Writing for the majority, Justice Breyer found that the Nebraska ban violates the Supreme Court precedents Roe v. Wade and Planned Parenthood v. Casey by failing to include an exception to preserve the health of the woman and by imposing an undue burden on a woman’s ability to choose an abortion.

The Supreme Court's decision in Carhart rejects the deceptive strategy behind "partial-birth abortion" bans, which focused public attention on post-viability D&X procedures while banning a much broader range of abortion methods. The Court found that the Nebraska law is not limited to abortions performed late in pregnancy or to a single procedure. It held that the statute encompasses the most commonly used method of abortion after the first trimester, and that such a broad ban imposes an unconstitutional burden on women seeking abortions.

The Carhart Court also struck down the Nebraska ban on the grounds that it denies women access to the most appropriate medical care. The Nebraska ban, like the vast majority of so-called "partial-birth abortion" bans, does not contain an exception for women's health. Accordingly, it prevents women seeking abortions from undergoing the medical procedure that their doctors believe is best for them.

The majority decision was joined by Justices Ginsberg, O’Conner, Souter, and Stevens. Four separate dissenting opinions were filed by Chief Justice Rehnquist and Justices Scalia, Kennedy, and Thomas, demonstrating that Roe and the right to choose is imperiled.

Bans on so-called "partial-birth abortion" and similar laws have been passed by 31 states, and legal challenges to these laws have been brought in 21 states. Most of those statutes use language identical or comparable to the Nebraska law struck down by the United States Supreme Court in Carhart. In addition, each of the challenges to those laws involve the same legal principles at issue in that case. Accordingly, the Court's decision in Carhart renders virtually all of the bans invalid.

CRLP represented the plaintiff, LeRoy Carhart, M.D..

Since it was decided in 1973, Roe has come under attack in three ways:

1. The first are efforts to undermine access to abortion, which make abortion impossible to obtain even though it is technically still a legal-even constitutional --option for women.

2. The second are legal strategies to destroy the central premise of Roe, which places women's health above any fetal interests.

3. Third is a new political, legal and public relations campaign to redefine what constitutes an abortion. Politicians, anti-choice advocates, and some Attorneys General have endorsed the legal theory that Roe applies only to the "unborn" in uterus, no where else in a woman's body. This reinterpretation of Roe, indeed, the definition of what constitutes an abortion, is exactly what was before the U.S. Supreme Court in the Carhart case.

Also, since 1973, the Supreme Court, with Reagan and Bush appointments has systematically weakened Roe. Out of four constitutional pillars originally supporting Roe, only two remain.

The four were:

1. Women have a fundamental, constitutional right to choose whether or not to have an abortion. This constitutional right was accorded the highest level of protection by requiring strict judicial scrutiny of any government restrictions.

2. The government must remain neutral regarding a woman's right to choose.
3. Before viability, the government may restrict abortion only to protect a woman's health.

4. After viability, the government may prohibit abortion, but even then, laws must make exceptions that permit abortion where necessary to protect a woman's health or life.

As a result of the Planned Parenthood v. Casey decision in 1992, only two principles remain:

1. A woman's right to choose is still constitutionally protected but pre-viability laws are reviewed under a lesser standard than strict scrutiny.

2. A state can only ban post-viability abortions and, even then, only so long as exceptions are made to protect the life and health of the woman.