evidence. Consequently, the trial court had the proper evidentiary basis to issue a temporary injunction in this case. Today we make clear, in Florida, any law that implicates the fundamental right of privacy, regardless of the activity, is subject to strict scrutiny and is presumptively unconstitutional. In this case, the State failed to present any evidence that the Mandatory Delay Law serves any compelling state interest, much less through the least restrictive means, and, therefore, the trial court correctly concluded that there is a substantial likelihood that the Mandatory Delay Law is unconstitutional. Accordingly, we quash the decision of the First District below and remand this case back to the First District for instructions not inconsistent with this opinion.
It is so ordered.
Notes
. We have jurisdiction based on the First District Court of Appeal’s misapplication of our precedent in North Florida Women's Health & Counseling Services, Inc. v. State,
. See Abortion, Gallup, http://www,gallup. com/poll/1576/abortion.aspx (last visited Feb. 1, 2017) (finding that, as of May 2016, nineteen percent of the country believe that abortion should be illegal under all circumstances).
. Florida Law currently only allows third-trimester abortions under the following two conditions:
(a) Two physicians certify in writing that, in reasonable medical judgment, the termination of the pregnancy is necessary to save the pregnant woman’s life or avert a serious risk of substantial and irreversible physical impairment of a major bodily function of the pregnant woman other than a psychological condition.
(b) The physician certifies in writing that, in reasonable medical judgment, there is a medical necessity for legitimate emergency medical procedures for termination of the pregnancy to save the pregnant woman’s life or avert a serious risk of imminent substantial and irreversible physical impairment of a major bodily function of the pregnant woman other than a psychological condition, and another physician is not available for consultation.
§ 390,0111(1), Fla. Stat. (2016), However, the Mandatory Delay Law contains an exception that allows the physician to forego the twenty-four hour waiting period ”[i]f a medical emergency exists and a physician cannot comply with the requirements for informed consent.” Id. § 390.01 ll(3)(b). This exception would certainly be satisfied in the context of post-viability abortions. Accordingly, the requirements of tire Mandatory Delay Law, generally, will only apply to first- and second-trimester abortions.
. See Initiative Information: Prohibition on Public Funding of Abortions; Construction of Abortion Rights, Fla. Dep’t of State, Division of Elections, http://dos.elections.myflorida. corn/initiatives/initdetail.asp?accouni=10& seqnum=82 (last visited Feb. 1, 2017). -
. See Gainesville Woman Care, LLC v. State, No. 15-CA-1323, at 3 (Fla. 2d Cir. Ct. July 1, 2015) (Corrected Order Granting Plaintiffs Motion for Temporary Injunction) ("Defendants concede the unavailability of an adequate remedy at law if the law goes into effect and is [subsequently] found to be unconstitutional.”); see also Gainesville Woman Care,
Dissenting Opinion
dissenting.
Because I conclude that there is no basis for this Court to exercise jurisdiction, I would discharge this case. Contrary to the view adopted by the majority, the decision of the First District in State v. Gainesville Woman Care, LLC,
I.
Nothing in North Florida Women’s or T.W. supports the majority’s jurisdictional claim. The majority asserts that the First District misapplied North Florida Women’s and T.W. “regarding strict scrutiny review of statutes that infringe on the right of privacy.” Majority op. at 1245 n.l. But the First District did not make any conclusions regarding the standard of judicial review applicable to statutes that infringe on the right of privacy. Instead, the First District addressed the conditions that must be met by a party seeking preliminary injunctive relief as well as the requirements applicable to orders granting such relief and ruled that the trial court’s injunction order was both factually and legally deficient. The First District did so without determining the standard of judicial review or reaching the merits on the underlying constitutional challenge.
This Court only applies strict scrutiny review to a statute regulating the right to abortion if the statute imposes a “significant restriction” on the right to abortion. In T.W. we “held that (a) if a legislative act imposes a significant restriction on a woman’s (or minor’s) right to seek an abortion, the act must further a compelling State interest through the least intrusive means.” North Florida Women’s,
The majority claims that the First District “misinterpreted and misconstrued our precedent concerning the right of privacy by requiring, on remand, that the trial court consider a list of speculative state interests, none of which this Court has ever recognized as compelling.” Majority op. at 1246. But the First District simply stated that “[t]he trial court’s failure to make sufficient factually-supported findings ... about the State’s [asserted] compelling interests[ ] renders the trial court’s sparse legal analysis and conclusions unsupportable and the injunction deficient, and hampers meaningful appellate review.” Gainesville Woman Care,
II.
The First District correctly decided this case on procedural grounds because the trial court’s temporary injunction order is factually deficient. The majority acknowledges that “competent, substantial evidence” must support each of the four conclusions necessary to justify entry of a temporary injunction. Majority op. at 1265; see North Florida Women’s,
the trial court’s order correctly found, based on the evidence presented at the temporary injunction hearing, that there is a substantial likelihood that the Mandatory Delay Law is unconstitutional as a violation of Florida’s fundamental right of privacy and consequently that Petitioners established a substantial likelihood of success on the merits in this case.
Majority op. at 1262 (emphasis added). The majority further errs in concluding that “[t]he trial court’s findings with respect to all four of the prongs of the temporary injunction test were supported by competent, substantial evidence” and “the trial court had the proper evidentiary basis to issue a temporary injunction in this case.” Majority op. at 1265.
The First District also correctly decided this case on procedural grounds because the trial court’s temporary injunction order is legally deficient. In order to obtain a temporary injunction, the party seeking the injunction “must satisfy a four-part test under Florida law: ‘a substantial likelihood of success on the merits; lack of an adequate remedy at law; irreparable harm absent the entry of an injunction; and that injunctive relief will serve the public interest.’ ” Liberty Counsel v. Florida Bar Bd. of Governors,
The trial court’s order is legally deficient because it does not contain any factual findings—much less sufficient factual findings—regarding the irreparable harm or public interest prongs of the preliminary injunction test.
The majority concedes that the trial court’s order does not contain any factual findings regarding the public interest prong. See majority op. at 1263-434. Nevertheless, the majority concludes that “[i]n light of finding that the Mandatory Delay Law is likely unconstitutional ... it would be specious to require, as the First District suggests, that the trial court make additional factual findings that enjoining the law would also be in the public interest.” Id. The majority’s reasoning fundamentally misapprehends the four-prong test for a preliminary injunction. Factual findings must support each of the four conclusions necessary to justify entry of a preliminary injunction. Naegele I,
III.
I disagree with the majority’s resolution of the substantive constitutional issue. The majority claims that “there is no threshold requirement that a petitioner must show by ‘sufficient factual findings’ that a law imposes a significant restriction on a woman’s right” to abortion before strict scrutiny applies because statutes regulating the right to abortion implicate the right of privacy. Majority op. at 1256. But the majority’s claim cannot be reconciled with this Court’s precedent imposing such a threshold requirement. In North Florida Women’s and T.W., this Court only applied strict scrutiny to statutes regulating the right to abortion after determining that each statute imposed a “significant restriction” on the right to abortion. See North Florida Women’s,
The majority claims that “[p]ut into the appropriate context, it is clear that T.W. in no way created a threshold requirement that a challenger must prove through sufficient, factually supported findings that a law imposes a significant restriction on a woman’s right of privacy before the law is reviewed under strict scrutiny.” Majority op. at 1255-56. The majority’s claim cannot be reconciled with T.W., which explicitly distinguishes between statutes that impose “significant restrictions” on the right to abortion and statutes that impose “insignificant burdens” on the right to abortion:
Under Florida law, prior to the end of the first trimester, the abortion decision must be left to the woman and may not be significantly restricted by the state. Following [the first trimester], the state may impose significant restrictions only in the least intrusive manner designed to safeguard the health of the mother. Insignificant burdens during [the first or second trimester] must substantially further important state interests.
T.W.,
The majority claims that “the significant restriction requirement that the State maintains is appropriate would equate the Florida constitutional inquiry in the termination of pregnancy context to the federal ‘undue burden’ test.” Majority op. at 1256. But this assertion flies in the face of what the Court said in T.W. before the federal undue burden test existed. In Planned Parenthood of Southeastern Pennsylvania v. Casey,
The majority claims that “[a]ny law that implicates the right of privacy is presumptively unconstitutional, and the burden falls on the State to prove both the existence of a compelling state interest and that the law serves that compelling state interest through the least restrictive means.” Majority op. at. 1256. But the majority fails to acknowledge that the extent of the right of privacy “must be considered in the context in which it is asserted and may not be considered wholly independent of those circumstances.” Florida Bd. of
Practically any law interferes in some manner with someone’s right of privacy. The difficulty lies in deciding the proper balance between this right and the legitimate interest of the state. As the representative of the people, the legislature is charged with the responsibility of deciding where to draw the line. Only when that decision clearly transgresses private rights should the courts interfere.
Stall v. State,
The majority claims that “[t]he Mandatory Delay Law, as opposed to the Woman’s Right to Know Act, turns informed consent on its head, placing the State squarely between a woman who has already made her decision to terminate her pregnancy and her doctor who has decided that the procedure is appropriate for his or her patient.” Majority op. at 1258. But the majority takes an unreasonably narrow view of the purpose of informed consent. This Court has acknowledged that the State has a compelling interest in safeguarding an individual’s “bodily integrity and patient autonomy” by “prohibiting] termination of pregnancy procedures from being performed or induced unless either the referring physician or the physician performing the procedure first obtains informed and voluntary written consent from the patient.” State v. Presidential Women’s Ctr.,
The analysis employed by the majority gives no consideration to the full context of the decision to obtain an abortion. The plurality opinion in Casey describes this context:
Abortion is a unique act. It is an act fraught with consequences for others: for the woman who must live with the implications of her decision; for the persons who perform and assist in the procedure; for the spouse, family, and society which must confront the knowledge that these procedures exist, procedures some deem nothing short of an act of violence against innocent human life; and, depending on one’s beliefs, for the life or potential life that is aborted.
Casey,
[I]n providing time for reflection and reconsideration, the waiting period helps ensure that a woman’s decision to abort is a well-considered one .... It “is surely a small cost to impose to ensure that the woman’s decision is well considered in light of its certain and irreparable consequences on fetal life, and the possible effects on her own.”
Id. at 969-70 (quoting City of Akron v. Akron Ctr. for Reprod. Health, Inc.,
The majority claims that “the trial court did not err in not explicitly deciding the disputed issue of what standard is appropriate,” majority op. at 1265, for a facial constitutional challenge to a statute regulating the right to abortion because “[t]he trial court’s finding that the Mandatory Delay Law imposes a significant restriction on all women’s fundamental right of privacy, by its plain terms, is sufficient to support an injunction barring the application of the law in its entirety.” Majority op. at 1264. But the trial court’s temporary injunction order will be searched in vain for any finding that the Mandatory Delay law imposes a “significant restriction” on the right to abortion. Regardless, the majority fails to acknowledge that—as a matter of Florida law—the no-set-of-circumstances test standard applies to Petitioners’ facial constitutional challenge. See, e.g., Abdool v. Bondi,
POLSTON, J., concurs.
. The trial court’s order states that "[t]he parties agreed that the [c]ourt was to consider the pleadings, together with the declarations filed with Plaintiffs’ motion and supplemental reply, and that the parties were authorized but not required to present any witnesses or other evidence at [the evidentiary hearing].’’ Gainesville Woman Care, LLC v. State, No. 15-CA-1323, at 1 (Fla. 2d Cir. Ct. July 1, 2015) (Corrected Order Granting Plaintiffs’ Motion for Temporary Injunction). Nonetheless, it is not clear from the record- on appeal that the State agreed that the trial court was to consider Plaintiffs’ pleadings and declarations as evidence, or that such documents meet the evidentiary requirements of Florida law.
. The State conceded the lack of an adequate remedy prong below.
