Federal Appeals Court Upholds Legal Status of Abortion Pill, But with Restrictions
A federal appeals court panel has ruled that the abortion pill mifepristone should remain legal in the United States but with significant restrictions on patient access. This decision sets the stage for a potential showdown before the Supreme Court regarding the fate of the most common method of terminating pregnancies.
The ruling, which would prohibit the pill from being sent through the mail or prescribed via telemedicine, is a major development in a closely-watched lawsuit aimed at removing abortion pills entirely from the market. However, the ruling will not have any immediate real-world effect as the Supreme Court ruled in April that mifepristone must remain available under the current rules until the appeals process concludes.
The lawsuit was filed by anti-abortion groups last year, several months after the Supreme Court overturned the constitutional right to abortion. In response to the appeals court ruling, the Justice Department has stated that it will ask the Supreme Court to hear the case.
The Supreme Court is expected to make a decision on this matter in the coming months. They have the option to deny review, thereby leaving the appeals court’s ruling intact but limiting access to the pill. Alternatively, they could agree to hear the appeal, revisiting a highly contested issue that some justices may prefer to avoid.
These deliberations will take place against the backdrop of the Supreme Court’s decision last year to overturn Roe v. Wade, which resulted in a significant drop in the court’s approval ratings, raised questions about its legitimacy, and became a political victory for Democrats.
The outcome of this case could extend beyond abortion, potentially raising questions about the Food and Drug Administration’s (FDA) regulatory authority over other drugs. Therefore, the Supreme Court’s ruling will be closely watched and highly significant.
In their ruling, a three-judge panel of the US Court of Appeals for the Fifth Circuit upheld part of a decision made by a federal judge in Texas. The decision effectively nullified the FDA’s approval of the pill but kept the FDA’s approval and the generic version of the drug in place.
If the appeals court’s decision is upheld by the Supreme Court, it would reverse recent changes made by the FDA that expanded access to the pill. These changes included allowing healthcare providers who are not doctors to prescribe mifepristone and allowing patients to receive the pill without an in-person visit. Under the appeals court ruling, patients would be required to make three visits to a doctor to obtain mifepristone and would not be able to receive it via mail.
The ability for patients to use telemedicine and have prescribed pills shipped to them has significantly increased the use of medication abortion, which now accounts for over half of pregnancy terminations in the United States.
The lawsuit against the FDA was brought by several anti-abortion doctors and the Alliance for Hippocratic Medicine, a consortium of anti-abortion medical groups. The appeals court majority stated that a statute of limitations appeared to bar a challenge to the FDA’s initial approval of mifepristone in 2000. They also noted that the approval of the generic version of the drug in 2019 should remain in effect.
Judge Jennifer W. Elrod, who was appointed by President George W. Bush, wrote the majority opinion, which was joined by Judge Cory T. Wilson, appointed by President Donald J. Trump. The decision argued that the FDA had failed to address concerns about the drug’s safety when it loosened restrictions. It called for rolling back changes made by the FDA in recent years.
Mifepristone has been used by over five million women in the United States to terminate pregnancies, and numerous studies have shown it to be safe and effective. The FDA has applied a stricter regulatory framework to mifepristone than most other drugs, and it is approved for use in many other countries as well.
The medication abortion protocol typically involves taking mifepristone to block the hormone that allows a pregnancy to develop, followed by another drug, misoprostol, to induce contractions and expel pregnancy tissue. If access to mifepristone is limited, abortion providers may have to rely solely on misoprostol, which is slightly less effective and more likely to cause side effects.
Judge James C. Ho, another Trump appointee on the appeals court panel, wrote a dissenting opinion, arguing that the approval of mifepristone in 2000 should be invalidated, citing mistakes made by the FDA.
The fate of mifepristone and access to medication abortion now rests with the Supreme Court, which will determine the future of this contentious issue and its potential implications for reproductive rights and FDA regulations.