Task: sc_lcdispositiondirection

What follows is an opinion from the Supreme Court of the United States. Your task is to determine whether the decision of the court whose decision the Supreme Court reviewed was itself liberal or conservative. In the context of issues pertaining to criminal procedure, civil rights, First Amendment, due process, privacy, and attorneys, consider liberal to be pro-person accused or convicted of crime, or denied a jury trial, pro-civil liberties or civil rights claimant, especially those exercising less protected civil rights (e.g., homosexuality), pro-child or juvenile, pro-indigent pro-Indian, pro-affirmative action, pro-neutrality in establishment clause cases, pro-female in abortion, pro-underdog, anti-slavery, incorporation of foreign territories anti-government in the context of due process, except for takings clause cases where a pro-government, anti-owner vote is considered liberal except in criminal forfeiture cases or those where the taking is pro-business violation of due process by exercising jurisdiction over nonresident, pro-attorney or governmental official in non-liability cases, pro-accountability and/or anti-corruption in campaign spending pro-privacy vis-a-vis the 1st Amendment where the privacy invaded is that of mental incompetents, pro-disclosure in Freedom of Information Act issues except for employment and student records. In the context of issues pertaining to unions and economic activity, consider liberal to be pro-union except in union antitrust where liberal = pro-competition, pro-government, anti-business anti-employer, pro-competition, pro-injured person, pro-indigent, pro-small business vis-a-vis large business pro-state/anti-business in state tax cases, pro-debtor, pro-bankrupt, pro-Indian, pro-environmental protection, pro-economic underdog pro-consumer, pro-accountability in governmental corruption, pro-original grantee, purchaser, or occupant in state and territorial land claims anti-union member or employee vis-a-vis union, anti-union in union antitrust, anti-union in union or closed shop, pro-trial in arbitration. In the context of issues pertaining to judicial power, consider liberal to be pro-exercise of judicial power, pro-judicial "activism", pro-judicial review of administrative action. In the context of issues pertaining to federalism, consider liberal to be pro-federal power, pro-executive power in executive/congressional disputes, anti-state. In the context of issues pertaining to federal taxation, consider liberal to be pro-United States and conservative pro-taxpayer. In miscellaneous, consider conservative the incorporation of foreign territories and executive authority vis-a-vis congress or the states or judcial authority vis-a-vis state or federal legislative authority, and consider liberal legislative veto. The lower court's decision direction is unspecifiable if the manner in which the Supreme Court took jurisdiction is original or certification; or if the direction of the Supreme Court's decision is unspecifiable and the main issue pertains to private law or interstate relations

Justice Stevens
announced the judgment of the Court and delivered the opinion of the Court with respect to Parts I, II, III, V, and VII, and an opinion with respect to Parts IV and VI, in which Justice Kennedy, Justice Souter, and Justice Ginsburg join.
Congress enacted the Medical Device Amendments of 1976, in the words of the statute’s preamble, “to provide for the safety and effectiveness of medical devices intended for human use.” 90 Stat. 539. The question presented is whether that statute pre-empts a state common-law negligence action against the manufacturer of an allegedly defective medical device. Specifically, we must consider whether Lora Lohr, who was injured when her pacemaker failed, may rely on Florida common law to recover damages from Med-tronic, Inc., the manufacturer of the device.
HH
Throughout our history the several States have exercised their police powers to protect the health and safety of their citizens. Because these are “primarily, and historically,... matter[s] of local concern,” Hillsborough County v. Automated, Medical Laboratories, Inc., 471 U. S. 707, 719 (1985), the “States traditionally have had great latitude under their police powers to legislate as to the protection of the lives, limbs, health, comfort, and quiet of all persons,” Metropolitan Life Ins. Co. v. Massachusetts, 471 U. S. 724, 756 (1985) (internal quotation marks omitted).
Despite the prominence of the States in matters of public health and safety, in recent decades the Federal Government has played an increasingly significant role in the protection of the health of our people. Congress’ first significant enactment in the field of public health was the Food and Drug Act of 1906, a broad prohibition against the manufacture or shipment in interstate commerce of any adulterated or mis-branded food or drug. See 34 Stat. 768; Regier, The Struggle for Federal Food and Drugs Legislation, 1 Law & Contemp. Prob. 1 (1933). Partly in response to an ongoing concern about radio and newspaper advertising making false therapeutic claims for both “quack machines” and legitimate devices such as surgical instruments and orthopedic shoes, in 1938 Congress broadened the coverage of the 1906 Act to include misbranded or adulterated medical devices and cosmetics. See Federal Food, Drug, and Cosmetic Act of 1938 (FDCA), §§501, 502, 52 Stat. 1049-1051; Cavers, The Food, Drug, and Cosmetic Act of 1938: Its Legislative History and Its Substantive Provisions, 6 Law & Contemp. Prob. 2 (1939); H. R. Rep. No. 94-853, p. 6 (1976).
While the FDCA provided for premarket approval of new drugs, Cavers, 6 Law & Contemp. Prob., at 40, it did not authorize any control over the introduction of new medical devices, see S. Rep. No. 93-670, pp. 1-2 (1974); H. R. Rep. No. 94-853, at 6. As technologies advanced and medicine relied to an increasing degree on a vast array of medical equipment “[f]rom bedpans to brainscans,” including kidney dialysis units, artificial heart valves, and heart pacemakers, policymakers and the public became concerned about the increasingly severe injuries that resulted from the failure of such devices. See generally Finck, The Effectiveness of FDA Medical Device Regulation, 7 U. C. D. L. Rev. 293, 297-301 (1974); H. R. Rep. No. 94-853, at 7.
In 1970, for example, the Daikon Shield, an intrauterine contraceptive device, was introduced to the American public and throughout the world. Touted as a safe and effective contraceptive, the Daikon Shield resulted in a disturbingly high percentage of inadvertent pregnancies, serious infections, and even, in a few cases, death. Id., at 8; Regulation of Medical Devices (Intrauterine Contraceptive Devices), Hearings before a Subcommittee of the House Committee on Government Operations, 93d Cong., 1st Sess. (1973). In the early 1970’s, several other devices, including catheters, artificial heart valves, defibrillators, and pacemakers (including pacemakers manufactured by petitioner Medtronic), attracted the attention of consumers, the Food and Drug Administration (FDA), and Congress as possible health risks. See Medical Device Amendments, 1973, Hearings before the Subcommittee on Health of the Senate Committee on Labor and Public Welfare, 93d Cong., 2d Sess., 270-361 (1973).
In response to the mounting consumer and regulatory concern, Congress enacted the statute at issue here: the Medical Device Amendments of 1976 (MDA or Act), 90 Stat. 539. The Act classifies medical devices in three categories based on the risk that they pose to the public. Devices that present no unreasonable risk of illness or injury are designated Class I and are subject only to minimal regulation by “general controls.” 21 U. S. C. § 360c(a)(l)(A). Devices that are potentially more harmful are designated Class II; although they may be marketed without advance approval, manufacturers of such devices must comply with federal performance regulations known as “special controls.” § 360c(a)(l)(B). Finally, devices that either “presenft] a potential unreasonable risk of illness or injury,” or which are “purported or represented to be for a use in supporting or sustaining human life or for a use which is of substantial importance in preventing impairment of human health,” are designated Class III. § 360c(a)(l)(C). Pacemakers are Class III devices. See 21 CFR §870.3610 (1995).
Before a new Class III device may be introduced to the market, the manufacturer must provide the FDA with a “reasonable assurance” that the device is both safe and effective. See 21 U. S. C. § 360e(d)(2). Despite its relatively innocuous phrasing, the process of establishing this “reasonable assurance,” which is known as the “premarket approval,” or “PMA” process, is a rigorous one. Manufacturers must submit detailed information regarding the safety and efficacy of their devices, which the FDA then reviews, spending an average of 1,200 hours on each submission. Hearings before the Subcommittee on Health and the Environment of the House Committee on Energy & Commerce, 100th Cong., 1st Sess. (Ser. No. 100-34), p. 384 (1987) (hereinafter 1987 Hearings); see generally Kahan, Premarket Approval Versus Premarket Notification: Different Routes to the Same Market, 39 Food Drug Cosm. L. J. 510, 512-514 (1984).
Not all, nor even most, Class III devices on the market today have received premarket approval because of two important exceptions to the PMA requirement. First, Congress realized that existing medical devices could not be withdrawn from the market while the FDA completed its PMA analysis for those devices. The statute therefore includes a “grandfathering” provision which allows pre-1976 devices to remain on the market without FDA approval until such time as the FDA initiates and completes the requisite PMA. See 21 U. S. C. § 360e(b)(l)(A); 21 CFR § 814.1(c)(1) (1995). Second, to prevent manufacturers of grandfathered devices from monopolizing the market while new devices clear the PMA hurdle, and to ensure that improvements to existing devices can be rapidly introduced into the market, the Act also permits devices that are “substantially equivalent” to pre-existing devices to avoid the PMA process. See 21 U. S. C. § 360e(b)(l)(B).
Although “substantially equivalent” Class III devices may be marketed without the rigorous PMA review, such new devices, as well as all new Class I and Class II devices, are subject to the requirements of §360(k). That section imposes a limited form of review on every manufacturer intending to market a new device by requiring it to submit a “pre-market notification” to the FDA (the process is also known as a “§ 510(k) process,” after the number of the section in the original Act). If the FDA concludes on the basis of the § 510(k) notification that the device is “substantially equivalent” to a pre-existing device, it can be marketed without further regulatory analysis (at least until the FDA initiates the PMA process for the underlying pre-1976 device to which the new device is “substantially equivalent”). The § 510(k) notification process is by no means comparable to the PMA process; in contrast to the 1,200 hours necessary to complete a PMA review, the § 510(k) review is completed in an average of only 20 hours. See 1987 Hearings, at 384. As one commentator noted: “The attraction of substantial equivalence to manufacturers is clear. [Section] 510(k) notification requires little information, rarely elicits a negative response from the FDA, and gets processed very quickly.” Adler, The 1976 Medical Device Amendments: A Step in the Right Direction Needs Another Step in the Right Direction, 43 Food Drug Cosm. L. J. 511, 516 (1988); see also Kahan, 39 Food Drug Cosm. L. J., at 514-519.
Congress anticipated that the FDA would complete the PMA process for Class III devices relatively swiftly. But because of the substantial investment of time and energy necessary for the resolution of each PMA application, the ever-increasing numbers of medical devices, and internal administrative and resource difficulties, the FDA simply could not keep up with the rigorous PMA process. As a result, the § 510(k) premarket notification process became the means by which most new medical devices — including Class III devices — were approved for the market. In 1983, for instance, a House Report concluded that nearly 1,000 of approximately 1,100 Class III devices that had been introduced to the market since 1976 were admitted as “substantial equivalents” and without any PMA review. See Medical Device Regulation: The FDA’s Neglected Child (Committee Print compiled for the Subcommittee on Oversight and Investigations of the House Committee on Energy and Commerce), Comm. Print 98-F, p. 34 (1983). This lopsidedness has apparently not evened out; despite an increasing effort by the FDA to consider the safety and efficacy of substantially equivalent devices, the House reported in 1990 that 80% of new Class III devices were being introduced to the market through the §510(k) process and without PMA review. H. R. Rep. No. 101-808, p. 14 (1990); see also D. Kessler, S. Pape, & D. Sundwall, The Federal Regulation of Medical Devices, 317 New England J. Med. 357,359 (1987) (55 § 510(k) notifications are filed for each PMA application; average FDA response to § 510(k) notification is one-fifth the response time to a PMA).
II
As have so many other medical device manufacturers, petitioner Medtronic took advantage of §510(k)’s expedited process in October 1982, when it notified the FDA that it intended to market its Model 4011 pacemaker lead as a device that was “substantially equivalent” to devices already on the market. (The lead is the portion of a pacemaker that transmits the heartbeat-steadying electrical signal from the “pulse generator” to the heart itself.) On November 30, 1982, the FDA found that the model was “substantially equivalent to devices introduced into interstate commerce” prior to the effective date of the Act, and advised Medtronic that it could therefore market its device subject only to the general control provisions of the Act, which could be found in the Code of Federal Regulations. See Respondent’s Memorandum in Support of Motion for Summary Judgment in No. 93-482 (MD Fla., Nov. 1,1993), Exh. A to Exh. 1 (Declaration of Charles H. Swanson) (hereinafter FDA Substantial Equivalence Letter). The agency emphasized, however, that this determination should not be construed as an endorsement of the pacemaker lead’s safety. Ibid.
Cross-petitioner Lora Lohr is dependent on pacemaker technology for the proper functioning of her heart.. In 1987 she was implanted with a Medtronic pacemaker equipped with one of the company’s Model 4011 pacemaker leads. On December 30,1990, the pacemaker failed, allegedly resulting in a “complete heart block” that required emergency surgery. According to her physician, a defect in the lead was the likely cause of the failure.
In 1993 Lohr and her husband filed this action in a Florida state court. Their complaint contained both a negligence count and a strict-liability count. The negligence count alleged a breach of Medtronic’s “duty to use reasonable care in the design, manufacture, assembly, and sale of the subject pacemaker” in several respects, including the use of defective materials in the lead and a failure to warn or properly instruct the plaintiff or her physicians of the tendency of the pacemaker to fail, despite knowledge of other earlier failures. Complaint ¶ 5. The strict-liability count alleged that the device was in a defective condition and unreasonably dangerous to foreseeable users at the time of its sale. Id., ¶ 11. (A third count alleging breach of warranty was dismissed for failure to state a claim under Florida law.)
Medtronic removed the case to Federal District Court, where it filed a motion for summary judgment arguing that both the negligence and strict-liability claims were preempted by 21 U. S. C. § 360k(a). That section, which is at the core of the dispute between the parties in this suit, provides:
“§360k. State and local requirements respecting devices
“(a) General rule
“Except as provided in subsection (b) of this section, no State or political subdivision of a State may establish or continue in effect with respect to a device intended for human use any requirement—
“(1) which is different from, or in addition to, any requirement applicable under this chapter to the device, and
“(2) which relates to the safety or effectiveness of the device or to any other matter included in a requirement applicable to the device under this chapter.”
The District Court initially denied Medtronic's motion, finding nothing in the statute to support the company’s argument that the MDA entirely exempted from liability a manufacturer who had allegedly violated the FDA’s regulations. See App. to Pet. for Cert. 5d. Not long after that decision, however, the United States Court of Appeals for the Eleventh Circuit concluded that §360k required pre-emption of at least some common-law claims brought against the manufacturer of a medical device. See Duncan v. Iolab Corp., 12 F. 3d 194 (1994). After reconsidering its ruling in light of Duncan, the District Court reversed its earlier decision and dismissed the Lohrs’ entire complaint.
The Court of Appeals reversed in part and affirmed in part. 56 F. 3d 1335 (CA11 1995). Rejecting the Lohrs’ broadest submission, it first decided that “common law actions are state requirements within the meaning of §360k(a).” Id., at 1342. It next held that pre-emption could not be avoided by merely alleging that the negligence flowed from a violation of federal standards. Id., at 1343. Then, after concluding that the term “requirements” in §360k(a) was unclear, it sought guidance from FDA’s regulations regarding pre-emption. Those regulations provide that a state requirement is not pre-empted unless the FDA has established “ ‘specific requirements applicable to a particular device.’ ” Id., at 1344 (citing 21 CFR § 808.1(d) (1995)). Under these regulations, the court concluded, it was not necessary that the federal regulation specifically deal with pacemakers, but only that the federal requirement “should, in some way, be ‘restricted by nature’ to a particular process, procedure, or device and should not be completely open-ended,” 56 F. 3d, at 1346 (footnote omitted), and that the specific device at issue should be subject to its requirements.
Under this approach, the court concluded that the Lohrs’ negligent design claims were not pre-empted. It rejected Medtronic’s argument that the FDA’s finding of “substantial equivalence” had any significance with respect to the pacemaker’s safety, or that the FDA’s continued surveillance of the device constituted a federal “requirement” that its design be maintained. Id., at 1347-1349. On the other hand, it concluded that the negligent manufacturing and failure to warn claims were pre-empted by FDA’s general “good manufacturing practices” regulations, which establish general requirements for most steps in every device’s manufacture, see id., at 1350; 21 CFR §§820.20-820.198 (1995), and by the FDA labeling regulations, which require devices to bear various warnings, see 56 F. 3d, at 1350-1351; 21 CFR §801.109 (1995). The court made a parallel disposition of the strict-liability claims, holding that there was no pre-emption insofar as plaintiffs alleged an unreasonably dangerous design, but they could not revive the negligent manufacturing or failure to warn claims under a strict-liability theory. 56 F. 3d, at 1351-1352.
Medtronic filed a petition for certiorari seeking review of the Court of Appeals’ decision insofar as it affirmed the District Court and the Lohrs filed a cross-petition seeking review of the judgment insofar as it upheld the pre-emption defense. Because the Courts of Appeals are divided over the extent to which state common-law claims are pre-empted by the MDA, we granted both petitions. 516 U. S. 1087 (1996).
Ill
As in Cipollone v. Liggett Group, Inc., 505 U. S. 504 (1992), we are presented with the task of interpreting a statutory provision that expressly pre-empts state law. While the pre-emptive language of § 360k(a) means that we need not go beyond that language to determine whether Congress intended the MDA to pre-empt at least some state law, see id., at 517, we must nonetheless “identify the domain expressly pre-empted” by that language, ibid. Although our analysis of the scope of the pre-emption statute must begin with its text, see Gade v. National Solid Wastes Management Assn., 505 U. S. 88, 111 (1992) (Kennedy, J., concurring in part and concurring in judgment), our interpretation of that language does not occur in a contextual vacuum. Rather, that interpretation is informed by two presumptions about the nature of pre-emption. See ibid.
First, because the States are independent sovereigns in our federal system, we have long presumed that Congress does not cavalierly pre-empt state-law causes of action. In all pre-emption cases, and particularly in those in which Congress has “legislated... in a field which the States have traditionally occupied,” Rice v. Santa Fe Elevator Corp., 331 U. S. 218, 230 (1947), we “start with the assumption that the historic police powers of the States were not to be superseded by the Federal Act unless that was the clear and manifest purpose of Congress.” Ibid.; Hillsborough Cty., 471 U. S., at 715-716; cf. Fort Halifax Packing Co. v. Coyne, 482 U. S. 1, 22 (1987). Although dissenting Justices have argued that this assumption should apply only to the question whether Congress intended any pre-emption at all, as opposed to questions concerning the scope of its intended invalidation of state law, see Cipollone, 505 U. S., at 545-546 (Scalia, J., concurring in judgment in part and dissenting in part), we used a “presumption against the pre-emption of state police power regulations” to support a narrow inter-:? pretation of such an express command in Cipollone. Id., at 518, 523. That approach is consistent with both federalism concerns and the historic primacy of state regulation of matters of health and safety.
Second, our analysis of the scope of the statute’s preemption is guided by our oft-repeated comment, initially made in Retail Clerks v. Schermerhorn, 375 U. S. 96, 103 (1963), that “[t]he purpose of Congress is the ultimate touchstone” in every pre-emption case. See, e. g., Cipollone, 505 U. S., at 516; Gade, 505 U. S., at 96; Malone v. White Motor Corp., 435 U. S. 497, 504 (1978). As a result, any understanding of the scope of a pre-emption statute must rest primarily on “a fair understanding of congressional purpose.” Cipollone, 505 U. S., at 530, n. 27 (opinion of Stevens, J.). Congress’ intent, of course, primarily is discerned from the language of the pre-emption statute and the “statutory framework” surrounding it. Gade, 505 U. S., at 111 (Kennedy, J., concurring in part and concurring in judgment). Also relevant, however, is the “structure and purpose of the statute as a whole,” id., at 98 (opinion of O’Connor, J.), as revealed not only in the text, but through the reviewing court’s reasoned understanding of the way in which Congress intended the statute and its surrounding regulatory scheme to affect business, consumers, and the law.
With these considerations in mind, we turn first to a consideration of petitioner Medtronic’s claim that the Court of Appeals should have found the entire action pre-empted and then to the merits of the Lohrs’ cross-petition.
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In its petition, Medtronic argues that the Court of Appeals erred by concluding that the Lohrs’ claims alleging negligent design were not pre-empted by 21 U. S. C. § 360k(a). That section provides that “no State or political subdivision of a State may establish or continue in effect with respect to a device intended for human use any requirement (1) which is different from, or in addition to, any requirement applicable under this chapter to the device, and (2) which relates to the safety or effectiveness of the device or to any other matter included in a requirement applicable to the device under this chapter.” Medtronic suggests that any common-law cause of action is a “requirement” which alters incentives and imposes duties “different from, or in addition to,” the generic federal standards that the FDA has promulgated in response to mandates under the MDA. In essence, the company argues that the plain language of the statute pre-empts any and all common-law claims brought by an injured plaintiff against a manufacturer of medical devices.
Medtronic’s argument is not only unpersuasive, it is implausible. Under Medtronic’s view of the statute, Congress effectively precluded state courts from affording state consumers any protection from injuries resulting from a defective medical device. Moreover, because there is no explicit private cause of action against manufacturers contained in the MDA, and no suggestion that the Act created an implied private right of action, Congress would have barred most, if not all, relief for persons injured by defective medical devices. Medtronic’s construction of §360k would therefore have the perverse effect of granting complete immunity from design defect liability to an entire industry that, in the judgment of Congress, needed more stringent regulation in order “to provide for the safety and effectiveness of medical devices intended for human use,” 90 Stat. 539 (preamble to Act). It is, to say the least, “difficult to believe that Congress would, without comment, remove all means of judicial recourse for those injured by illegal conduct,” Silkwood v. Kerr-McGee Corp., 464 U. S. 238, 251 (1984), and it would take language much plainer than the text of §360k to convince us that Congress intended that result.
Furthermore, if Congress intended to preclude all common-law causes of action, it chose a singularly odd word with which to do it. The statute would have achieved an identical result, for instance, if it had precluded any “remedy” under state law relating to medical devices. “Requirement” appears to presume that the State is imposing a specific duty upon the manufacturer, and although we have on prior occasions concluded that a statute pre-empting certain state “requirements” could also pre-empt common-law damages claims, see Cipollone, 505 U. S., at 521-522 (opinion of Stevens, J.), that statute did not sweep nearly as broadly as Medtronic would have us believe that this statute does.
The pre-emptive statute in Cipollone was targeted at a limited set of state requirements — those “based on smoking and health” — and then only at a limited subset of the possible applications of those requirements — those involving the “advertising or promotion of any cigarettes the packages of which are labeled in conformity with the provisions of” the federal statute. See id., at 515. In that context, giving the term “requirement” its widest reasonable meaning did not have nearly the pre-emptive scope nor the effect on potential remedies that Medtronic’s broad reading of the term would have in this suit. The Court in Cipollone held that the petitioner in that case was able to maintain some common-law actions using theories of the case that did not run afoul of the pre-emption statute. See id., at 524-530. Here, however, Medtronic’s sweeping interpretation of the statute would require far greater interference with state legal remedies, producing a serious intrusion into state sovereignty while simultaneously wiping out the possibility of remedy for the Lohrs’ alleged injuries. Given the ambiguities in the statute and the scope of the preclusion that would occur otherwise, we cannot accept Medtronic’s argument that by using the term “requirement,” Congress clearly signaled its intent to deprive States of any role in protecting consumers from the dangers inherent in many medical devices.
Other differences between this statute and the one in Cipollone further convince us that when Congress enacted § 360k, it was primarily concerned with the problem of specific, conflicting state statutes and regulations rather than the general duties enforced by common-law actions. Unlike the statute at issue in Cipollone, §360k refers to “requirements” many times throughout its text. In each instance, the word is linked with language suggesting that its focus is device-specific enactments of positive law by legislative or administrative bodies, not the application of general rules of common law by judges and juries. For instance, subsections (a)(2) and (b) of the statute also refer to “requirements”— but those “requirements” refer only to statutory and regulatory law that exists pursuant to the MDA itself, suggesting that the pre-empted “requirements” established or continued by States also refer primarily to positive enactments of state law. Moreover, in subsection (b) the FDA is given authority to exclude certain “requirements” from the scope of the preemption statute. Of the limited number of “exemptions” from pre-emption that the FDA has granted, none even remotely resemble common-law claims.
An examination of the basic purpose of the legislation as well as its history entirely supports our rejection of Med-tronic’s extreme position. The MDA was enacted “to provide for the safety and effectiveness of medical devices intended for human use.” 90 Stat. 539. Medtronic asserts that the Act was also intended, however, to “protect innovations in device technology from being ‘stifled by unnecessary restrictions,’ ” Brief for Petitioner in No. 95-754, p. 3 (citing H. R. Rep. No. 94-853, at 12), and that this interest extended to the pre-emption of common-law claims. While the Act certainly reflects some of these concerns, the legislative history indicates that any fears regarding regulatory burdens were related more to the risk of additional federal and state regulation rather than the danger of pre-existing duties under common law. See, e. g., 122 Cong. Rec. 5850 (1976) (statement of Rep. Collins) (opposing further “redundant and burdensome Federal requirements”); id., at 5855 (discussing efforts taken in MDA to protect small businesses from the additional requirements of the Act). Indeed, nowhere in the materials relating to the Act’s history have we discovered a reference to a fear that product liability actions would hamper the development of medical devices. To the extent that Congress was concerned about protecting the industry, that intent was manifested primarily through fewer substantive requirements under the Act, not the pre-emption provision; furthermore, any such concern was far outweighed by concerns about the primary issue motivating the MDA’s enactment: the safety of those who use medical devices.
The legislative history also confirms our understanding that § 360(k) simply was not intended to pre-empt most, let alone all, general common-law duties enforced by damages actions. There is, to the best of our knowledge, nothing in the hearings, the Committee Reports, or the debates suggesting that any proponent of the legislation intended a sweeping pre-emption of traditional common-law remedies against manufacturers and distributors of defective, devices. If Congress intended such a result, its failure even to hint at it is spectacularly odd, particularly since Members of both Houses were acutely aware of ongoing product liability litigation. Along with the less-than-precise language of §360k(a), that silence surely indicates that at least some common-law claims against medical device manufacturers may be maintained after the enactment of the MDA.
V
Medtronic asserts several specific reasons why, even if § 360k does not pre-empt all common-law claims, it at least pre-empts the Lohrs’ claims in this suit. In contrast, the Lohrs argue that their entire complaint should survive a reasonable evaluation of the pre-emptive scope of §360k(a). First, the Lohrs claim that the Court of Appeals correctly held that their negligent design claims were not pre-empted because the § 510(k) premarket notification process imposes no “requirement” on the design of Medtronic’s pacemaker. Second, they suggest that even if the FDA’s general rules regulating manufacturing practices and labeling are “requirements” that pre-empt different state requirements, § 360k(a) does not pre-empt state rules that merely duplicate some or all of those federal requirements. Finally, they argue that because the State’s general rules imposing' common-law duties upon Medtronic do not impose a requirement “with respect to a device,” they do not conflict with the FDA’s general rules relating to manufacturing and labeling and are therefore not pre-empted.
Design Claim
The Court of Appeals concluded that the Lohrs’ defective design claims were not pre-empted because the requirements with which the company had to comply were not sufficiently concrete to constitute a pre-empting federal requirement. Medtronic counters by pointing to the FDA’s determination that Model 4011 is “substantially equivalent” to an earlier device as well as the agency’s continuing authority to exclude the device from the market if its design is changed. These factors, Medtronic argues, amount to a specific, federally enforceable design requirement that cannot be affected by state-law pressures such as those imposed on manufacturers subject to product liability suits.
The company’s defense exaggerates the importance of the § 510(k) process and the FDA letter to the company regarding the pacemaker’s substantial equivalence to a grandfathered device. As the court below noted, “[t]he 510(k) process is focused on equivalence, not safety.” 56 F. 3d, at 1348. As a result, “substantial equivalence determinations provide little protection to the public. These determinations simply compare a post-1976 device to a pre-1976 device to ascertain whether the later device is no more dangerous and no less effective than the earlier device. If the earlier device poses a severe risk or is ineffective, then the later device may also be risky or ineffective.” Adler, 43 Food Drug Cosm. L. J., at 516. The design of the Model 4011, as with the design of pre-1976 and other “substantially equivalent” devices, has never been formally reviewed under the MDA for safety or efficacy.
The FDA stressed this basic conclusion in its letter to Medtronic finding the 4011 lead “substantially equivalent” to devices already on the market. That letter only required Medtronic to comply with “general standards” — the lowest level of protection “applicable to all medical devices,” and including “listing of devices, good manufacturing practices, labeling, and the misbranding and adulteration provisions of the Act.” It explicitly warned Medtronic that the letter did “not in any way denote official FDA approval of your device,” and that “[a]ny representation that creates an impression of official approval of this device because of compliance with the premarket notification regulations is misleading and constitutes misbranding.” FDA Substantial Equivalence Letter.
Thus, even though the FDA may well examine §510(k) applications for Class III devices (as it examines the entire medical device industry) with a concern for the safety and effectiveness of the device, see Brief for Petitioner in No. 95-754, at 22-26, it did not “require” Medtronics’ pacemaker to take any particular form for any particular reason; the agency simply allowed the pacemaker, as a device substantially equivalent to one that existed before 1976, to be marketed without running the gauntlet of the PMA process. In providing for this exemption to PMA review, Congress intended merely to give manufacturers the freedom to compete, to a limited degree, with and on the same terms as manufacturers of medical devices that existed prior to 1976. There is no suggestion in either the statutory scheme or the legislative history that the §510(k) exemption process was intended to do anything other than maintain the status quo with respect to the marketing of existing medical devices and their substantial equivalents. That status quo included the possibility that the manufacturer of the device would have to defend itself against state-law claims of negligent design. Given this background behind the “substantial equivalence” exemption, the fact that “[t]he purpose of Congress is the ultimate touchstone” in every pre-emption case, 505 U. S., at 516 (internal quotation marks and citations omitted), and the presumption against pre-emption, the Court of Appeals properly concluded that the “substantial equivalence” provision did not pre-empt the Lohrs’ design claims.
Identity of Requirements Claims
The Lohrs next suggest that even if “requirements” exist with respect to the manufacturing and labeling of the pacemaker, and even if we can also consider state law to impose a “requirement” under the Act

Question: What is the ideological direction of the decision reviewed by the Supreme Court?
A. Conservative
B. Liberal
C. Unspeciﬁable
Answer:

Answer: B