NEED TO KNOW

• Supreme Court rules 8-1 that Colorado’s conversion therapy ban violates free speech
• Justice Gorsuch says law “censors speech based on viewpoint”
• Decision expected to invalidate similar bans in approximately two dozen states

WASHINGTON (TDR) — The Supreme Court ruled Tuesday that Colorado’s ban on “conversion therapy” for LGBTQ youth violates the First Amendment, siding with a Christian counselor who argued the law restricts her speech rights in an 8-1 decision expected to unravel similar protections in approximately two dozen states.

The big picture: The ruling marks a significant expansion of free speech protections into professional licensing, with the Court treating talk therapy as protected expression rather than medical practice subject to state regulation—potentially opening the door to challenges against a wide range of health care standards.

• Justice Neil Gorsuch wrote for the majority that the law “censors speech based on viewpoint” and that the First Amendment “stands as a shield against any effort to enforce orthodoxy in thought or speech in this country”
• The case, Chiles v. Salazar, was brought by Kaley Chiles, a licensed counselor who describes herself as a practicing Christian seeking to offer talk therapy to minors who want to reduce same-sex attraction
• Chiles was represented by the Alliance Defending Freedom, the conservative legal group that successfully challenged Colorado’s anti-discrimination law in the 2023 website designer case

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Why it matters: The decision threatens to invalidate conversion therapy bans in roughly half the country, removing protections that medical associations have endorsed due to documented harms—including depression and suicide—while establishing that professional speech receives heightened First Amendment protection.

• Major medical associations including the American Psychological Association and American Medical Association have condemned conversion therapy as scientifically discredited and linked to serious harm
• Colorado’s 2019 law allowed conversations about gender identity but barred using therapy to “convert” LGBTQ people to heterosexuality or traditional gender expectations
• No counselor had been sanctioned under the Colorado law, which carried potential fines and license suspension

Driving the news: The ruling continues the Court’s pattern of backing religious freedom claims over LGBTQ protections, with the Trump administration supporting Chiles and Justice Jackson warning the decision “opens a dangerous can of worms” for medical regulation.

• The Trump administration urged the court to rule that Colorado’s ban violates free speech rights
• Justice Ketanji Brown Jackson, the sole dissenter, wrote that states should be free to regulate health care and that the decision “threatens to impair states’ ability to regulate the provision of medical care in any respect”
• The ruling does not affect bans on prescribing hormones or puberty blockers, which the Court upheld 6-3 last year in a Tennessee case

What they’re saying: The split reveals fundamental disagreement about whether therapy is medical practice subject to professional standards or protected speech subject to First Amendment scrutiny.

• Justice Neil Gorsuch — “The First Amendment… stands as a shield against any effort to enforce orthodoxy in thought or speech in this country”
• Justice Ketanji Brown Jackson — “This decision opens a dangerous can of worms… Even if a health-care regulation has an incidental effect on speech, the First Amendment is not implicated”
• Counselor Kaley Chiles — Argued the ban prevented her from offering “voluntary, faith-based therapy” and made it hard for parents to find therapists willing to discuss gender identity unless the counseling affirms transition

Yes, but: The ruling applies only to talk therapy—not medical interventions—leaving intact state bans on prescribing hormones or performing surgeries for gender transition, which the Court separately upheld.

• Chiles is not licensed to prescribe medicine or perform surgery, so the ruling does not impact states’ power to regulate those interventions
• Colorado argued its law regulates conduct (medical practice) rather than speech, but the Court rejected that framing

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Between the lines: The decision extends the Court’s trend of treating professional speech as fully protected expression, potentially threatening regulations governing everything from medical advice to legal counsel if they disfavor particular viewpoints.

• The ruling’s logic could support challenges to state laws requiring doctors to provide certain information to patients, if that information is deemed “ideological”
• The 8-1 margin suggests broad agreement among conservative and some liberal justices that viewpoint-based regulation of professional speech is constitutionally suspect

What’s next:

• The case returns to lower courts to apply strict scrutiny, a legal standard few laws survive; Colorado’s ban is effectively unenforceable
• Similar bans in California, New York, and approximately 20 other states face immediate legal challenges based on the ruling
• Medical licensing boards must now navigate between regulating harmful practices and avoiding viewpoint discrimination

If professional counseling that medical associations condemn as harmful receives full First Amendment protection, what remains of states’ power to regulate health care—or does the Constitution now protect professional speech regardless of consequences?

Sources

This report was compiled using information from STAT News, Politico, NBC News, CBS News, and The 19th.

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