Today the Supreme Court held that anti-abortion doctors lack standing to challenge the Food and Drug Administration's regulations governing mifepristone. This was as expected. Justice Kavanaugh wrote the opinion for a unanimous Court in Alliance for Hippocratic Medicine v. Food & Drug Administration. Justice Thomas also wrote a separate concurrence on third-party and associational standing.
As I documented in a series of posts (linked here and below) the arguments offered in support of standing by AHM and the lower courts were never particularly strong, particularly once courts concluded that challenges to the FDA's initial approval of mifepristone in 2000 were time barred. There was never much question that the Supreme Court would conclude that the plaintiffs lacked Article III standing in this case. The only question was whether it would be unanimous (as opposed to 8-1 or 7-2). Access to mifepristone was never at risk from this litigation.
Here is how Justice Kavanaugh summarizes his unanimous opinion for the Court:
In 2016 and 2021, the Food and Drug Administration relaxed its regulatory requirements for mifepristone, an abortion drug. Those changes made it easier for doctors to prescribe and pregnant women to obtain mifepristone. Several pro-life doctors and associations sued FDA, arguing that FDA's actions violated the Administrative Procedure Act. But the plaintiffs do not prescribe or use mifepristone. And FDA is not requiring them to do or refrain from doing anything. Rather, the plaintiffs want FDA to make mifepristone more difficult for other doctors to prescribe and for pregnant women to obtain. Under Article III of the Constitution, a plaintiff 's desire to make a drug less available for others does not establish standing to sue. Nor do the plaintiffs' other standing theories suffice. Therefore, the plaintiffs lack standing to challenge FDA's actions
As Justice Kavanaugh explains, AHM offered a variety of theories for Article III standing to challenge the FDA's decision to loosen the regulation of mifepristone, but none were adequate.
The plaintiffs do not allege the kinds of injuries described above that unregulated parties sometimes can assert to demonstrate causation. Because the plaintiffs do not prescribe, manufacture, sell, or advertise mifepristone or sponsor a competing drug, the plaintiffs suffer no direct monetary injuries from FDA's actions relaxing regulation of mifepristone. Nor do they suffer injuries to their property, or to the value of their property, from FDA's actions. Because the plaintiffs do not use mifepristone, they obviously can suffer no physical injuries from FDA's actions relaxing regulation of mifepristone.
Rather, the plaintiffs say that they are pro-life, oppose elective abortion, and have sincere legal, moral, ideological, and policy objections to mifepristone being prescribed and used by others. The plaintiffs appear to recognize that those general legal, moral, ideological, and policy concerns do not suffice on their own to confer Article III standing to sue in federal court. So to try to establish standing, the plaintiffs advance several complicated causation theories to connect FDA's actions to the plaintiffs' alleged injuries in fact.
The standing theory Justice Kavanaugh addresses first, and that received the most attention at oral argument, was that the FDA's decision to loosen restrictions on mifepristone would result in more emergency room visits by women suffering complications, and that this would result in conscience injuries to anti-abortion doctors forced to provide care in such situations. Without being dismissive of the genuine conscience-based objections some doctors may have to facilitating abortions, Justice Kavanaugh explained why these claims were insufficient to demonstrate standing.



