Liberal Bloc Splits in Supreme Court’s Conversion Therapy Ruling

Justice Ketanji Brown Jackson penned the lone dissent as the US Supreme Court ruled in favor of a Christian counselor challenging a Colorado law prohibiting conversion therapy for minors, warning the ruling could undermine states’ authority to regulate medical care.

In an 8-1 decision on Tuesday, the conservative-led court held that the Minor Conversion Therapy Law violated the free speech rights of licensed therapist Kaley Chiles. Writing for the majority, Justice Neil Gorsuch said the First Amendment bars the state from attempting to “enforce orthodoxy in thought or speech” through restrictions on talk therapy.

Justices Elena Kagan and Sonia Sotomayor joined the majority but filed a concurring opinion emphasizing that a more viewpoint-neutral statute might present a tougher question for the court.

Jackson, who read her 34-page dissent from the bench in a first for the term, said the majority failed to follow established precedent and risked weakening states’ ability to oversee medical practice. The decision opens a “dangerous can of worms,” she wrote, by extending constitutional protections into areas traditionally governed by professional regulation.

“It extends the Constitution into uncharted territory in an utterly irrational fashion,” Jackson wrote. “And it ultimately risks grave harm to Americans’ health and wellbeing.”

Jackson argued the majority—including the court’s liberal justices—did not properly apply the framework set out in Planned Parenthood v. Casey. In that case, the court upheld a Pennsylvania informed-consent requirement mandating that physicians provide specific information to patients seeking abortion services.

Although the court overturned Casey’s core holding on abortion rights in 2022, Jackson said the court has separately relied on the decision’s analysis on how states may regulate speech as part of the practice of medicine.

Under that framework, Jackson said, heightened First Amendment scrutiny is not required when professional speech is only incidentally affected by a state’s “otherwise legitimate regulation of the medical treatments being offered.”

She warned the ruling could lead to a “precipitous drop” in healthcare quality if courts invalidate other state regulations governing medical practice.

The majority rejected those concerns, saying the greater danger lies in allowing states to restrict speech in ways that could limit the evolution of medical knowledge.

“‘The people lose’ whenever the government transforms prevailing opinion into enforced conformity,” Gorsuch wrote.

In her concurrence, Kagan said Jackson’s dissent depends on “reimagining—and in that way collapsing” the longstanding distinction between viewpoint-based and content-based speech restrictions.

More than two dozen states have enacted full or partial conversion therapy bans. The American Medical Association opposes the practice, saying it may cause significant psychological distress and hasn’t been shown to be effective.

The ruling is one of at least two decisions expected this term addressing laws affecting LGBTQ youth. In January, the justices heard arguments in two cases seeking to restore state laws restricting transgender youth participation in sports. The court has not yet ruled on those cases.

The case is Chiles v. Salazar, U.S., No. 24-539, decided on 3/31/26.