On October 7th 2025, the marble steps of the Supreme Court were filled with protesters. Rainbow flags and picket signs were waved in the air, while just nearby, groups of men and women huddled together in prayer. That day, the Supreme Court debated whether or not Colorado’s ban on conversion therapy was an issue of free speech or medical practices.
This wasn’t the first time.
In 2023, the Supreme Court declined to review the case of Brian Tingley, a counselor who argued that the Senate Bill 5722 violated his First Amendment rights. More specifically, this bill tacked on conversion therapy for minors as the list of reasons a therapist could lose his license. According to Tingley, he felt restricted, as it would allegedly limit his ability to speak candidly to his younger clients about matters of sexuality and gender identity. He relied on the Supreme Court’s 2018 decision, National Institute of Family and Life Advocates v. Becerra, which held that crisis pregnancy centers, typically Christian in nature, had their free-speech rights violated by California’s FACT law, which would compel them to post visible notices about the availability of abortion in state-sponsored clinics and whether or not they were licensed. This, Tingley held, proved that restricting conversion therapy naturally fell under the same category when it came to professional practices.
As mentioned, the Supreme Court declined to review the case. Yet, three of the nine justices were dissatisfied. Two penned dissents, and one indicated that he would have granted Tingley’s petition. Now, in the midst of a hostile battleground for LGBTQ+ rights, the conservative majority within the Supreme Court have decided to grant a similar case their ear, seeming ready to rule in favor of the Evangelical Christian therapist.
Kaley Chiles is a licensed counselor from the state of Colorado, who occasionally provides services informed by her faith. The heart of her case lies in the fact that she argues as though she’s being “silenced” by the ban. Chiles wishes “to provide talk therapy to minors who want to reduce feelings of same-sex attraction or feel more comfortable in their bodies,” according to Josh Gerstein of Politico. In other words: conversion therapy.
Conversion therapy is the umbrella term towards any kind of treatment, be it individual, group, or behavioral therapies, talk or otherwise, that intends to change someone’s sexuality and gender identity. This practice is widely censured by major mental health organizations, as it’s been proven to cause profound harm and be exceedingly ineffective in its aims. For instance, to the American Psychological Association, conversion therapy is little more than a pseudoscience, considering their “non-scientific explanations of sexual orientation and diversity” and their “dissemination of inaccurate information” regarding the outcomes and effects of said practices. As of 2025, a small battalion of scientific studies have been conducted and published, all decrying the dangers of the practice.
Due to this, as of 2025, 22 states, including the District of Columbia, have banned it entirely. Yet, Chiles and her team insist that as her version of talk conversion therapy allegedly lacks coercitive nature, all the state ban does is prevent minors from being able to receive proper care. In fact, Chiles’ attorney, James Campbell, went one step further and stated that upholding Colorado’s law would permit states to “silence all kinds of speech in the counseling room, such as disfavored views on divorce or abortion.” Some of the Justices seemed to agree with this notion, such as conservative justice Samuel Alito, who argued that the law was “blatant viewpoint discrimination.” By this, according to Nina Totenberg of NPR, he meant that the state was supporting a view that was “something of a one-way street.” In order words, the state would allow counselors to deal with and treat a minor’s sexuality one particular way, silencing any other. Liberal Justice Elena Kagan also seemed to agree, stating that if one doctor was allowed to treat sexuality as something to be accepted, and another one who wished to treat it as something to be overcome was not, it was a case of censure on behalf of the state. After all, free speech does not mean that only one side gets to speak.
But is the ban on conversion therapy a matter of free speech? Liberal Justice Ketanji Brown Jackson didn’t seem to think so. She seemed to equate it as a doctor battling against a restriction the state had imposed on a medication that had been overwhelmingly deemed as harmful. More than that, she found the Court’s inclination towards ruling in favor of the counselor inconsistent. After all, it was only last term that the Court decided in United States v. Skrmetti that Tennessee’s ban on transgender therapy was not unconstitutional. Both regulations work in similar ways: prohibiting treatments that were made to change a child’s gender identity. So why would the Court want to lean towards ruling in favor of Chiles, when it’s been proven before that states have license towards regulating professional conduct? If a treatment violates a standard of care, the state has every right to, and should prohibit it.
The Court didn’t seem to be convinced. Justice Alito was quick to point out that expert medical consensus could be “taken over by ideology,” as was the infamous decision in Buck v. Bell, which held as constitutional the involuntary sterilization of “feeble-minded” people. According to Mark Joseph Stern of Slate, this seemed to indicate that Alito viewed the 1927 ruling as a reason for medical expertise to be viewed with a degree of suspicion, not that it was the Court’s prerogative to defend marginalized peoples. Even so, there’s a broad historical precedent in favor of states regulating medical treatment, a fact that was present in the case of Dobbs v. Jackson, which relegated the status of abortion as something to be decided by the states, but is conveniently absent now. Legal experts have expressed concerns that the Court’s pattern of management of abortion will repeat itself in the case of transgender healthcare — that “distortion of doctrine.” The fact that the Justice Department joined the case on behalf of the plaintiff underscores how politically charged the term “viewpoint discrimination” has become.
More than that, collapsing professional speech as part of free speech has far reaching consequences for medical lawsuit cases. In NIFLA v. Becerra, the Court decided that speech integral to professional conduct can still be regulated. A doctor that gives advice, treatment, or a warning is speaking in their professional capacity as a doctor, so it’s regulated. When it comes to malpractice, what’s examined is regarding the professional conduct that the speech represented. Suppose a doctor counsels a patient and then the patient is harmed as a result of following that advice. The patient sues, but it doesn’t violate the First Amendment, as the doctor’s speech was treated as part of their actions as a doctor. When it comes to therapy, things get trickier, as speech itself is the treatment, and it’s within a formal setting, not public discourse. If the Court sides with Chiles, it could mean that virtually any sort of regulation on the practice of therapy could be struck down, as now speech within therapy is not considered a treatment, but just another kind of expression. In suits, defendants could claim constitutional protections, and the restrictions on misinformation in medicine could collapse even further, considering that those statements are “protected opinion.”
For the protestors outside the steps of the Court on October 7th, and the minors potentially receiving the treatments, the question rested on whether care can harm under the protection of free speech. Should clinicians be held liable for the effects of their words alone? Where does medicine end and speech begin? The Court has been asked to draw the line — it’s only a matter of time before we see if they decide on a matter of preference, or principle.
Some months later, the answer became clear. On March 31st, 2026, the Supreme Court ruled against Colorado’s law prohibiting conversion therapy. The 8-1 decision in favor of therapist Kaley Chiles collapsed her free speech rights as part of her professional ones, the resolution stating that the ban “censors speech based on viewpoint,” in the words of Justice Neil Gorsuch.
Emotional neglect by family was a significant factor. This is a great win for kids, of course.
The case, decided on the global Transgender Day of Visibility, was stated by the majority to be one concerning speech, not conduct. Colorado’s law, in the majority’s view, restricted the manner in which Chiles could interact with her clients: she could express support and acceptance for those in nascent stages of discovering their identities, but was unable to express anything along the lines of changing gender expressions or romantic inclinations. The Court likened therapeutic speech to teaching and protesting, concluding that there wasn’t, in their wisely informed perspective, a historical precedent to using a lower standard of review for Colorado’s law. In less flowery speech: Colorado was unable to provide enough evidence of a long-standing tradition justifying this form of restriction, so it should be shot down.
The Justices have sent back the case to the lower courts, where the law would be subject to “extreme scrutiny,” as it was now decided that it addressed and restricted speech. While experts say that the law will likely fail to meet this higher standard, for now, the ban remains in effect.
Unfortunately, the ruling threatens the legality of similar bans on conversion therapy across the nation. Especially since many have taken a relatively similar approach to Colorado’s law in terms of reach and phrasing. Others may simply remain in word only, but unenforceable: in a similar manner that many states maintained gay marriage bans, even after gay marriage was legalized. Victims will now have to seek legal redress themselves, but, in the absence of a clear preventative regulation, it might be significantly more difficult. A patient might find it troublesome to clearly prove that their distress was caused as a result of the conversion therapy, and not some other sort of mental anguish. Not to mention that similar practices might become common again; although ‘life coaches’ and ‘religious counselors’ were unimpeded by the ban as it only restricted medical professionals, harmful clinicians may wrongfully presume this ruling as endorsement.
Yet, more liberal-inclined justices have argued that this decision could have a ‘mirror-image’ effect: if states cannot ban conversion therapy, they cannot ban therapy affirming gender identity either. In a broader trend, the Courts have embraced free speech and religious expressions rights when they clash with anti-discrimination regulations protecting LGBTQ+ communities. In 2025, for example, the Courts ruled in favor of a challenge to a Maryland school’s rules not offering parents an option to opt out of exposure to LGBTQ+ books in the classroom. It doesn’t quite change the fact that after Chiles, the government has less power to proactively prevent professionals from causing harm to their clients.
“I hope this win for free speech will fuel a greater pursuit for truth,” said Chiles, after the decision. “Because of today’s ruling, families will have more options and states won’t be able to shut those options down.”
When it comes to speaking freely, one should celebrate the broadening of opportunities to express opinions, even those that might appear distasteful at first glance. However, just as speech inciting violence isn’t enshrined under the ever-expansive protections of the First Amendment, it leads many to wonder whether speech that precludes or aids medical malpractice or misinformation in the field of health ought to as well. The line between professional and non-professional speech in the field of psychology has been irrevocably blurred. As well-intentioned the liberal justices of the honorable Supreme Court may have been, they have simply stomped over the corpse of the canary in the coal mine, another sign of more troubled times to come for the LGBTQ+ community.