The Supreme Court on Thursday kept access to the abortion pill available, rejecting a bid by a group of anti-abortion organizations and doctors to overturn the Food and Drug Administration’s approval of the drug.
In a unanimous decision, written by Justice Brett M. Kavanaugh, the court held that anti-abortion groups have less direct stake in the dispute, the requirement to challenge the FDA approval of the pill, mifepristone.
“The plaintiffs did not prescribe or use mifepristone,” Justice Kavanaugh wrote. “And the FDA doesn’t require them to do or not do anything.”
He added, “The plaintiff’s desire to make a drug less available to others does not create standing to sue.”
The case originally sought to remove FDA approval for mifepristone. But by the time it reached the Supreme Court, the question had narrowed whether the agency acted legally in 2016 and 2021, when it expanded the distribution of the pill, eventually including telemedicine and mail options.
The ruling provided a silent victory for abortion rights groups. Although he praised the decision to avoid severe restrictions on the availability of pills, he warned that the results could be short-lived.
Anti-abortion groups have vowed to press on, vowing that the battle is far from over and raising the possibility that other plaintiffs, particularly state-owned, will challenge the drug.
The decision does not affect separate restrictions on the pill in more than a dozen states that have passed near-total bans on abortion since the court removed the constitutional right to the procedure in Dobbs v. Jackson Women’s Health Organization. (The ban does not distinguish between medication and surgical abortion.)
Access to abortion remains popular, and since the court overturned Roe v. Wade two years ago, prompting several states to quickly impose restrictions, the issue became a major focus of political campaigns. Democrats have succeeded in galvanizing voters to defeat anti-abortion measures and plan to highlight abortion rights in the November election.
By avoiding a ruling on the merits of the case, judges avoid giving a clear and substantive victory to a political party or a decision that can be used to motivate the bottom line.
President Biden said in a statement that “this decision does not change the fact that the fight for reproductive freedom continues.”
He added, “It doesn’t change the fact that the Supreme Court overturned Roe v. Wade two years ago, and women lost their basic freedom.
The Biden campaign also raised concerns that the ruling would not do enough to protect access to abortion drugs if former President Donald J. Trump wins a second term, saying his administration would impose new restrictions through executive action.
Mr. Trump has wrestled with what position to take on abortion access after the Supreme Court, which supermajority conservatives appointed, overturned Roe v. Wade landmark abortion-rights case. A few weeks ago, he said that countries should set their own policies.
The campaign suggested they take a similar position on the abortion pill decision, without giving advice on the administration of the drug. “The Supreme Court has ruled unanimously 9-0; the matter is over,” said Danielle Alvarez, a spokeswoman for Trump.
Abortion rights groups warn that the decision merely maintains the status quo.
“The anti-abortion movement sees how critical the abortion pill is in this post-Roe world, and they are desperate to cut access,” Nancy Northup, president of the Center for Reproductive Rights, said in a statement.
Erin Hawley, senior counsel for the Alliance Defending Freedom, a conservative legal organization representing the plaintiffs, suggested that the case could be revived through the three Republican-led states, Idaho, Kansas and Missouri, which have intervened as plaintiffs at the lower court level.
“We are grateful that three countries stand ready to hold the FDA responsible for jeopardizing the health and safety of women and girls in this country,” Ms. Hawley said in a statement.
Mifepristone, part of a two-drug regimen, is used in nearly two-thirds of abortions in the United States. Many studies have found the pill to be safe, and years of research have shown that serious complications are rare.
After the FDA eased restrictions on the availability of the drug during the pandemic, so that it can be prescribed online or sent by mail, its use has only increased. An increasing number of medication abortions are being provided by telemedicine. By one count, about one in six abortions, or about 14,000 per month, occurred via telehealth from July to September 2023.
Medical abortion has become a practical form of abortion for women in countries where the procedure is prohibited. Clinicians, protected by the so-called shield in some countries where abortion is legal, have mail pills to women based in the country with a ban.
Justice Kavanaugh focused part of the majority opinion on why the justices disagreed with the lower court’s decision, all of which determined that the group had standing to bring the case.
Citing Justice Antonin Scalia, Justice Kavanaugh wrote that to bring suit, a plaintiff must answer a basic question: “What are you?”
Plaintiffs must show “a foreseeable chain of events from the government’s conduct to the alleged injury,” Justice Kavanaugh wrote.
In this case, he wrote, the doctors and medical associations trying to challenge the FDA regulations failed to show actual injury because the plaintiffs did not include people who actually participated in the pill, such as doctors who prescribed mifepristone or pregnant women who took it.
The plaintiffs’ claim that they have “genuine legal, moral, ideological, and policy objections to mifepristone being administered and used by others” does not meet the threshold for standing to sue, Justice Kavanaugh wrote.
The judges also rejected the argument of anti-abortion doctors that they should be prosecuted because they may be required to provide emergency abortions against their conscience.
Federal conscience laws already protect doctors from being forced to perform abortions or other treatments that violate their conscience, and no doctor has shown otherwise, Judge Kavanaugh said.
In his opinion, Justice Clarence Thomas noted that he supported the decision “in full,” but warned that courts should take a limited view when allowing organizations to claim standing on behalf of their members.
The case returned the issue of abortion to the Supreme Court, even though the conservative majority had declared, in overturning Roe v. Wade, that he would leave the question of access “to the people and their elected representatives.”
Thursday’s decision appears to vindicate that promise, although the court will decide another case on abortion, which is a clash between federal law and strict state bans.
The abortion pill case, FDA v Alliance for Hippocratic Medicine, represents a new front in the bitter battle over abortion.
In the fall of 2022, an umbrella group of anti-abortion medical organizations, along with several doctors, challenged the FDA’s approval of mifepristone more than two decades ago. In a preliminary ruling, a federal judge in Texas, Matthew J. Kacsmaryk, said the FDA’s approval of the drug should be delayed, removing mifepristone from the market.
Judge Kacsmaryk, a Trump appointee, joined the federal bench after years of litigating at the conservative religious freedom firm, First Liberty Institute.
An appeals court, in New Orleans, overturned the portion of Judge Kacsmaryk’s ruling that revoked the FDA’s approval of the pill, but imposed certain restrictions on its distribution. These restrictions include prohibiting the drug from being sent by mail or administered by telemedicine.
Maggie Haberman and Lisa Lehrer contributed reports from New York.