As Supreme Court weighs conversion therapy, conservative justices question medical authority

On Tuesday, the Supreme Court appeared ready to rule against a Colorado law that prohibits licensed mental health professionals from offering any therapy aimed at altering a young person’s sexual orientation or gender identity. The justices are expected to release their decision on the matter by the end of June 2026.

The ruling has potential significant implications for young LGBTQ+ individuals and the future of conversion therapy practices. Additionally, it could influence broader regulations in medicine and how medical consensus is viewed.

Kaley Chiles, a Christian counselor from Colorado, initiated the challenge, arguing that the state law represents a form of censorship that infringes upon her free speech based on her beliefs regarding gender and sexuality.

“This law indicates that if any [gender dysphoric] kids seek help from a licensed professional to align their identity with their biological sex, that provider must refuse assistance,” stated James A. Campbell, a lawyer from the Alliance Defending Freedom, part of the legal team for Chiles.

According to the law, licensed professionals are expressly forbidden from attempting to modify a person’s sexual orientation or gender identity. Chiles’ legal team insists that her intention isn’t to change anyone’s identity but rather to engage in conversations about “exploring concepts of identity.” Approximately half of U.S. states have similar laws, grounded in extensive research indicating that conversion therapy is associated with increased symptoms of depression, PTSD, and suicidal ideation.

However, during Tuesday’s proceedings, the validity of this evidence—alongside the existing medical consensus—was questioned by Campbell, a representative from the Department of Justice who submitted an amicus brief, and several conservative justices.

Campbell argued that Colorado’s cited research is flawed due to biased sampling and failed to specifically assess licensed therapists or talk therapy as a treatment method. Justice Clarence Thomas inquired about the level of evidence Colorado would require to justify the ban, while Hashim M. Mooppan, the U.S. principal deputy solicitor general, stated that compelling proof of patient harm without any benefits would be necessary.

Nonetheless, medical experts and advocates for the Colorado law argue that existing studies substantiate their claims, suggesting the danger lies in the conceit of these practices.

“The harm arises when you inform a young person that they can alter an inherent aspect of themselves, leading to attempts to change followed by inevitable failure,” explained Shannon W. Stevenson, Colorado’s state solicitor general.

Major medical organizations, including the American Medical Association, American Psychological Association, and American Psychiatric Association, oppose conversion therapy, including talk therapy methods. However, Chiles’ legal team and some justices sought to question the validity of this medical consensus.

“While medical consensus is generally reasonable and significant,” Justice Samuel Alito observed, “have there been instances where it has become politicized or dominated by ideology?”

He then referenced the 1927 Supreme Court case Buck v. Bell, which allowed for the forced sterilization of individuals with intellectual disabilities, suggesting that such cases warrant First Amendment scrutiny regarding regulations on speech and not simply a reliance on “medical standards of care.”

Mooppan echoed this sentiment, citing that in certain authoritarian regimes, doctors may be restricted from discussing topics like birth control despite their licenses.

Campbell posited that conversion therapy shouldn’t be classified as medical treatment, regardless of whether it involves licensed clinicians like Chiles. “I do not categorize it that way, but I believe it’s irrelevant,” he stated, reiterating that speech, even within a therapeutic session, should be regarded as protected by the First Amendment.

The notion that talk therapy resembles a casual dialogue and thus asserts the therapist’s First Amendment rights was a key argument for Chiles’ team, asserting that this case differs from a recent ruling in L.W. v. Skrmetti, where the Court permitted Tennessee to regulate gender-affirming medical care through medications and surgeries.

Justice Ketanji Brown Jackson countered this argument, questioning why licensed professionals treating young individuals with gender dysphoria should be subject to different constitutional scrutiny based solely on the modality of treatment—talk therapy compared to medication.

Stevenson reiterated that talk therapy from a licensed professional constitutes medical treatment that requires oversight, emphasizing a lack of positive evidence supporting the efficacy of conversion therapy and stressing the significance of the medical context in evaluating the law.

“There exists a unique bond between a healthcare provider and a patient, placing the patient in a vulnerable position relying on their provider, who has a duty to prioritize the patient’s best interests,” she stated.

The extent of the court’s ruling will partially hinge on whether it clarifies how medical consensus impacts a state’s regulatory authority. The Supreme Court may uphold the lower court’s decision deeming Colorado’s conversion therapy law constitutional, remand the case to lower courts for heightened scrutiny—which could lead to the law being struck down—or declare the law unconstitutional.

“If some medical professionals assert that gender-affirming care poses risks to minors while others claim that conversion talk therapy is harmful,” Justice Amy Coney Barrett posited to Stevenson, “does a state have the authority to choose a side?”

About half of states currently prohibit licensed healthcare providers from practicing conversion therapy, while 18 do not have any related legislation. Many states lacking conversion therapy regulations have simultaneously enacted bans on gender-affirming medications and surgeries for transgender teenagers. Furthermore, several of these states are the same ones imposing restrictions or bans on abortion. In an environment where medical care has become highly politicized, many states have already made their choices, regardless of prevailing medical consensus.