Last November, the State of Texas — which has a near-total abortion ban — sued a New York physician for prescribing abortion-inducing drugs to a Texas woman. Two months later, in the first criminal case of its kind, a grand jury in Louisiana indicted the same physician, Dr. Margaret Daley Carpenter, for prescribing the drugs to a woman there. New York is one of eight states with a telemedicine abortion shield law that protect its physicians who assist women in abortion-restrictive states. But abortion-restrictive states argue that, no matter where the provider might be located, the patient, and hence the medical care, occurred in their jurisdiction and is therefore subject to their laws.
The battle between states is ripe for a legal showdown that may well end up in the U.S. Supreme Court, says Carmel Shachar J.D./M.P.H. ’10, assistant clinical professor of law and faculty director of the Health Law and Policy Clinic at Harvard Law School’s Center for Health Law and Policy Innovation. In the January 30, 2025 issue of the New England Journal of Medicine (NEJM), Shachar and two of her students — Sravya Chary ’25 and Morgan Carmen ’24 — published “Providing Interstate Telehealth Abortion Services to Patients in Restrictive States.”
Harvard Law Today spoke to Shachar about the rapidly evolving legal issues around telehealth abortion care.

Harvard Law Today: How did the article on telehealth abortion services come about?
Carmel Shachar: I focus my career on access to health care broadly, including digital health care and access to reproductive health care. Increasingly, many people are using telehealth to access abortion care. There’s incredible interest among Harvard Law students to work in the areas of reproductive justice and reproductive rights, and I was lucky to work with two wonderful students, a current student, Sravya Chary ’25, and a student who had recently graduated, Morgan Carmen ’24. It goes to show how topical this issue is that as we were writing and revising it this fall, Texas filed the first [telehealth abortion] case, against New York’s so-called shield law, which protects abortion providers in New York who provide telehealth care.
HLT: What is telehealth abortion care?
Shachar: Over the past 50 years, health care in general has become more and more digital, with patients seeing their physicians online. Abortion care is no exception. Since Roe v. Wade [which legalized abortion in 1973 before being overturned in 2022 by Dobbs v. Jackson], there has been a rise in telehealth abortion care, where a patient has a virtual consult with a physician who will prescribe medication [to induce] an abortion. Patients chose telehealth abortion care for a variety of reasons, [including] they don’t have time to travel to an abortion clinic within their state, or they live in a place where access to abortion is really restricted so this is the best way for them to access care.
HLT: The Texas lawsuit claims the New York doctor practiced medicine in Texas without a license there and improperly aided an abortion. How does the case reflect the issues around telehealth abortion care?
Shachar: An important thing to understand about telehealth is that you can see it happening in two different locations: the location of the provider and the location of the patient. The law needs to figure out where it’s going to say the service actually happened. Virtually all states have said that the telehealth visit occurs where the patient is located; for example, if you live in Massachusetts but travel to Florida on vacation and need to see your regular physician, you can’t do it with a telehealth visit unless your doctor is also licensed in Florida. What’s really interesting with telehealth abortion care is that states are trying to protect their medical providers who provide these services by passing shield laws.
HLT: What are shield laws in the telehealth abortion context?
Shachar: Shield laws say, essentially, “We are not going to comply with other states trying to prosecute our physicians.” Many states have language in their shield laws saying the location of the patient is irrelevant for the purposes of the shield law or for purposes of the telehealth visit. On the other hand, states with restrictions on abortions say, “If it’s a telehealth visit and the patient is in our state, the visit happened in our state, and this is criminalized conduct. You the providers may have never even been to our state, but you are still violating our laws.” A state like Texas is going to rely heavily on the Full Faith and Credit Clause [of the U.S. Constitution], once they have fully prosecuted this case, to say, “There is a legal judgment coming out of a Texas court, and New York courts need to respect that judgment.” The conflict is really going to pressure-test this issue: Can a shield law meaningfully protect providers?
HLT: Just this week, on February 3, the New York governor signed a law that allows New York doctors to anonymously prescribe abortion medication when sending pills out of state. How will this affect the escalating conflict between states?
Shachar: I think that this move will help make it more difficult for abortion-restricting states to identify and prosecute physicians providing telehealth abortion care. However, I suspect that this move to anonymize physicians prescribing will also end up litigated in court: whether a state can truly resist providing information for another state’s legal process, especially once there is a judgment.
HLT: Do you foresee the U.S. Supreme Court taking this up?
Shachar: I think this is exactly the kind of case where it really involves a conflict between states and so it’s inevitable that it will make it to the Supreme Court.
HLT: What is the Interstate Medical Licensure Compact (IMLC) and how does it come into play in these cases? All but 10 states participate in IMLC, some which have shield laws and some which don’t.
Shachar: The IMLC is an interstate compact that is trying to make it more efficient for physicians to get multiple licenses, in part to help physicians have a more multi-state telehealth practice. The IMLC doesn’t get rid of each state’s individual licensure requirement but kind of streamlines the process, so that some physicians, once they get licensed, will turn to the IMLC to get further licenses.
The IMLC says that its rules trump state law. This is a little bit concerning because there may be physicians who get multiple licenses through the IMLC and then think they are protected by their own state’s shield law. But they might not be protected, because the IMLC may insist the physician follow its rules, which require the physician to comply with the regulations of the states where they are providing medical care. The IMLC has not said much about shield laws but has taken the position that if you’re providing telehealth, you need to respect the rules of the state where the patient is located — which would mean not providing abortion care to somebody located in Alabama, for example.
HLT: Should states seeking to maximize protections for their physicians reconsider their participation in ILMC? Should doctors reconsider pursuing licenses in other states?
Shachar: I think it’s important for states that are really committed to the project of shield laws and of protecting their providers to understand what it means to participate in the IMLC and whether that pokes a hole in their shield law. I also think it’s important for providers to understand the legal risks. I have known physicians who had licenses through the IMLC who, because of this issue, have given up those other licenses so they’re no longer linked through the IMLC, in order to try to reduce their risk as they practice in this area.
At a minimum, state policymakers need to understand how all this works together. And physicians who are thinking about providing services that are politically disfavored should ask, when they’re considering multiple licenses: “How do I best protect my own practice? How comfortable do I feel relying on shield laws which have not yet been fully tested by the courts?” Because some of the laws that ban abortion have very significant penalties for physicians who violate those laws.
HLT: Are there other controversial health issues besides abortion that may be affected by telehealth questions?
Shachar: I think abortion is just the tip of the iceberg. I think it’s a really worrying trend that we’ll probably see again and again with politically disfavored or politically controversial care. There are some states that are really trying to limit the scope of medical practice not just when it comes to abortion, but also when it comes to gender-affirming care. What might be next? It might be substance use treatment, or HIV and hepatitis C care, or vaccines. I worry that what we’ll see in the coming years is that the scope of medicine available to patients and the scope of medicine that physicians are allowed to practice is really going to fracture state by state.
HLT: What do you enjoy about this area of the law?
Shachar: As a health lawyer, almost everything I do is very up to the moment. A couple of years ago I worked a lot on the law around vaccines; before that, it was implementation of the ACA [Affordable Care Act]. I get to work with amazing law students who are at the start of their careers, and because these issues are so new I don’t know any more than they do because there’s no historical record that they’ve missed. Their ideas and thoughts are so creative and so sophisticated. For so much of the work that went into this project and this paper, I really have to give credit to Sravya and Morgan, the students who worked with it on me. They are named authors because it was their fresh set of eyes and their fresh legal thinking that really helped us map out this very cutting-edge issue.
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