The Supreme Court is set to hear oral arguments on Tuesday regarding Chiles v. Salazar, a case that contests a Colorado statute prohibiting licensed mental health providers from attempting to alter the sexual orientation or gender identity of minors—commonly referred to as conversion therapy.
This marks the first instance in which the Supreme Court has deliberated on such bans. The ruling may significantly impact the oversight of medical practices, raising complex issues around the civil rights of LGBTQ+ individuals and the right to religious freedom, as conversion therapy is frequently carried out in religious contexts or by faith leaders.
“The implications are immense, not only in terms of the dangers associated with conversion therapy itself but also in the broader context of states regulating medical practices,” commented Shannon Minter, legal director of the National Center for LGBTQ Rights, a legal organization that submitted an amicus brief supporting Colorado’s legislation.
Since 2012, nearly half of all U.S. states have prohibited licensed counselors from offering conversion therapy to minors, even if minors express a desire for such services. These conversion methods, which can include psychological counseling, aversion techniques, and religious rituals, have primarily targeted LGBTQ+ youth, including both gay and trans individuals. Research indicates that experiencing conversion therapy correlates with heightened levels of depression, PTSD, and suicidal ideation. One study showed that lesbian, gay, or bisexual individuals who underwent such therapy were nearly twice as likely to contemplate suicide compared to their peers.
The expansion of restrictions on clinician involvement has helped broaden public awareness about the harms posed by conversion therapy, stated Marie-Amélie George, a professor and historian of LGBTQ+ rights at Wake Forest University School of Law.
“This wave of legislation is a way to highlight the dangers of conversion therapy,” George explained, “so that parents considering this for their children can better understand the potential consequences.”
Kaley Chiles, a licensed counselor, took her case to federal court in 2022, claiming that the Colorado law represents a “viewpoint-based speech restriction” infringing upon her First Amendment rights, as she views her counseling practice as integrated with her Christian faith, according to court filings.
A federal court denied her request for a preliminary injunction, and an appellate court upheld that ruling. However, another federal appeals court overturned a similar ban in Boca Raton and Palm Beach County, Florida, resulting in what experts describe as a split among circuit courts. The Supreme Court is now responsible for clarifying these conflicting rulings.
What to Expect
The arguments on Tuesday are expected to focus on the scope of the law and whether a therapist’s interactions with clients constitute protected speech under the Constitution or are subject to professional regulation, according to legal experts.
There is significant contention between opposing parties regarding the interpretation of Colorado’s law. Chiles argues that the legislation only permits her to discuss identities in a way that affirms transgender identities and prohibits her from supporting clients in aligning with their biological sex. Conversely, supporters of the ban contend that this interpretation misrepresents the law, which explicitly defines conversion therapy as efforts to change a person’s sexual orientation or gender identity, implying that therapists can engage with clients’ concerns in any direction.
“I would anticipate this to be a primary focus of the discussions,” Minter remarked.
The Supreme Court’s recent ruling in L.W. v. Skrmetti, which upheld a ban on gender-affirming care for minors in Tennessee, may also play a crucial role in this case’s arguments.
“If the justices aim for consistency and fairness, they should find that Skrmetti essentially resolves this matter for them,” Minter asserted. “The issues at hand are nearly identical: Do states have the right to limit types of medical care, in this case, mental health treatment, based on their assessment of risks versus benefits?”
However, key differences exist between the two cases. The Tennessee ban specifically targeted medical interventions like hormone treatments, while the principal issue in this case revolves around therapist-client communication. Professional medical organizations in the U.S. support gender-affirming care, whereas they have consistently opposed conversion therapy.
In an amicus brief for Chiles, the Trump administration argued that evidence regarding the harms of talk therapy conversion practices and the effectiveness of gender-affirming therapies is insufficient. The brief also cited historical injustices, such as the classification of homosexuality as a mental illness and the coerced sterilization of disabled individuals, to highlight the dangers of relying solely on professional consensus to determine lawful speech for providers.
Similar to the Skrmetti case, Chiles v. Salazar, at face value, appears centered on LGBTQ+ health issues; however, experts warn that the implications extend far beyond this narrow scope. “This case encompasses a myriad of issues that we may overlook while focused solely on conversion therapy and LGBTQ health,” noted Tara McKay, director of the LGBTQ+ Policy Lab at Vanderbilt University. “These cases are about so much more than this singular issue and could carry widespread implications.”
Potential Impact on Healthcare Regulation
Several states have imposed other restrictions affecting medical care: 12 states maintain total abortion bans, while 29 enforce gestational limits on abortions ranging from 6 to 24 weeks. Approximately half of U.S. states prohibit gender-affirming medical treatments for transgender minors. Nevertheless, Nicole Huberfeld, a professor at Boston University School of Law who analyzes the intersection of health and constitutional law, notes that these laws are predominantly driven by political and religious ideologies, while Colorado’s ban on conversion therapy is rooted in concerns about safety and efficacy.
“What we are witnessing is a clash of perspectives regarding how states should regulate healthcare—whether such regulation ought to be strictly evidence-based,” she explained.
If the Supreme Court ultimately determines that the law violates a clinician’s free speech rights, experts sympathetic to Colorado’s stance warn that it could generate confusion among medical professionals regarding the accepted standard of care. Moreover, concerns arise that the ruling could set a legal precedent for clinicians who harm patients to invoke free speech as a defense, raising ethical questions about appropriate conduct, including the potential for inappropriate advances made by therapists.
An amicus brief from health law scholars emphasizes that numerous laws governing medical licensure already limit speech to ensure appropriate medical care. Given that verbal communication is key in psychotherapy, it remains uncertain whether any state regulation governing the profession would be deemed lawful if the court sides with Chiles, as noted in the scholars’ brief.
“Creating a free speech exception for any form of communication inherent to care would represent a major shift in legal standards,” Minter cautioned. “If the Court were to adopt this approach, it could lead to significant deregulation in medical practice, leaving patients vulnerable to various forms of harm and unprofessional treatment.”
Supporters of Chiles contend otherwise. In 2018, the Supreme Court ruled that professional speech can be regulated if it is incidental to conduct. For example, a sign stating “whites only” is considered speech that can be regulated because it is linked to the broader discriminatory act of racial segregation. Chiles’ attorneys argue in court documents that the interactions therapists have with clients are neither conduct nor incidental to conduct, suggesting that potential regulations would remain intact even if a ruling is made in their favor.
Potential Impact on LGBTQ+ Individuals
For LGBTQ+ communities, the significant implications of the case may not stem solely from the legality of conversion therapy but rather from what it signifies for their broader civil rights.
“Where do civil rights protections for LGBTQ+ individuals end, and where do the rights for free religious expression begin?” Huberfeld queried. “This complex tension has been evolving in the courts for years.”
This issue was left somewhat unresolved in the Supreme Court’s 2015 Obergefell decision, which respected same-sex marriage while acknowledging potential conflicts with religious freedom. This tension has played out in various legal battles, such as with the baker who declined to create a wedding cake for a same-sex couple and the website designer who refused to craft wedding sites for LGBTQ+ clients; in every case, the Supreme Court has favored business claims. “Attempts to restrict anti-discrimination laws through free speech and religious claims are evident,” Huberfeld noted. Now, the focus has shifted to healthcare.
Chiles’ legal representation suggests alternative measures for regulating “conduct-based” conversion therapy practices, such as extreme techniques like “rebirthing,” which involves restraining a child to mimic the birth experience.
Conversion therapy is typically conducted by religious practitioners, often in ways that obscure its prevalence in the U.S. In 2023, the Trevor Project identified over 1,300 practitioners nationwide, including more than 600 who held valid professional licenses.
Advocates for LGBTQ+ rights express concern that a ruling favoring the therapist could pose a risk to young individuals who may find themselves subjected to conversion therapy by licensed professionals. However, should the court rule against the ban, it doesn’t imply a surge in clinicians performing conversion therapy, nor is there evidence suggesting that insurance providers would cover such treatments.
A decision in favor of Chiles could also create uncertainty for parents differentiating between validated healthcare practices and alternative methods, according to advocates. Existing organizations aiming to alter sexual orientation or gender identity often utilize similar therapeutic terminology as authentically affirming providers, leading to potential confusion. The controversial report released by the Trump administration in May on gender dysphoria emphasized more “exploratory psychotherapy,” a term that many recognized as a euphemism for conversion therapy.
Among the extensive amicus briefs submitted in this case is one representing a collective of former leaders of the conversion therapy movement who now formally denounce the practice, opposing Chiles’ argument for licensed clinicians’ participation.
“They cannot undo the harm they inflicted,” states the brief. “However, they acknowledge their unique responsibility and opportunity to avert future damage by sharing insights gained from decades of unsuccessful attempts to change sexual orientation and gender identity.”
