SCOTUS Unanimously Rejects Challenge to Abortion Pill Due to Lack of Standing

The Supreme Court released a unanimous opinion Thursday morning rejecting an effort to roll back the Food and Drug Administration’s (FDA) recently-loosened restrictions on the administration of mifepristone, a drug used in medication-induced abortions.

This was the first time that the Court has considered an abortion-related case since overturning Roe v. Wade in 2022.

Much of the discussion during oral arguments back in March focused not on the merits of the case, but rather on the issues of standing and the scope of relief being sought by the challengers.

In the unanimous opinion authored by Justice Brett Kavanaugh, the Court largely mirrors this emphasis, explaining that their decision rested on the fact that the plaintiffs who brought the case “lack[ed] Article III standing to challenge FDA’s actions regarding the regulation of mifepristone.”

Consequently, the Justices reversed the Fifth Circuit ruling in favor of the plaintiffs and remanded the decision for further proceedings consistent with their opinion.

According to the FDA’s website, mifepristone “blocks a hormone called progesterone that is needed for a pregnancy to continue.”

“Mifepristone, when used together with another medicine called misoprostol, is used to end a pregnancy through ten weeks gestation,” the FDA explains.

Mifepristone was first approved by the FDA in 2000 for use in medication abortions up to seven weeks into a pregnancy. This time frame was extended to ten weeks in 2016.

In 2023, the FDA announced that it would make permanent a COVID-era policy lifting the requirement that mifepristone be administered to women in person at a clinic or hospital, or under the supervision of a certified medical professional.

The removal of this requirement allowed the abortion drug to be obtained by women at a retail pharmacy or through the mail via telemedicine.

[RELATED: SCOTUS Hears Oral Arguments in First Abortion-Related Case Since Overturning Roe v. Wade]

The doctors challenging these updated regulations contended that they are harmed when they are faced with treating patients experiencing complications associated with the un-monitored use of mifepristone, as it requires them to “participate in a process that facilitates abortions” and that would violate their sincerely held beliefs.

In addition to this, they also argued that they would face monetary injury as a result of needing to divert time, money, and resources to treating an increased number of patients with mifepristone complications.

The medical associations that signed onto this case as plaintiffs argued that the FDA’s updated regulations would cause them injury as well because they would need to spend funds opposing the agency’s actions.

According to the Justices, however, none of the three arguments were sufficient to establish standing in this case under Article III of the Constitution.

“Plaintiffs are pro-life, oppose elective abortion, and have sincere legal, moral, ideological, and policy objections to mifepristone being prescribed and used by others,” the Justices said. “Because plaintiffs do not prescribe or use mifepristone, plaintiffs are unregulated parties who seek to challenge FDA’s regulation of others.”

“Plaintiffs advance several complicated causation theories to connect FDA’s actions to the plaintiffs’ alleged injuries in fact,” they continued. “None of these theories suffices to establish Article III standing.”

“We recognize that many citizens, including the plaintiff doctors here, have sincere concerns about and objections to other using mifepristone and obtaining abortions,” the Court said. “But citizens and doctors do not have standing to sue simply because others are allowed to engage in certain activities — at least without the plaintiffs demonstrating how they would be injured by the government’s alleged under-regulation of others.”

The Court explained in its opinion that the doctors’ concerns over being forced to “render emergency treatment completing the abortions or providing other abortion-related treatment” fail to give them standing because federal conscience laws already provide sufficient protections.

“Moreover, as the Government notes, federal conscience protections encompass ‘the doctor’s beliefs rather than particular procedures,’ meaning that doctors cannot be required to treat mifepristone complications in any way that would violate the doctors’ consciences,” the opinion said.

“In short, given the broad and comprehensive conscience protections guaranteed by federal law, the plaintiffs have not shown — and cannot show — that FDA’s actions will cause them to suffer any conscience injury,” the Justices concluded.

[RELATED: Dispute Over Emergency Abortion Requirements Considered by SCOTUS]

The Court also argued that the doctors’ concerns over potential monetary injury — including “diverting resources and time from other patients to treat patients with mifepristone complications; increasing risk of liability suits from treating those patients; and potentially increasing insurance costs” — were also also insufficient to establish standing.

According to the Justices, “the causal link between FDA’s regulatory actions and those alleged injuries is too speculative or otherwise too attenuated to establish standing.”

The Court goes on to explain that that “the law has never permitted doctors to challenge the government’s loosening of general public safety requirements simply because more individuals might then show up at emergency rooms or in doctors’ offices with follow-on injuries.”

The medical associations in this case argued that they had “organizational standing” to bring legal action against the FDA because the agency “‘impaired’ their ‘ability to provide services and achieve their organizational missions'” by “‘forc[ing]’ the associations to ‘expend considerable time, energy, and resource’ drafting citizen petitions to FDA, as well as engaging in public advocacy and public education.”

In response to this, the Justices explained that an organization “cannot manufacture its own standing” by “spend[ing] its way into standing simply by expending money to gather information and advocate against the defendant’s action.”

Justice Clarence Thomas issued a concurring opinion in which he agreed with the Court’s application of precedents to conclude that the plaintiffs lacked standing but took the opportunity to address his concerns with the “associational-standing doctrine” more generally.

In this opinion, Justice Thomas explains that “no party challenges our associational-standing doctrine today” and “rejecting our associational-standing doctrine is not necessary to conclude that the plaintiffs lack standing,” but he encourages the Court “in an appropriate case” to “address whether associational standing can be squared with Article II’s requirement that courts respect the bounds of judicial power.”

Click Here to Read the Supreme Court’s Full Opinion

In a statement released Thursday, Gov. Janet Mills (D) and Maine Attorney General Aaron Frey praised the ruling as “welcome news” and “a big win for health care access.”

“The Supreme Court was right to reject this legally and scientifically meritless case, and I join the many Maine people who today are breathing a sigh of relief that mifepristone will remain legal and accessible across our state and nation,” Gov. Mills said.

“While this ruling is welcome news, we know this,” she continued, “the reproductive rights of women remain under direct and constant attack, and I pledge that my Administration will continue to fight any attempts to undermine reproductive rights in Maine.”

“This ruling is a big win for health care access,” said Attorney General Frey. “And while I, like so many, am deeply relieved, my Office will remain vigilant for the anti-abortion movement’s next attempt to roll back reproductive freedom.”

Click Here to Read the Full Press Release from Gov. Mills and Attorney General Frey