524 U.S. 624 (1998)
Sidney Abbott has been infected with HIV since 1986.1 On September 16, 1994, she went to the office of Randon Bragdon in Bangor, Maine, for a dental appointment and disclosed her HIV infection on the patient registration form.2 Bragdon completed a dental examination, discovered a cavity, and informed Abbott of his policy against filling cavities of HIV-infected patients.3
Bragdon offered to perform the work at a hospital with no added fee for his services, though Abbott would be responsible for the cost of using the hospital's facilities.4 Abbott declined the offer.5 She sued Bragdon under state law and section 302 of the ADA, alleging discrimination on the basis of her disability.6 The United States and the Maine Human Rights Commission intervened as plaintiffs.7
After discovery, the parties filed cross-motions for summary judgment.8 The District Court ruled in favor of the plaintiffs.9 The Court of Appeals affirmed.10 The Supreme Court granted certiorari to review the questions presented.11
The record includes affidavits submitted by Dr. Donald Wayne Marianos, Director of the Division of Oral Health of the Centers for Disease Control and Prevention.12 The Court of Appeals relied on the 1993 CDC Dentistry Guidelines and the 1991 American Dental Association Policy on HIV.13 Abbott's infection had not manifested its most serious symptoms at the time of the events.14
Whether HIV infection is a disability under the ADA when the infection has not yet progressed to the symptomatic phase?15
The statute defines disability as a physical or mental impairment that substantially limits one or more of the major life activities of such individual.
Yes. Sidney Abbott has been infected with HIV since 1986. Her infection had not manifested its most serious symptoms at the time of the events.16 HIV infection constitutes a physical impairment from the moment of infection because it causes immediate abnormalities in the blood and a constant detrimental effect on the hemic and lymphatic systems.17
Reproduction qualifies as a major life activity because it is central to the life process itself.18 The approximately 25 percent risk of transmitting HIV to a child or partner substantially limits the ability to reproduce.19 Abbott's HIV infection is therefore a disability under the ADA even when asymptomatic.
HIV infection is a disability under the ADA even when asymptomatic.20
Related opinions on this issue
Joined by Breyer, J., Joined
The Court's opinion demonstrates that respondent's HIV infection easily falls within the statute's definition of disability.21 The Court's discussion in Part III of the relevant evidence has persuaded Justice Stevens that the judgment of the Court of Appeals should be affirmed on the direct threat question.22 He does not believe petitioner has sustained his burden of adducing evidence sufficient to raise a triable issue of fact on the significance of the risk posed by treating respondent in his office.23
The Court of Appeals reached that conclusion after a careful and extensive study of the record.24 Its analysis on this question was perfectly consistent with the legal reasoning in the majority opinion.25 Justice Stevens joins the majority opinion to provide a judgment supported by a majority even though he would prefer an outright affirmance.26
HIV infection has been regarded as a disease limiting life itself.27 The disease inevitably pervades life's choices including education, employment, family and financial undertakings.28 It affects the need for and the ability to obtain health care because of the reaction of others to the impairment.29
No rational legislator would require nondiscrimination once symptoms become visible but permit discrimination when the disease though present is not yet visible.30 Justice Ginsburg is therefore satisfied that the statutory and regulatory definitions are well met.31 HIV infection is a physical impairment that substantially limits major life activities or is so perceived including the afflicted individual's family relations employment potential and ability to care for herself.32
She agrees that remand is wise to ensure a fully informed determination on the direct threat issue.33
Whether the Court of Appeals cited sufficient material in the record to determine as a matter of law that respondent's infection with HIV posed no direct threat to the health and safety of her treating dentist?34
Under the ADA a public accommodation need not permit an individual to participate if the individual poses a direct threat to the health or safety of others that cannot be eliminated by modification of policies, practices, or procedures.35 The existence of a significant risk must be determined from the standpoint of the person refusing treatment based on objective medical evidence.36 Views of public health authorities are given special weight but are not conclusive.37
No. The Court of Appeals relied on the 1993 CDC Dentistry Guidelines and the 1991 American Dental Association Policy on HIV.38 These sources do not necessarily establish the absence of risk as a matter of law.39 The Guidelines set out CDC's recommendation that universal precautions are the best way to combat the risk of HIV transmission but they do not assess the level of risk.40 The record includes affidavits submitted by Dr. Donald Wayne Marianos and other evidence.41
The Supreme Court remands because further exploration through the adversary process is needed to assess whether petitioner raised a triable issue of fact on the significance of the risk.42 The judgment on the direct threat issue is therefore vacated.43
The Court of Appeals' determination on the direct threat issue is vacated and the case is remanded for further proceedings.44
Related opinions on this issue
Joined by Scalia And Thomas, Jj., Joined, And O'connor, J., Joined As To Part Ii
The individualized inquiry required by the ADA shows no evidence that absent HIV respondent would have had or was considering having children.45 Reproduction is not a major life activity in the same sense as the statute's listed activities because it is not repetitively performed and essential in day-to-day existence.46 Petitioner presented more than enough evidence to avoid summary judgment on the direct threat question.47
This evidence includes the CDC study identifying seven instances of possible transmission of HIV from patients to dental workers.48 It also includes 42 documented incidents of occupational transmission to other health care workers.49 The fact that those workers were not dentists is no more valid a basis for distinguishing these transmissions than the fact that they did not practice in Maine.50
Petitioner can establish that it was objectively reasonable for him to conclude that treating respondent in his office posed a direct threat to his safety.51
The act of giving birth to a child is not generally the same as the representative major life activities listed in the regulations.52 Respondent has not proved that her asymptomatic HIV status substantially limited one or more of her major life activities.53 There is no need to address whether other aspects of intimate or family relationships could constitute major life activities.54
Nor is there reason to consider whether HIV status would impose a substantial limitation on one's ability to reproduce if reproduction were a major life activity.55 Justice O'Connor joins in the portion of the Chief Justice's opinion concluding that the Court of Appeals failed to properly determine whether respondent's condition posed a direct threat.56 A remand is necessary on that issue.57
It is wise to remand. Erring if at all on the side of caution ensures a fully informed determination whether respondent Abbott's disease posed a significant risk that could not be eliminated by modification of policies, practices, or procedures.58