Last week, the Supreme Court of the United States ruled that Colorado cannot enforce its ban on conversion therapy for minors as applied to talk therapy. The 8–1 decision in Chiles v. Salazar found that the law, by permitting therapists to affirm LGBTQ+ identities while prohibiting them from helping clients reduce same-sex attraction, discriminates based on viewpoint in violation of the First Amendment.
It is important to be precise about what this ruling means and what it does not.
It resolves a constitutional question about the regulation of professional speech, for now, in favor of a therapist who argued that her in-session words are protected expression. It does not mean that conversion therapy is safe. It does not mean it is effective. And it does not mean that LGBTQ+ young people are now better protected.
They are not. They are less protected. That should be stated clearly.
The Court has ruled on a legal question. The medical community answered the clinical question decades ago.
Conversion therapy, the practice of using therapeutic techniques to change a person’s sexual orientation or gender identity, has been condemned by every major medical and mental health organization in the United States. The American Psychological Association, American Medical Association, American Academy of Pediatrics, and American Psychiatric Association have all reached the same conclusion: These practices do not work, and they cause harm. Young people who undergo them face higher rates of depression, anxiety, and suicidal ideation. For LGBTQ+ adolescents, that harm is not abstract. It is measurable and preventable.
Colorado enacted its Minor Conversion Therapy Law in 2019 based on this evidence and its responsibility to regulate licensed professionals in the public interest. A professional license is not simply a credential. It is a grant of authority that carries an obligation to practice in accordance with established standards of care.
When a young person sits across from a licensed provider and is told their identity should be changed or cured, they are not receiving a personal opinion. They are receiving what is intended to function as clinical guidance. That asymmetry of power is exactly what professional regulation is designed to address.
This is why we do not allow physicians to prescribe treatments that have been proven ineffective. This is why informed consent exists. It is why standards of care exist at all.
Justice Ketanji Brown Jackson was the lone dissenter and read her opinion from the bench, signaling the stakes. She argued that medical and therapeutic speech is categorically different from public speech, and that patients must be able to rely on licensed professionals for guidance aligned with scientific consensus rather than personal ideology. She is right. Her reasoning reflects a foundational principle of healthcare.
As the case returns to the lower courts, Colorado’s legislature, licensing boards, and professional associations still have both the authority and the obligation to act.
Licensing boards can make clear that conversion therapy falls outside the standard of care and may warrant disciplinary action. Professional associations can strengthen ethical guidance and support clinicians who refuse to engage in these practices. The state can also consider whether a more narrowly tailored, viewpoint-neutral regulatory approach could meet the Court’s standard.
None of this is simple. Constitutional law rarely is. But complexity does not diminish the responsibility to protect young people from harm.
The implications extend beyond this case. If the First Amendment is interpreted to shield licensed professionals from adhering to evidence-based standards within the treatment relationship, it raises fundamental questions about the state’s ability to regulate medicine, counseling, and other health professions more broadly.
Colorado did not pass this law because of ideology. It passed because of the evidence. That evidence has not changed.
I am a public health researcher at George Washington University studying how we identify and respond to suicide risk among marginalized youth, including LGBTQ+ adolescents. My work is grounded in a simple premise: the healthcare system must accurately understand the young people it serves and respond in ways that reduce harm rather than compound it.
This decision makes our work harder. It does not make it less necessary.
The Supreme Court has spoken on the legal question. The rest of us still have a responsibility to act.
