Bragdon v. Abbott, 524 U.S. 624 (1998), U.S. Supreme Court
Bragdon v. Abbott is a foundational case in American disability law that squarely addressed whether an individual with asymptomatic HIV qualifies as "disabled" under the Americans with Disabilities Act (ADA).
Does asymptomatic HIV infection qualify as a disability under the ADA because it substantially limits a major life activity, and may a health care provider refuse in-office treatment under the ADA's "direct threat" exception based on a generalized fear of HIV transmission?
Title III of the ADA prohibits discrimination on the basis of disability in places of public accommodation, including professional offices of health care providers. 42 U.S.C. §§ 12181(7)(F), 12182(a). A "disability" is a physical or mental impairment that substantially limits one or more major life activities. 42 U.S.C. § 12102(2)(A) (pre-ADAAA). A public accommodation may exclude an individual only if the individual poses a "direct threat"—a significant risk to the health or safety of others—that cannot be eliminated by reasonable modifications or by the provision of auxiliary aids or services. 42 U.S.C. § 12182(b)(3); see also 28 C.F.R. § 36.208(b). The direct threat inquiry must be individualized and grounded in reasonable medical judgment based on the most current medical knowledge and/or the best available objective evidence, considering factors identified in School Board of Nassau County v. Arline, 480 U.S. 273 (1987) (nature of the risk, duration, severity, probability of harm, and whether reasonable modifications can mitigate the risk). The informed views of public health authorities, such as the CDC and professional organizations, are entitled to special weight.
Asymptomatic HIV infection constitutes a disability under the ADA because it substantially limits the major life activity of reproduction, and a dentist's office is a place of public accommodation covered by Title III. The "direct threat" defense requires an objective, evidence-based assessment; subjective beliefs or generalized fears are insufficient. The Court affirmed the disability determination and remanded for further proceedings on whether, under the correct standard and on the summary judgment record, treating the patient in the dental office posed a significant risk that could not be eliminated by reasonable measures.
Bragdon is a cornerstone ADA case for at least three reasons. First, it recognizes asymptomatic HIV as a disability, establishing that the ADA protects individuals whose impairments substantially limit major life activities even absent overt symptoms. Second, it elevates reproduction to a recognized major life activity, a concept that later informed and was reinforced by the ADA Amendments Act of 2008, which expressly includes major bodily functions such as immune and reproductive functions. Third, it articulates the stringent, evidence-based standard for the "direct threat" defense, requiring individualized, science-driven risk assessments and rejecting decisions grounded in fear or generalizations. For law students, Bragdon offers a model of statutory interpretation, the integration of medical evidence into legal analysis, and the mechanics of burden allocation and proof under Title III.