Cline v. Oklahoma Coalition for Reproductive Justice
2013 OK 93
| Okla. | 2013Background
- The Oklahoma Supreme Court certified two questions under the Revised Uniform Certification of Questions of Law Act regarding H.B. 1970, addressing misoprostol and methotrexate use in abortion-related contexts.
- H.B. 1970 prohibits using misoprostol to induce abortions (including with mifepristone per FDA protocol) and prohibits using methotrexate to treat ectopic pregnancies.
- The district court held H.B. 1970 unconstitutional as conflicting with medical practice and standards; the Oklahoma Supreme Court affirmed.
- The U.S. Supreme Court granted certiorari and certified two questions to determine statutory meaning and applicability.
- The statute defines an ‘abortion-inducing drug’ and requires provision or prescription according to FDA-approved protocols and labels, affecting off-label and evidence-based regimens.
- The Court held that misoprostol and methotrexate are abortion-inducing drugs under the statute and that off-label use not aligned with FDA labels is prohibited, effectively restricting medication abortions.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Plain meaning of abortion-inducing drug | HB 1970 bans abortion-inducing drugs broadly (misoprostol, methotrexate) in all contexts. | Statutory language distinguishes RU-486 from other drugs; off-label uses are permissible under medical practice. | HB 1970's language treats misoprostol and methotrexate as abortion-inducing drugs; off-label use is prohibited. |
| Does the term abortion-inducing drug include off-label uses | Off-label uses fall within ‘abortion-inducing drug’ as defined by intent to terminate pregnancy. | Abortion-inducing drug definition requires specific labeling context; FDA labeling constrains interpretation. | Off-label uses of misoprostol and methotrexate are prohibited under the statute. |
| Relation to FDA labeling and medical judgment | Physicians may use FDA-approved drugs according to best medical practice and evidence-based regimens. | statute requires adherence to FDA protocols and labels for RU-486 and abortion-inducing drugs. | Statute constrains medical judgment by requiring use according to FDA labeling, banning off-label regimens. |
| Impact on treatment of ectopic pregnancies | Methotrexate could treat ectopic pregnancies under medical practice without FDA labeling limitations. | HB 1970 defines abortion-inducing drugs to include methotrexate used for abortion-inducing purposes, including ectopic contexts. | HB 1970 prohibits methotrexate use for treating ectopic pregnancies under the abortion-inducing drug framework. |
Key Cases Cited
- Planned Parenthood v. Casey, 505 U.S. 833 (U.S. 1992) (central framework for abortion regulations)
- Okla. Coal. for Reprod. Justice v. Cline, 292 P.3d 27 (Okla. 2012) ( Oklahoma constitutional interpretation of abortion-related statutes)
- McClure v. ConocoPhillips Co., 142 P.3d 390 (Okla. 2006) (statutory interpretation framework; intent from text)
- In re J.L.M., 109 P.3d 336 (Okla. 2005) (disjunctive 'or' indicates separate alternatives in statutory language)
- Weaver v. Reagan, 886 F.2d 194 (8th Cir. 1989) (treatment of medical practice and official labeling context)
- Planned Parenthood v. DeWine, 696 F.3d 490 (6th Cir. 2012) (off-label drug use and medical practice considerations)