Food and Drug Administration v. Alliance for Hippocratic Medicine

NOTICE: This opinion is subject to
formal revision before publication in the United States Reports.
Readers are requested to notify the Reporter of Decisions, Supreme
Court of the United States, Washington, D. C. 20543,
pio@supremecourt.gov, of any typographical or other formal
errors.

															SUPREME COURT OF THE UNITED STATES

															_________________

															Nos. 23–235 and 23–236

															_________________

															FOOD AND DRUG ADMINISTRATION,
et al., PETITIONERS

															23–235 v. ALLIANCE FOR HIPPOCRATIC MEDICINE,
et al.

															DANCO LABORATORIES, L.L.C.,
PETITIONER

															23–236 v. ALLIANCE FOR HIPPOCRATIC MEDICINE,
et al.

															on writs of certiorari to the united states
court of appeals for the fifth circuit

															[June 13, 2024]

															Justice Kavanaugh delivered the opinion of the
Court.

															In 2016 and 2021, the Food and Drug
Administration relaxed its regulatory requirements for
mifepristone, an abortion drug. Those changes made it easier for
doctors to prescribe and pregnant women to obtain mifepristone.
Several pro-life doctors and associations sued FDA, arguing that
FDA’s actions violated the Administrative Procedure Act. But the
plaintiffs do not prescribe or use mifepristone. And FDA is not
requiring them to do or refrain from doing anything. Rather, the
plaintiffs want FDA to make mifepristone more difficult for other
doctors to prescribe and for pregnant women to obtain. Under
Article III of the Constitution, a plaintiff ’s desire to make
a drug less available for others does not establish standing
to sue. Nor do the plaintiffs’ other standing theories suffice.
Therefore, the plaintiffs lack standing to challenge FDA’s
actions.

															I

															A

															Under federal law, the U. S. Food and
Drug Administration, an agency within the Executive Branch, ensures
that drugs on the market are safe and effective. For FDA to approve
a new drug, the drug sponsor (usually the drug’s manufacturer or
potential marketer) must submit an application demonstrating that
the drug is safe and effective when used as directed. 21
U. S. C. §355(d). The sponsor’s application must
generally include proposed labeling that specifies the drug’s
dosage, how to take the drug, and the specific conditions that the
drug may treat. 21 CFR §§201.5, 314.50 (2022).

															If FDA determines that additional safety
requirements are necessary, FDA may impose extra requirements on
prescription and use of the drug. 21 U. S. C.
§355–1(f )(3). For example, FDA may require that prescribers
undergo specialized training; mandate that the drug be dispensed
only in certain settings like hospitals; or direct that doctors
monitor patients taking the drug. Ibid. In 2000, FDA approved a new drug application for
mifepristone tablets marketed under the brand name Mifeprex. FDA
approved Mifeprex for use to terminate pregnancies, but only up to
seven weeks of pregnancy. To help ensure that Mifeprex would be
used safely and effectively, FDA placed further restrictions on the
drug’s use and distribution. For example, only doctors could
prescribe or supervise prescription of Mifeprex. Doctors and
patients also had to follow a strict regimen requiring the patient
to appear for three in-person visits with the doctor. And FDA
directed prescribing doctors to report incidents of
hospitalizations, blood transfusions, or other serious adverse
events to the drug sponsor (who, in turn, was required to report
the events to FDA).

															In 2015, Mifeprex’s distributor Danco
Laboratories submitted a supplemental new drug application seeking
to amend Mifeprex’s labeling and to relax some of the restrictions
that FDA had imposed. In 2016, FDA approved the proposed changes.
FDA deemed Mifeprex safe to terminate pregnancies up to 10 weeks
rather than 7 weeks. FDA allowed healthcare providers such as nurse
practitioners to prescribe Mifeprex. And FDA approved a dosing
regimen that reduced the number of required in-person visits from
three to one—a single visit to receive Mifeprex. In addition, FDA
changed prescribers’ adverse event reporting obligations to require
prescribers to report only fatalities—a reporting requirement that
was still more stringent than the requirements for most other
drugs.

															In 2019, FDA approved an application for generic
mifepristone. FDA established the same conditions of use for
generic mifepristone as for Mifeprex.

															In 2021, FDA again relaxed the requirements for
Mifeprex and generic mifepristone. Relying on experience gained
during the COVID–19 pandemic about pregnant women using
mifepristone without an in-person visit to a healthcare provider,
FDA announced that it would no longer enforce the initial in-person
visit requirement.

															B

															Because mifepristone is used to terminate
pregnancies, FDA’s approval and regulation of mifepristone have
generated substantial controversy from the start. In 2002, three
pro-life associations submitted a joint citizen petition asking FDA
to rescind its approval of Mifeprex. FDA denied their petition.

															In 2019, two pro-life medical associations filed
another petition, this time asking FDA to withdraw its 2016
modifications to mifepristone’s conditions of use. FDA denied that
petition as well.

															This case began in 2022. Four pro-life medical
associations, as well as several individual doctors, sued FDA in
the U. S. District Court for the Northern District of Texas.
Plaintiffs brought claims under the Administrative Procedure Act.
They challenged the lawfulness of FDA’s 2000 approval of Mifeprex;
FDA’s 2019 approval of generic mifepristone; and FDA’s 2016 and
2021 actions modifying mifepristone’s conditions of use. Danco
Laboratories, which sponsors Mifeprex, intervened to defend FDA’s
actions. The plaintiffs moved for a preliminary injunction that
would require FDA to rescind approval of mifepristone or, at the
very least, to rescind FDA’s 2016 and 2021 actions.

															The District Court agreed with the plaintiffs
and in effect enjoined FDA’s approval of mifepristone, thereby
ordering mifepristone off the market. 668 F. Supp. 3d 507 (ND
Tex. 2023). The court first held that the plaintiffs possessed
Article III standing. It then determined that the plaintiffs were
likely to succeed on the merits of each of their claims. Finally,
the court concluded that the plaintiffs would suffer irreparable
harm from FDA’s continued approval of mifepristone and that an
injunction would serve the public interest.

															FDA and Danco promptly appealed and moved to
stay the District Court’s order pending appeal. The U. S.
Court of Appeals for the Fifth Circuit granted the stay motion in
part and temporarily reinstated FDA’s approval of Mifeprex. 2023 WL
2913725, *21 (Apr. 12, 2023). But the Court of Appeals declined to
stay the rest of the District Court’s order. The Court of Appeals’
partial stay would have left Mifeprex (though not generic
mifepristone) on the market, but only under the more stringent
requirements imposed when FDA first approved Mifeprex in
2000—available only up to seven weeks of pregnancy, only when
prescribed by doctors, and only with three in-person visits, among
other requirements.

															FDA and Danco then sought a full stay in this
Court. This Court stayed the District Court’s order in its entirety
pending the disposition of FDA’s and Danco’s appeals in the Court
of Appeals and ultimate resolution by this Court. 598 U. S.
___ (2023). As a result of this Court’s stay, Mifeprex and generic
mifepristone have remained available as allowed by FDA’s relaxed
2016 and 2021 requirements.

															A few months later, the Court of Appeals issued
its decision on the merits of the District Court’s order, affirming
in part and vacating in part. 78 F. 4th 210, 222–223 (CA5
2023). The Court of Appeals first concluded that the individual
doctors and the pro-life medical associations had standing. The
Court of Appeals next concluded that plaintiffs were not likely to
succeed on their challenge to FDA’s 2000 approval of Mifeprex and
2019 approval of generic mifepristone. So the Court of Appeals
vacated the District Court’s order as to those agency actions. But
the Court of Appeals agreed with the District Court that plaintiffs
were likely to succeed in showing that FDA’s 2016 and 2021 actions
were unlawful.

															The Court of Appeals’ merits decision did not
alter this Court’s stay of the District Court’s order pending this
Court’s review. This Court then granted certiorari with respect to
the 2016 and 2021 FDA actions held unlawful by the Court of
Appeals. 601 U. S. ___ (2023).

															II

															The threshold question is whether the
plaintiffs have standing to sue under Article III of the
Constitution. Article III standing is a “bedrock constitutional
requirement that this Court has applied to all manner of important
disputes.” United States v. Texas , 599 U.S. 670, 675
(2023). Standing is “built on a single basic idea—the idea of
separation of powers.” Ibid. (quotation marks omitted).
Importantly, separation of powers “was not simply an abstract
generalization in the minds of the Framers: it was woven into the
document that they drafted in Philadelphia in the summer of 1787.” TransUnion LLC v. Ramirez , 594 U.S. 413, 422–423
(2021) (quotation marks omitted). Therefore, we begin as always
with the precise text of the Constitution.

															Article III of the Constitution confines the
jurisdiction of federal courts to “Cases” and “Controversies.” The
case or controversy requirement limits the role of the Federal
Judiciary in our system of separated powers. As this Court
explained to President George Washington in 1793 in response to his
request for a legal opinion, federal courts do not issue advisory
opinions about the law—even when requested by the President. 13
Papers of George Washington: Presidential Series 392 (C. Patrick
ed. 2007). Nor do federal courts operate as an open forum for
citizens “to press general complaints about the way in which
government goes about its business.” Allen v. Wright , 468 U.S.
737 , 760 (1984) (quotation marks omitted); see California v. Texas , 593 U.S. 659, 673 (2021); Valley Forge Christian College v. Americans United for
Separation of Church and State, Inc. , 454
U.S. 464 , 487 (1982); United States v. Richardson , 418 U.S.
166 , 175 (1974); Ex parte Levitt , 302 U.S. 633, 634
(1937) ( per curiam ); Massachusetts v. Mellon , 262 U.S.
447 , 487–488 (1923); Fairchild v. Hughes , 258 U.S.
126 , 129–130 (1922).

															As Justice Scalia memorably said, Article III
requires a plaintiff to first answer a basic question:
“ ‘What’s it to you?’ ” A. Scalia, The Doctrine of
Standing as an Essential Element of the Separation of Powers, 17
Suffolk U. L. Rev. 881, 882 (1983). For a plaintiff to
get in the federal courthouse door and obtain a judicial
determination of what the governing law is, the plaintiff cannot be
a mere bystander, but instead must have a “personal stake” in the
dispute. TransUnion , 594 U. S., at 423. The requirement
that the plaintiff possess a personal stake helps ensure that
courts decide litigants’ legal rights in specific cases, as Article
III requires, and that courts do not opine on legal issues in
response to citizens who might “roam the country in search of
governmental wrongdoing.” Valley Forge , 454 U. S., at
487; see, e . g ., Schlesinger v. Reservists
Comm. to Stop the War , 418 U.S.
208 , 227 (1974); Richardson , 418 U. S., at 175; Tyler v. Judges of Court of Registration , 179 U.S.
405 , 406 (1900). Standing also “tends to assure that the legal
questions presented to the court will be resolved, not in the
rarified atmosphere of a debating society, but in a concrete
factual context conducive to a realistic appreciation of the
consequences of judicial action.” Valley Forge , 454
U. S., at 472. Moreover, the standing doctrine serves to
protect the “autonomy” of those who are most directly affected so
that they can decide whether and how to challenge the defendant’s
action. Id. , at 473.

															By limiting who can sue, the standing
requirement implements “the Framers’ concept of the proper—and
properly limited—role of the courts in a democratic society.” J.
Roberts, Article III Limits on Statutory Standing, 42 Duke
L. J. 1219, 1220 (1993) (quotation marks omitted). In
particular, the standing requirement means that the federal courts
decide some contested legal questions later rather than sooner,
thereby allowing issues to percolate and potentially be resolved by
the political branches in the democratic process. See Raines v. Byrd , 521 U.S.
811 , 829–830 (1997); cf. Clapper v. Amnesty Int’l
USA , 568 U.S.
398 , 420–422 (2013). And the standing requirement means that
the federal courts may never need to decide some contested legal
questions: “Our system of government leaves many crucial decisions
to the political processes,” where democratic debate can occur and
a wide variety of interests and views can be weighed. Schlesinger , 418 U. S., at 227; see Campbell v. Clinton , 203 F.3d 19 , 23 (CADC 2000).

															A

															The fundamentals of standing are well-known
and firmly rooted in American constitutional law. To establish
standing, as this Court has often stated, a plaintiff must
demonstrate (i) that she has suffered or likely will suffer an
injury in fact, (ii) that the injury likely was caused or will
be caused by the defendant, and (iii) that the injury likely
would be redressed by the requested judicial relief. See Summers v. Earth Island Institute , 555 U.S.
488 , 493 (2009); Lujan v. Defenders of Wildlife , 504 U.S.
555 , 560–561 (1992). Those specific standing requirements
constitute “an essential and unchanging part of the
case-or-controversy requirement of Article III.” Id. , at
560.

															The second and third standing
requirements—causation and redressability—are often “flip sides of
the same coin.” Sprint Communications Co. v. APCC
Services, Inc. , 554 U.S.
269 , 288 (2008). If a defendant’s action causes an injury,
enjoining the action or awarding damages for the action will
typically redress that injury. So the two key questions in most
standing disputes are injury in fact and causation.[ 1 ] First is injury in fact. An injury in
fact must be “concrete,” meaning that it must be real and not
abstract. See TransUnion , 594 U. S., at 424. The injury
also must be particularized; the injury must affect “the plaintiff
in a personal and individual way” and not be a generalized
grievance. Lujan , 504 U. S., at 560, n. 1. An injury in
fact can be a physical injury, a monetary injury, an injury to
one’s property, or an injury to one’s constitutional rights, to
take just a few common examples. Moreover, the injury must be
actual or imminent, not speculative—meaning that the injury must
have already occurred or be likely to occur soon. Clapper ,
568 U. S., at 409. And when a plaintiff seeks prospective
relief such as an injunction, the plaintiff must establish a
sufficient likelihood of future injury. Id. , at 401.

															By requiring the plaintiff to show an injury in
fact, Article III standing screens out plaintiffs who might have
only a general legal, moral, ideological, or policy objection to a
particular government action. For example, a citizen does not have
standing to challenge a government regulation simply because the
plaintiff believes that the government is acting illegally. See Valley Forge , 454 U. S., at 473, 487. A citizen may not
sue based only on an “asserted right to have the Government act in
accordance with law.” Allen , 468 U. S., at 754; Schlesinger , 418 U. S., at 225–227. Nor may citizens
sue merely because their legal objection is accompanied by a strong
moral, ideological, or policy objection to a government action. See Valley Forge , 454 U. S., at 473.

															The injury in fact requirement prevents the
federal courts from becoming a “vehicle for the vindication of the
value interests of concerned bystanders.” Allen , 468
U. S., at 756 (quotation marks omitted). An Article III court
is not a legislative assembly, a town square, or a faculty lounge.
Article III does not contemplate a system where 330 million
citizens can come to federal court whenever they believe that the
government is acting contrary to the Constitution or other federal
law. See id. , at 754. Vindicating “the public interest (including the public interest in Government observance of
the Constitution and laws) is the function of Congress and the
Chief Executive.” Lujan , 504 U. S., at 576.

															In sum, to sue in federal court, a plaintiff
must show that he or she has suffered or likely will suffer an
injury in fact. Second is causation. The plaintiff must
also establish that the plaintiff ’s injury likely was caused
or likely will be caused by the defendant’s conduct.

															Government regulations that require or forbid
some action by the plaintiff almost invariably satisfy both the
injury in fact and causation requirements. So in those cases,
standing is usually easy to establish. See Lujan , 504
U. S., at 561–562; see, e . g ., Susan B.
Anthony List v. Driehaus , 573 U.S.
149 , 162–163 (2014).

															By contrast, when (as here) a plaintiff
challenges the government’s “unlawful regulation (or lack of
regulation) of someone else ,” “standing is not precluded,
but it is ordinarily substantially more difficult to establish.” Lujan , 504 U. S., at 562 (quotation marks omitted); see Summers , 555 U. S., at 493. That is often because
unregulated parties may have more difficulty establishing
causation—that is, linking their asserted injuries to the
government’s regulation (or lack of regulation) of someone else.
See Clapper , 568 U. S., at 413–414; Lujan , 504
U. S., at 562; Duke Power Co. v. Carolina
Environmental Study Group, Inc. , 438 U.S.
59 , 74 (1978); Simon v. Eastern Ky. Welfare Rights
Organization , 426 U.S.
26 , 41–46 (1976); Warth v. Seldin , 422 U.S.
490 , 504–508 (1975).

															When the plaintiff is an unregulated party,
causation “ordinarily hinge[s] on the response of the regulated (or
regulable) third party to the government action or inaction—and
perhaps on the response of others as well.” Lujan , 504
U. S., at 562. Yet the Court has said that plaintiffs
attempting to show causation generally cannot “rely on speculation
about the unfettered choices made by independent actors not before
the courts.” Clapper , 568 U. S., at 415, n. 5
(quotation marks omitted); see also Bennett v. Spear , 520 U.S.
154 , 168–169 (1997). Therefore, to thread the causation needle
in those circumstances, the plaintiff must show that the
“ ‘third parties will likely react in predictable ways’ ”
that in turn will likely injure the plaintiffs. California ,
593 U. S., at 675 (quoting Department of Commerce v. New York , 588 U.S. 752, 768 (2019)).

															As this Court has explained, the “line of
causation between the illegal conduct and injury”—the “links in the
chain of causation,” Allen , 468 U. S., at 752, 759—must
not be too speculative or too attenuated, Clapper , 568
U. S., at 410–411. The causation requirement precludes
speculative links—that is, where it is not sufficiently predictable
how third parties would react to government action or cause
downstream injury to plaintiffs. See Allen , 468 U. S., at
757–759; Simon , 426 U. S., at 41–46. The causation
requirement also rules out attenuated links—that is, where the
government action is so far removed from its distant (even if
predictable) ripple effects that the plaintiffs cannot establish
Article III standing. See Allen , 468 U. S., at 757–759; cf. Department of Commerce , 588 U. S., at 768.

															The causation requirement is central to Article
III standing. Like the injury in fact requirement, the causation
requirement screens out plaintiffs who were not injured by the
defendant’s action. Without the causation requirement, courts would
be “virtually continuing monitors of the wisdom and soundness” of
government action. Allen , 468 U. S., at 760 (quotation
marks omitted).

															Determining causation in cases involving suits
by unregulated parties against the government is admittedly not a
“mechanical exercise.” Id. , at 751. That is because the
causation inquiry can be heavily fact-dependent and a “question of
degree,” as private petitioner’s counsel aptly described it here.
Tr. of Oral Arg. 50. Unfortunately, applying the law of standing
cannot be made easy, and that is particularly true for causation.
Just as causation in tort law can pose line-drawing difficulties,
so too can causation in standing law when determining whether an
unregulated party has standing.

															That said, the “absence of precise definitions”
has not left courts entirely “at sea in applying the law of
standing.” Allen , 468 U. S., at 751. Like “most legal
notions, the standing concepts have gained considerable definition
from developing case law.” Ibid. As the Court has explained,
in “many cases the standing question can be answered chiefly by
comparing the allegations of the particular complaint to those made
in prior standing cases.” Id. , at 751–752. Stated otherwise,
assessing standing “in a particular case may be facilitated by
clarifying principles or even clear rules developed in prior
cases.” Id. , at 752.

															Consistent with that understanding of how
standing principles can develop and solidify, the Court has
identified a variety of familiar circumstances where government
regulation of a third-party individual or business may be likely to
cause injury in fact to an unregulated plaintiff. For example, when
the government regulates (or under-regulates) a business, the
regulation (or lack thereof ) may cause downstream or upstream
economic injuries to others in the chain, such as certain
manufacturers, retailers, suppliers, competitors, or customers. E.g. , National Credit Union Admin. v. First Nat.
Bank & Trust Co. , 522 U.S.
479 , 488, n. 4 (1998); General Motors Corp. v. Tracy , 519 U.S.
278 , 286–287 (1997); Barlow v. Collins , 397 U.S.
159 , 162–164 (1970); Association of Data Processing Service
Organizations, Inc. v. Camp , 397
U.S. 150 , 152 (1970). When the government regulates parks,
national forests, or bodies of water, for example, the regulation
may cause harm to individual users. E.g. , Summers ,
555 U. S., at 494. When the government regulates one property,
it may reduce the value of adjacent property. The list goes on.
See, e . g ., Department of Commerce , 588
U. S., at 766–768.

															As those cases illustrate, to establish
causation, the plaintiff must show a predictable chain of events
leading from the government action to the asserted injury—in other
words, that the government action has caused or likely will cause
injury in fact to the plaintiff.[ 2 ]

															B

															Here, the plaintiff doctors and medical
associations are unregulated parties who seek to challenge FDA’s
regulation of others . Specifically, FDA’s regulations
apply to doctors prescribing mifepristone and to pregnant women
taking mifepristone. But the plaintiff doctors and medical
associations do not prescribe or use mifepristone. And FDA has not
required the plaintiffs to do anything or to refrain from doing
anything.

															The plaintiffs do not allege the kinds of
injuries described above that unregulated parties sometimes can
assert to demonstrate causation. Because the plaintiffs do not
prescribe, manufacture, sell, or advertise mifepristone or sponsor
a competing drug, the plaintiffs suffer no direct monetary injuries
from FDA’s actions relaxing regulation of mifepristone. Nor do they
suffer injuries to their property, or to the value of their
property, from FDA’s actions. Because the plaintiffs do not use
mifepristone, they obviously can suffer no physical injuries from
FDA’s actions relaxing regulation of mifepristone.

															Rather, the plaintiffs say that they are
pro-life, oppose elective abortion, and have sincere legal, moral,
ideological, and policy objections to mifepristone being prescribed
and used by others . The plaintiffs appear to recognize that
those general legal, moral, ideological, and policy concerns do not
suffice on their own to confer Article III standing to sue in
federal court. So to try to establish standing, the plaintiffs
advance several complicated causation theories to connect FDA’s
actions to the plaintiffs’ alleged injuries in fact.

															The first set of causation theories contends
that FDA’s relaxed regulation of mifepristone may cause downstream
conscience injuries to the individual doctor plaintiffs and the
specified members of the plaintiff medical associations, who are
also doctors. (We will refer to them collectively as “the
doctors.”) The second set of causation theories asserts that FDA’s
relaxed regulation of mifepristone may cause downstream economic
injuries to the doctors. The third set of causation theories
maintains that FDA’s relaxed regulation of mifepristone causes
injuries to the medical associations themselves, who assert their
own organizational standing. As we will explain, none of the
theories suffices to establish Article III standing.

															1

															We first address the plaintiffs’ claim that
FDA’s relaxed regulation of mifepristone causes conscience injuries
to the doctors.

															The doctors contend that FDA’s 2016 and 2021
actions will cause more pregnant women to suffer complications from
mifepristone, and those women in turn will need more emergency
abortions by doctors. The plaintiff doctors say that they therefore
may be required—against their consciences—to render emergency
treatment completing the abortions or providing other
abortion-related treatment.

															The Government correctly acknowledges that a
conscience injury of that kind constitutes a concrete injury in
fact for purposes of Article III. See Tr. of Oral Arg. 11–12; TransUnion , 594 U. S., at 425; see, e . g ., Holt v. Hobbs , 574 U.S.
352 (2015). So doctors would have standing to challenge a
government action that likely would cause them to provide medical
treatment against their consciences.

															But in this case—even assuming for the sake of
argument that FDA’s 2016 and 2021 changes to mifepristone’s
conditions of use cause more pregnant women to require emergency
abortions and that some women would likely seek treatment from
these plaintiff doctors—the plaintiff doctors have not shown that
they could be forced to participate in an abortion or provide
abortion-related medical treatment over their conscience
objections.

															That is because, as the Government explains,
federal conscience laws definitively protect doctors from being
required to perform abortions or to provide other treatment that
violates their consciences. See 42 U. S. C.
§300a–7(c)(1); see also H. R. 4366, 118th Cong., 2d Sess.,
Div. C, Title II, §203 (2024). The Church Amendments, for instance,
speak clearly. They allow doctors and other healthcare personnel to
“refus[e] to perform or assist” an abortion without punishment or
discrimination from their employers. 42 U. S. C.
§300a–7(c)(1). And the Church Amendments more broadly provide that
doctors shall not be required to provide treatment or assistance
that would violate the doctors’ religious beliefs or moral
convictions. §300a–7(d). Most if not all States have conscience
laws to the same effect. See N. Sawicki, Protections From Civil
Liability in State Abortion Conscience Laws, 322 JAMA 1918 (2019);
see, e . g ., Tex. Occ. Code Ann. §103.001 (West
2022).

															Moreover, as the Government notes, federal
conscience protections encompass “the doctor’s beliefs rather than
particular procedures,” meaning that doctors cannot be required to
treat mifepristone complications in any way that would violate the
doctors’ consciences. Tr. of Oral Arg. 37; see §300a–7(c)(1). As
the Government points out, that strong protection for conscience
remains true even in a so-called healthcare desert, where other
doctors are not readily available. Tr. of Oral Arg. 18.

															Not only as a matter of law but also as a matter
of fact, the federal conscience laws have protected pro-life
doctors ever since FDA approved mifepristone in 2000. The
plaintiffs have not identified any instances where a doctor was
required, notwithstanding conscience objections, to perform an
abortion or to provide other abortion-related treatment that
violated the doctor’s conscience. Nor is there any evidence in the
record here of hospitals overriding or failing to accommodate
doctors’ conscience objections.

															In other words, none of the doctors’
declarations says anything like the following: “Here is the
treatment I provided, here is how it violated my conscience, and
here is why the conscience protections were unavailable to me.” Cf.
App. 153–154 (Dr. Francis saw a patient suffering complications
from an abortion drug obtained from India; no allegation that Dr.
Francis helped perform an abortion); id. , at 154 (Dr.
Francis witnessed another doctor perform an abortion; no allegation
that the other doctor raised conscience objections or tried not to
participate); id., at 163–164 (doctor’s hospital treated
women suffering complications from abortion drugs; no allegation
that the doctors treating the patients had or raised conscience
objections to the treatment they provided); id ., at 173–174
(doctor treated a patient suffering from mifepristone
complications; no description of what that treatment involved and
no statement that the doctor raised a conscience objection to
providing that treatment).

															In response to all of that, the doctors still
express fear that another federal law, the Emergency Medical
Treatment and Labor Act or EMTALA, might be interpreted to override
those federal conscience laws and to require individual emergency
room doctors to participate in emergency abortions in some
circumstances. See 42 U. S. C. §1395dd. But the
Government has disclaimed that reading of EMTALA. And we agree with
the Government’s view of EMTALA on that point. EMTALA does not
require doctors to perform abortions or provide abortion-related
medical treatment over their conscience objections because EMTALA
does not impose obligations on individual doctors. See Brief for
United States 23, n. 3. As the Solicitor General succinctly
and correctly stated, EMTALA does not “override an individual
doctor’s conscience objections.” Tr. of Oral Arg. 18; see also Tr.
of Oral Arg. in Moyle v. United States , O. T. 2023,
No. 23–726 etc., pp. 88–91 ( Moyle Tr.). We agree with the
Solicitor General’s representation that federal conscience
protections provide “broad coverage” and will “shield a doctor who
doesn’t want to provide care in violation of those protections.”
Tr. of Oral Arg. 18, 36.

															The doctors say, however, that emergency room
doctors summoned to provide emergency treatment may not have time
to invoke federal conscience protections. But as the Government
correctly explained, doctors need not follow a time-intensive
procedure to invoke federal conscience protections. Reply Brief for
United States 5 . A doctor may simply refuse; federal law
protects doctors from repercussions when they have “refused” to
participate in an abortion. §300a–7(c)(1); Reply Brief for United
States 5. And as the Government states, “[h]ospitals must
accommodate doctors in emergency rooms no less than in other
contexts.” Ibid . For that reason, hospitals and doctors
typically try to plan ahead for how to deal with a doctor’s absence
due to conscience objections. Tr. of Oral Arg. 18; Moyle Tr.
89–90. And again, nothing in the record since 2000 supports
plaintiffs’ speculation that doctors will be unable to successfully
invoke federal conscience protections in emergency
circumstances.

															In short, given the broad and comprehensive
conscience protections guaranteed by federal law, the plaintiffs
have not shown—and cannot show—that FDA’s actions will cause them
to suffer any conscience injury. Federal law fully protects doctors
against being required to provide abortions or other medical
treatment against their consciences—and therefore breaks any chain
of causation between FDA’s relaxed regulation of mifepristone and
any asserted conscience injuries to the doctors.[ 3 ]

															2

															In addition to alleging conscience injuries,
the doctors cite various monetary and related injuries that they
allegedly will suffer as a result of FDA’s actions—in particular,
diverting resources and time from other patients to treat patients
with mifepristone complications; increasing risk of liability suits
from treating those patients; and potentially increasing insurance
costs.

															Those standing allegations suffer from the same
problem—a lack of causation. The causal link between FDA’s
regulatory actions and those alleged injuries is too speculative or
otherwise too attenuated to establish standing.

															To begin with, the claim that the doctors will
incur those injuries as a result of FDA’s 2016 and 2021 relaxed
regulations lacks record support and is highly speculative. The
doctors have not offered evidence tending to suggest that FDA’s
deregulatory actions have both caused an increase in the number of
pregnant women seeking treatment from the plaintiff doctors and caused a resulting diversion of the doctors’ time and
resources from other patients. Moreover, the doctors have not
identified any instances in the past where they have been sued or
required to pay higher insurance costs because they have treated
pregnant women suffering mifepristone complications. Nor have the
plaintiffs offered any persuasive evidence or reason to believe
that the future will be different.

															In any event, and perhaps more to the point, the
law has never permitted doctors to challenge the government’s
loosening of general public safety requirements simply because more
individuals might then show up at emergency rooms or in doctors’
offices with follow-on injuries. Stated otherwise, there is no
Article III doctrine of “doctor standing” that allows doctors to
challenge general government safety regulations. Nor will this
Court now create such a novel standing doctrine out of whole
cloth.

															Consider some examples. EPA rolls back emissions
standards for power plants—does a doctor have standing to sue
because she may need to spend more time treating asthma patients? A
local school district starts a middle school football league—does a
pediatrician have standing to challenge its constitutionality
because she might need to spend more time treating concussions? A
federal agency increases a speed limit from 65 to 80 miles per
hour—does an emergency room doctor have standing to sue because he
may have to treat more car accident victims? The government repeals
certain restrictions on guns—does a surgeon have standing to sue
because he might have to operate on more gunshot victims?

															The answer is no: The chain of causation is
simply too attenuated. Allowing doctors or other healthcare
providers to challenge general safety regulations as unlawfully lax
would be an unprecedented and limitless approach and would allow
doctors to sue in federal court to challenge almost any policy
affecting public health.[ 4 ]

															And in the FDA drug-approval context, virtually
all drugs come with complications, risks, and side effects. Some
drugs increase the risk of heart attack, some may cause cancer,
some may cause birth defects, and some heighten the possibility of
stroke. Approval of a new drug may therefore yield more visits to
doctors to treat complications or side effects. So the plaintiffs’
loose approach to causation would also essentially allow any doctor
or healthcare provider to challenge any FDA decision approving a
new drug. But doctors have never had standing to challenge FDA’s
drug approvals simply on the theory that use of the drugs by others
may cause more visits to doctors.

															And if we were now to invent a new doctrine of
doctor standing, there would be no principled way to cabin such a
sweeping doctrinal change to doctors or other healthcare providers.
Firefighters could sue to object to relaxed building codes that
increase fire risks. Police officers could sue to challenge a
government decision to legalize certain activities that are
associated with increased crime. Teachers in border states could
sue to challenge allegedly lax immigration policies that lead to
overcrowded classrooms.

															We decline to start the Federal Judiciary down
that uncharted path. That path would seemingly not end until
virtually every citizen had standing to challenge virtually every
government action that they do not like—an approach to standing
that this Court has consistently rejected as flatly inconsistent
with Article III.

															We recognize that many citizens, including the
plaintiff doctors here, have sincere concerns about and objections
to others using mifepristone and obtaining abortions. But citizens
and doctors do not have standing to sue simply because others are allowed to engage in certain activities—at least
without the plaintiffs demonstrating how they would be injured by
the government’s alleged under-regulation of others. See Coalition for Mercury-Free Drugs v. Sebelius , 671
F.3d 1275, 1277 (CADC 2012). Citizens and doctors who object to
what the law allows others to do may always take their concerns to
the Executive and Legislative Branches and seek greater regulatory
or legislative restrictions on certain activities.

															In sum, the doctors in this case have failed to
establish Article III standing. The doctors have not shown that
FDA’s actions likely will cause them any injury in fact. The
asserted causal link is simply too speculative or too attenuated to
support Article III standing.[ 5 ]

															3

															That leaves the medical associations’ argument
that the associations themselves have organizational standing.
Under this Court’s precedents, organizations may have standing “to
sue on their own behalf for injuries they have sustained.” Havens Realty Corp. v. Coleman , 455
U.S. 363 , 379, n. 19 (1982). In doing so, however,
organizations must satisfy the usual standards for injury in fact,
causation, and redressability that apply to individuals. Id. , at 378–379.

															According to the medical associations, FDA has
“impaired” their “ability to provide services and achieve their
organizational missions.” Brief for Respondents 43. That argument
does not work to demonstrate standing.

															Like an individual, an organization may not
establish standing simply based on the “intensity of the litigant’s
interest” or because of strong opposition to the government’s
conduct, Valley Forge , 454 U. S., at 486, “no matter
how longstanding the interest and no matter how qualified the
organization,” Sierra Club v. Morton , 405 U.S.
727 , 739 (1972). A plaintiff must show “far more than simply a
setback to the organization’s abstract social interests.” Havens , 455 U. S., at 379. The plaintiff associations
therefore cannot assert standing simply because they object to
FDA’s actions.

															The medical associations say that they have
demonstrated something more here. They claim to have standing not
based on their mere disagreement with FDA’s policies, but based on
their incurring costs to oppose FDA’s actions. They say that FDA
has “caused” the associations to conduct their own studies on
mifepristone so that the associations can better inform their
members and the public about mifepristone’s risks. Brief for
Respondents 43. They contend that FDA has “forced” the associations
to “expend considerable time, energy, and resources” drafting
citizen petitions to FDA, as well as engaging in public advocacy
and public education. Id. , at 44 (quotation marks omitted).
And all of that has caused the associations to spend “considerable
resources” to the detriment of other spending priorities. Ibid. But an organization that has not suffered a
concrete injury caused by a defendant’s action cannot spend its way
into standing simply by expending money to gather information and
advocate against the defendant’s action. An organization cannot
manufacture its own standing in that way.

															The medical associations respond that under Havens Realty Corp. v. Coleman , standing exists when
an organization diverts its resources in response to a defendant’s
actions. 455 U.S.
363 . That is incorrect. Indeed, that theory would mean that all
the organizations in America would have standing to challenge
almost every federal policy that they dislike, provided they spend
a single dollar opposing those policies. Havens does not
support such an expansive theory of standing.

															The relevant question in Havens was
whether a housing counseling organization, HOME, had standing to
bring a claim under the Fair Housing Act against Havens Realty,
which owned and operated apartment complexes. Id ., at 368,
378. Havens had provided HOME’s black employees false information
about apartment availability—a practice known as racial steering. Id. , at 366, and n. 1, 368. Critically, HOME not only
was an issue-advocacy organization, but also operated a housing
counseling service. Id. , at 368. And when Havens gave HOME’s
employees false information about apartment availability, HOME sued
Havens because Havens “perceptibly impaired HOME’s ability to
provide counseling and referral services for low- and
moderate-income homeseekers.” Id. , at 379. In other words,
Havens’s actions directly affected and interfered with HOME’s core
business activities—not dissimilar to a retailer who sues a
manufacturer for selling defective goods to the retailer.

															That is not the kind of injury that the medical
associations have alleged here. FDA’s actions relaxing regulation
of mifepristone have not imposed any similar impediment to the
medical associations’ advocacy businesses.

															At most, the medical associations suggest that
FDA is not properly collecting and disseminating information about
mifepristone, which the associations say in turn makes it more
difficult for them to inform the public about safety risks. But the
associations have not claimed an informational injury, and in any
event the associations have not suggested that federal law requires
FDA to disseminate such information upon request by members of the
public. Cf. Federal Election Comm’n v. Akins , 524 U.S.
11 (1998). Havens was an unusual case, and this
Court has been careful not to extend the Havens holding
beyond its context. So too here.

															Finally, it has been suggested that the
plaintiffs here must have standing because if these plaintiffs do
not have standing, then it may be that no one would have standing
to challenge FDA’s 2016 and 2021 actions. For starters, it is not
clear that no one else would have standing to challenge FDA’s
relaxed regulation of mifepristone. But even if no one would have
standing, this Court has long rejected that kind of “if not us,
who?” argument as a basis for standing. See Clapper , 568
U. S., at 420–421; Valley Forge , 454 U. S., at
489; Richardson , 418 U. S., at 179–180. The
“assumption” that if these plaintiffs lack “standing to sue, no one
would have standing, is not a reason to find standing.” Schlesinger , 418 U. S., at 227. Rather, some issues may
be left to the political and democratic processes: The Framers of
the Constitution did not “set up something in the nature of an
Athenian democracy or a New England town meeting to oversee the
conduct of the National Government by means of lawsuits in federal
courts.” Richardson , 418 U. S., at 179; see Texas , 599 U. S., at 685.

															*  *  *

															The plaintiffs have sincere legal, moral,
ideological, and policy objections to elective abortion and to
FDA’s relaxed regulation of mifepristone. But under Article III of
the Constitution, those kinds of objections alone do not establish
a justiciable case or controversy in federal court. Here, 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
plaintiffs may present their concerns and objections to the
President and FDA in the regulatory process, or to Congress and the
President in the legislative process. And they may also express
their views about abortion and mifepristone to fellow citizens,
including in the political and electoral processes.

															“No principle is more fundamental to the
judiciary’s proper role in our system of government than the
constitutional limitation of federal-court jurisdiction to actual
cases or controversies.” Simon , 426 U. S., at 37. We
reverse the judgment of the U. S. Court of Appeals for the
Fifth Circuit and remand the case for further proceedings
consistent with this opinion.

															It is so ordered. Notes 1 Redressability can still
pose an independent bar in some cases. For example, a plaintiff who
suffers injuries caused by the government still may not be able to
sue because the case may not be of the kind “traditionally
redressable in federal court.” United States v. Texas , 599 U.S. 670, 676 (2023); cf. California v. Texas , 593 U.S. 659, 671–672 (2021). 2 In cases of alleged
future injuries to unregulated parties from government regulation,
the causation requirement and the imminence element of the injury
in fact requirement can overlap. Both target the same issue: Is it
likely that the government’s regulation or lack of regulation of
someone else will cause a concrete and particularized injury in
fact to the unregulated plaintiff? 3 The doctors also suggest
that they are distressed by others’ use of mifepristone and by
emergency abortions. It is not clear that this alleged injury is
distinct from the alleged conscience injury. But even if it is,
this Court has long made clear that distress at or disagreement
with the activities of others is not a basis under Article III for
a plaintiff to bring a federal lawsuit challenging the legality of
a government regulation allowing those activities. See, e . g ., Valley Forge Christian College v. Americans United for Separation of Church and State, Inc. , 454 U.S.
464 , 473, 485–486 (1982); United States v. Richardson, 418 U.S.
166 , 175 (1974); Sierra Club v. Morton , 405 U.S.
727 , 739 (1972). 4 A safety law regulating
hospitals or the doctors’ medical practices obviously would present
a different issue—either such a law would directly regulate
doctors, or the causal link at least would be substantially less
attenuated. 5 The doctors also suggest
that they can sue in a representative capacity to vindicate their
patients’ injuries or potential future injuries, even if the
doctors have not suffered and would not suffer an injury
themselves. This Court has repeatedly rejected such arguments.
Under this Court’s precedents, third-party standing, as some have
called it, allows a narrow class of litigants to assert the legal
rights of others. See Hollingsworth v. Perry , 570 U.S.
693 , 708 (2013). But “even when we have allowed litigants to
assert the interests of others, the litigants themselves still must
have suffered an injury in fact, thus giving them a sufficiently
concrete interest in the outcome of the issue in dispute.” Ibid. (quotation marks and alterations omitted). The
third-party standing doctrine does not allow doctors to shoehorn
themselves into Article III standing simply by showing that their
patients have suffered injuries or may suffer future
injuries. SUPREME COURT OF THE UNITED STATES

															_________________

															Nos. 23–235 and 23–236

															_________________

															FOOD AND DRUG ADMINISTRATION,
et al., PETITIONER

															23–235 v. ALLIANCE FOR HIPPOCRATIC MEDICINE,
et al.

															DANCO LABORATORIES, L.L.C.,
PETITIONER

															23–236 v. ALLIANCE FOR HIPPOCRATIC MEDICINE,
et al.

															on writs of certiorari to the united states
court of appeals for the fifth circuit

															[June 13, 2024]

															Justice Thomas, concurring.

															I join the Court’s opinion in full because it
correctly applies our precedents to conclude that the Alliance for
Hippocratic Medicine and other plaintiffs lack standing. Our
precedents require a plaintiff to demonstrate that the defendant’s
challenged actions caused his asserted injuries. And, the Court
aptly explains why plaintiffs have failed to establish that the
Food and Drug Administration’s changes to the regulation of
mifepristone injured them. Ante, at 13–24.

															The Court also rejects the plaintiff doctors’
theory that they have third-party standing to assert the rights of
their patients. Ante, at 21, n. 5. Our third-party
standing precedents allow a plaintiff to assert the rights of
another person when the plaintiff has a “close relationship with
the person who possesses the right” and “there is a hindrance to
the possessor’s ability to protect his own interests.” Kowalski v. Tesmer , 543 U.S.
125 , 130 (2004) (internal quotation marks omitted). Applying
these precedents, the Court explains that the doctors cannot
establish third-party standing to sue for violations of their
patients’ rights without showing an injury of their own. Ante, at 21, n. 5. But, there is a far simpler reason
to reject this theory: Our third-party standing doctrine is
mistaken. As I have previously explained, a plaintiff cannot
establish an Article III case or controversy by asserting another
person’s rights.[ 1 ] See June
Medical Services L. L. C. v. Russo , 591 U.S.
299, 366 (2020) (Thomas, J., dissenting); Kowalski , 543
U. S., at 135 (Thomas, J., concurring). So, just as
abortionists lack standing to assert the rights of their clients,
doctors who oppose abortion cannot vicariously assert the rights of
their patients.

															I write separately to highlight what appear to
be similar problems with another theory of standing asserted in
this suit. The Alliance and other plaintiff associations claim that
they have associational standing to sue for their members’
injuries.[ 2 ] Under the Court’s
precedents, “an association has standing to bring suit on behalf of
its members when: (a) its members would otherwise have standing to
sue in their own right; (b) the interests it seeks to protect are
germane to the organization’s purpose; and (c) neither the claim
asserted nor the relief requested requires the participation of
individual members in the lawsuit.” Hunt v. Washington
State Apple Advertising Comm’n , 432 U.S.
333 , 343 (1977). If an association can satisfy these
requirements, we allow the association to pursue its members’
claims, without joining those members as parties to the suit.

															Associational standing, however, is simply
another form of third-party standing. And, the Court has never
explained or justified either doctrine’s expansion of Article III
standing. In an appropriate case, we should explain just how the
Constitution permits associational standing.

															I

															Associational standing raises constitutional
concerns by relaxing both the injury and redressability
requirements for Article III standing. It also upsets other legal
doctrines.

															First, associational standing conflicts with
Article III by permitting an association to assert its members’
injuries instead of its own. The “judicial power” conferred by
Article III “is limited to cases and controversies of the sort
traditionally amenable to, and resolved by, the judicial process.”
See June Medical , 591 U. S., at 364 (opinion of
Thomas, J.) (internal quotation marks omitted). “[T]o
ascertain the scope of Article III’s case-or-controversy
requirement,” courts therefore “refer directly to the traditional,
fundamental limitations upon the powers of common-law courts.” Ibid . (internal quotation marks omitted). Traditionally, a
plaintiff had to show a violation of his own rights to have his
claim considered by a common-law court. See id ., at 364–366.
So, “private parties could not bring suit to vindicate the
constitutional [or other legal] rights of individuals who are not
before the Court.” Id ., at 359. “After all, ‘[t]he province
of the court is, solely, to decide on the rights of
individuals,’ ” not to answer legal debates in the abstract. Acheson Hotels, LLC v. Laufer , 601 U.S. 1, 10 (2023)
(Thomas, J., concurring in judgment) (quoting Marbury v. Madison , 1 Cranch 137, 170 (1803)); see also ante, at
5–7.

															Associational standing seems to run roughshod
over this traditional understanding of the judicial power. Our
doctrine permits an association to have standing based purely upon
a member’s injury, not its own. If a single member of an
association has suffered an injury, our doctrine permits that
association to seek relief for its entire membership—even if the
association has tens of millions of other, non-injured members. See
Brief for Professor F. Andrew Hessick as Amicus Curiae 28
(explaining that, among other associations, the American
Association of Retired People’s “potential standing is staggering”
because our doctrine permits it to “sue to redress” the injury of a
single member out of its “almost thirty-eight million members”). As
I have already explained in the context of third-party standing,
Article III does not allow a plaintiff to seek to vindicate someone
else’s injuries. See June Medical , 591 U. S., at
364–366 (opinion of Thomas, J.); Kowalski , 543
U. S., at 135 (opinion of Thomas, J.). It is difficult to
see why that logic should not apply with equal force to an
association as to any other plaintiff. I thus have serious doubts
that an association can have standing to vicariously assert a
member’s injury.

															The Alliance’s attempted use of our
associational-standing doctrine illustrates how far we have strayed
from the traditional rule that plaintiffs must assert only their
own injuries. The Alliance is an association whose members are
other associations. See 1 App. 9–10. None of its members are
doctors. Instead, the Alliance seeks to have associational standing
based on injuries to the doctors who are members of its member
associations. Thus, the allegedly injured parties—the doctors—are
two degrees removed from the party before us pursuing those
injuries.

															Second, our associational-standing doctrine does
not appear to comport with the requirement that the plaintiff
present an injury that the court can redress. For a plaintiff to
have standing, a court must be able to “provid[e] a remedy that can
redress the plaintiff ’s injury.” Uzuegbunam v. Preczewski , 592 U.S. 279, 291 (2021) (emphasis added). But,
as explained, associational standing creates a mismatch: Although
the association is the plaintiff in the suit, it has no injury to
redress. The party who needs the remedy—the injured member—is not
before the court. Without such members as parties to the suit, it
is questionable whether “relief to these nonparties . . .
exceed[s] constitutional bounds.” Association of American
Physicians & Surgeons v. FDA , 13 F. 4th 531,
540 (CA6 2021); see also Department of Homeland Security v. New York , 589 U. S. ___, ___ (2020) (Gorsuch, J.,
concurring in grant of stay) (explaining that remedies “are meant
to redress the injuries sustained by a particular plaintiff in a
particular lawsuit”); Brief for Professor F. Andrew Hessick as Amicus Curiae 18 (“A bedrock principle of the Anglo-American
legal system was that the right to a remedy for an injury was
personal”).

															Consider the remedial problem when an
association seeks an injunction, as the Alliance did here. See 1
App. 113. “We have long held” that our equity jurisdiction is
limited to “the jurisdiction in equity exercised by the High Court
of Chancery in England at the time of the adoption of the
Constitution.” Grupo Mexicano de Desarrollo, S. A. v. Alliance Bond Fund, Inc. , 527 U.S.
308 , 318 (1999). And, “as a general rule, American courts of
equity did not provide relief beyond the parties to the case.” Trump v. Hawaii , 585 U.S. 667, 717 (2018)
(Thomas, J., concurring). For associations, that principle
would mean that the relief could not extend beyond the association.
But, if a court entered “[a]n injunction that bars a defendant from
enforcing a law or regulation against the specific party before the
court—the associational plaintiff —[it would] not satisfy
Article III because it w[ould] not redress an injury.” Association of American Physicians & Surgeons , 13
F. 4th, at 540 (internal quotation marks omitted).[ 3 ]

															Our precedents have provided a workaround for
this obvious remedial problem through the invention of the
so-called “universal injunction.” Universal injunctions typically
“prohibit the Government from enforcing a policy with respect to
anyone.” Trump , 585 U. S., at 713, n. 1
(Thomas, J., concurring). By providing relief beyond the
parties to the case, this remedy is “legally and historically
dubious.” Id ., at 721; see also Labrador v. Poe , 601 U. S. ___, ___–___ (2024) (slip op., at 4–5)
(Gorsuch, J., concurring in grant of stay). It seems no coincidence
that associational standing’s “emergence in the 1960s overlaps with
the emergence of [this] remedial phenomenon” of a similarly
questionable nature. Association of American Physicians &
Surgeons , 13 F. 4th, at 541. Because no party should be
permitted to obtain an injunction in favor of nonparties, I have
difficulty seeing why an association should be permitted to do so
for its members. Associational standing thus seems to distort our
traditional understanding of the judicial power.

															In addition to these Article III concerns, there
is tension between associational standing and other areas of law.
First, the availability of associational standing subverts the
class-action mechanism. A class action allows a named plaintiff to
represent others with similar injuries, but it is subject to the
many requirements of Federal Rule of Civil Procedure 23.
Associational standing achieves that same end goal: One lawsuit can
provide relief to a large group of people. “As compared to a class
action,” however, associational standing seems to require
“show[ing] an injury to only a single member,” and the association
“need not show that litigation by representation is superior to
individual litigation.” 13A C. Wright, A. Miller, & E. Cooper,
Federal Practice and Procedure §3531.9.5, pp. 879–880 (3d ed.,
Supp. 2023); see also Fed. Rule Civ. Proc. 23(a).
Associational standing thus allows a party to effectively bring a
class action without satisfying any of the ordinary requirements.
Second, associational standing creates the possibility of
asymmetrical preclusion. The basic idea behind preclusion is that a
party gets only one bite at the apple. If a party litigates and
loses an issue or claim, it can be barred from reasserting that
same issue or claim in another suit. In general, preclusion
prevents the relitigation of claims or issues only by a party to a
previous action, and we have been careful to limit the exceptions
to that rule. See Taylor v. Sturgell , 553 U.S.
880 , 892–893 (2008). In the context of associational standing,
the general rule would mean that preclusion applies only to the
association, even though the purpose of the association’s suit is
to assert the injuries of its members. See id ., at 893–896.
But, if the association loses, it is not clear whether the adverse
judgment would bind the members. See Automobile Workers v. Brock , 477 U.S.
274 , 290 (1986) (suggesting that, if an association fails to
adequately represent its members, “a judgment won against it might
not preclude subsequent claims by the association’s members without
offending due process principles”). Associational standing might
allow a member two bites at the apple—after an association’s claims
are rejected, the underlying members might be able to assert the
exact same issues or claims in a suit in their own names.

															In short, our associational-standing doctrine
appears to create serious problems, both constitutional and
otherwise.

															II

															I am particularly doubtful of
associational-standing doctrine because the Court has never
attempted to reconcile it with the traditional understanding of the
judicial power. Instead, the Court departed from that traditional
understanding without explanation, seemingly by accident. To date,
the Court has provided only practical reasons for its doctrine.

															For over a century and a half, the Court did not
have a separate standing doctrine for associations. As far as I can
tell, the Court did not expressly contemplate such a doctrine until
the late 1950s. In NAACP v. Alabama ex rel.
Patterson , 357 U.S.
449 (1958), the Court permitted an association to assert the
constitutional rights of its members to prevent the disclosure of
its membership lists. While the Court allowed the NAACP to raise a
challenge on behalf of its members, it also acknowledged that the
NAACP had arguably faced an injury of its own. Id ., at
459–460. The Court, however, soon discarded any notion that an
association needed to have its own injury, creating our modern
associational-standing doctrine. In National Motor Freight
Traffic Assn., Inc. v. United States , 372 U.S.
246 (1963) ( per curiam ), the Court suggested that an
uninjured industry group had standing to challenge a tariff
schedule on behalf of its members. Id ., at 247. The Court
offered no explanation for how that theory of standing comported
with the traditional understanding of the judicial power. In fact,
the Court’s entire analysis consisted of a one-paragraph order
denying rehearing. Since then, however, the Court has parroted that
“ [e]ven in the absence of injury to itself , an association
may have standing solely as the representative of its members.” Warth v. Seldin , 422 U.S.
490 , 511 (1975) (emphasis added; citing National Motor
Freight Traffic Assn. , 372 U. S. 246); see also, e . g ., Automobile Workers , 477 U. S., at
281. The Court has gone so far as to hold that a state agency—not a
membership organization at all—had associational standing to
“asser[t] the claims of the Washington apple growers and dealers
who form its constituency.” Hunt , 432 U. S., at
344.

															Despite its continued reliance on associational
standing, the Court has yet to explain how the doctrine comports
with Article III. When once asked to “reconsider and reject the
principles of associational standing” in favor of the class-action
mechanism, the Court justified the doctrine solely by reference to
its “special features, advantageous both to the individuals
represented and to the judicial system as a whole.” Automobile
Workers , 477 U. S., at 288–289. Those “special features”
included an association’s “pre-existing reservoir of expertise and
capital,” and the fact that people often join an association “to
create an effective vehicle for vindicating interests that they
share with others.” Id ., at 289–290. But, considerations of
practical judicial policy cannot overcome the Constitution’s
mandates. The lack of any identifiable justification further
suggests that the Court should reconsider its
associational-standing doctrine.

															*  *  *

															No party challenges our associational-standing
doctrine today. That is understandable; the Court consistently
applies the doctrine, discussing only the finer points of its
operation. See, e . g ., Students for Fair
Admissions, Inc. v. President and Fellows of Harvard
College , 600 U.S. 181, 199–201 (2023). In this suit, rejecting
our associational-standing doctrine is not necessary to conclude
that the plaintiffs lack standing. In an appropriate case, however,
the Court should address whether associational standing can be
squared with Article III’s requirement that courts respect the
bounds of their judicial power. Notes 1 Certain forms of standing
that may be representational in a general sense, such as next
friend standing, are “not inconsistent with this point.” June
Medical Services, L. L. C. v. Russo , 591 U.S.
299, 365, n. 2 (2020) (Thomas, J., dissenting). 2 By “associational
standing,” I do not refer to standing premised upon an
association’s own alleged injuries. Instead, I refer to the
doctrine that permits a plaintiff association to assert the rights
of its members. See Warth v. Seldin , 422 U.S.
490 , 511 (1975). 3 This also raises the
question of who should pick the remedy. Associations “may have very
different interests from the individuals whose rights they are
raising.” Kowalski v. Tesmer , 543
U.S. 125 , 135 (2004) (Thomas, J., concurring). For example, an
association might prefer an injunction preventing the enforcement
of a law that harms its members, while an injured member may
instead want damages to compensate him for his injuries. Or perhaps
a member would wish to settle the litigation, whereas an
association might want to continue the fight. Our
associational-standing doctrine ignores these obvious
concerns.

Summary: The Supreme Court ruled that the plaintiffs, a group of pro-life doctors and associations, lacked standing to challenge the Food and Drug Administration's (FDA) relaxed regulatory requirements for mifepristone, an abortion drug. The plaintiffs did not establish a concrete and particularized injury as they do not prescribe or use mifepristone, and the FDA's actions do not require them to do or refrain from doing anything. The Court also rejected the plaintiffs' other standing theories, including associational standing, which allows an association to assert the rights of its members. Justice Kavanaugh questioned the constitutionality of associational standing, suggesting that it may not align with Article III's requirement of judicial power bounds.