In Bragdon v. Abbott, decided in 1998, the Supreme Court ruled that HIV is a disability protected by the Americans with Disabilities Act from the moment of infection, even when the person has no symptoms. The Court also held that a dentist, doctor, or other public accommodation cannot refuse to treat a person with HIV based on safety concerns unless those concerns rest on objective medical evidence rather than personal fear.1Cornell Law School. Bragdon v. Abbott – Opinion
The Dental Visit Behind the Case
Sidney Abbott went to Dr. Randon Bragdon’s office in September 1994 for a check-up. On the intake form she disclosed that she had HIV and was asymptomatic. Bragdon found a cavity but refused to fill it in his office, offering instead to perform the procedure at a hospital, with Abbott paying his regular fee plus the hospital’s facility costs. She refused and sued under Title III of the ADA, which bars discrimination in public accommodations.1Cornell Law School. Bragdon v. Abbott – Opinion
Why HIV Counts as a Disability Under the ADA
The ADA defines disability through a three-part inquiry: whether the condition is a physical impairment, what major life activity it affects, and whether it substantially limits that activity.1Cornell Law School. Bragdon v. Abbott – Opinion
On the first question, the Court looked at the biology. HIV causes immediate changes in the blood and lymphatic system, attacks white blood cells, and replicates throughout the body. Those physiological effects begin at infection, whether or not the person feels sick or shows outward signs. On that basis, the Court held that HIV is a physical impairment from the moment of infection, including during the asymptomatic phase.1Cornell Law School. Bragdon v. Abbott – Opinion
Reproduction as a Major Life Activity
The harder question was which major life activity HIV limited. The Court identified reproduction and childbearing. An activity does not have to be public, economic, or performed daily to qualify as major; what matters is its significance to the individual’s life.2Cornell Law School. Bragdon v. Abbott – Syllabus
HIV substantially limits reproduction because a person carrying the virus faces significant risks of transmitting it to a partner during conception and to a child during birth. Those risks were enough to satisfy the substantial-limitation test, bringing asymptomatic HIV within the ADA’s protection.2Cornell Law School. Bragdon v. Abbott – Syllabus
When a Provider Can Refuse Care on Safety Grounds
The ADA lets a provider decline service when a patient poses a direct threat to the health or safety of others. The Court held that any such assessment must rest on objective medical or scientific evidence available at the time. A provider’s personal beliefs, discomfort, or generalized fear of infection do not meet that standard.1Cornell Law School. Bragdon v. Abbott – Opinion
The Court reviewed guidance from the Centers for Disease Control and the American Dental Association. Both recommended universal precautions, but neither gave a definitive assessment of the specific transmission risk during a cavity filling. Because the lower courts had not fully analyzed the actual risk under the scientific evidence available in 1994, the Supreme Court sent the case back for further review.1Cornell Law School. Bragdon v. Abbott – Opinion Safety decisions, in other words, have to be grounded in evidence rather than bias or outdated perceptions of risk.2Cornell Law School. Bragdon v. Abbott – Syllabus