Rust v. Sullivan, 500 U.S. 173 (1991), was a case in the United States Supreme Court that upheld Department of Health and Human Services regulations prohibiting employees in federally funded family-planning facilities from counseling a patient on abortion.

[10] Based on the GAO's recommendation that the HHS clarify §1008 regulations the Secretary of Health and Human Services proposed amendments in 1987 "to set specific standards for compliance with the statutory requirement".

[16] These regulations were challenged by the recipients of Title X funds on the grounds that they exceeded the Congressional intent of the statute and violated the free speech rights of doctors counseling patients.

[23] The court also rejected the argument that the regulations had conditioned the receipt of a benefit on the non-exercise of free speech rights that protect abortion advocacy and counseling.

[25] The court pointed out that it would "strain logic, in light of the more extreme restrictions in those cases, to find that the mere decision to exclude abortion-related services" from a preventive family planning program would impermissibly deprive women of their Fifth Amendment right to terminate their pregnancy.

[26] The Court also rejects petitioner's argument that the regulations impermissibly deprive women of their Fifth Amendment right to medical self-determination under City of Akron v. Akron Center for Reproductive Health (1983) and Thornburgh v. American College of Obstetricians and Gynecologists (1986) by placing restrictions on the counsel a doctor can give a patient within the context of the doctor-patient relationship:[26] "Under the Secretary's regulations...a doctor's ability to provide, and a woman's right to receive, information concerning abortion and abortion-related services outside the context of the Title X project remains unfettered...the Constitution does not require that the Government distort the scope of its mandated program in order to provide that information.

Applying Chevron the Court explained that an administrative agency's plausible construction of an authorizing statute receives deference when the legislative history was ambiguous as to congressional intent about restricting funds for abortion counseling.

[28] In a dissenting opinion, Justice Blackmun said "the Court for the first time upholds viewpoint-based suppression of speech, solely because it is imposed on those dependent upon the government for economic support.

Stevens wrote separately that "not a word in the statute...authorizes the (HHS) Secretary to impose any restrictions on the dissemination of truthful information or professional advice by grant recipients."

[29] Congress quickly passed an amendment to Title X that said publicly-funded clinics should be permitted to make referrals to licensed abortion providers when requested by a pregnant patient.

[30] The Supreme Court had signaled their disapproval of any application of the regulations that would prevent a doctor from providing a patient with a referral for a medically needed abortion.

Eliminating the Title X "gag rule" had been a campaign promise and the regulations were promptly reversed as one of the first official acts of the new administration in January 1993.

People from all over the United States carried signs and wore stickers with non-partisan statements like "In Your Heart You Know It's Wrong" and "The Natural Choice is Life".