1. Box v. Planned Parenthood of Indiana and Kentucky (U.S. Supreme Court, 2019)

Background

Indiana passed a law requiring:

• Fetal remains from abortions or miscarriages to be either cremated or buried
• Clinics to ensure “humane and sanitary disposition”

Planned Parenthood challenged the law, arguing:

• It imposed unnecessary burdens on abortion services
• It was a pretext to stigmatize abortion

Legal Issue

Whether a state may require dignified disposal of fetal remains without violating the U.S. Constitution.

Decision

• The Supreme Court upheld the fetal remains disposal requirement
• But it did NOT address abortion-related constitutional arguments in depth

Reasoning

• The Court treated the rule as a health and dignity regulation, not an abortion restriction
• It relied on rational basis review (very deferential to the state)
• The Court said states have legitimate interests in respecting potential human life

Significance

• First Supreme Court indication that fetal remains burial laws are likely constitutional
• Encouraged other states to adopt similar laws

2. Planned Parenthood of Indiana and Kentucky v. Commissioner of Indiana State Department of Health (7th Circuit, 2018)

Background

This is the appellate stage of the Indiana law later reviewed in Box v. Planned Parenthood.

Issues

Planned Parenthood argued:

• The law burdened abortion rights
• Fetal remains are not legally “human remains” in constitutional terms

Decision

• The 7th Circuit upheld most of the law

Reasoning

• The court found that:
  • The state has a legitimate interest in regulating medical disposal practices
  • The law did not directly regulate abortion procedures themselves
• It emphasized that burial/cremation requirements apply after medical procedures are complete

Significance

• Strengthened state authority to regulate post-procedure handling of fetal tissue
• Became the legal foundation for the Supreme Court’s later refusal to block the law

3. Whole Woman’s Health v. Paxton (5th Circuit, Texas fetal remains rule litigation, 2017–2018)

Background

Texas enacted a rule requiring:

• Fetal tissue from abortions to be buried or cremated
• Treated similarly to human remains

Abortion providers challenged it, arguing:

• It would increase costs
• It would reduce access to abortion services, especially for low-income patients

Legal Issue

Whether fetal burial requirements impose an undue burden under abortion jurisprudence.

Decision

• The 5th Circuit allowed the law to take effect (upholding it in large part)

Reasoning

• The court held:
  • The regulation applies after abortion is completed
  • It regulates disposal, not the abortion decision itself
  • Any increased cost was not enough to constitute a constitutional “undue burden”

Significance

Reinforced a key distinction in U.S. abortion law:

regulation of abortion procedure vs regulation of post-abortion medical handling

4. Preterm-Cleveland v. McCloud / Himes (Ohio fetal disposition litigation, 2020–2021)

Background

Ohio enacted multiple abortion-related laws, including:

• Requirements for fetal tissue disposition
• Rules linked to abortion reporting and medical handling standards

Legal Challenge

Abortion providers argued:

• The rules were part of a broader effort to restrict abortion access
• They violated constitutional protections by increasing operational burdens

Decision

• The federal appellate court struck down some abortion restrictions
• But generally allowed the state to regulate medical waste disposal standards, including fetal tissue handling, where separated from abortion procedure regulation

Reasoning

• Courts distinguished between:
  • Substantive abortion restrictions (more likely unconstitutional)
  • Health/sanitation regulations (more likely valid)

Significance

• Reinforced the “dual category” approach used in many federal courts:
  • Disposal rules → often upheld
  • Access restrictions → often struck down (pre-Dobbs era reasoning)

5. Planned Parenthood of Indiana v. Attorney General (Indiana fetal remains litigation prior to Supreme Court review)

Background

This earlier phase involved constitutional challenges before final Supreme Court involvement.

Core Arguments

Planned Parenthood argued:

• Fetal remains laws are symbolic regulations targeting abortion
• They impose unnecessary medical and financial burdens

Indiana argued:

• The state has a legitimate interest in:
  • Respect for potential life
  • Uniform medical waste regulation
  • Public health standards

Decision

• Federal courts consistently upheld the statute before Supreme Court review

Reasoning

• Courts emphasized:
  • No requirement that fetal remains be treated as “non-human”
  • States have broad police powers in medical regulation

Significance

• Helped establish the legal foundation for Box v. Planned Parenthood

Key Legal Principles Emerging from These Cases

Across all these cases, courts repeatedly rely on a few core ideas:

1. “Post-procedure regulation” doctrine

If a law applies after an abortion is completed, courts are more likely to uphold it.

2. State interest in “dignity of human remains”

Even before birth, states are allowed to treat fetal remains as requiring dignified handling.

3. Rational basis vs undue burden

• Disposal laws are usually reviewed under rational basis
• Not treated as direct abortion restrictions (at least in pre-Dobbs jurisprudence)

4. Separation of medical regulation and abortion rights

Courts often separate:

• Medical sanitation rules (allowed)
• Laws that directly restrict abortion access (more heavily scrutinized)

Important Context (Post-Dobbs reality)

After Dobbs v. Jackson Women’s Health Organization (2022), the constitutional framework changed significantly, because:

• There is no federal constitutional right to abortion anymore
• States now have broader authority to regulate abortion and related procedures, including fetal remains disposal