Appeals court considers future of nationwide access to medication abortion

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The issue of medication abortion was back before a New Orleans-based appeals court on Wednesday, in the latest iteration of a yearslong legal effort to end the provision of abortion drugs via telehealth.

Medication abortion now accounts for two-thirds of US abortions, which overall have increased since the 2022 Supreme Court decision that ended abortion rights protections nationwide. The latest case was brought against the Trump administration by Louisiana, which has argued its abortion prohibitions are being undermined by federal regulations that allow mifepristone to be sent to patients in the mail, without an in-person doctor’s visit.

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Over roughly 100 minutes of arguments, the 5th US Circuit Court of Appeals wrestled with whether it could interfere with the US government’s regulatory approach to the abortion pill. The Justice Department has tried to head off the lawsuit by raising procedural issues with the case while refusing to endorse the safety of the drug.

The appeals court did not indicate how it intended to rule on Louisiana’s case; however it rules, it is expected that the Supreme Court will have the final word on the matter.

The high court issued an emergency order in May keeping the current rules allowing telehealth abortions in place for this current round of legal wrangling. Much of Wednesday’s hearing centered on what the appeals court could even do in the case in light of that order.

The judges also focused on the larger procedural question of Louisiana’s standing to bring the case, meaning whether it had shown the regulations were harming it in a way that made it appropriate for courts to intervene.

“I’m having trouble finding anywhere in the record that the FDA has approved the mailing of this drug into states where it’s unlawful to do that,” Judge Priscilla Richman, a George W. Bush appointee, told Louisiana Solicitor General Ben Aguiñaga.

Multiple judges on the panel pointed to Supreme Court precedents – including in a separate, earlier abortion pill case brought anti-abortion doctors – that shut the door to lawsuits that could only establish the challenger’s standing to sue through an “attenuated” chain of events.

DOJ attorney Daniel Winik said those standing issues alone were enough of a reason for the court to reject Louisiana’s request, as he dodged questions from the judges about the state’s arguments that FDA’s regulatory approach to the drug is flawed.

But Judge Stephen Higginson, an Obama appointee, expressed frustration when Winnick said he was not “authorized” to give his views about whether Louisiana was required to take steps to air its objections through the regulatory process before it could file its lawsuit.

While the 5th Circuit is generally a very conservative court, the trio of judges assigned to this stage of the case had a moderate-left lean, with President Joe Biden appointee Judge Dana Douglas joining Higginson and Richman on the panel.

The case has brought political heat for the administration, as anti-abortion groups have been irate that Trump’s FDA hasn’t sought to end telehealth abortion on its own and that it’s opposing the legal challenges.

The FDA says it’s undertaking a review of the drug’s safety profile and has sought to put the entire case on hold for that reason. Anti-abortion activists have accused the FDA of slow-walking the issue for political reasons, while reproductive rights groups worry that the administration will clamp down on medication abortion access after the midterms.

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Higginson repeatedly noted that courts in other parts of the country – in cases brought by abortion providers and reproductive rights groups – had issued rulings faulting the FDA for being too strict in its regulations for medication abortion. He also raised a 2021 Supreme Court ruling that reversed a lower court order that required the FDA to allow telehealth abortions because of the Covid-19 pandemic.

“I guess what I’m saying – and then Chief Justice Roberts writes — it looks like the Supreme Court is being constant with one principle: Let FDA do its work,” Higginson said.

Still, the 5th Circuit panel didn’t shy away from Louisiana’s arguments for second-guessing the FDA’s regulations, with several questions about the data the agency considered when coming with the current rules and about the administrative process for reconsidering the regulations.

Erik Baptist, a senior counsel for Alliance Defending Freedom, Louisiana’s co-counsel in the case, told CNN after the hearing that the court’s willingness to dig into the merits of the lawsuit gave Louisiana the opportunity to flesh out its argument.

“We were happy to explain (to) the 5th Circuit the numerous harms that the state of is Louisiana incurring” because of the FDA’s rules, he said, describing those regulations as an “intentional” effort to send medication abortion drugs into anti-abortion states.

伊芙琳·霍克斯坦/路透社/档案照片

周三，药物流产问题再次提交给位于新奥尔良的一家上诉法院审理，这是多年来旨在终止通过远程医疗提供堕胎药物的法律努力的最新进展。

药物流产目前占美国堕胎总数的2/3，而自2022年最高法院裁定终止全国范围内的堕胎权保护以来，堕胎总数总体呈上升趋势。路易斯安那州最近对特朗普政府提起诉讼，认为联邦法规允许通过邮寄方式向患者寄送米非司酮，无需患者亲自就诊，从而削弱了该州的堕胎禁令。

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特朗普平息了关于堕胎和婚姻的争论。保守派活动人士希望在2028年重新挑起这些争论。

在长达约100分钟的辩论中，美国第五巡回上诉法院就其是否有权干预美国政府对堕胎药的监管方式展开了激烈的辩论。司法部试图通过提出程序性问题来阻止诉讼，同时拒绝认可该药物的安全性。

上诉法院没有表明打算如何裁决路易斯安那州的案件；无论其裁决如何，预计最高法院将对该事项拥有最终决定权。

最高法院五月份发布了一项紧急命令，维持现行的远程堕胎规定，以应对当前这轮法律纠纷。周三的听证会主要围绕上诉法院在这项命令的约束下，究竟能对此案做些什么展开。

法官们还关注了路易斯安那州提起诉讼的资格这一更大的程序性问题，即路易斯安那州是否已证明这些法规正在以某种方式损害其利益，从而使法院介入成为合适的。

“我很难在记录中找到任何证据表明 FDA 批准将这种药物邮寄到禁止邮寄的州，”乔治·W·布什任命的法官普里西拉·里奇曼告诉路易斯安那州副检察长本·阿吉尼亚加。

小组中的多位法官指出，最高法院的先例——包括在另一起由反堕胎医生提起的堕胎药案件中——关闭了只能通过“牵强附会”的事件链来确立挑战者诉讼资格的诉讼大门。

司法部律师丹尼尔·维尼克表示，仅凭这些诉讼资格问题就足以让法院驳回路易斯安那州的请求。他回避了法官们关于该州认为FDA对该药物的监管方法存在缺陷的论点的问题。

但奥巴马任命的法官斯蒂芬·希金森对温尼克表示他“无权”就路易斯安那州是否必须先通过监管程序表达反对意见才能提起诉讼发表意见感到沮丧。

虽然第五巡回法院通常是一个非常保守的法院，但被指派到此案这一阶段的三位法官却倾向于温和的左翼，由乔·拜登总统任命的达纳·道格拉斯法官与希金森和里奇曼一起组成了合议庭。

该案给特朗普政府带来了政治压力，反堕胎团体对特朗普领导下的FDA没有主动寻求终止远程医疗堕胎，反而反对法律挑战感到愤怒。

美国食品药品监督管理局（FDA）表示，正在对该药物的安全性进行审查，并因此暂停了整个案件的审理。反堕胎人士指责FDA出于政治原因拖延此事，而生殖权利组织则担心，中期选举后，政府会收紧药物流产的途径。

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希金森多次指出，美国其他地区的法院——在堕胎服务提供者和生殖权利组织提起的诉讼中——都曾做出裁决，指责美国食品药品监督管理局（FDA）对药物流产的监管过于严格。他还提及最高法院2021年的一项裁决，该裁决推翻了下级法院要求FDA因新冠疫情而允许远程医疗堕胎的命令。

“我想说的是——罗伯茨首席大法官也写道——最高法院似乎始终坚持一个原则：让FDA做好自己的工作，”希金森说。

尽管如此，第五巡回上诉法院小组并没有回避路易斯安那州对FDA法规提出质疑的论点，而是就该机构在制定现行规则时考虑的数据以及重新考虑法规的行政程序提出了几个问题。

路易斯安那州在该案中的共同律师“捍卫自由联盟”的高级律师埃里克·巴普蒂斯特在听证会后告诉 CNN，法院愿意深入调查诉讼的实质内容，这给了路易斯安那州机会来充实其论点。

他说：“我们很高兴向第五巡回法院解释路易斯安那州因FDA的规定而遭受的诸多损害”，并将这些规定描述为“蓄意”将药物堕胎药送往反堕胎州。