FDA v. Alliance for Hippocratic Medicine

P R E L I M I N A R Y P R I N T
Volume 602 U. S. Part 1
Pages 367–405
OFFICIAL REPORTS
OF
T H E S U P R E M E C O U R T
June 13, 2024
REBECCA A. WOMELDORF
reporter of decisions
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N O T I C E : This preliminary print is subject to formal revision before
the bound volume is published. Users 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.

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TERM, 2023
367
Syllabus
FOOD AND DRUG ADMINISTRATION et al. v. AL-
LIANCE
FOR HIPPOCRATIC MEDICINE et al.
certiorari to the united states court of appeals for
the fth circuit
No. 23–235. Argued March 26, 2024—Decided June 13, 2024*
In 2000, the Food and Drug Administration approved a new drug applica-
tion for mifepristone tablets marketed under the brand name Mifeprex
for use in terminating pregnancies up to seven weeks. To help ensure
that Mifeprex would be used safely and effectively, FDA placed addi-
tional restrictions on the drug 's use and distribution, for example re-
quiring doctors to prescribe or to supervise prescription of Mifeprex,
and requiring patients to have three in-person visits with the doctor
to receive the drug. In 2016, FDA relaxed some of these restrictions:
deeming Mifeprex safe to terminate pregnancies up to 10 weeks; allow-
ing healthcare providers, such as nurse practitioners, to prescribe Mife-
prex; and approving a dosing regimen that required just one in-person
visit to receive the drug. In 2019, FDA approved an application for
generic mifepristone. In 2021, FDA announced that it would no longer
enforce the initial in-person visit requirement. Four pro-life medical
associations and several individual doctors moved for a preliminary in-
junction that would require FDA either to rescind approval of mifepri-
stone or to rescind FDA's 2016 and 2021 regulatory actions. Danco
Laboratories, which sponsors Mifeprex, intervened to defend FDA's
actions.
The District Court agreed with the plaintiffs and in effect enjoined
FDA's approval of mifepristone, thereby ordering mifepristone off the
market. FDA and Danco appealed and moved to stay the District
Court's order pending appeal. As relevant here, this Court ultimately
stayed the District Court's order pending the disposition of proceedings
in the Fifth Circuit and this Court. On the merits, the Fifth Circuit
held that plaintiffs had standing. It concluded that plaintiffs were un-
likely to succeed on their challenge to FDA's 2000 and 2019 drug approv-
als, but were likely to succeed in showing that FDA's 2016 and 2021
actions were unlawful. This Court granted certiorari with respect to
the 2016 and 2021 FDA actions.
*Together with No. 23–236, Danco Laboratories, L.L.C. v. Alliance for
Hippocratic Medicine et al., also on certiorari to the United States Court
of Appeals for the Fifth Circuit.

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A v. ALLIANCE FOR HIPPOCRATIC MEDICINE
Syllabus
Held: Plaintiffs lack Article III standing to challenge FDA's actions re-
gardi
ng the regulation of mifepristone. Pp. 378–397.
(a) 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. Standing is “built on a single basic
idea—the idea of separation of powers.” Ibid. Article III confnes the
jurisdiction of federal courts to “Cases” and “Controversies.” Federal
courts do not 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. To obtain a judicial determination
of what the governing law is, a plaintiff must have a “personal stake”
in the dispute. TransUnion LLC v. Ramirez, 594 U. S. 413, 423.
To establish standing, 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 Sum-
mers v. Earth Island Institute, 555 U. S. 488, 493. The two key ques-
tions in most standing disputes are injury in fact and causation. By
requiring the plaintiff to show an injury in fact, Article III standing
screens out plaintiffs who might have only a general legal, moral, ideo-
logical, or policy objection to a particular government action. Causa-
tion requires the plaintiff to establish that the plaintiff 's injury likely
was caused or likely will be caused by the defendant's conduct. Causa-
tion is “ordinarily substantially more diffcult to establish” when (as
here) a plaintiff challenges the government's “unlawful regulation (or
lack of regulation) of someone else.” Lujan v. Defenders of Wildlife,
504 U. S. 555, 560–561. That is because unregulated parties often may
have more diffculty linking their asserted injuries to the government's
regulation (or lack of regulation) of someone else. Pp. 378–385.
(b) Plaintiffs are pro-life, oppose elective abortion, and have sincere
legal, moral, ideological, and policy objections to mifepristone being pre-
scribed and used by others. Because plaintiffs do not prescribe or use
mifepristone, plaintiffs are unregulated parties who seek to challenge
FDA's regulation of others. Plaintiffs advance several complicated cau-
sation theories to connect FDA's actions to the plaintiffs' alleged inju-
ries in fact. None of these theories suffces to establish Article III
standing. Pp. 385–396.
(1) Plaintiffs frst contend that FDA's relaxed regulation of mifepri-
stone may cause downstream conscience injuries to the individual doc-
tors. Even assuming that FDA's 2016 and 2021 changes to mifepri-
stone'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

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as: 602 U. S. 367 (2024)
369
Syllabus
they could be forced to participate in an abortion or provide abortion-
related
medical treatment over their conscience objections. Federal
conscience laws defnitively protect doctors from being required to per-
form abortions or to provide other treatment that violates their con-
sciences. Federal law protects doctors from repercussions when they
have “refused” to participate in an abortion. 42 U. S. C. § 300a–7(c)(1).
The plaintiffs have not identifed any instances where a doctor was re-
quired, notwithstanding conscience objections, to perform an abortion
or to provide other abortion-related treatment that violated the doctor's
conscience since mifepristone's 2000 approval. Further, the Emer-
gency Medical Treatment and Labor Act (or EMTALA) neither over-
rides federal conscience laws nor requires individual emergency room
doctors to participate in emergency abortions. Thus, there is a break
in any chain of causation between FDA's relaxed regulation of mifepri-
stone and any asserted conscience injuries to the doctors. Pp. 386–390.
(2) Plaintiffs next assert they have standing because FDA's relaxed
regulation of mifepristone may cause downstream economic injuries to
the doctors. The doctors cite various monetary and related injuries
that they will allegedly suffer as a result of FDA's actions—in particu-
lar, 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. But
the causal link between FDA's regulatory actions in 2016 and 2021 and
those alleged injuries is too speculative, lacks support in the record, and
is otherwise too attenuated to establish standing. Moreover, 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' offces with
follow-on injuries. 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 re-
strictions. Pp. 390–393.
(3) Plaintiff medical associations assert their own organizational
standing. Under the Court's precedents, organi zati ons 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, but organiza-
tions 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 Respond-
ents 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 opposi-

370 FD
A v. ALLIANCE FOR HIPPOCRATIC MEDICINE
Syllabus
tion to the government's conduct, Valley Forge Christian College v.
Ame
ricans United for Separation of Church and State, Inc., 454 U. S.
464, 486. The plaintiff associations therefore cannot establish standing
simply because they object to FDA's actions. The medical associations
claim to have standing 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 associa-
tions to “expend considerable time, energy, and resources” drafting citi-
zen petitions to FDA, as well as engaging in public advocacy and public
education, all to the detriment of other spending priorities. Id., at 44.
But an organization that has not suffered a concrete injury caused by a
defendant's action cannot spend its way into standing simply by expend-
ing money to gather information and advocate against the defendant's
action. Contrary to what the medical associations contend, the Court's
decision in Havens Realty Corp. v. Coleman does not stand for the ex-
pansive theory that standing exists when an organization diverts its
resources in response to a defendant's actions. 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 was suggested that plaintiffs must have standing because
otherwise it may be that no one would have standing to challenge FDA's
2016 and 2021 actions. That suggestion fails because the Court has long
rejected that kind of argument as a basis for standing. The “assump-
tion” that if these plaintiffs lack “standing to sue, no one would have
standing, is not a reason to fnd standing.” Schlesinger v. Reservists
Comm. to Stop the War, 418 U. S. 208, 227. Rather, some issues may
be left to the political and democratic processes. Pp. 393–396.
78 F. 4th 210, reversed and remanded.
Kavanaugh, J., delivered the opinion for a unanimous Court. Thomas,
J., fled a concurring opinion, post, p. 397.
Solicitor General Prelogar argued the cause for federal
petitioners in No. 23–235. With her on the briefs in both
cases were Principal Deputy Assistant Attorney General
Boynton, Deputy Solicitors General Fletcher and Kneedler,
Deputy Assistant Attorney General Harrington, Erica L.
Ross, Charles L. McCloud, Michael S. Raab, Cynthia A.
Barmore, and Samuel R. Bagenstos.
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as: 602 U. S. 367 (2024)
371
Counsel
Jessica L. Ellsworth argued the cause for petitioner Danco
Laborator
ies, L. L. C., in No. 23–236. With her on the brief
in both cases were Catherine E. Stetson, Jo-Ann Tamila
Sagar, Danielle Desaulniers Stempel, Marlan Golden, Dana
A. Raphael, and Philip Katz.
Erin M. Hawley argued the cause for respondents in both
cases. With her on the brief were John J. Bursch, Matthew
S. Bowman, James A. Campbell, Erik C. Baptist, and Cody
S. Barnett.*
*Briefs of amici curiae urging reversal in both cases were fled for the
State of New York et al. by Letitia James, Attorney General of New York,
Barbara D. Underwood, Solicitor General, Ester Murdukhayeva, Deputy
Solicitor General, and Galen Sherwin, by Brian L. Schwalb, Attorney Gen-
eral of the District of Columbia, and by the Attorneys General for their
respective States as follows: Kris Mayes of Arizona, Rob Bonta of Califor-
nia, Philip J. Weiser of Colorado, William Tong of Connecticut, Kathleen
Jennings of Delaware, Anne E. Lopez of Hawaii, Kwame Raoul of Illinois,
Aaron M. Frey of Maine, Anthony G. Brown of Maryland, Andrea Joy
Campbell of Massachusetts, Dana Nessel of Michigan, Keith Ellison of
Minnesota, Aaron D. Ford of Nevada, Matthew J. Platkin of New Jersey,
Raúl Torrez of New Mexico, Joshua H. Stein of North Carolina, Ellen F.
Rosenblum of Oregon, Michelle A. Henry of Pennsylvania, Peter F. Ner-
onha of Rhode Island, Charity R. Clark of Vermont, Robert W. Ferguson
of Washington, and Joshua L. Kaul of Wisconsin; for the City of New York
et al. by Sylvia O. Hinds-Radix, Richard Dearing, Devin Slack, Elina
Druker, Tony LoPresti, Meredith A. Johnson, Rachel A. Neil, and Jessica
M. Scheller; for the American Civil Liberties Union et al. by Julia Kaye,
Andrew D. Beck, Jennifer Dalven, Lorie A. Chaiten, David D. Cole, Rabia
Muqaddam, Autumn Katz, Rupali Sharma, and Stephanie Toti; for the
American College of Obstetricians and Gynecologists et al. by Shannon
Rose Selden; for the American Psychological Association et al. by Jessica
Ring Amunson and Deanne M. Ottaviano; for the Association of Ameri-
can Medical Colleges by Douglas Hallward-Driemeier, Deanna Barkett
FitzGerald, and Frank R. Trinity; for the Disability Rights Education &
Defense Fund et al. by Maria Michelle Uzeta and James P. Gagen; for
Doctors for America et al. by Christopher J. Morten and Thomas S. Leath-
erbury; for Food and Drug Law Scholars et al. by Robert A. Long; for
Former Commissioners of the U. S. Food and Drug Administration by Wil-
liam B. Schultz, Margaret M. Dotzel, and Alyssa M. Howard; for Former
Military Offcials et al. by Susanne Sachsman Grooms, Carmen Iguina
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372 FD
A v. ALLIANCE FOR HIPPOCRATIC MEDICINE
Opinion of the Court
Justice Kavanaugh delivered the opinion of the Court.
In
2016 and 2021, the Food and Drug Administration re-
laxed its regulatory requirements for mifepristone, an abor-
González, and Kate Epstein; for Former U. S. Department of Justice Off-
cials by Alan Schoen feld, Kimberly A. Parker, Daniel S. Volchok, and
Colleen Campbell; for the Freedom From Religion Foundation et al. by
Patrick C. Elliott and Geoffrey T. Blackwell; for GenBioPro, Inc., by John
P. Elwood, Daphne O'Connor, Robert J. Katerberg, Kolya D. Glick, David
C. Frederick, Derek C. Reinbold, Skye L. Perryman, and Carrie Y. Flax-
man; for Honeybee Health, Inc., by Stephanie L. Gutwein, A. Scott Chinn,
Matthew K. Giffn, Elizabeth A. Charles, and Libby L. Baney; for Legal
Voice et al. by Matthew Gordon; for Local Governments et al. by Jonathan
B. Miller, Cheran Ivery, Anne L. Morgan, Myriam Zreczny Kasper, Su-
zanne M. Loose, Mark D. Griffn, Valerie L. Flores, Scott Marcus, Shaun
Dabby Jacobs, John P. Markovs, and Lyndsey M. Olson; for Medical Stu-
dents for Choice by Jayme Jonat; for the NAACP Legal Defense & Educa-
tional Fund, Inc., by Janai S. Nelson and Samuel Spital; for the National
Council of Jewish Women et al. by Eugene M. Gelernter; for Over 640
State Legislators by Amanda Shafer Berman; for Patient and Provider
Advocacy Organizations by Caroline L. Wolverton and Aileen M. Mc-
Grath; for Pharmaceutical Companies et al. by Eva A. Temkin, Paul Ales-
sio Mezzina, Joshua N. Mitchell, and Anne M. Voigts; for the Pharmaceu-
tical Research and Manufacturers of America by Peter Safr, David M.
Zionts, Daniel G. Randolph, Kendall T. Burchard, James C. Stansel, and
Melissa B. Kimmel; for Physicians for Reproductive Health by Janice
Mac Avoy; for Public Citizen et al. by Nicolas A. Sansone and Allison M.
Zieve; for the Reproductive Freedom Alliance by Jaime A. Santos, An-
naka Nava, Dorothy Hazan, Jennifer Fisher, and Daryl L. Wiesen; for
the Women's Bar Association of the District of Columbia by Candace Beck;
for Women Who Have Obtained Medication Abortion Via Telemedicine by
Vanessa K. Burrows and Julie F. Kay; for David S. Cohen et al. by David
S. Cohen, pro se, and Susan J. Frietsche; for 237 Reproductive Health
Organizations et al. by Lindsay C. Harrison; and for 263 Members of
Congress by Boris Bershteyn and Jennifer L. Bragg. F. Andrew Hessick,
pro se, and Richard A. Simpson fled a brief as amicus curiae urging
vacatur in both cases.
Briefs of amici curiae urging affrmance in both cases were fled for the
State of Mississippi et al. by Lynn Fitch, Attorney General of Mississippi,
Whitney H. Lipscomb, Deputy Attorney General, Scott G. Stewart, Solici-
tor General, and Justin L. Matheny and Anthony M. Shults, Deputy Solic-
itors General, and by the Attorneys General for their respective States as
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as: 602 U. S. 367 (2024)
373
Opinion of the Court
tion drug. Those changes made it easier for doctors to pre-
scr
ibe and pregnant women to obtain mifepristone. Several
pro-life doctors and associations sued FDA, arguing that
FDA's actions violated the Administrative Procedure Act.
follows: Steve Marshall of Alabama, Treg Taylor of Alaska, Tim Griffn
of Arkansas, Ashley Moody of Florida, Christopher M. Carr of Georgia,
Theodore E. Rokita of Indiana, Brenna Bird of Iowa, Russell Coleman of
Kentucky, Liz Murrill of Louisiana, Austin Knudsen of Montana, Michael
T. Hilgers of Nebraska, Drew H. Wrigley of North Dakota, Dave Yost of
Ohio, Gentner F. Drummond of Oklahoma, Alan Wilson of South Caro-
lina, Marty J. Jackley of South Dakota, Jonathan Skrmetti of Tennessee,
Ken Paxton of Texas, Sean D. Reyes of Utah, Patrick Morrisey of West
Virginia, and Bridget Hill of Wyoming; for the American Center for Law
and Justice by Jay Alan Sekulow, Jordan A. Sekulow, Stuart J. Roth,
Walter M. Weber, Geoffrey R. Surtees, and Laura B. Hernandez; for
Americans United for Life by Steven H. Aden and Clarke D. Forsythe; for
the Charlotte Lozier Institute by Gene C. Schaerr; for Democrats for Life
of America by Rachel N. Morrison and Eric N. Kniffn; for the Elliot
Institute et al. by Jay Alan Sekulow, Jordan A. Sekulow, Stuart J. Roth,
and Walter M. Weber; for the Family Policy Alliance et al. by Randall L.
Wenger, Jeremy L. Samek, and Janice Martino-Gottshall; for the Family
Research Council et al. by Christopher E. Mills; for Former U. S. Depart-
ment of Health and Human Services Offcials et al. by James R. Lawrence
III; for Heartbeat International by Thomas Brejcha and B. Tyler Brooks;
for Judicial Watch, Inc., by Meredith L. Di Liberto; for the Life Legal
Defense Foundation by Catherine Short and Sheila A. Green; for the Na-
tional Hispanic Leadership Conference et al. by Mathew D. Staver, Anita
L. Staver, and Horatio G. Mihet; for Operation Rescue et al. by Jay Alan
Sekulow, Jordan A. Sekulow, Stuart J. Roth, and Walter M. Weber; for
Priests for Life by Robert Joseph Muise and David Yerushalmi; for the
Prolife Center at the University of St. Thomas (MN) by Teresa Stanton
Collett; for the Robertson Center for Constitutional Law by Christopher
T. Holinger and Bradley J. Lingo; for the Southeastern Legal Foundation
et al. by Thomas R. McCarthy, Braden H. Boucek, and Robert Henneke;
for Stanton International by Erin Mersino and Robert J. Muise; for Susan
B. Anthony Pro-Life America et al. by Heather Gebelin Hacker; for the
United States Medical Association by Nathan W. Kellum; for Women and
Families Harmed by Mifepristone et al. by Linda Boston Schlueter; for
Women Injured by Abortion by Mary J. Browning, Allan E. Parker, R.
Clayton Trotter, and Catherine Glenn Foster; for the World Faith Founda-
tion et al. by James L. Hirsen, Tami Fitzgerald, and Deborah J. Dewart;

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Opinion of the Court
But the plaintiffs do not prescribe or use mifepristone. And
FD
A is not requiring them to do or refrain from doing any-
thing. Rather, the plaintiffs want FDA to make mifepri-
stone more diffcult for other doctors to prescribe and for
pregnant women to obtain. Under Article III of the Consti-
tution, a plaintiff 's desire to make a drug less available for
others does not establish standing to sue. Nor do the plain-
tiffs' other standing theories suffce. Therefore, the plain-
tiffs lack standing to challenge FDA's actions.
I
A
Under federal law, the U. S. Food and Drug Administra-
tion, an agency within the Executive Branch, ensures that
for Former Secretary David Longly Bernhardt by John C. Sullivan; for
Gianina Cazan-London et al. by William Wagner; for Grazie Pozo Christie
et al. by Megan M. Wold; for Former U. S. Attorney General Edwin Meese
III by David H. Thompson, Brian W. Barnes, and Clark L. Hildabrand;
for Calum Miller by Kristine Brown; for Allan Sawyer by Michael S.
Overing and Edward C. Wilde; and for 145 Members of Congress by Ste-
ven H. Aden.
Briefs of amici curiae were fled in both cases for the State of Missouri
et al. by Andrew Bailey, Attorney General of Missouri, Joshua M. Divine,
Solicitor General, and Maria A. Lanahan and Samuel C. Freedlund, Dep-
uty Solicitors General, by Raúl R. Labrador, Attorney General of Idaho,
Alan M. Hurst, Solicitor General, Joshua N. Turner, Deputy Solicitor Gen-
eral, and James E. M. Craig, and by Kris W. Kobach, Attorney General of
Kansas, Anthony J. Powell, Solicitor General, and Erin B. Gaide, Assist-
ant Attorney General; for Advancing American Freedom et al. by J. Marc
Wheat; for Business Leaders by Jonathan R. Whitehead; for the Ethics
and Public Policy Center by M. Edward Whelan III, Charles W. Fillmore,
and H. Dustin Fillmore III; for the Human Coalition et al. by Elissa M.
Graves and Chelsey D. Youman; for the Jewish Coalition for Religious
Liberty by Howard Slugh; for the Mountain States Legal Foundation by
Jennifer L. Mascott, R. Trent McCotter, and Ivan L. London; for the Na-
tional Association of Nurse Practitioners in Women's Health et al. by Jon-
athan K. Youngwood and Simona G. Strauss; for Over 300 Reproductive
Health Researchers by Melissa Goodman and Claudia Hammerman; and
for Students for Life of America by William Bock III.
Niyati Shah and Noah Baron fled a brief for AANHPI et al. as amici
curiae in No. 23–235.

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as: 602 U. S. 367 (2024)
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Opinion of the Court
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 applica-
tion demonstrating that the drug is safe and effective when
used as directed. 21 U. S. C. § 355(d). The sponsor's appli-
cation must generally include proposed labeling that specifes
the drug 's dosage, how to take the drug, and the specifc
conditi ons that the dr ug may treat. 21 CFR §§ 201.5,
314.50 (2022).
If FDA determines that additional safety requirements
are necessary, FDA may impose extra requirements on pre-
scription and use of the drug. 21 U. S. C. § 355–1(f )(3). For
example, FDA may require that prescribers undergo special-
ized 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 mifepri-
stone 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 distribu-
tion. For example, only doctors could prescribe or super-
vise 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 di-
rected prescribing doctors to report incidents of hospitaliza-
tions, 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 sub-
mitted a supplementa l new dr ug application seeking to
amend Mifeprex's labeling and to relax some of the restric-
tions 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 al-
lowed healthcare providers such as nurse practitioners to
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376 FD
A v. ALLIANCE FOR HIPPOCRATIC MEDICINE
Opinion of the Court
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 addi-
tion, FDA changed prescribers' adverse event reporting obli-
gations 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 mifepri-
stone. FDA established the same conditions of use for ge-
neric mifepristone as for Mifeprex.
In 2021, FDA again relaxed the requirements for Mifeprex
and generic mifepristone. Relying on experience gained
dur ing the COVID–19 pandemic about preg nant 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 gener-
ated 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 fled another pe-
tition, this time asking FDA to withdraw its 2016 modifca-
tions to mifepristone's conditions of use. FDA denied that
petition as well.
This case began in 2022. Four pro-life medical associa-
tions, 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 Proce-
dure Act. They challenged the lawfulness of FDA's 2000
approval of Mifeprex; FDA's 2019 approval of generic mife-
pristone; and FDA's 2016 and 2021 actions modifying mife-
pristone's conditions of use. Danco Laboratories, which
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377
Opinion of the Court
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 frst 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 mifepri-
stone 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 Ap-
peals 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
frst 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 deci-
sion on the merits of the District Court's order, affrming in
part and vacating in part. 78 F. 4th 210, 222–223 (CA5
2023). The Court of Appeals frst concluded that the indi-

378 FD
A v. ALLIANCE FOR HIPPOCRATIC MEDICINE
Opinion of the Court
vidual doctors and the pro-life medical associations had
st
anding. The Court of Appeals next concluded that plain-
tiffs were not likely to succeed on their challenge to FDA's
2000 approval of Mifeprex and 2019 approval of generic mife-
pristone. 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 ac-
tions were unlawful.
The Court of Appeals' merits decision did not alter this
Cour t's stay of the D istr ic t Cour t's order pendi ng th is
Court's review. This Court then granted certiorari with re-
spect 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. Arti-
cle 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 pow-
ers.” Ibid. (quotation marks omitted). Importantly, sepa-
ration 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 confnes the jurisdiction of
federal courts to “Cases” and “Controversies.” The case or
controversy requirement limits the role of the Federal Judi-
ciary in our system of separated powers. As this Court ex-
plained 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
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the President. 13 Papers of George Washington: Presiden-
tia
l Series 392 (C. Patrick ed. 2007). Nor do federal courts
operate as an open forum for citizens “to press general com-
plaints about the way in which government goes about its
business.” Allen v. Wright, 468 U. S. 737, 760 (1984) (quota-
tion 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 cu-
riam); 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 frst 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 specifc 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 rarifed atmosphere of
a debating society, but in a concrete factual context condu-
cive 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
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whether and how to challenge the defendant's action. Id.,
at
473.
By limiting who can sue, the standing requirement imple-
ments “the Framers' concept of the proper—and properly
limited—role of the courts in a democratic society.” J. Rob-
erts, 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 de-
cide some contested legal questions later rather than sooner,
thereby allowing issues to percolate and potentially be re-
solved 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. Schle-
singer, 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 frmly
rooted in American constitutional law. To establish stand-
ing, as this Court has often stated, a plaintiff must demon-
strate (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
specifc 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 “fip sides of the same coin.”
Sprint Communications Co. v. APCC Services, Inc., 554
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U. S. 269, 288 (2008). If a defendant's action causes an in-
jury
, 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 “con-
crete,” meaning that it must be real and not abstract. See
TransUnion, 594 U. S., at 424. The injury also must be par-
ticularized; 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 prop-
erty, or an injury to one's constitutional rights, to take just
a few common examples. Moreover, the injury must be ac-
tual 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 pro-
spective relief such as an injunction, the plaintiff must estab-
lish a suffcient 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 par-
ticular 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.
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 “tradition-
ally 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).
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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. Ar-
ticle 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 observ-
ance 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, stand-
ing is usually easy to establish. See id., 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 gov-
ernment's “unlawful regulation (or lack of regulation) of
someone else,” “standing is not precluded, but it is ordinarily
substantially more diffcult 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 diffculty 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
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U. S. 26, 41–46 (1976); Warth v. Seldin, 422 U. S. 490, 504–
508
(1975).
When the plaintiff is an unregulated party, causation “ordi-
narily hinge[s] on the response of the regulated (or regulable)
third party to the government action or inaction—and per-
haps 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 be-
fore 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 be-
tween 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 suffciently predictable how third parties
would react to government action or cause downstream in-
jury 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 stand-
ing. 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 stand-
ing. Like the injury in fact requirement, the causation
requirement screens out plaintiffs who were not injured by
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courts would be “virtually continuing monitors of the wis-
dom
and soundness” of government action. Allen, 468 U. S.,
at 760 (quotation marks omitted).
Determining causation in cases involving suits by unregu-
lated 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 de-
scribed it here. Tr. of Oral Arg. 50. Unfortunately, apply-
ing 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 diffculties, so too can causation in
standing law when determining whether an unregulated
party has standing.
That said, the “absence of precise defnitions” has not left
courts entirely “at sea in applying the law of standing.”
Allen, 468 U. S., at 751. Like “most legal notions, the stand-
ing concepts have gained considerable defnition from devel-
oping case law.” Ibid. As the Court has explained, in
“many cases the standing question can be answered chiefy
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 prin-
ciples can develop and solidify, the Court has identifed a va-
riety 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 busi-
ness, 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); Gen-
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eral Motors Corp. v. Tracy, 519 U. S. 278, 286–287 (1997);
Barl
ow 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., Sum-
mers, 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 plain-
tiff 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 un-
regulated parties who seek to challenge FDA's regulation
of others. Specifcally, FDA's regulations apply to doctors
prescribing mifepristone and to pregnant women taking mi-
fepristone. But the plaintiff doctors and medical associa-
tions 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 dem-
onstrate causation. Because the plaintiffs do not prescribe,
manufacture, sell, or advertise mifepristone or sponsor a
competing drug, the plaintiffs suffer no direct monetary inju-
2
In cases of alleged future injuries to unregulated parties from govern-
ment 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 some-
one else will cause a concrete and particularized injury in fact to the un-
regulated plaintiff ?
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ries from FDA's actions relaxing regulation of mifepristone.
N
or do they suffer injuries to their property, or to the value
of their property, from FDA's actions. Because the plain-
tiffs 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 suffce 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 frst set of causation theories contends that FDA's re-
laxed regulation of mifepristone may cause downstream con-
science injuries to the individual doctor plaintiffs and the
specifed 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 down-
stream 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 suffces to establish
Article III standing.
1
We frst 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 mi-
fepristone, and those women in turn will need more emer-
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gency 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; Trans-
Union, 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 condi-
tions of use cause more pregnant women to require emer-
gency 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 con-
science laws defnitively protect doctors from being required
to perform abortions or to provide other treatment that vio-
lates 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 punish-
ment 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 treat-
ment 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. Sa-
wicki, Protections From Civil Liability in State Abortion
Conscience Laws, 322 JAMA 1918 (2019); see, e.g., Tex. Occ.
Code Ann. § 103.001 (West 2022).
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Moreover, as the Government notes, federal conscience
protec
tions encompass “the doctor's beliefs rather than par-
ticular 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 avail-
able. 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 plain-
tiffs have not identifed 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 evi-
dence in the record here of hospitals overriding or failing to
accommodate doctors' conscience objections.
In other words, none of the doctors' declarations says any-
thing 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. 1 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 mife-
pristone 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
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and Labor Act or EMTALA, might be interpreted to over-
r
ide those federal conscience laws and to require individual
emergency room doctors to participate in emergency abor-
tions 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 indi-
vidual 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 doc-
tor 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 pro-
tections. Reply Brief for United States 5. A doctor may
simply refuse; federal law protects doctors from repercus-
sions 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 con-
science objections. Tr. of Oral Arg. 18; Moyle Tr. 89–90.
And again, nothing in the record since 2000 supports plain-
tiffs' speculation that doctors will be unable to successfully
i nvoke federa l conscience protec ti ons i n emergency
circumstances.
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In short, given the broad and comprehensive conscience
protec
tions 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 pro-
tects doctors against being required to provide abortions
or other medical treatment against their consciences—and
therefore breaks any chain of causation between FDA's re-
laxed 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, divert-
ing 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 prob-
lem—a lack of causation. The causal link between FDA's
regulatory actions and those alleged injuries is too specula-
tive 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 regula-
tions 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
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 activi-
ties of others is not a basis under Article III for a plaintiff to bring a
federal lawsuit challenging the legality of a government regulation allow-
ing those activities. See, e.g., Valley Forge Christian College v. Ameri-
cans 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).
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the number of pregnant women seeking treatment from the
plai
ntiff doctors and caused a resulting diversion of the doc-
tors' time and resources from other patients. Moreover, the
doctors have not identifed 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 loos-
ening of general public safety requirements simply because
more individuals might then show up at emergency rooms or
in doctors' offces with follow-on injuries. Stated otherwise,
there is no Article III doctrine of “doctor standing ” that
allows doctors to challenge general government safety regu-
lations. Nor will this Court now create such a novel stand-
ing doctrine out of whole cloth.
Consider some examples. EPA rolls back emissi ons
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 in-
creases 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 at-
tenuated. Allowing doctors or other healthcare providers
to challenge general safety regulations as unlawfully lax
would be an unprecedented and limitless approach and would
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allow doctors to sue in federal court to challenge almost any
pol
icy 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 can-
cer, 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 oth-
ers 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. Firefghters could sue to object to relaxed build-
ing codes that increase fre risks. Police offcers could sue
to challenge a government decision to legalize certain activi-
ties that are associated with increased crime. Teachers in
border states could sue to challenge allegedly lax immigra-
tion policies that lead to overcrowded classrooms.
We decline to start the Federal Judiciary down that un-
charted path. That path would seemingly not end until vir-
tually 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 fatly
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 citi-
4
A safety law regulating hospitals or the doctors' medical practices ob-
viously would present a different issue—either such a law would directly
regulate doctors, or the causal link at least would be substantially less
attenuated.

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393
Opinion of the Court
zens and doctors do not have standing to sue simply because
o
thers are allowed to engage in certain activities—at least
without the plaintiffs demonstrating how they would be in-
jured by the government's alleged under-regulation of oth-
ers. 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 cer-
tain 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 attenu-
ated to support Article III standing.
5
3
That leaves the medical associations' argument that the
associati ons themselves have organi zati ona l st andi ng.
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
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 liti-
gants to assert the interests of others, the litigants themselves still must
have suffered an injury in fact, thus giving them a suffciently 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.
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Opinion of the Court
satisfy the usual standards for injury in fact, causation, and
redressabi
lity that apply to individuals. Id., at 378–379.
According to the medical associations, FDA has “impaired”
their “ability to provide services and achieve their organiza-
tional missions.” Brief for Respondents 43. That argu-
ment does not work to demonstrate standing.
Like an individual, an organization may not establish
standing simply based on the “intensity of the litigant's in-
terest” or because of strong opposition to the government's
conduct, Valley Forge, 454 U. S., at 486, “no matter how long-
standing the interest and no matter how qualifed the organi-
zation,” 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 mife-
pristone's risks. Brief for Respondents 43. They contend
that FDA has “forced” the associations to “expend consider-
able 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 organiza-
tion cannot manufacture its own standing in that way.
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395
Opinion of the Court
The medical associations respond that under Havens Re-
a
lty 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 infor-
mation 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 oper-
ated 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 home-
seekers.” Id., at 379. In other words, Havens's actions di-
rectly affected and interfered with HOME's core business
activities—not dissimilar to a retailer who sues a manufac-
turer 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 mi-
fepristone 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 mi-
fepristone, which the associations say in turn makes it more
diffcult for them to inform the public about safety risks.
But the associations have not claimed an informational in-
jury, and in any event the associations have not suggested
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Opinion of the Court
that federal law requires FDA to disseminate such informa-
ti
on 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 care-
ful 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 stand-
ing, then it may be that no one would have standing to chal-
lenge 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 fnd standing.” Schle-
singer, 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 reg-
ulatory 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
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397
Thomas, J., concurring
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 abor-
tion and mifepristone to fellow citizens, including in the polit-
ical and electoral processes.
“No principle is more fundamental to the judiciary's proper
role in our system of government than the constitutional lim-
itation of federal-court jurisdiction to actual cases or contro-
versies.” Simon, 426 U. S., at 37. We reverse the judg-
ment 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.
Justice Thomas, concurring.
I join the Court's opinion in full because it correctly ap-
plies our precedents to conclude that the Alliance for Hippo-
cratic Medicine and other plaintiffs lack standing. Our prec-
edents 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 reg-
ulation of mifepristone injured them. Ante, at 385–396.
The Court also rejects the plaintiff doctors' theory that
they have third-party standing to assert the rights of their
patients. Ante, at 393, n. 5. Our third-party standing prec-
edents 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 393, n. 5. But, there is a far

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Thomas, J., concurring
simpler reason to reject this theory: Our third-party stand-
i
ng doctrine is mistaken. As I have previously explained,
a plaintiff cannot establish an Article III case or contro-
versy 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., concurr ing). So, just as abor ti onists 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 associ-
ation can satisfy these requirements, we allow the associa-
tion 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 justifed either doctrine's expansion of Article III stand-
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).

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399
Thomas, J., concurring
ing. In an appropriate case, we should explain just how the
Constituti
on 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 conficts with Article III by
permitting an association to assert its members' injuries in-
stead of its own. The “judicial power” conferred by Article
III “is limited to cases and controversies of the sort tradi-
tionally 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, funda-
mental 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.
Ach eso n Ho tel s, LLC v. L aufe r, 601 U. S. 1, 10 (2023)
(Thomas, J., concurring in judgment) (quoting Marbury v.
Madison, 1 Cranch 137, 170 (1803)); see also ante, at 378–380.
Associational standing seems to run roughshod over this
traditional understanding of the judicial power. Our doc-
trine 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 member-
ship—even if the association has tens of millions of other,
non-injured members. See Brief for Professor F. Andrew
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Thomas, J., concurring
Hessick as Amicus Curiae 28 (explaining that, among other
associati
ons, the American Association of Retired Person's
“potential standing is staggering ” because our doctrine per-
mits 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, Ar-
ticle III does not allow a plaintiff to seek to vindicate some-
one 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 diffcult 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 tradi-
tional rule that plaintiffs must assert only their own injuries.
The Alliance is an association whose members are other as-
sociations. 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 ap-
pear to comport with the requirement that the plaintiff pres-
ent 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: Al-
though 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
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401
Thomas, J., concurring
v. FDA, 13 F. 4th 531, 540 (CA6 2021); see also Department
o
f 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 Profes-
sor 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 Con-
stitution.” Grupo Mexicano de Desarrollo, S. A. v. Alli-
ance 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 injunc-
tion that bars a defendant from enforcing a law or regulation
against the specifc party before the court—the associa-
tional 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 obvi-
ous remedial problem through the invention of the so-called
3
This also raises the question of who should pick the remedy. Associa-
tions “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 associati on might want to conti nue the fight. Our
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402 FD
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Thomas, J., concurring
“universal injunction. ” Universal injunctions typically
“proh
ibit the Government from enforcing a policy with re-
spect 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) (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 phe-
nomenon” of a similarly questionable nature. Association
of American Physicians & Surgeons, 13 F. 4th, at 541. Be-
cause no party should be permitted to obtain an injunction
in favor of nonparties, I have diffculty seeing why an associ-
ation should be permitted to do so for its members. Asso-
ciational standing thus seems to distort our traditional
understanding of the judicial power.
In addition to these Article III concerns, there is ten-
sion 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, associa-
tional 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 litiga-
tion.” 13A C. Wright, A. Miller, & E. Cooper, Federal Prac-
tice 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 ac-
tion 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
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403
Thomas, J., concurring
litigates and loses an issue or claim, it can be barred from
reasser
ting that same issue or claim in another suit. In gen-
eral, preclusion prevents the relitigation of claims or issues
only by a party to a previous action, and we have been care-
ful to limit the exceptions to that rule. See Taylor v. Stur-
gell, 553 U. S. 880, 892–893 (2008). In the context of associa-
tional 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 mem-
bers. 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 doc-
trine because the Court has never attempted to reconcile
it with the traditional understanding of the judicial power.
Instead, the Court departed from that traditional under-
standing 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. Patter-
son, 357 U. S. 449 (1958), the Court permitted an association
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Thomas, J., concurring
to assert the constitutional rights of its members to prevent
the
disclosure of its membership lists. While the Court al-
lowed the NAACP to raise a challenge on behalf of its mem-
bers, 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 i n jury, creati ng our moder n
associati ona l-st andi ng doc tr i ne. In Na t io n a l M o t o r
Freight Traffc 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 representa-
tive of its members.” Warth v. Seldin, 422 U. S. 490, 511
(1975) (emphasis added; citing National Motor Freight Traf-
fc 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 Washing-
ton 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 justifed 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 res-
ervoir of expertise and capital,” and the fact that people
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Thomas, J., concurring
often join an association “to create an effective vehicle for
v
indicating interests that they share with others.” Id., at
289–290. But, considerations of practical judicial policy can-
not overcome the Constitution's mandates. The lack of any
identifable justifcation further suggests that the Court
should reconsider its associational-standing doctrine.
***
No party challenges our associational-standing doctrine
today. That is understandable; the Cour t consistently
applies the doctrine, discussing only the fner 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 plain-
tiffs 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.
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Reporter’s Note
The attached opinion has been revised to refect the usual publication
and citation style of the United States Reports. The revised pagination
makes available the offcial United States Reports citation in advance of
publication. The syllabus has been prepared by the Reporter of Decisions
for the convenience of the reader and constitutes no part of the opinion of
the Court. A list of counsel who argued or fled briefs in this case, and
who were members of the bar of this Court at the time this case was
argued, has been inserted following the syllabus. Other revisions may
include adjustments to formatting, captions, citation form, and any errant
punctuation. The following additional edits were made:
None