FOR PUBLICATION

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

SHANDHINI RAIDOO, M.D., 

M.P.H.; BLISS KANESHIRO, M.D., 

M.P.H., on behalf of themselves and 

their patients, 

Plaintiffs-Appellees, 

 v. 

DOUGLAS MOYLAN, in his official 

capacity as Attorney General of 

Guam; NATHANIEL BERG, M.D., in 

his official capacity as Chair of the 

Guam Board of Medical Examiners; 

PHILIP FLORES, in his official 

capacity as Vice-Chair of the Guam 

Board of Medical Examiners; 

ARANIA ADOLPHSON, M.D., in her 

official capacity as a member of the 

Guam Board of Medical Examiners; 

LUIS G. CRUZ, M.D., in his official 

capacity as a member of the Guam 

Board of Medical Examiners; 

ANNETTE DAVID, M.D., M.P.H., in 

her official capacity as member of the 

Guam Board of Medical Examiners; 

JOLEEN AGUON, M.D., in her 

official capacity as member of the 

No. 21-16559 

D.C. No. 1:21-cv00009 

OPINION
2 RAIDOO V. MOYLAN

Guam Board of Medical Examiners;

SCOTT SHAY, M.D., in his official 

capacity as a member of the Guam 

Board of Medical Examiners,

Defendants-Appellants.

Appeal from the United States District Court

for the District of Guam

Frances Tydingco-Gatewood, Chief District Judge, 

Presiding

Argued and Submitted February 16, 2023

Honolulu, Hawaii

Filed August 1, 2023

Before: Carlos T. Bea, Daniel P. Collins, and Kenneth K. 

Lee, Circuit Judges.

Opinion by Judge Lee
RAIDOO V. MOYLAN 3

SUMMARY*

Abortion

The panel vacated the district court’s preliminary 

injunction enjoining enforcement of the informed-consent 

requirement in Guam’s Women’s Reproductive Health 

Information Act, which requires that women seeking 

abortions have an in-person meeting with a physician, or a 

qualified agent of the physician, who must disclose certain 

medical as well as other information.

Plaintiffs are Guam-licensed OBGYN physicians in 

Hawaii who wish to provide abortion services to Guam 

patients through telemedicine. They point out that women 

in Guam seeking abortions must obtain chemical 

abortifacients via telemedicine, given the current lack of 

doctors who perform abortions in Guam.

Applying rational basis review, the panel concluded that 

the in-person informed consent requirement does not violate 

the Due Process Clause because it furthers Guam’s 

legitimate governmental interests in preservation of 

potential life, protection of maternal health, and promotion 

of the integrity of the medical profession.

The panel rejected plaintiffs’ as-applied challenge under 

the Due Process Clause, in which plaintiffs argued that the 

in-person consultation requirement undermines informed 

consent because of the possibility that non-medical 

personnel may provide the required medical 

* This summary constitutes no part of the opinion of the court. It has 

been prepared by court staff for the convenience of the reader.
4 RAIDOO V. MOYLAN

disclosures. The panel held that the requirement does not 

undermine informed consent because it does not mandate 

that a non-medical professional provide the in-person 

medical disclosures, nor does it prevent the treating 

telemedicine doctor from providing medical information to 

the patient; it merely requires that patients receive certain 

information in person before receiving an abortion. 

Finally, the panel rejected plaintiffs’ argument that 

Guam’s in-person informed-consent law violates their equal 

protection rights because it irrationally treats physicians who 

provide abortions differently than similarly situated 

telemedicine providers. Applying rational basis review, the 

panel held that Guam can require an in-person consultation 

for abortions because, unlike other medical procedures, 

abortion implicates fetal life in addition to the patient’s 

health, and the in-person requirement bears a reasonable 

relationship to the legitimate governmental interest of 

safeguarding fetal life.

COUNSEL

Jordan L. Pauluhn (argued) and Heather M. Zona, Assistant 

Attorneys General; James L. Canto II, Deputy Attorney 

General; Leevin Taitano Camacho, Attorney General of 

Guam; Office of the Attorney General, Litigation Division; 

Tamuning, Guam; for Defendants-Appellants.

Alexa Kolbi-Molinas (argued), Meagan M. Burrows, and 

Rachel M. Reeves, American Civil Liberties Union 

Foundation, New York, New York; Vanessa L. Williams, 

Law Office of Vanessa L. Williams PC, Hagatna, Guam; 

Chelsea G. Tejada, ACLU Reproductive Freedom Project, 

New York, New York; for Plaintiffs-Appellees.
RAIDOO V. MOYLAN 5

OPINION

LEE, Circuit Judge:

In Dobbs v. Jackson Women’s Health Organization, the 

Supreme Court made clear that the Constitution does not 

guarantee a right to an abortion because it is neither 

enumerated in the constitutional text nor deeply rooted in our 

nation’s history. 142 S. Ct. 2228 (2022). So now the 

people’s representatives—not judges—decide whether to 

allow, ban, or regulate abortions. And in turn, courts play 

only a modest and minor role: We merely apply a highly 

deferential rational basis review in assessing the 

constitutionality of an abortion-related law.

Under this new legal landscape, we vacate the district 

court’s preliminary injunction against Guam’s in-person 

informed-consent law. That law requires women seeking 

abortions to have an in-person meeting with a physician—or 

a qualified agent of the doctor—who must disclose certain 

medical as well as other information (e.g., medical risks, 

adoption opportunities) to a patient before she has an 

abortion. Guam has legitimate interests in requiring an inperson consultation: the consultation can underscore the 

medical and moral gravity of an abortion and encourage a 

robust exchange of information. As we learned during the 

pandemic, a telephonic or video meeting may be a poor 

substitute for an in-person meeting, whether it be in the 

classroom, courtroom, or clinic.

Plaintiffs point out that women in Guam seeking 

abortions must obtain chemical abortifacients via 

telemedicine, given the current lack of doctors who perform 

abortions on the island. Plaintiffs argue that the law may 

thus thwart informed consent because the treating doctor off 
6 RAIDOO V. MOYLAN

the island may have to pick a non-medical agent to provide 

the in-person medical disclosures. But nothing in the law 

prevents the treating doctor from providing the same or 

additional information as that required in the in-person 

meeting when the doctor meets with patient via 

videoconference or phone. The law sets a minimum, not a 

maximum, disclosure requirement, and does not prohibit the 

doctor from communicating additional information that the 

doctor believes is required under another law or professional 

obligation. In short, Guam’s law passes muster under the 

low bar of rational basis review.

Plaintiffs’ equal protection challenge fails as well.

Guam can require an in-person consultation for abortions—

but not for other medical procedures—because abortion is 

different, as it involves what Dobbs described as the “States’ 

interest in protecting fetal life.” Id. at 2261. People across 

the United States and its territories may in good-faith 

strongly disagree on abortion, but the people of Guam can 

make the policy choice to treat abortion differently from 

other medical procedures.

I. BACKGROUND

A. Guam requires in-person informed consent for 

abortions.

In 2012, Guam enacted the Women’s Reproductive

Health Information Act, which requires in-person informed 

consent from women seeking abortions. 10 Guam Code 

Ann. § 3218.1. The statute provides that “consent to an 

abortion is voluntary and informed if and only if” certain 

conditions are met. 10 Guam Code Ann. § 3218.1(b). This 

statute has two key provisions governing the disclosure of 

information.
RAIDOO V. MOYLAN 7

First, as relevant here, the woman seeking an abortion 

must receive certain medical information in person at least 

24-hours before the procedure. 10 Guam Code Ann. 

§ 3218.1(b)(1). The required medical information includes 

“medically accurate information that a reasonable person 

would consider material to the decision of whether or not to 

undergo the abortion,” such as immediate and long-term 

medical risks associated with abortion, the likely gestational 

age of the fetus, and medical risks associated with carrying 

the child to term. See 10 Guam Code Ann.

§ 3218.1(b)(1)(B)–(E).

Second, section (b)(2) requires in-person disclosure of 

information about social services and other assistance 

available to an expectant mother. 10 Guam Code Ann.

§ 3218.1(b)(2). For example, a woman seeking an abortion 

must be informed of medical assistance benefits, public 

assistance for her child, adoption services, and the father’s 

liability for child support. See 10 Guam Code Ann.

§ 3218.1(b)(2)(A)–(F). 

Relevant here, both sections (b)(1) and (b)(2) require the 

physician who will perform the abortion—or a “qualified 

person”—to provide the information in person. 10 Guam 

Code Ann. § 3218.1(b)(1), (2). The statute defines a 

“qualified person” as “an agent of a physician who is a 

psychologist, licensed social worker, licensed professional 

counselor, registered nurse, or physician.” 10 Guam Code 

Ann. § 3218.1(a)(13).
8 RAIDOO V. MOYLAN

B. No doctor in Guam will perform an abortion but 

women can obtain medication abortions via 

telemedicine. 

In 2018, the last physician known to provide abortions in 

Guam retired. And no physician has since been known to 

provide abortions on the island. 

In 2017, the Guam Attorney General concluded that 

Guam-licensed physicians located off the island can provide 

medical care to patients in Guam using telemedicine. See

Guam Att’y Gen. Op. No. 17-0531, 2–3 (Nov. 6, 2017). In 

2021, the Guam Attorney General specifically stipulated in 

another lawsuit that Guam law permits the use of 

telemedicine to provide medication abortions. 

Plaintiffs Shandhini Raidoo, M.D., M.P.H., and Bliss 

Kaneshiro, M.D., M.P.H., are Guam-licensed OBGYN 

physicians in Hawaii who wish to provide abortion services, 

including medication abortions, to Guam patients through 

telemedicine. They believe that they are the only doctors 

who are willing to provide abortion services to women in 

Guam. But Plaintiffs acknowledge that supportive 

physicians in Guam are “willing to provide pre- and postabortion care.” Guam law requires in-person informedconsent for abortions, even if women use chemical 

abortifacients obtained via telemedicine. 

C. The district court enjoins the Guam law in 

reliance on Roe and Casey.

In January 2021, Plaintiffs filed a complaint alleging that 

the in-person informed-consent requirement violates their 

patients’ right to an abortion under Roe v. Wade, 410 U.S. 

113 (1973), and Planned Parenthood of Southeastern 

Pennsylvania v. Casey, 505 U.S. 833 (1992). The complaint 
RAIDOO V. MOYLAN 9

also alleged that the law violates the Equal Protection Clause 

of the Fourteenth Amendment. 

A week later, Plaintiffs moved for a preliminary 

injunction. And in September 2021, the district court 

enjoined enforcement of the in-person informed-consent 

provision, ruling that the law imposed an “undue burden” on 

a woman’s right to an abortion under Casey. It found that 

Guam failed to show any “real justification or benefits of the 

in-person requirement” while the burdens imposed were 

“substantial.” 

Guam then appealed the district court’s grant of a 

preliminary injunction. We have jurisdiction under 28 

U.S.C. § 1292(a)(1).

II. STANDARD OF REVIEW

We review the district court’s grant of a preliminary 

injunction for abuse of discretion. See Porretti v. Dzurenda, 

11 F.4th 1037, 1046 (9th Cir. 2021). We review legal 

questions de novo, Bouman v. Block, 940 F.2d 1211, 1220 

(9th Cir. 1991), and factual findings for clear error, United 

States v. Hinkson, 585 F.3d 1247, 1259 (9th Cir. 2009) (en 

banc). 

To obtain a preliminary injunction, a plaintiff must 

establish (1) a likelihood of success on the merits, (2) a 

likelihood of irreparable harm in the absence of preliminary 

relief, (3) that the balance of equities favors the plaintiff, and 

(4) that an injunction serves the public interest. See Winter 

v. Nat. Res. Def. Council, Inc., 555 U.S. 7, 20 (2008). “A 

preliminary injunction is an extraordinary remedy never 

awarded as of right.” Id. at 24.
10 RAIDOO V. MOYLAN

III. DISCUSSION

We vacate the district court’s grant of a preliminary 

injunction enjoining enforcement of the in-person informedconsent requirement of 10 Guam Code Ann. § 3218.1. 

After the district court issued its order, the Supreme 

Court announced in Dobbs that abortion statutes are no 

longer subject to Casey’s undue burden standard. Dobbs, 

142 S. Ct. at 2242. Rather, an abortion-related law must only 

survive rational basis review. Id. at 2284. And under that 

deferential standard, Plaintiffs cannot show a likelihood of 

success on the merits because Guam has legitimate interests 

in imposing an in-person requirement and the law is 

rationally related to those goals.

A. We apply rational basis review in assessing 

Guam’s in-person informed-consent requirement 

for abortions.

The Supreme Court in Dobbs overturned Roe and Casey, 

rejecting a constitutional right to an abortion and casting 

aside Casey’s undue burden test for assessing abortion laws. 

Dobbs, 142 S. Ct. at 2242, 2283. Now, abortion laws—“like 

other health and welfare laws”—are decided by the people 

and their elected representatives, and are generally subject 

only to rational basis review by the courts. Id. at 2284.

Rational basis review is “a paradigm of judicial 

restraint,” FCC v. Beach Commc’ns, Inc., 508 U.S. 307, 314 

(1993), that is “highly deferential to the government,” Erotic 

Serv. Provider Legal Educ. & Rsch. Project v. Gascon, 880 

F.3d 450, 457 (9th Cir. 2018) (citing United States v. 

Hancock, 231 F.3d 557, 566 (9th Cir. 2000)). We must 

uphold a law under rational basis review if the government 

has a legitimate interest in enacting the statute, and the law 
RAIDOO V. MOYLAN 11

is rationally related to that interest. Under this deferential 

standard, laws enacted by the people are “entitled to a 

‘strong presumption of validity.’” Dobbs, 142 S. Ct. at 2284 

(internal citation omitted). Challengers of the law “have the 

burden ‘to negative every conceivable basis which might 

support it.’” Beach Commc’ns, Inc., 508 U.S. at 315 

(quoting Lehnhausen v. Lake Shore Auto Parts Co., 410 U.S. 

356, 364 (1973)). 

It matters not that judges may think the law unwise or

believe it could have been drafted more narrowly or 

differently. Indeed, a law survives rational basis review so 

long as some conceivable legitimate purpose could have 

supported it—regardless of a legislature’s actual purpose in 

enacting a statute. Beach Commc’ns, Inc., 508 U.S. at 315. 

The legislature does not need proof that the statute will 

achieve its asserted purpose: a statute will pass muster if the 

purpose of the law rests on “rational speculation,” even if the 

speculation is “unsupported by evidence or empirical data.” 

Id. A law thus survives rational basis review even if it 

requires “rough accommodations” that may be “illogical” or

“unscientific,” and that may even appear “unjust and 

oppressive.” Metropolis Theater Co. v. City of Chicago, 228 

U.S. 61, 69–70 (1913). 

B. Guam’s in-person informed-consent law survives 

rational basis review.

In assessing the constitutionality of Guam’s in-person 

informed-consent requirement, we examine whether the law

furthers any legitimate governmental purpose and is 

rationally related to that goal. Nordlinger v. Hahn, 505 U.S. 

1, 10 (1992). We may find a law unconstitutional under 

rational basis review, for example, if the means employed 

are “directly contrary to the [law’s] basic purpose” or if the 
12 RAIDOO V. MOYLAN

means are “wholly unconnected to any legitimate state 

interest.” Silveira v. Lockyer, 312 F.3d 1052, 1089–91 (9th 

Cir. 2003). Guam’s law easily meets that bar.

1. Guam has valid and legitimate state interests 

in requiring an in-person consultation before

a patient undergoes an abortion.

We reject Plaintiffs’ argument that an in-person 

informed-consent requirement for women seeking an 

abortion is not rationally connected to any legitimate 

governmental interest. 

Guam identifies three legitimate purposes that the inperson requirement furthers: (1) preservation of “potential 

life,” (2) protection of maternal health, and (3) promotion of 

the integrity of the medical profession. Guam contends that 

a “private, in-person setting is the appropriate and solemn 

setting for a patient to fully appreciate the information being 

provided,” and the “same level of formality is not present 

when the information is being provided over video 

conferencing” or other similar media.

Each of Guam’s asserted interests constitutes a 

legitimate governmental interest. The Supreme Court has 

recognized that legitimate governmental interests include 

“respect for and preservation of prenatal life at all stages of 

development; the protection of maternal health and safety; 

. . . [and] the preservation of the integrity of the medical 

profession.” Dobbs, 142 S. Ct. at 2284. This case therefore 

turns on whether Guam’s in-person informed-consent law is 

rationally related to any of those interests. We believe it is.

Guam could reasonably conclude that communication in 

a face-to-face setting has a different impact than in virtual 
RAIDOO V. MOYLAN 13

spaces.

1 It could rationally determine that face-to-face 

meetings can facilitate clearer communication, as well as 

enhance the ability to read body language and other nonverbal cues.2 And it could likewise reasonably believe that 

in-person settings encourage more frank and robust 

discussions, enable connectedness between those having the 

discussion, and ensure a more focused and undistracted 

setting.3 

1 See, e.g., Anne Bowen Poulin, Criminal Justice and Videoconferencing 

Technology: The Remote Defendant, 78 Tul. L. Rev. 1089, 1124–25 

(2004) (explaining how video interactions versus in-person interactions 

can affect how a person acts or is perceived to be acting).

2 Ed Spillane, The End of Jury Trials: Covid-19 and the Courts, 18 Ohio 

St. J. Crim. L. 537, 542 (2021) (stating that “there is a difference between 

in-person interaction and virtual interactions” and noting that “[c]hildren 

testifying via remote closed-circuit television have been found to be less 

credible and accurate than children testifying in-person according to a 

mock jury”); Elizabeth G. Thornburg, Observing Online Courts: Lessons 

from the Pandemic, 54 Fam. L.Q. 181, 202–03 (2020) (explaining how 

presentation and argument is received differently in person as compared 

to over Zoom).

3 See, e.g., Stephanie Riegg Cellini, How does virtual learning impact 

students in higher education?, Brookings: Brown Center Chalkboard 

(August 13, 2021) (explaining that online learning often leads to 

“negative learning impacts, reduced course completion, and lack of 

connection with other students and faculty” which “could ultimately 

reduce college completion rates”); see also Kelli A. Bird, Benjamin L. 

Castleman & Gabrielle Lohner, Negative Impacts from the Shift to 

Online Learning During the COVID-19 Crisis: Evidence from a 

Statewide Community College System., 8 AERA Open 1, 3 (2022) (“The 

lack of in-person interaction in online courses can lead to a sense of 

isolation and disconnectedness from a learning community, and can 

make it more difficult for students to engage with and learn from peers 

and instructors.” (citation omitted)).
14 RAIDOO V. MOYLAN

It is thus reasonable for Guam to prefer an in-person 

meeting before a pregnant woman moves forward with the 

weighty decision of having an abortion. For example, an inperson meeting can advance the state’s goal of protecting the 

health of the mother because a face-to-face meeting can feel 

less rushed and more intimate than a phone call or a virtual 

meeting. A pregnant woman may ask more follow-up 

questions in a face-to-face meeting, leading to a more 

detailed discussion about the potential impact of an abortion 

(or giving birth) on her health. See Dobbs, 142 S. Ct. at 2284 

(“legitimate interests include . . . the protection of maternal 

health and safety”). 

Similarly, in the more solemn context of a face-to-face 

meeting—unlike a Zoom call—a pregnant woman may 

decide against an abortion after having a candid conversation 

at the clinic about the gestational age of her fetus and 

concluding that the fetus represents human life. See 10 

Guam Code Ann. § 3218.1(b)(1)(B)–(F) (requiring, among 

other things, disclosure of gestational age of her fetus). Or a 

pregnant woman may take more time to reconsider an 

abortion after learning of social welfare programs that assist 

mothers with newborns. See 10 Guam Code Ann. 

§ 3218.1(b)(2)(A)–(F) (requiring disclosure of information, 

among other things, about medical assistance benefits, 

public assistance for her child, adoption options, and the 

father’s liability for child support). It also may turn out that 

the in-person meeting does not affect a woman’s decision 

and may even reaffirm her conviction to move forward with 

an abortion. Regardless of the law’s actual impact on a given 

woman’s decision, we cannot deny that the in-person 

requirement could rationally serve a legitimate state interest 

in protecting fetal life. Dobbs, 142 S. Ct. at 2284. 
RAIDOO V. MOYLAN 15

Finally, a face-to-face meeting can further the legitimate 

state goal of “the preservation of the integrity of the medical 

profession.” Id. While telemedicine has been a boon for 

many patients, it can implicate certain ethical issues for 

physicians. See, e.g., Danielle Chaet, Ron Clearield, James 

E. Sabin & Kathryn Skimming, Ethical Practice in 

Telehealth and Telemedicine, 32 J. Gen. Internal Med. 1136 

(2017)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602756/.

The ethical questions can range from privacy protection

(e.g., virtual calls may not be as secure as a meeting in a 

doctor’s office) to more serious problems (e.g., questions 

about transparency and informed consent in a potentially 

more rushed virtual setting). Id. Guam’s law could 

potentially place a guardrail against such potential problems. 

In sum, so long as the law rests on “rational speculation,” 

we must uphold it under rational basis review. Beach 

Commc’ns, Inc., 508 U.S. at 315. Guam has met that low 

legal bar of offering a rational basis for requiring an inperson consultation before a pregnant woman moves 

forward with an abortion. Ultimately, we cannot “substitute 

[our] social and economic beliefs for the judgment of 

legislative bodies.” Dobbs, 142 S. Ct. at 2284.

2. Plaintiffs’ as-applied challenge fails because 

enforcement of the in-person requirement 

does not undermine informed consent. 

Plaintiffs also offer a more nuanced argument that the inperson consultation requirement undermines informed 

consent here because of the possibility that non-medical 

personnel may provide the required medical disclosures. 

This argument, too, fails. 
16 RAIDOO V. MOYLAN

Informed consent is grounded in “the patient’s interest in 

achieving his [or her] own determination on treatment,” 

Canterbury v. Spence, 464 F.2d 772, 787 (D.C. Cir. 1972), 

and “is meant to ensure that each patient has the information 

she needs to meaningfully consent to medical procedures.” 

Stuart v. Camnitz, 774 F.3d 238, 251 (4th Cir. 2014) 

(cleaned up). Informed consent thus generally imposes a 

duty to disclose all material facts related to a patient’s 

treatment or procedure. See, e.g., Harbeson v. Parke Davis, 

Inc., 746 F.2d 517, 522 (9th Cir. 1984).

Because no physicians currently provide abortion 

services in Guam, Plaintiffs contend that the in-person 

requirement undermines the very purpose of Guam’s 

informed-consent statute to provide “complete and accurate

information material to her decision to undergo an abortion.” 

Guam Pub. L. 31-235 (2012). Plaintiffs assert that Guam’s 

law would effectively mean that a Guam-based counselor, 

psychologist, or social worker—not the treating physician—

would convey medical information to a woman considering 

an abortion.

But Guam’s law does not mandate that a non-medical 

professional provide the in-person medical disclosures, nor 

does it prevent the treating telemedicine doctor from 

providing medical information to the patient. Indeed, 

doctors generally have an ethical duty to patients to provide 

all relevant information and answer questions. See, e.g., 

Harbeson, 746 F.2d at 522; see also Committee on Ethics, 

American College of Obstetricians and Gynecologists,

Informed Consent and Shared Decision Making in 

Obstetrics and Gynecology, 137 Obstetrics & Gynecology 

e34, e35 (2021) (Committee Opinion No. 819) (stating that 

“[m]eeting the ethical obligations of informed consent 

requires that an obstetrician–gynecologist gives the patient 
RAIDOO V. MOYLAN 17

adequate, accurate, and understandable information”). In 

other words, Guam’s statute sets a minimum disclosure 

requirement for informed consent, not a maximum. It does 

not prevent the treating doctor from providing the same 

information or more information; it merely requires that 

patients receive certain information in person before

receiving an abortion. See generally 10 Guam Code Ann.

§ 3218.1. 

Plaintiffs imply that Guam’s informed-consent statute 

could be more effective if it required a physician to provide 

the state-mandated information. But it does not matter under 

rational basis review that the “fit between [the] means and 

[the] ends” of the statute may be “imperfect”: “courts are 

compelled” to uphold the statute if it bears a rational 

relationship to some legitimate governmental purpose. 

Aleman v. Glickman, 217 F.3d 1191, 1201 (9th Cir. 2000) 

(cleaned up). And Guam’s informed-consent statute bears a 

rational relationship to the preservation of fetal life and 

health of the mother because an in-person requirement 

ensures a more intimate setting for a woman to receive 

information before she makes the final decision to terminate 

fetal life.

In any event, it is unclear from the record that Guam 

patients will receive informed-consent information from 

only non-medical professionals. To start, the law does not 

require a non-medical professional to provide the medical 

information. The treating physician chooses his or her 

qualified agent to provide the information, and presumably 

the doctor will select the appropriate person under the 

patient’s unique circumstances. As Plaintiffs themselves 

state, “there is nothing intrinsically unreasonable about a 

physician delegating the responsibility for the informed 
18 RAIDOO V. MOYLAN

consent conversation to another physician or health care 

professional who is sufficiently knowledgeable about the 

relevant treatment or procedure to facilitate the informed 

consent process.”

Further, Plaintiffs’ declarations make clear that there are 

“multiple supportive physicians in Guam who are willing to 

provide pre- and post-abortion” care, even if they do not 

want to personally perform abortions. Put another way, 

nothing in the record shows that those same physicians are 

unwilling to provide the state-mandated informed-consent 

information to patients.

4 In the end, Plaintiffs have not met 

their burden “to negative every conceivable basis which 

might support” the law. Beach Commc’ns, Inc., 508 U.S. at 

315.

In short, the in-person requirement does not violate the 

Due Process Clause as it furthers Guam’s legitimate state 

interests and does not undermine informed consent.

3. Plaintiffs’ equal protection claim also fails 

because abortion is meaningfully different 

from other medical procedures. 

Finally, Plaintiffs assert that Guam’s in-person 

informed-consent law violates their equal protection rights

because it irrationally treats physicians who provide 

abortions “differently than similarly situated telemedicine 

providers.” That claim also fails.

4 At oral argument, Plaintiffs stated for the first time that the physicians 

who provide pre- and post-abortion care would not be willing to provide 

in-person consultations because they would have to formally associate 

themselves with abortion providers and that they refuse to do so. But the 

record is silent about this contention.
RAIDOO V. MOYLAN 19

We review equal protection challenges under rational 

basis unless the law “impermissibly interferes with the 

exercise of a fundamental right or operates to the peculiar 

disadvantage of a suspect class.” Mass. Bd. of Ret. v. 

Murgia, 427 U.S. 307, 312 (1976). Heightened scrutiny 

does not apply here because abortion is not a fundamental 

right, and no suspect class is at play. See United States v. 

Whitlock, 639 F.3d 935, 940 (9th Cir. 2011). 

Under rational basis review, a legislative “classification 

must be upheld against equal protection challenge if there is 

any reasonably conceivable state of facts that could provide 

a rational basis for the classification.” Gallinger v. Becerra, 

898 F.3d 1012, 1017 (9th Cir. 2018) (emphasis omitted)

(quoting Heller v. Doe, 509 U.S. 312, 320 (1993)). Put 

another way, a law that differentiates between similarly 

situated groups is constitutional if it “bears a reasonable 

relationship to a legitimate governmental interest.” United 

States. v. LeMay, 260 F.3d 1018, 1031 (9th Cir. 2001). 

Even assuming that doctors who perform abortions are 

otherwise similarly situated to doctors who perform other 

medical services, it was rational for the Guam legislature to 

treat them differently because abortion presents different 

considerations than other medical procedures. Unlike other 

medical procedures, abortion implicates fetal life in addition 

to the patient’s health. See Dobbs, 142 S. Ct. at 2277

(“‘[A]bortion is a unique act’ because it terminates ‘life or 

potential life.’”); Harris v. McRae, 448 U.S. 297, 325 (1980) 

(“Abortion is inherently different from other medical 

procedures, because no other procedure involves the 

purposeful termination of a potential life.”). The in-person 

requirement “bear[s] a reasonable relationship to [the]

legitimate governmental interest” of safeguarding fetal life. 

Whitlock, 639 F.3d at 940 (cleaned up). Guam’s law thus 
20 RAIDOO V. MOYLAN

survives rational basis review and does not violate the Equal 

Protection Clause.

IV. CONCLUSION

As the Supreme Court has instructed, abortion policy is

best left to the people’s representatives. Dobbs, 142 S. Ct. 

at 2243. And when the legislature, as it must, “engage[s] in 

a process of line-drawing,” United States R.R. Ret. Bd. v. 

Fritz, 449 U.S. 166, 179 (1980), the Supreme Court has 

routinely emphasized that the legislature “must be allowed 

leeway” in its approach, Beach Commc’ns, Inc., 508 U.S. at 

316. Guam can enact laws that it believes are best for its 

people, even if some people might strenuously oppose such 

laws or think them unwise. 

We hold that Plaintiffs have failed to show a likelihood 

of success on the merits that the in-person informed-consent 

requirement of 10 Guam Code Ann. § 3218.1 fails rational

basis review. We thus vacate the district court’s grant of a 

preliminary injunction. Garcia v. Google, Inc., 786 F.3d 

733, 740 (9th Cir. 2015) (en banc).

VACATED.