FOOD AND DRUG ADMINISTRATION et al. v. ALLIANCE FOR HIPPOCRATIC MEDICINE et al.

Certiorari To The United States Court Of Appeals For The Fifth Circuit

No. 23–235. Argued March 26, 2024—Decided June 13, 20241

In 2000, the Food and Drug Administration approved a new drug application 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 additional restrictions on the drug’s use and distribution, for example requiring 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; allowing healthcare providers, such as nurse practitioners, to prescribe Mifeprex; 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 injunction that would require FDA either to rescind approval of mifepristone 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 unlikely to succeed on their challenge to FDA’s 2000 and 2019 drug approvals, 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.

Held: Plaintiffs lack Article III standing to challenge FDA’s actions regarding the regulation of mifepristone. Pp. 5–25.

 (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 confines 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 Summers v. Earth Island Institute, 555 U. S. 488, 493. The two key questions 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, ideological, or policy objection to a particular government action. Causation requires the plaintiff to establish that the plaintiff ’s injury likely was caused or likely will be caused by the defendant’s conduct. Causation is “ordinarily substantially more difficult 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 difficulty linking their asserted injuries to the government’s regulation (or lack of regulation) of someone else. Pp. 5–12.

 (b) Plaintiffs are pro-life, oppose elective abortion, and have sincere legal, moral, ideological, and policy objections to mifepristone being prescribed 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 causation theories to connect FDA’s actions to the plaintiffs’ alleged injuries in fact. None of these theories suffices to establish Article III standing. Pp. 13–24.

  (1) Plaintiffs first contend that FDA’s relaxed regulation of mifepristone may cause downstream conscience injuries to the individual doctors. Even assuming that FDA’s 2016 and 2021 changes to mifepristone’s conditions of use cause more pregnant women to require emergency abortions and that some women would likely seek treatment from these plaintiff doctors, the plaintiff doctors have not shown that they could be forced to participate in an abortion or provide abortion-related medical treatment over their conscience objections. Federal conscience laws definitively protect doctors from being required to perform abortions or to provide other treatment that violates their consciences. Federal law protects doctors from repercussions when they have “refused” to participate in an abortion. §300a–7(c)(1). The plaintiffs have not identified any instances where a doctor was required, notwithstanding conscience objections, to perform an abortion or to provide other abortion-related treatment that violated the doctor’s conscience since mifepristone’s 2000 approval. Further, the Emergency Medical Treatment and Labor Act (or EMTALA) neither overrides 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 mifepristone and any asserted conscience injuries to the doctors. Pp. 14–17.

  (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 particular, diverting resources and time from other patients to treat patients with mifepristone complications; increasing risk of liability suits from treating those patients; and potentially increasing insurance costs. 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’ offices 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 restrictions. Pp. 18–21.

  (3) Plaintiff medical associations assert their own organizational standing. Under the 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, but organizations must satisfy the usual standards for injury in fact, causation, and redressability that apply to individuals, id., at 378–379. According to the medical associations, FDA has “impaired” their “ability to provide services and achieve their organizational missions.” Brief for Respondents 43. That argument does not work to demonstrate standing. Like an individual, an organization may not establish standing simply based on the “intensity of the litigant’s interest” or because of strong opposition to the government’s conduct, Valley Forge Christian College v. Americans 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 associations to “expend considerable time, energy, and resources” drafting citizen 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 expending 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 expansive 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 “assumption” that if these plaintiffs lack “standing to sue, no one would have standing, is not a reason to find 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. 21–24.

78 F. 4th 210, reversed and remanded.

 Kavanaugh, J., delivered the opinion for a unanimous Court. Thomas, J., filed a concurring opinion.

Notes
1 Together with No. 23–236, Danco Laboratories, L.L.C. v. Alliance for Hippocratic Medicine, also on certiorari to the United States Court of Appeals for the Fifth Circuit.


STARBUCKS CORP. v. McKINNEY, REGIONAL DIRECTOR OF REGION 15 OF THE NATIONAL LABOR RELATIONS BOARD, for and on behalf of the NATIONAL LABOR RELATIONS BOARD

Certiorari To The United States Court Of Appeals For The Sixth Circuit

No. 23–367. Argued April 23, 2024—Decided June 13, 2024

After several Starbucks employees announced plans to unionize, they invited a news crew from a local television station to visit the store after hours to promote their unionizing effort. Starbucks fired multiple employees involved with the media event for violating company policy. The National Labor Relations Board filed an administrative complaint against Starbucks alleging that it had engaged in unfair labor practices. The Board’s regional Director then filed a petition under §10( j) of the National Labor Relations Act seeking a preliminary injunction for the duration of the administrative proceedings that would, among other things, require Starbucks to reinstate the fired employees. The District Court assessed whether the Board was entitled to a preliminary injunction by applying a two-part test that asks whether “there is reasonable cause to believe that unfair labor practices have occurred,” and whether injunctive relief is “just and proper.” McKinney v. Ozburn-Hessey Logistics, LLC, 875 F. 3d 333, 339. Applying this standard, the District Court granted the injunction, and the Sixth Circuit affirmed.

Held: When considering the NLRB’s request for a preliminary injunction under §10( j), district courts must apply the traditional four factors articulated in Winter v. Natural Resources Defense Council, Inc., 555 U. S. 7. Pp. 4–11.

  (a) Section 10( j) authorizes a federal district court “to grant . . . such temporary relief . . . as it deems just and proper” during the pendency of the Board’s administrative proceedings. §160( j). When Congress empowers courts to grant equitable relief, there is a strong presumption that courts will exercise that authority in a manner consistent with traditional principles of equity. For preliminary injunctions, the four criteria identified in Winter encompass the relevant equitable principles. Nothing in §10( j) displaces the presumption that those traditional principles govern. Pp. 4–5.

  (b) The traditional rule is that a plaintiff seeking a preliminary injunction must make a clear showing that “he is likely to succeed on the merits, that he is likely to suffer irreparable harm in the absence of preliminary relief, that the balance of equities tips in his favor, and that an injunction is in the public interest.” Winter, 555 U. S., at 20, 22. “These commonplace considerations applicable to cases in which injunctions are sought in the federal courts reflect a ‘practice with a background of several hundred years of history.’ ” Weinberger v. Romero-Barcelo, 456 U. S. 305, 313. When interpreting a statute that authorizes federal courts to grant preliminary injunctions, the Court “do[es] not lightly assume that Congress has intended to depart from established principles.” Ibid. Absent a clear command from Congress, then, courts must adhere to the traditional four-factor test articulated in Winter.

  Section 10( j)’s statutory directive to grant injunctive relief when the district court “deems” it “just and proper” does not jettison the normal equitable rules; it simply invokes the discretion that courts have traditionally exercised when faced with requests for equitable relief. Furthermore, §10( j)’s text bears no resemblance to the language that Congress has employed when it has altered the normal equitable rules. Pp. 5–8.

  (c) The Board argues that statutory context requires district courts evaluating §10( j) petitions to apply the traditional criteria in a less exacting way, consistent with the Sixth Circuit’s reasonable-cause standard. But, the reasonable-cause standard goes far beyond simply fine tuning the traditional criteria to the §10( j) context—it substantively lowers the bar for securing a preliminary injunction by requiring courts to yield to the Board’s preliminary view of the facts, law, and equities. Under the traditional standard, for example, the Board would have to make a clear showing that it “is likely to succeed on the merits.” Winter, 555 U. S., at 20. By contrast, the Board may obtain a §10( j) injunction under the reasonable-cause standard by merely showing “reasonable cause to believe that unfair labor practices have occurred.” Ozburn-Hessey Logistics, 875 F. 3d, at 339. Section 10( j)’s statutory context does not compel this watered-down approach to equity.

  The Board suggests that district courts risk supplanting its adjudi catory authority by conducting an independent assessment of the merits and equitable factors. But no matter how searching the district court’s merits inquiry or what evidence it considers or credits, the Board remains free to reach its own legal conclusions and develop its own record in its administrative proceedings. And, since irreparable harm and the other equitable factors are not part of the unfair-labor-practice claim, a district court’s assessment of those factors is irrelevant to the Board’s adjudicatory authority.

  The Board also reasons that district courts should apply a deferential standard because the Board’s final decisions are reviewed deferentially by a court of appeals. But the views advanced in a §10( j) petition are preliminary and do not represent the Board’s formal position. Deference to what is “nothing more than an agency’s convenient litigating position” is “entirely inappropriate.” Bowen v. Georgetown Univ. Hospital, 488 U. S. 204, 213. The Board’s attempt to salvage the reasonable-cause standard using statutory context thus fails. Pp. 8–10.

77 F. 4th 391, vacated and remanded.

 Thomas, J., delivered the opinion of the Court, in which Roberts, C. J., and Alito, Sotomayor, Kagan, Gorsuch, Kavanaugh, and Barrett, JJ., joined. Jackson, J., filed an opinion concurring in part, dissenting in part, and concurring in the judgment.


VIDAL, UNDER SECRETARY OF COMMERCE FOR INTELLECTUAL PROPERTY AND DIRECTOR, UNITED STATES PATENT AND TRADEMARK OFFICE v. ELSTER

Certiorari To The United States Court Of Appeals For The Federal Circuit

No. 22–704. Argued November 1, 2023—Decided June 13, 2024

Drawing on a 2016 Presidential primary debate exchange between then-candidate Donald Trump and Senator Marco Rubio, respondent Steve Elster sought to federally register the trademark “Trump too small” to use on shirts and hats. An examiner from the Patent and Trademark Office refused registration based on the “names clause,” a Lanham Act prohibition on the registration of a mark that “[c]onsists of or comprises a name . . . identifying a particular living individual except by his written consent,” 15 U. S. C. §1052(c). The Trademark Trial and Appeal Board affirmed, rejecting Elster’s argument that the names clause violates his First Amendment right to free speech. The Federal Circuit reversed.

Held: The Lanham Act’s names clause does not violate the First Amendment. Pp. 3–22.

 (a) When enforcing the First Amendment’s prohibition against abridging freedom of speech, this Court “distinguish[es] between content-based and content-neutral regulations of speech.” National Institute of Family and Life Advocates v. Becerra, 585 U. S. 755, 766. A content-based regulation “target[s] speech based on its communicative content,” Reed v. Town of Gilbert, 576 U. S. 155, 163, and is “ ‘presumptively unconstitutional,’ ” National Institute of Family and Life Advocates, 585 U. S., at 766. Viewpoint discrimination is a particularly “egregious form of content discrimination” that targets not merely a subject matter “but particular views taken by speakers on the subject.” Rosenberger v. Rector and Visitors of Univ. of Va., 515 U. S. 819, 829. This Court has twice concluded that trademark restrictions that discriminate based on viewpoint violate the First Amendment. See Matal v. Tam, 582 U. S. 218; Iancu v. Brunetti, 588 U. S. 388.

 Because the names clause does not single out a trademark “based on the specific motivating ideology or the opinion or perspective of the speaker,” Reed, 576 U. S., at 168, it does not facially discriminate against any viewpoint. But a law that does not facially discriminate based on viewpoint may still be found to discriminate based on viewpoint in its practical operation. See Sorrell v. IMS Health Inc., 564 U. S. 552, 565. Elster suggests that is the case here because obtaining consent for a trademark under the names clause is easier if it flatters rather than mocks a subject. But there are many reasons why a person may wish to withhold consent to register a trademark bearing his name.

 Although the names clause is not viewpoint based, it is content based because “it applies to particular speech because of the topic discussed or the idea or message expressed,” Reed, 576 U. S., at 163—i.e., it turns on whether the proposed trademark contains a person’s name. Thus, the Court confronts a situation not addressed in Tam and Brunetti. Pp. 3–6.

 (b) Although a content-based regulation of speech is presumptively unconstitutional, this Court has not decided whether heightened scrutiny extends to a content-based—but viewpoint-neutral—trademark restriction. Several features of trademark counsel against a per se rule of applying heightened scrutiny in such cases. Most importantly, trademark rights have always coexisted with the First Amendment, and the inherently content-based nature of trademark law has never been a cause for constitutional concern.

 This country has recognized trademark rights since the founding. Much of early American trademark law came by way of English law, where the protection of trademarks was an inherently content-based endeavor. For most of the 18th and 19th centuries, trademark law fell largely within the “province of the States,” Tam, 582 U. S., at 224, and went largely unrecorded. The first reported decisions in state and federal courts revolved around a trademark’s content. See Thomson v. Winchester, 36 Mass. 214, 216; Taylor v. Carpenter, 3 Story 458 (D. Mass.). And as recorded trademark law began to take off in the last decades of the 19th century, its established content-based nature continued. In 1870, Congress enacted the first federal trademark law, containing prohibitions on what could be protected as a trademark. It restricted a trademark based upon its content. And as trademark disputes increased, courts continued to assess trademarks based on their content. The content-based nature of trademark law did not change when Congress enacted the Lanham Act in 1946. The Act’s comprehensive system for federal registration of trademarks continues to distinguish based on a mark’s content. This history demonstrates that restrictions on trademarks have always turned on a mark’s content and have existed harmoniously alongside the First Amendment from the beginning. That relationship suggests that heightened scrutiny need not always apply in this unique context.

 The content-based nature of trademark protection is compelled by the historical rationales of trademark law—to prohibit confusion by identifying the ownership and source of goods. Indicating ownership and the manufacturing source touch on the content of the mark, i.e., from whom the product came. And policing trademarks so as to prevent confusion over the source of goods requires looking to the mark’s content. Because of the uniquely content-based nature of trademark regulation and the longstanding coexistence of trademark regulation with the First Amendment, a solely content-based restriction of trademark registration need not be evaluated under heightened scrutiny. R. A. V. v. St. Paul, 505 U. S. 377, 387. Pp. 6–12.

 (c) The history and tradition of restricting trademarks containing names is sufficient to conclude that the names clause is compatible with the First Amendment. Pp. 12–19.

  (1) Restrictions on trademarking names have historically been grounded in the notion that a person has ownership over his own name, and that he may not be excluded from using that name by another’s trademark. See Brown Chemical Co. v. Meyer, 139 U. S. 540, 544. The common law prevented a person from trademarking any name—even his own—by itself. It did, however, allow a person to obtain a trademark containing his own name, provided that he could not use the mark containing his name to the exclusion of a person with the same name. The common-law approach thus protected only a person’s right to use his own name, an understanding that was carried over into federal statutory law and included in the names clause. The Court finds no evidence that the common law afforded protection to a person seeking a trademark of another living person’s name. This common-law understanding is reflected in federal statutory law, and its requirement that a trademark contain more than merely a name remains largely intact. See §1052(e)(4). It is thus unsurprising that the Lanham Act included the names clause.

 The restriction on trademarking names also reflects trademark law’s historical rationale of identifying the source of goods and thus ensuring that consumers know the source of a product and can evaluate it based upon the manufacturer’s reputation and goodwill. Moreover, the clause respects the established connection between a trademark and its protection of the markholder’s reputation. This Court has long recognized that a trademark protects the markholder’s reputation, and the connection is even stronger when the mark contains a person’s name.

 Applying these principles, the Court has also recognized that a party has no First Amendment right to piggyback off the goodwill another entity has built in its name. See San Francisco Arts & Athletics, Inc. v. United States Olympic Comm., 483 U. S. 522, 528. By protecting a person’s use of his name, the names clause “secur[es] to the producer the benefits of [his] good reputation.” Park ’N Fly, Inc. v. Dollar Park & Fly, Inc., 469 U. S. 189, 198. Pp. 12–19.

  (2) A tradition of restricting the trademarking of names has coexisted with the First Amendment, and the names clause fits within that tradition. The names clause reflects the common-law tradition by prohibiting a person from obtaining a trademark of another living person’s name without consent, thereby protecting the other’s reputation and goodwill. A firm grounding in traditional trademark law is sufficient to justify the content-based trademark restriction here, but a case presenting a content-based trademark restriction without a historical analog may require a different approach. In this case, the Court sees no reason to disturb this longstanding tradition, which supports the restriction of the use of another’s name in a trademark. P. 19–20.

 (d) This decision is narrow. It does not set forth a comprehensive framework for judging whether all content-based but viewpoint-neutral trademark restrictions are constitutional. Nor does it suggest that an equivalent history and tradition is required to uphold every content-based trademark restriction. The Court holds only that history and tradition establish that the particular restriction here, the names clause in §1052(c), does not violate the First Amendment. P. 22.

26 F. 4th 1328, reversed.

 Thomas, J., announced the judgment of the Court and delivered the opinion of the Court, except as to Part III. Alito and Gorsuch, JJ., joined that opinion in full; Roberts, C. J., and Kavanaugh, J., joined all but Part III; and Barrett, J., joined Parts I, II–A, and II–B. Kavanaugh, J., filed an opinion concurring in part, in which Roberts, C. J., joined. Barrett, J., filed an opinion concurring in part, in which Kagan, J., joined, in which Sotomayor, J., joined as to Parts I, II, and III–B, and in which Jackson, J., joined as to Parts I and II. Sotomayor, J., filed an opinion concurring in the judgment, in which Kagan and Jackson, JJ., joined.