Supreme Court preserves access to abortion pill mifepristone in unanimous ruling

In a unanimous ruling, the Supreme Court of the United States (SCOTUS) has rejected a bid to restrict people's access to the widely used abortion pill mifepristone. The drug is one half of a two-pill regimen prescribed for medication abortions, which made up more than 60% of all abortions in the U.S. last year.

The plaintiffs in the case were members of the Alliance for Hippocratic Medicine (AHM), a collective of anti-abortion groups that includes doctors. The defendant was the Food and Drug Administration (FDA). 

The plaintiffs argued that AHM has the right to sue the FDA over how it regulates mifepristone because the collective's members may end up treating patients who experience side effects of the drug. In recent years, the FDA has made it easier for patients to access the pill — for instance, people can now be prescribed mifepristone after a telehealth appointment, rather than an in-person doctor's visit, and they can then receive it in person from a pharmacy or by mail.  

Telehealth abortions are as safe and effective as those prescribed in person, but in a small percentage of cases, people may experience serious side effects or require additional treatment to end their pregnancy. The plaintiffs argued that, if tasked with treating such patients, AHM members would have to divert resources from other patients, and in addition, treating patients with these side effects would violate the doctors' moral stances around abortion.

Related: Roe v. Wade: Facts about the landmark case

The Supreme Court had to address whether AHM had the legal standing to sue the FDA on these grounds. On Thursday (June 13), the court unanimously agreed that the plaintiff did not have legal standing.

In a 9-0 opinion delivered by Justice Brett Kavanaugh, the court declared that "the plaintiffs have failed to demonstrate that FDA's relaxed regulatory requirements likely would cause them to suffer an injury in fact. For that reason, the federal courts are the wrong forum for addressing the plaintiffs' concerns about FDA's actions." 

The full text of the ruling can be read online. 

The regimen involving mifepristone and a second pill, misoprostol, is the most commonly prescribed regimen for medication abortions in the United States. Mifepristone ended up in the Supreme Court after its approval and regulation was challenged in lower courts. 

Initially, a Texas judge ruled that the FDA's original approval of the pill in 2000 should be overturned. That ruling was appealed, and an appellate court said that the drug's approval should stand unchallenged. 

However, the appellate court wanted to roll back regulatory changes that the FDA made in 2016 and 2021, on the grounds that the FDA didn't adequately follow procedure or explain its reasoning when it made these changes. This rollback would have reinstated the requirement for patients to get the pill in person from a certified doctor, along with other restrictions. 

The appellate court's decision was then appealed by both the AHM and FDA, and the case moved up to SCOTUS.

Had SCOTUS decided that the AHM had legal standing, it could have impacted the FDA's authority over all drugs — not only abortion pills. Stakeholders in the pharmaceutical industry and medical ethics experts expressed concerns that setting such a precedent could have opened the door for doctors to sue over any drug approval or regulation they disagree with, regardless of that medicine's safety or effectiveness.

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