Opinion | Abortion Law Is Far From Settled

In his majority opinion in the case overturning Roe v. Wade, Justice Samuel Alito insisted that the high court was finally settling the vexed abortion debate by returning the “authority to regulate abortion” to the “people and their elected representatives.”

Despite these assurances, less than two years after Dobbs v. Jackson Women’s Health Organization, abortion is back at the Supreme Court. In the next month, the justices will hear arguments in two high-stakes cases that may shape the future of access to medication abortion and to lifesaving care for pregnancy emergencies. These cases make clear that Dobbs did not settle the question of abortion in America — instead, it generated a new slate of questions. One of those questions involves the interaction of existing legal rules with the concept of fetal personhood — the view, held by many in the anti-abortion movement, that a fetus is a person entitled to the same rights and protections as any other person.

The first case, scheduled for argument on Tuesday, F.D.A. v. Alliance for Hippocratic Medicine, is a challenge to the Food and Drug Administration’s protocols for approving and regulating mifepristone, one of the two drugs used for medication abortions. An anti-abortion physicians’ group argues that the F.D.A. acted unlawfully when it relaxed existing restrictions on the use and distribution of mifepristone in 2016 and 2021. In 2016, the agency implemented changes that allowed the use of mifepristone up to 10 weeks of pregnancy, rather than seven; reduced the number of required in-person visits for dispensing the drug from three to one; and allowed the drug to be prescribed by individuals like nurse practitioners. In 2021, it eliminated the in-person visit requirement, clearing the way for the drug to be dispensed by mail. The physicians’ group has urged the court to throw out those regulations and reinstate the previous, more restrictive regulations surrounding the drug — a ruling that could affect access to the drug in every state, regardless of the state’s abortion politics.

The second case, scheduled for argument on April 24, involves the Emergency Medical Treatment and Labor Act (known by doctors and health policymakers as EMTALA), which requires federally funded hospitals to provide patients, including pregnant patients, with stabilizing care or transfer to a hospital that can provide such care. At issue is the law’s interaction with state laws that severely restrict abortion, like an Idaho law that bans abortion except in cases of rape or incest and circumstances where abortion is “necessary to prevent the death of the pregnant woman.”

Although the Idaho law limits the provision of abortion care to circumstances where death is imminent, the federal government argues that under EMTALA and basic principles of federal supremacy, pregnant patients experiencing emergencies at federally funded hospitals in Idaho are entitled to abortion care, even if they are not in danger of imminent death.

These cases may be framed in the technical jargon of administrative law and federal pre-emption doctrine, but both cases involve incredibly high-stakes issues for the lives and health of pregnant persons — and offer the court an opportunity to shape the landscape of abortion access in the post-Roe era.

These two cases may also give the court a chance to seed new ground for fetal personhood. Woven throughout both cases are arguments that gesture toward the view that a fetus is a person.

If that is the case, the legal rules that would typically hold sway in these cases might not apply. If these questions must account for the rights and entitlements of the fetus, the entire calculus is upended.

In this new scenario, the issue is not simply whether EMTALA’s protections for pregnant patients pre-empt Idaho’s abortion ban, but rather which set of interests — the patient’s or the fetus’s — should be prioritized in the contest between state and federal law. Likewise, the analysis of F.D.A. regulatory protocols is entirely different if one of the arguments is that the drug to be regulated may be used to end a life.

Neither case presents the justices with a clear opportunity to endorse the notion of fetal personhood — but such claims are lurking beneath the surface. The Idaho abortion ban is called the Defense of Life Act, and in its first bill introduced in 2024, the Idaho Legislature proposed replacing the term “fetus” with “preborn child” in existing Idaho law. In its briefs before the court, Idaho continues to beat the drum of fetal personhood, insisting that EMTALA protects the unborn — rather than pregnant women who need abortions during health emergencies.

According to the state, nothing in EMTALA imposes an obligation to provide stabilizing abortion care for pregnant women. Rather, the law “actually requires stabilizing treatment for the unborn children of pregnant women.” In the mifepristone case, advocates referred to fetuses as “unborn children,” while the district judge in Texas who invalidated F.D.A. approval of the drug described it as one that “starves the unborn human until death.”

Fetal personhood language is in ascent throughout the country. In a recent decision, the Alabama Supreme Court allowed a wrongful-death suit for the destruction of frozen embryos intended for in vitro fertilization, or I.V.F. — embryos that the court characterized as “extrauterine children.”

Less discussed but as worrisome is a recent oral argument at the Florida Supreme Court concerning a proposed ballot initiative intended to enshrine a right to reproductive freedom in the state’s Constitution. In considering the proposed initiative, the chief justice of the state Supreme Court repeatedly peppered Nathan Forrester, the senior deputy solicitor general who was representing the state, with questions about whether the state recognized the fetus as a person under the Florida Constitution. The point was plain: If the fetus was a person, then the proposed ballot initiative, and its protections for reproductive rights, would change the fetus’s rights under the law, raising constitutional questions.

As these cases make clear, the drive toward fetal personhood goes beyond simply recasting abortion as homicide. If the fetus is a person, any act that involves reproduction may implicate fetal rights. Fetal personhood thus has strong potential to raise questions about access to abortion, contraception and various forms of assisted reproductive technology, including I.V.F.

In response to the shifting landscape of reproductive rights, President Biden has pledged to “restore Roe v. Wade as the law of the land.” Roe and its successor, Planned Parenthood v. Casey, were far from perfect; they afforded states significant leeway to impose onerous restrictions on abortion, making meaningful access an empty promise for many women and families of limited means. But the two decisions reflected a constitutional vision that, at least in theory, protected the liberty to make certain intimate choices — including choices surrounding if, when and how to become a parent.

Under the logic of Roe and Casey, the enforceability of EMTALA, the F.D.A.’s power to regulate mifepristone and access to I.V.F. weren’t in question. But in the post-Dobbs landscape, all bets are off. We no longer live in a world in which a shared conception of constitutional liberty makes a ban on I.V.F. or certain forms of contraception beyond the pale.

Melissa Murray, a law professor at New York University and a host of the Supreme Court podcast “Strict Scrutiny,” is a co-author of “The Trump Indictments: The Historic Charging Documents With Commentary.”

Kate Shaw is a contributing Opinion writer, a professor of law at the University of Pennsylvania Carey Law School and also a host of “Strict Scrutiny.” She served as a law clerk to Justice John Paul Stevens and Judge Richard Posner.

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