Picture this: A 15-year-old boy in Colorado confides in his therapist that he may be gay. Instead of finding help, he was told to pray harder, imagine himself with the girl, and imagine God “fixing” him. After a few weeks, he stopped showing up for sessions. His parents thought he was improving. In fact, he had learned that honesty comes with punishment. He is one of thousands of LGBTQ youth who have sought help and gone through therapy, only to quit believing they are broken.
Stories like this are why states banned conversion therapy in the first place, and why the Supreme Court’s latest case could invalidate those protections.
The justices who heard arguments in Chile v. Salazar on October 7 were not simply considering a dispute over counseling. They were deciding whether scientific consensus could still be considered fact under American law.
At issue in court is a 2019 Colorado law that prohibits licensed mental health professionals from performing so-called conversion therapy on minors, interventions that purport to change a person’s sexual orientation or gender identity. All major medical and public health organizations in the United States reject these practices as ineffective and harmful. The American Psychological Association, American Academy of Pediatrics, and American Medical Association all warn that such interventions increase the risk of anxiety, depression, and suicide in young people.
However, some judges appear to be more concerned about the “speech rights” of counselors who want the practice to continue. They suggested that Colorado’s law could amount to “viewpoint discrimination” because it allows therapists to affirm LGBTQ identities but prohibits them from trying to change them. In that framework, evidence-based medicine becomes ideology, and ideology becomes protected speech.
This reversal of expertise is a recurring theme in contemporary jurisprudence. During the pandemic, courts have treated epidemiological evidence as discretionary, limiting states’ ability to enforce public health orders. In Dobbs v. Jackson Women’s Health, the court’s majority ignored decades of medical testimony regarding the safety of abortion care. Now, in Chile v. Salazar, the justices are poised to decide whether the overwhelming scientific consensus on psychological harm can be reduced to a matter of personal belief.
But medicine is not a marketplace of ideas where all perspectives should be given equal weight. This is a field governed by empirical testing, ethical standards, and a duty to do no harm. Calling conversion therapy “just speech” is tantamount to erasing the patient sitting across from the clinician, a vulnerable minor whose trust and health depend on her professional integrity. The role of the state in setting these standards is not to censor viewpoints. It’s public health in action.
Let’s use the analogy of prescribing medicine. A doctor who tells a patient that antibiotics will cure a viral infection is not exercising his free speech rights. She is providing substandard care. The state medical board that disciplined her isn’t cracking down on ideology. It’s about enforcing evidence-based practice. Mental health care is no exception. Words are a therapist’s tool, and when used to shame or pathologize an identity, they can be just as deeply hurtful as any physical act.
If the court were to strike down Colorado’s law, it would undermine the principle that professional actions must be based on evidence. Countries may be unable to regulate misinformation in clinical settings, from anti-vaccination counseling to denial of gender-affirming care. The ripple effects will extend to school-based programs, public health campaigns, and any specialty that relies on communication as a form of treatment.
For LGBTQ youth, the impact will be immediate. The Trevor Project reports that LGBTQ youth who undergo conversion efforts are more than twice as likely to attempt suicide. Legalizing such acts under the guise of “speech” does not protect expression. It protects against harm.
Public health policy relies on one fragile norm: that evidence and scientific consensus matter. When the judiciary treats empirically tested standards as partisan viewpoints, we lose the ability to distinguish between expertise and ideology. This not only threatens LGBTQ youth, but also all patients who look to their clinics as a refuge from politics.
Science will survive this court. But that authority, and the health of the people it protects, does not emerge unscathed. Whatever the verdict, we must be clear that it is not ideology that protects young people from harm. It’s evidence-backed care.
harry barbieis an assistant professor at the Johns Hopkins Bloomberg School of Public Health. Their research and teaching focuses on LGBTQ+ health, aging, and public policy.
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