译者|崔程新 湖南大学本科‍‍‍
一审| 张亦衡 美国南加州大学本科
二审| 俞悠悠 国际关系学院本科
编辑|
 扎恩哈尔·阿黑哈提 新疆农业大学本科

         李建云 中国政法大学硕士
责编 | 扎恩哈尔·阿黑哈提 新疆农业大学本科
Olmstead v. L. C.
奥姆斯特德诉L.C.案
[Case Reference]
【案例索引】
案号：527 U.S. 581
法院：Supreme Court of the United States
争讼日期：1999.4.21
判决日期：1999.6.22
[Background]
【背景】
In the Americans with Disabilities Act of 1990(ADA), Congress described the isolation and segregation of individuals with disabilities as a serious and pervasive form of discrimination. 42 U.S.C. §§ 12101(a)(2), (5). Title II of the ADA, which proscribes discrimination in the provision of public services, specifies, interalia, that no qualified individual with a disability shall, ‘‘by reason of such disability,’’ be excluded from participation in, or be denied the benefits of, a public entity’s services, programs, or activities. § 12132. Congress instructed the Attorney General to issue regulations implementing Title II’s discrimination proscription. See § 12134(a). One such regulation, known as the ‘‘integration regulation,’’ requires a ‘‘public entity [to] administer programs in the most integrated setting appropriate to the needs of qualified individuals with disabilities.’’ 28 CFR § 35.130(d). A further prescription, here called the ‘‘reasonable-modifications regulation,’’ requires public entities to ‘‘make reasonable modifications’’ to avoid ‘‘discrimination on the basis of disability,’’ but does not require measures that would ‘‘fundamentally alter’’ the nature of the entity’s programs. § 35.130(b)(7).
在1990年的《美国残疾人法案》（Americans with Disabilities Act，ADA）中，国会将对残疾人的孤立和隔离描述为一种严重和普遍的歧视形式（见《残疾人法案》第42卷第12101(a)(2), (5)条）。《美国残疾人法案》第二章禁止在提供公共服务方面的歧视，其中规定，任何符合法律规定的残疾人都不得“因其残疾而”被公共实体的服务、项目或活动排除在外，或剥夺其利益（见第12132条）。国会据此指示司法部长颁布相关条例，实施第二章禁止歧视的规定（见第12134(a)条）。其中一项条款，即“包容条款”，要求“公共实体应当在最包容的环境下提供适合法定残疾人需求的公共服务”（见28 CFR 第35.130(d)条）。更进一步的规定，在此称为“合理完善条例”，要求公共实体“做出合理完善措施”，以避免“基于残疾的歧视”，但不要求“从根本上改变”公共实体项目的性质（见第35.130(b)(7)条）。
Respondents L.C. and E.W. are mentally retarded women; L.C. has also been diagnosed with schizophrenia, and E. W., with a personality disorder. Both women were voluntarily admitted to Georgia Regional Hospital at Atlanta (GRH), where they were confined for treatment in a psychiatric unit. Although their treatment professionals eventually concluded that each of the women could be cared for appropriately in a community -based program, the women remained institutionalized at GRH. Seeking placement in community care, L.C. filed this suit against petitioner state officials (collectively, the State) under 42 U.S.C. § 1983 and Title II. She alleged that the State violated Title II in failing to place her in a community-based program once her treating professionals determined that such placement was appropriate. E.W. intervened, stating an identical claim. The District Court granted partial summary judgment for the women, ordering their placement in an appropriate community-based treatment program. The court rejected the State’s argument that inadequate funding, not discrimination against L.C. and E.W. “by reason of [their] disabilit[ies],” accounted for their retention at GRH. Under Title II, the court concluded, unnecessary institutional segregation constitutes discrimination per se, which cannot be justified by a lack of funding. The court also rejected the State’s defense that requiring immediate transfers in such cases would “fundamentally alter” the State’s programs. The Eleventh Circuit affirmed the District Court’s judgment, but remanded for reassessment of the State’s cost-based defense. The District Court had left virtually no room for such a defense. The appeals court read the statute and regulations to allow the defense, but only in tightly limited circumstances. Accordingly, the Eleventh Circuit instructed the District Court to consider, as a key factor, whether the additional cost for treatment of L.C. and E.W. in communitybased care would be unreasonable given the demands of the State’s mental health budget.
被告人L.C.和E.W.是两位具有智力障碍的女性；L.C.还被诊断为精神分裂症，E.W.被诊断为人格障碍。两名女性都自愿被送往位于亚特兰大的乔治亚地区医院(Georgia Regional Hospital at Atlanta，GRH)，在那里她们被限制在一个精神疾病单元进行治疗。尽管治疗专家认定这两位女性都可以在社区护理项目中得到适当的治疗，但这两名女性仍然被关在乔治亚地区医院。为了寻求社区护理，L.C.根据《美国残疾人法案》第42卷第1983条和第2章，对其州政府官员（统称为州政府）提起诉讼。她诉称，州政府在治疗专家认定社区护理合适的情况下未能将她转移到社区护理的项目，因此违反了第2章。E.W.加入了这起诉讼，并提出了相同的诉求。地区法院批准了对这两名妇女的部分即决判决[1]，命令将她们安置在一个适当的社区治疗项目中。法院驳回了州政府的抗辩主张，即将L.C.和E.W.留在乔治亚地区医院是由于资金不足，而并非因为“基于残疾的歧视”。法院认为，根据第2章，医疗机构不必要的隔离本身即构成歧视，不能以“缺乏资金”作为理由。法院还驳回了该州政府的另一抗辩主张，即要求在这种情况下立即转移病人，将“从根本上改变 ”该州的公共医疗系统。第十一巡回法院维持了地区法院的判决，但发回重审，要求重新评估该州基于医疗成本费用的抗辩主张。地区法院几乎没有为这种抗辩主张留下任何余地。上诉法院对法规和条例进行了重新解释，允许在严格限缩的情况下进行基于成本费用的抗辩。因此，第十一巡回法院指示地区法院重新审视这一重要裁决因素，即相比于限制性的精神疾病治疗单元，L.C.和E.W.在接受社区护理治疗中所产生的额外费用对于州政府的精神健康预算而言是否合理。
（图片来源于网络）
[Holding]
【判决】
The judgment is affirmed in part and vacated in part, and the case is remanded.
判决部分维持原判，部分撤销，并将案件发回重审。
Justice GINSBURG delivered the opinion of the Court with respect to Parts I, II, and III–A, concluding that, under Title II of the ADA, States are required to place persons with mental disabilities in community settings rather than in institutions when the State’s treatment professionals have determined that community placement is appropriate, the transfer from institutional care to a less restrictive setting is not opposed by the affected individual, and the placement can be reasonably accommodated, taking into account the resources available to the State and the needs of others with mental disabilities. Pp. 2185–2188.
金斯伯格法官就第一部分、第二部分和第三A部分发表了最高法院意见，结论是：根据《美国残疾人法案》第2章，如果州的治疗专家认定社区安置是适当的，当事人不反对从监禁护理被转移到限制性较低的环境中，并且在考虑到州政府的有限资源和其他精神残疾者的需求的情况下仍可以合理地安置当事人，则州政府必须将精神残疾者安置在社区环境中，而不是将其继续限制于护理机构（见本判决书第2185–2188页）。
(a) The integration and reasonable-modifications regulations issued by the Attorney General rest on two key determinations: (1) Unjustified placement or retention of persons in institutions severely limits their exposure to the outside community, and therefore constitutes a form of discrimination based on disability prohibited by Title II, and (2) qualifying their obligation to avoid unjustified isolation of individuals with disabilities, States can resist modifications that would fundamentally alter the nature of their services and programs. The Eleventh Circuit essentially upheld the Attorney General’s construction of the ADA. This Court affirms the Court of Appeals decision in substantial part. P. 2185.
(a) 司法部长发布的包容和合理完善条例基于两个关键判断：(1)不合理地将人安置或限制在精神护理机构中，严重限制了他们与外部社区的接触，因此构成了第2章所禁止的基于残疾的歧视形式；(2)各州可以拒绝任何会从根本上改变其服务和项目性质的修改，从而避免不合理地孤立残疾人。第十一巡回法院基本上支持司法部长对《美国残疾人法案》的解释。最高法院维持上诉法院的判决的实质部分（见本判决书第2185页）。
(b) Undue institutionalization qualifies as discrimination ‘‘by reason of disability.’’ The Department of Justice has consistently advocated that it does. Because the Department is the agency directed by Congress to issue Title II regulations, its views warrant respect. This Court need not inquire whether the degree of deference described in Chevron U.S.A. Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 844, 104 S.Ct. 2778, 81 L.Ed.2d 694, is in order; the well-reasoned views of the agencies implementing a statute constitute a body of experience and informed judgment to which courts and litigants may properly resort for guidance. E.g., Bragdon v. Abbott, 524 U.S. 624, 642, 118 S.Ct. 2196, 141 L.Ed.2d 540. According to the State, L.C. and E.W. encountered no discrimination ‘‘by reason of’’ their disabilities because they were not denied community placement on account of those disabilities, nor were they subjected to ‘‘discrimination,’’ for they identified no comparison class of similarly situated individuals given preferential treatment. In rejecting these positions, the Court recognizes that Congress had a more comprehensive view of the concept of discrimination advanced in the ADA. The ADA stepped up earlier efforts in the Developmentally Disabled Assistance and Bill of Rights Act and the Rehabilitation Act of 1973 to secure opportunities for people with developmental disabilities to enjoy the benefits of community living. 
(b) 过度医疗监禁符合“基于残疾”的歧视。司法部一直主张这一点。由于国会指示司法部发布第2章相关法规，司法部的观点值得尊重。本法院不需要考虑雪佛龙美国公司诉自然资源保护委员会公司案[2]中所描述的对政府机构意见的尊重程度是否合理；行政机关的相关合理意见所构成的判断体系往往明智且富有经验，可供法院和诉讼当事人寻求法律解读指导，例如布拉格顿诉阿伯特案[3]。该州政府声称，L.C.和E.W.并没有因他们的残疾情况而受到歧视：不仅因为他们被拒绝社区安置并非“由于”其身患残疾，而且他们也没有受到“歧视”——因为他们没有发现处境相似的个人得到更加优惠的待遇。在驳回这些立场时，法院认识到国会对《美国残疾人法案》中提出的歧视概念有更全面的看法。《美国残疾人法案》加强了早先在《发育障碍者援助和权利法案》（Developmentally Disabled Assistance and Bill of Rights Act）和《1973年康复法案》（the Rehabilitation Act of 1973）中的努力，以确保发育障碍者有机会享受社区生活所带来的福祉。
The ADA both requires all public entities to refrain from discrimination, see § 12132, and specifically identifies unjustified ‘‘segregation’’ of persons with disabilities as a ‘‘for[m] of discrimination,’’ see §§ 12101(a)(2), 12101(a)(5). The identification of unjustified segregation as discrimination reflects two evident judgments: Institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life, cf., e.g., Allen v. Wright, 468 U.S. 737, 755, 104 S.Ct. 3315, 82 L.Ed.2d 556; and institutional confinement severely diminishes individuals’ everyday life activities. Dissimilar treatment correspondingly exists in this key respect: In order to receive needed medical services, persons with mental disabilities must, because of those disabilities, relinquish participation in community life they could enjoy given reasonable accommodations, while persons without mental disabilities can receive the medical services they need without similar sacrifice. The State correctly uses the past tense to frame its argument that, despite Congress’ ADA findings, the Medicaid statute ‘‘reflected’’ a congressional policy preference for institutional treatment over treatment in the community. 
《美国残疾人法案》既要求所有公共实体不得歧视（见第12132条），又具体指出对残疾人的不合理“隔离”属于一种“形式的歧视”（见第12101(a)(2)，12101(a)(5)条）。将不合理的隔离确定为歧视明显地反映了该法案的两个思想：将能适应社区环境并从社区环境中受益的人安置在限制性的精神护理机构中，会使其继续不合理地被视为没有能力或不值得参与社区生活，例如艾伦诉赖特案[4]；精神监禁严重限制了个人日常生活的各项活动。与健康人士相比，精神障碍人士在这个关键方面也相应地受到了不同的待遇：为了获得所需的医疗服务，精神残疾者由于其残疾，必须放弃参与在合理条件下本可以享受的社区生活；而非精神残疾者则可以获得所需的医疗服务，无需作出类似牺牲。该州政府正确地使用了过去式来阐述其论点，即尽管国会在《美国残疾人法案》中的立法精神反对精神医疗监禁，但是医疗补助相关的联邦法规“反映了”国会在政策上倾向于优先采取监禁机构治疗，而非社区治疗。
Since 1981, Medicaid has in fact provided funding for state-run home and community-based care through a waiver program. This Court emphasizes that nothing in the ADA or its implementing regulations condones termination of institutional settings for persons unable to handle or benefit from community settings. Nor is there any federal requirement that community-based treatment be imposed on patients who do not desire it. In this case, however, it is not genuinely disputed that L.C. and E.W. are individuals ‘‘qualified’’ for noninstitutional care: The State’s own professionals determined that community-based treatment would be appropriate for L.C. and E. W., and neither woman opposed such treatment. Pp. 2185–2188.
自1981年以来，联邦医疗补助项目实际上是通过豁免计划为州营养老院[5]和社区护理提供资金。本院强调，《美国残疾人法案》或其实施法规中没有任何条款允许将无法适应或受益于社区环境的病人从监禁医疗环境中转至社区医护环境。联邦法律也没有任何规定，要求不愿意接受社区治疗的患者接受社区治疗。然而，在本案中，L.C.和E.W.是无需争议的“有资格”接受非机构治疗的个人：该州自己的专业人员认定，基于社区的治疗对L.C.和E.W.是合适的，而且这两名女性都不反对这种治疗（见本判决书第2185—2188页）。
（图片来源于网络）
[Observation]
【评论】
Olmstead opinion marked the Court’s most expansive endorsement of the disability rights movement’s broad conception of discrimination and of its goal of integrating people with disabilities throughout the fabric of community life[6]. 
奥姆斯特德案的判决标志着最高法院对残疾人权利运动的广义歧视概念及其将残疾人融入社会生活的目标给予了最广泛的支持。
The state had argued that its failure to provide community residential placements for people with disabilities[7] could not constitute “discrimination,” because the state did not provide such community placements for individuals without disabilities. But Justice Ginsburg, writing for the Court, was “satisfied that Congress had a more comprehensive view of the concept of discrimination advanced in the ADA.”[8] The Justice gave two basic reasons for that conclusion, both of which invoke core principles articulated by the disability rights movement: “First, institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life.”[9] And “[s]econd, confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment.”[10] 
该州政府辩称其没有为残疾人提供社区居住安置并不构成“歧视”，因为州政府没有为非残疾个人提供这种社区安置。但金斯伯格大法官在为法院撰写判决书时，“对国会关于《美国残疾人法案》中提出的更全面的歧视定义感到满意”。大法官为这一结论提出了两个基本理由，这两个理由都援引了残疾人权利运动所阐述的核心原则。“首先，将能够适应并受益于社区环境的人安置在监禁精神护理机构中，会使被隔离的人持续被视为没有能力或不值得参与社区生活。”“其次，在机构中的监禁严重限制了个人的日常生活活动，包括家庭关系、社会交往、工作选择、经济独立、教育进步及文化涵养”。
Given the Court's expansive definition of discrimination, and Justice Ginsburg's extensive articulation of the disability rights principles behind that definition, the Olmstead opinion will likely have an effect far beyond the deinstitutionalization context. Whether or not Justice Ginsburg herself is too modest to acknowledge it, disability rights activists have ample reason to call Olmstead their Brown v. Board of Education-atag that perfectly suits an opinion written by the Justice often called "the Thurgood Marshall of the women's rights movement."[11]
鉴于法院对歧视的广泛定义，以及金斯伯格法官对该定义背后的残疾人权利精神的广泛阐述，奥姆斯特德案意见的影响可能会远远超出非机构化的范畴。无论金斯伯格大法官本人是否因为过于谦虚而不承认这一点，残疾人权利活动家们都有充分的理由将奥姆斯特德案称为“残疾人平权领域的布朗诉教育委员会案”——鉴于金斯伯格大法官常被称为“妇女权利运动的瑟古德·马歇尔（Thurgood Marshall）”，对此案作出这样的评价再合适不过。
注释
[1]译者注：即决判决（Summary Judgment），指在案件审理前，根据案件中不存在可供审判的事实问题而作出的法律判决，也可以作出部分即决判决，例如确定某人确实对某件事承担责任，但将案件移送审判，以确定损害赔偿额。
[2]Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc.,468 U.S. 837 , 844, 104 S.Ct. 2778, 81 L.Ed.2d 694 (1984)
[3]Bragdon v. Abbott, 524 U.S. 624, 642, 118 S.Ct. 2196, 141 L.Ed.2d 540 (1998)
[4]Allen v. Wright, 468 U.S. 737, 755, 104 S.Ct. 3315, 82 L.Ed.2d 556 (1984)
[5]译者注：state-run home是指由该州政府出资并管理的具有公益性质的养老机构。
[6]对于融合作为残疾人权利运动首要目标的开创性认可，见Jacobus tenBroek, The Right to Live in the World: The Disabled in the Law of Torts, 54 Cal. L. Rev. 841, 843-48 (1966).
[7]见 Olmstead, 527 U.S. at 598.
[8]同上。
[9]同上，第600页。
[10]同上，第601页。
[11]见，例如, Nadine Strossen, In the Defense of Freedom and Equality: The American Civil Liberties Union Past, Present, and Future, 29 Harv. C.R.-C.L. L. Rev. 143, 157 (1994).
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