The US Supreme Court ruled Tuesday that Colorado’s ban on conversion therapy for minors violates the First Amendment when applied to counselors who use only talk therapy, a landmark decision with sweeping implications for how states regulate speech by licensed health care professionals.
The court voted 8-1 to reverse a lower court ruling that had upheld the law, finding that Colorado’s statute discriminates based on viewpoint by allowing counselors to affirm a minor’s sexual orientation or gender identity but prohibiting them from helping clients who wish to change those things.
Justice Neil Gorsuch, writing for the majority, said the law “censors speech based on viewpoint” and cannot survive under the First Amendment simply because the state labels talk therapy as professional conduct.
“The First Amendment is no word game,” Gorsuch wrote. “And the rights it protects cannot be renamed away or their protections nullified by mere labels.”
The case was brought by Kaley Chiles, a licensed mental health counselor who argued that Colorado’s 2019 law prevented her from helping clients reach their own stated goals through conversation alone.
Justice Elena Kagan, joined by Justice Sonia Sotomayor, concurred but wrote separately to note that a viewpoint-neutral law restricting speech in medical settings would present “a different and more difficult question.”
Justice Ketanji Brown Jackson was the lone dissenter, warning the ruling could make speech-based medical treatments “effectively unregulatable” and that the decision “plays with fire.”
Jackson argued the court had long recognized that states may regulate the practice of medicine, including treatments delivered through speech, without triggering heightened constitutional scrutiny.
Twenty-five other states have enacted similar conversion therapy bans. The decision is expected to prompt legal challenges to those laws across the country. However, its practical reach will depend on how lower courts apply the ruling’s distinction between viewpoint-based and viewpoint-neutral restrictions on professional speech.
