Supreme Court backs religious counselor, ruling against ban on conversion therapy

Colorado is one of two dozen states (including Hawaii) that bars medical professionals from attempting to change minors’ sexual orientation or gender identity.

FLASHBACK 2018: "Hawaii becomes 12th state to ban 'conversion therapy' for LGBTQ youth"

SB270 of 2018: Text, Status

Chiles v. Salazar – ADF Media:  “On the issue of gender identity, the law only prohibits counseling conversations in one direction. It allows conversations that push young people toward a gender identity different from their sex but prohibits conversations that help them grow comfortable with their body and realign their identity with their sex when they desire to do that.”

by Kelsey Reichmann, Court House News,  March 31, 2026

WASHINGTON (CN) — Ruling against Colorado’s conversion therapy ban, the Supreme Court on Tuesday held that a religious counselor had a First Amendment right to provide faith-based counseling to change sexual behaviors.

In an 8-1 ruling, the court said Colorado’s law censored speech based on viewpoint because it prohibited not only long-abandoned aversive physical interventions but also voluntary counseling conversions.

“Colorado may regard its policy as essential to public health and safety,” Justice Neil Gorsuch, a Donald Trump appointee, wrote for the majority. “Certainly, censorious governments throughout history have believed the same. But the First Amendment stands as a shield against any effort to enforce orthodoxy in thought or speech in this country.”

Penning a lone dissent, Justice Ketanji Brown Jackson said precedent governed the opposite result. The Joe Biden appointee claimed speech for medical purposes could be restricted.

“To do anything else opens a dangerous can of worms,” Jackson wrote. “It threatens to impair states’ ability to regulate the provision of medical care in any respect. It extends the Constitution into uncharted territory in an utterly irrational fashion. And it ultimately risks grave harm to Americans’ health and well-being.”

Justices typically only read their dissents from the bench in significant cases, emphasizing their importance. Jackson read from the bench for around 20 minutes on Tuesday morning, accusing her colleagues of “missing the point our precedents make by a mile” and applying “maddeningly circular reasoning.”

Conversion therapy has been widely condemned by medical professionals as harmful and ineffective. The American Psychological Association and 13 other mental health and medical professional organizations say the practice does not meet the criteria of a legitimate therapeutic treatment.

Kaley Chiles, a counselor at Deeper Stories Counseling in Colorado Springs, said the opposite was true, suggesting that gender-affirming care could have negative consequences. Colorado’s ban on the treatment, Chiles argued, discriminated based on viewpoint, violating the First Amendment.

Colorado countered that states have regulated health care practices for centuries. Patients expected licensed professionals to provide a high standard of care, the state said, arguing that the First Amendment has never barred states’ ability to prohibit substandard care.

Shannon Stevenson, Colorado’s solicitor general, said that states pass laws like the conversion therapy ban when harmful practices persist despite medical expertise. A similar example includes barring medical doctors from prescribing anabolic steroids for sports performance.

When the Supreme Court heard oral arguments in October, Colorado doesn’t enforce the law unless a patient files a complaint with the medical licensing board, Stevenson said, and Chiles hasn’t been prosecuted under the law, instead bringing a pre-enforcement challenge.

The lower courts upheld Colorado’s law under rational basis review. Chiles argued that strict scrutiny — a more tenuous standard — needed to be applied. She claimed that Colorado couldn’t provide evidence that minors seeking conversion therapy were harmed by the practice.

The Supreme Court agreed, holding the lower courts failed to apply sufficiently rigorous First Amendment scrutiny. Gorsuch explained that Colorado’s law aimed to regulate the content of Chiles’ words — the quintessential form of protected speech. He dismissed the state’s attempt to frame her speech as conduct because it could be described as a treatment.

“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.’”

Gorsuch said greenlighting a speech restriction to regulate medical treatments would open up opportunities for states to enact similar laws for teaching or protesting. The speech element, Gorsuch said, distinguished Colorado’s law from medical care standards in malpractice cases.

“A prevailing standard of care may reflect what most practitioners believe today, but it cannot mark the outer boundary of what they may say tomorrow,” Gorsuch wrote. “Far from a test of professional consensus, the First Amendment rests instead on a simple truth: ‘[T]he people lose’ whenever the government transforms prevailing opinion into enforced conformity.”

Jackson said state regulations like Colorado’s are responsible for the country’s tradition of high-quality medical care. She worried the court’s ruling would make a broad swath of regulations unenforceable if a health care provider risks harming patients with speech rather than an operation.

“Ultimately, because the majority plays with fire in this case, I fear that the people of this country will get burned,” Jackson wrote.

Jackson was puzzled by her colleagues’ conclusions that Colorado shouldn’t have taken a position on conversion therapy. Medical standards are driven by science, Jackson said; therefore they are inherently not viewpoint neutral.

“Like it or not, treatment standards exist in America,” Jackson wrote. “And those standards necessarily reflect the expert medical community’s current beliefs about the safety and efficacy of various medical treatments, whatever those beliefs might be.”

Without establishing such standards, Jackson worried state licenses would no longer hold the same weight.

“To put it bluntly, the court could be ushering in an era of unprofessional and unsafe medical care administered by effectively unsupervised health care providers,” Jackson said.

Jackson’s liberal colleagues wrote a concurring opinion, suggesting a potential opening for states. Justice Elena Kagan, a Barack Obama appointee, said if Colorado enacted a content-based but viewpoint-neutral law, the First Amendment analysis would be different and present a more difficult question.

“Medical care typically involves speech, so the regulation of medical care (which is, of course, pervasive) may involve speech restrictions,” Kagan wrote in a concurrence joined by Justice Sonia Sotomayor, also an Obama appointee. “And those restrictions will generally refer to the speech’s content. But laws of that kind may not pose the risk of censorship — of ‘official suppression of ideas’ — that appropriately triggers our most rigorous review.”

Chiles celebrated the ruling as a victory for counselors, kids and families.

“When my young clients come to me for counsel, they often want to discuss issues of gender and sexuality,” Chiles said in a statement provided by the Alliance for Defending Freedom. “I look forward to being able to help them when they choose the goal of growing comfortable with their bodies.”

Colorado’s Attorney General Phil Weiser said the state strongly disagreed with the court’s reasoning and was reviewing how the decision would impact its responsibility to protect consumers and patients.

“Today’s decision is a setback for Colorado’s efforts to protect children and families from harmful and discredited mental health practices, and it limits the authority states have long exercised to safeguard patients from substandard care,” Weiser said in a statement. “Colorado enacted a law to protect minors from so-called conversion therapy, a practice that every major medical and mental health association in the country has rejected as unsafe and ineffective. It does not change a young person’s sexual orientation or gender identity. What it can do is cause serious harm, including depression, anxiety, and an increased risk of suicide.”

LGBTQ advocates described the decision as “a tragic step backward for our country that will put young lives at risk.” The Trevor Project’s CEO, Jaymes Black, said LGBTQ youth subjected to conversion therapy were more than twice as likely to attempt suicide compared to their peers.

“The court’s decision today is painful, but it does not change the facts: Conversion therapy is dangerous, it is malpractice and survivors still have the ability to seek justice for the harms caused by these practices,” Black said in a statement.