Supreme Court Declares Asymptomatic HIV A Disability

Refusal to Treat HIV Infected Patient in Office Violated ADA
Reproduction is Major Life Activity Under the ADA
Significant Implications For Employers

The Supreme Court’s first ruling on the ADA will affect employers not only in dealing with HIV and AIDS but potentially also in making decisions about employees with a wide range of reproductive problems.

The Supreme Court’s first decision on the Americans with Disabilities Act ("ADA") upheld that a person’s asymptomatic HIV infection is a disability under the Act.  In coming to this conclusion in Bragdon v. Abbott, US Sup. Ct. No. 97-156 (6/25/98), the Court also determined that reproduction is a major life activity under the ADA and set out the standard for evaluating whether a disability causes a direct threat to the health and safety of others.

Refusal to Treat HIV Infected Patient in Office Violated ADA

This decision came in response to a claim filed by an HIV-positive patient that her dentist discriminated against her based on her disability when the dentist refused to fill her cavity unless she agreed to have it done in a hospital. The patient was infected with the HIV virus but did not have any symptoms of AIDS. The patient brought suit under Title III of the ADA, which prohibits discrimination on the basis of disability in the provision of goods and services. The dentist argued that he should not be liable because the ADA also allows the denial of services if the disabled individual poses a direct threat to the health or safety of others. The First Circuit Court of Appeals found that asymptomatic HIV is a disability and that treating the patient in the dentist’s office would not have posed a direct threat. The dentist appealed to the Supreme Court.

Reproduction is Major Life Activity Under the ADA

In order for a medical condition to be a disability under the ADA, it must meet two criteria: (1) it must be considered a physical or mental impairment; and (2) it must substantially limit a major life activity. The Court determined that the HIV infection meets the definition of a physical impairment since it creates immediate abnormalities in a person’s blood and has a progressively detrimental effect on a person’s hemic and lymphatic systems.

Turning to the second prong of the disability definition, the Court addressed what major life activity the HIV infection affects. The patient argued that reproduction is the major life activity substantially limited by HIV infection. The Court focused on the plain meaning of the word "major" and concluded that reproduction and the sexual dynamics surrounding it are central to the life process and thus fall "well within the phrase ‘major life activity.’" The Court further determined that
reproduction was substantially limited by the HIV infection because of the high risk of transmission of the disease during conception and in childbirth.

In analyzing the dentist’s direct threat defense, the Court looked to the ADA’s definition. Under the ADA, a direct threat is defined as a "significant risk to the health or safety of others that cannot be eliminated by a modification of policies, practices, or procedures or by the provision of auxiliary aids or services." According to the Court, whether the risk is significant must be based on medical or other objective, scientific evidence.  A good faith belief that the risk is significant is not enough. The Court sent the case back to the Court of Appeals to further consider the available studies concerning the risk of transmission of the HIV virus.

Significant Implications For Employers

Although decided under Title III of the ADA, this ruling is likely to have significant implications under Title I, which prohibits disability discrimination in employment and requires employers to make accommodations for the disabled. For example, applicants or employees with varying stages of HIV infection may be disabled and entitled to accommodation under the ADA. In addition, since the Court determined that reproduction is a major life activity, ADA coverage may extend to persons who are impaired because of sterility, impotency, or infertility. Employers may then be required to accommodate employees with these conditions, such as by giving them time off from work for medical treatment.