The U.S. Supreme Court ruled Thursday in a much-anticipated decision against efforts by conservative doctors and medical groups challenging access to mifepristone, one of two pharmaceuticals used in medication abortions. As a result of the high court’s decision, access to the drug won’t change.

Associate Supreme Court Justice Brett Kavanaugh, writing for the court, reversed a lower court decision that would have made it more difficult to obtain the drug, which is used in about two-thirds of U.S. abortions. The ruling however was narrow in scope as it only addressed what is known as legal standing in a case.

SCOTUSblog senior court reporter Amy Howe noted that Kavanaugh acknowledged what he characterized as the challengers’ “sincere legal, moral, ideological, and policy objections” to elective abortion “by others” and to FDA’s 2016 and 2021 changes to the conditions on the use of the drug.

But the challengers had not shown that they would be harmed by the FDA’s mifepristone policies, he explained, and under the Constitution, merely objecting to abortion and the FDA’s policies are not enough to bring a case in federal court. The proper place to voice those objections, he suggested, is in the political or regulatory arena.

“Under Article III of the Constitution, a plaintiff’s desire to make a drug less available for others does not establish standing to sue,” Kavanaugh wrote.

“We are pleased with the Supreme Court’s decision in this incredibly important case. By rejecting the Fifth Circuit’s radical, unprecedented and unsupportable interpretation of who has standing to sue, the justices reaffirmed longstanding basic principles of administrative law,” said Abigail Long, a spokesperson for Danco. “The decision also safeguards access to a drug that has decades of safe and effective use.”

The White House released a statement from President Joe Biden on Supreme Court Decision on FDA v. Alliance for Hippocratic Medicine:

“Today’s decision does not change the fact that the fight for reproductive freedom continues. It does not change the fact that the Supreme Court overturned Roe v. Wade two years ago, and women lost a fundamental freedom. It does not change the fact that the right for a woman to get the treatment she needs is imperiled if not impossible in many states.
 
It does mean that mifepristone, or medication abortion, remains available and approved. Women can continue to access this medication – approved by the FDA as safe and effective more than 20 years ago. 
 
But let’s be clear: attacks on medication abortion are part of Republican elected officials’ extreme and dangerous agenda to ban abortion nationwide. Since the overturning of Roe v. Wade, Republican elected officials have imposed extreme abortion bans in 21 states, some of which include zero exceptions for rape or incest. Women are being turned away from emergency rooms, or forced to go to court to plead for care that their doctor recommended or to travel hundreds of miles for care. Doctors and nurses are being threatened with jail time, including life in prison, for providing the health care they have been trained to provide. And contraception and IVF are under attack.
 
The stakes could not be higher for women across America. Vice President Harris and I stand with the vast majority of Americans who support a woman’s right to make deeply personal health care decisions. We will continue to fight to ensure that women in every state get the health care they need and we will continue to call on Congress to restore the protections of Roe v. Wade in federal law — that is our commitment.”

U.S. District Court for the Northern District of Texas Judge Matthew Kacsmaryk in Amarillo, Texas, in a ruling a year ago, waved aside decades of scientific approval, ruled that the U.S. Food and Drug Administration improperly approved mifepristone more than 20 years ago in 2000.

Kacsmaryk, appointed to the federal bench by former President Donald Trump, in his 67 page opinion wrote that the FDA’s two-decade-old approval violated a federal rule that allows for accelerated approval for certain drugs and, along with subsequent actions by the agency, was unlawful.

The suit, Alliance for Hippocratic Medicine v. FDA, was originally filed in the U.S. District Court for the North District of Texas in mid-November by Alliance Defending Freedom, an anti-abortion, anti-LGBTQ+ legal organization.

Applauding Kacsmaryk’s ruling, Erik Baptist, speaking for the Alliance Defending Freedom said in a statement: “By illegally approving dangerous chemical abortion drugs, the FDA put women and girls in harm’s way, and it’s high time the agency is held accountable for its reckless actions.”

Erin Hawley, a senior attorney for the conservative group Alliance Defending Freedom who argued the case at the Supreme Court, said the opinion was “disappointing,” but told reporters in a press gaggle after the ruling that the explicit mention of conscience protections was a victory.

“The Supreme Court was crystal clear that pro life doctors do have federal conscience protections, even in emergency situations,” Hawley said. “So that’s a huge win for the pro-life cause. The Supreme Court clearly said that our doctors are entitled to those federal conscious protections that are based on their religious beliefs.”

The case now returns to the lower courts, and the dispute over access to the drug likely is not over. 

SCOTUSblog also reported that Nancy Northrup, the president and CEO of the Center for Reproductive Rights, praised the decision but conceded that the dispute could continue even after Thursday’s ruling. She, too, noted that the three states “could still attempt to keep the case going, including taking it back up to the Supreme Court,” and she warned that access to mifepristone “is still at risk nationwide.”

The Hill notes that for instance, the same district court in Texas that originally ruled against the FDA said a group of three red states—Missouri, Idaho and Kansas— can intervene in the lawsuit.

“I would expect the litigation to continue with those states raising different standing arguments than made by our doctors,” ADF’s Hawley told reporters.

Equality California, the nation’s largest statewide LGBTQ+ civil rights organization, emailed the Blade the following statement from Executive Director Tony Hoang in response to a unanimous ruling by the United States Supreme Court:

“We appreciate today’s unanimous decision to uphold access to the abortion drug mifepristone, authored by a conservative Justice. This ruling reinforces the critical importance of maintaining accessible reproductive healthcare and highlights the necessity of safeguarding these rights from baseless legal attacks.

However, it is imperative to recognize that the Court should never have accepted this case. The so-called Alliance for Hippocratic Medicine lacked the standing to initiate this challenge. Moreover, federal conscience exemptions already exist for healthcare providers who object to offering abortion-related care. 

Medication abortions involving mifepristone constitute the majority of abortions in America, including those sought by LGBTQ+ people. Our community understands the necessity of bodily autonomy and the right to make decisions regarding our own medical care, including reproductive care. Patients deserve access to the medications they need, and providers should be able to deliver that care without unwarranted interference from extremist courts or politicians.   

Attacks on abortion do not end with this decision; millions of people nationwide are still unable to get abortion care and abortion opponents remain focused on their end goal of a nationwide abortion ban. 

Equality California will continue to work with our legislative partners in Sacramento and Washington, D.C., as well as organizational allies, like Planned Parenthood, to help protect and expand access to abortion and reproductive healthcare.”