Chiles v. Salazar, Docket No. 24-539
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The Supreme Court has made it much harder for states to ban conversion therapy, the controversial practice of trying to change someone's sexual orientation or gender identity. In a decision that split the justices and alarmed civil rights advocates, the Court ruled that Colorado's ban on the practice violates free speech rights when applied to talk therapy. The ruling could affect similar laws in 25 other states and raises urgent questions about what protections minors have when seeking help from licensed counselors.
The Case: A Colorado Counselor Challenges a Ban
Kaley Chiles is a licensed mental health counselor in Colorado who provides talk therapy to minors. Some of her young clients come to her wanting to reduce same-sex attractions or align their gender identity with their biological sex. In 2019, Colorado banned licensed counselors from practicing conversion therapy with minors, defining it as any attempt to change sexual orientation or gender identity, including through talk alone.
Chiles sued, arguing the law violated her right to free speech. She said her work is pure speech because she uses only words, no medications or procedures. Lower courts disagreed, saying the law regulates professional conduct, not speech. The Supreme Court took the case to settle conflicting rulings among lower courts.
The Arguments: Free Speech Versus Medical Regulation
Chiles's lawyers made a straightforward claim: because she uses only words, her therapy is speech protected by the First Amendment. They argued Colorado's law unfairly takes sides in a debate by allowing therapists to affirm LGBTQ+ identities while banning efforts to change them. This is called viewpoint discrimination, and it's one of the most serious violations of free speech law.
Colorado countered that the law regulates medical treatment, not speech. States have long regulated healthcare professionals, the state argued, and a therapist's words function like a prescription. Colorado also pointed to statements from major medical organizations saying conversion therapy is ineffective and harmful.
The federal government sided with Chiles, offering a powerful historical argument: if Colorado's reasoning were correct, a state in the 1970s could have banned therapists from telling gay patients they were not sick, since homosexuality was then classified as a mental disorder. Everyone agrees that would have been unconstitutional. So the same standard must apply today.
What the Court Decided
Justice Gorsuch wrote the majority opinion, joined by eight justices. The Court ruled that Colorado's law regulates speech based on viewpoint and must meet the highest level of constitutional scrutiny, called strict scrutiny. This is the hardest standard for any law to survive.
The Court's logic was direct: Chiles uses only words, so her therapy is speech. Colorado's law restricts that speech by allowing her to express one viewpoint while forbidding another. Calling speech a "treatment" doesn't change its constitutional protection. The Court also rejected the idea that the law only incidentally burdens speech. It directly targets what Chiles is allowed to say based on the message itself.
The Court dismissed Colorado's argument about regulating healthcare. State licensing of counselors only began in 1976 and traditionally focused on qualifications, not silencing particular viewpoints. The Court sent the case back to lower courts, instructing them to apply strict scrutiny. Colorado must now prove the law serves a compelling government interest and is narrowly tailored to achieve it, a very difficult standard to meet.
Where the Justices Disagreed
Justice Kagan agreed the law engages in viewpoint discrimination but wrote separately to flag an important limit. Not every content-based healthcare law automatically demands the highest scrutiny, she argued. A law that banned all talk therapy on sexual orientation for minors, covering both affirming and conversion approaches equally, might survive under a less demanding standard. Her concurrence essentially offers states a roadmap: regulate viewpoint-neutrally, and you might avoid this ruling.
Justice Jackson dissented alone. She argued the majority misunderstands what happens when states regulate medical care that involves speech. Chiles is a licensed medical professional subject to healthcare regulation, not a speaker being censored for her ideas. Jackson warned that the majority's reasoning could make it nearly impossible to regulate any therapy involving practitioner speech, since medical standards of care are inherently based on professional judgment about what helps patients.
Limited States' Power to Ban Conversion Therapy
The decision is both sweeping and incomplete. The Court established one clear rule: states cannot regulate talk therapy based on viewpoint. But it did not strike down Colorado's law or apply strict scrutiny itself. That falls to lower courts now.
The practical impact is significant. Twenty-five states have conversion therapy bans, many written like Colorado's. Those laws are now constitutionally vulnerable. States wanting to regulate in this area will likely need to draft laws that treat all approaches equally, rather than allowing some while banning others.
The deeper tension the Court left unresolved is real: medical standards of care are inherently based on professional judgment about what works and what harms patients. The majority's answer is that the First Amendment prevents the government from turning prevailing professional opinion into enforced conformity, especially given that professional consensus has been wrong before in ways that hurt real people. But Justice Jackson's dissent shows this reasoning has limits that remain unclear.
For everyday citizens, the bottom line is this: the Court has made it harder for states to protect minors from conversion therapy through licensing laws, at least when those laws single out one viewpoint while allowing another. Whether states can regulate the practice in other ways remains an open question.