When Faith Becomes a License to Harm: The Supreme Court’s Conversion Therapy Case

On October 7, 2025, the U.S. Supreme Court heard oral arguments in Chiles v. Salazar, a case that could redefine the boundary between religious freedom and professional accountability. At its center is Kaley Chiles, a Colorado counselor who wants to provide what she calls “talk therapy” to help minors “reduce unwanted same-sex attraction” and “resolve dysphoria by getting comfortable with their body.” Colorado’s law prohibits licensed therapists from performing conversion therapy on minors. Chiles, backed by the Alliance Defending Freedom (ADF), argues that ban violates her First Amendment rights.

The oral arguments revealed deep fractures in how the Court views professional speech, religious liberty, and the state’s power to protect children. What emerged wasn’t just a debate about one counselor’s practice, it was a referendum on whether “sincerely held belief” can override evidence-based medical standards.

The Standing Question That Wouldn’t Die

The hearing opened with an unexpected complication. Justice Sotomayor immediately pressed Chiles’ attorney on standing, noting that “we have basically 6 years of no enforcement of this law. 3 before this lawsuit, 3 since.” She pointed out that both the district court and the Tenth Circuit had ruled for Colorado, yet “we have the entity charged with administering the law, saying we’re not going to apply it to your kind of therapy.”

Colorado’s revised interpretation, buried in footnote 18 of their brief, claimed the law only prohibits attempts to change sexual orientation or gender identity, not behaviors, expressions, or attractions, even though the statute explicitly says “including efforts to change behavior, gender expression, or attraction.” When Justice Gorsuch asked Chiles’ lawyer to define exactly what therapy she wants to provide, he walked through the verified complaint: “She helps clients when their goals are to resolve gender dysphoria by getting comfortable with their body and realigning their identity with their sex. She also helps them if they’re experiencing unwanted same-sex attraction… and she helps them deal with issues of unwanted same-sex behavior.”

That created a problem for Colorado’s late-breaking reinterpretation. As the U.S. Solicitor General noted in support of Chiles, “if you match up paragraph 87 of the complaint with the statute, the conduct that Petitioner wanted to engage in is clearly covered by the plain terms of the statute.” Colorado’s attempt to narrow the law’s scope after the Court granted certiorari looked like exactly what it was, a litigation tactic, not a genuine reading of the law.

Viewpoint Discrimination or Public Health Regulation?

The heart of the case turned on a question Justice Alito crystallized with a hypothetical. He described two scenarios: an adolescent male who wants therapy to overcome same-sex attraction, and another who wants therapy to feel comfortable as a gay young man. Under Colorado’s law, one seems permitted and the other prohibited based entirely on the therapeutic goal. “It looks like blatant viewpoint discrimination,” Alito said.

Colorado’s attorney, Ms. Stevenson, tried to distinguish them by arguing that only therapy with “the purpose of changing a minor’s sexual orientation or gender identity” violates the law. But Justice Alito wasn’t satisfied. He pointed out that Colorado’s own pleadings below had taken a different position, specifically acknowledging in footnote 3 of their motion to dismiss that “efforts to change unwanted same-sex behavior or to reduce unwanted same-sex attraction would indeed violate the law.”

Justice Kagan then posed what she called the “mirror image” question: What if a state in the 1970s, when homosexuality was classified as a mental disorder, had passed a law prohibiting therapists from affirming gay identities? Would that also receive mere rational basis review? Colorado’s attorney answered yes, if it was consistent with the then-prevailing standard of care. That concession was striking. It meant that under Colorado’s theory, states could prohibit gender-affirming therapy today if medical consensus shifted, and therapists would have no First Amendment defense.

The Professional Speech Problem

Colorado’s central argument was that this isn’t really about speech at all, it’s about regulating medical treatment. “When we’re talking about words used to deliver medical treatment, those issues are the same whether you’re talking about words being used or whether you’re talking about medical practices that don’t involve words,” Stevenson argued. She compared it to a doctor giving advice about high cholesterol: whether the doctor prescribes medication, recommends dietary changes, or does nothing, any violation of the standard of care “could be equally harmful.”

But that argument ran headlong into NIFLA v. Becerra, the 2018 case where the Court struck down California’s requirement that crisis pregnancy centers provide information about abortion services. Justice Jackson pressed Stevenson on how to distinguish NIFLA, which explicitly rejected a broad “professional speech” exception to the First Amendment. Stevenson argued this case involves the “very narrow context where a health care provider is delivering health care to a patient… under fiduciary duties to act in that patient’s best interest, and they are subject to malpractice liability.”

The problem with that distinction became apparent when Justice Sotomayor asked about other professional contexts. If a bar association prohibited lawyers from advising terrorists on how to break the law, would that also get rational basis review? Stevenson said yes, if “there is a duty between the professional and the receiver of the professional services.” But that threatened to resurrect exactly the kind of professional speech carve-out that NIFLA rejected.

Where the Evidence Actually Stands

Amid the legal abstractions, Justice Barrett asked the critical question: “What is your best evidence on this record… that this kind of talk therapy by licensed therapists to minors causes harm?” Stevenson pointed to the record at JA 64-74, specifically citing the Green study of 34,000 youth aged 13-25 and the Turban study of 27,000 participants. The Green study found that after controlling for other factors, conversion therapy was associated with twice the rate of attempted suicides. The Turban study looked specifically at gender identity change efforts, including for children under 10, and found associations with adverse mental health outcomes in adulthood.

But here’s what didn’t come up during oral arguments, and what makes ADF’s legal strategy particularly troubling: their Supreme Court petition cited research by Dr. Lisa Diamond and Professor Clifford Rosky to argue that conversion therapy bans are overreach. The problem is that Diamond and Rosky’s study explicitly condemns conversion therapy as harmful and ineffective. When the researchers discovered ADF had cherry-picked quotes while omitting passages documenting “elevated rates of depression, anxiety, and suicidality,” they filed an amicus brief to correct the record.

Rosky told The Guardian, “It’s deceptive. Lawyers owe a duty of candor to the court. You cannot offer false evidence. They claim our work supports conversion therapy when our work clearly and specifically condemns conversion therapy on the same page they’re citing.” This wasn’t a good-faith disagreement about evidence, it was a legal strategy built on misrepresentation.

The Religious Exemption No One Mentioned

One detail that went entirely unmentioned during the two-hour argument is that Colorado’s law already includes a religious exemption. People “engaged in the practice of religious ministry” are explicitly exempt from the ban. If you’re a pastor, priest, rabbi, or imam providing religious counseling, you can still counsel according to your religious beliefs about sexuality and gender. The law doesn’t touch that.

What it regulates is licensed mental health professionals, therapists, counselors, and psychologists who hold state-issued licenses that come with professional and ethical obligations. Kaley Chiles isn’t being told she can’t believe homosexuality is sinful or talk about her beliefs in church. She’s being told she can’t use her state-licensed therapy practice to perform a treatment that every major medical organization has condemned as harmful.

Religious liberty has never been absolute. You can’t refuse chemotherapy for your child and call it faith. You can’t perform surgery in your basement and call it ministry. You can’t withhold insulin from a diabetic kid because you believe prayer is sufficient. Religious freedom ends where harm to others begins.

What Happens If ADF Wins

The implications of a ruling for Chiles extend far beyond conversion therapy. Justice Kavanaugh raised the question directly: if talk therapy gets First Amendment protection, what about licensing requirements tied to standard of care? “Don’t states tend to tie licensing requirements to the standard of care?” he asked. “If we had a situation like this in which a state licensing board disciplined a doctor for a speech-based practice outside of the standard of care, would that doctor have a First Amendment defense?”

The Solicitor General, arguing in support of Chiles, acknowledged there’s “a long history and tradition in this country of licensing,” but insisted there isn’t “a long history and tradition of, as a condition of that license, imposing a prior restraint on the types of speech they engage in.” That distinction sounds clean in theory but collapses in practice. If religious speech can override professional standards, then licensing requirements become optional whenever someone claims a sincere religious belief.

Consider how the logic spreads. A pharmacist who believes hormonal birth control is sinful refuses to fill prescriptions, not discrimination, just compelled speech. A surgeon who thinks certain procedures violate God’s design declines to perform them, not malpractice, just religious liberty. A therapist who believes depression is a spiritual issue refuses to recommend medication, not negligence, just faith-based practice.

Twenty-three state laws protecting minors from conversion therapy could fall overnight. Medical boards, psychology licensing bodies, and professional associations that prohibit harmful practices would lose the ability to enforce ethical codes whenever someone invokes religious belief. Medical misinformation gets rebranded as ministry. Professional harm becomes a matter of conscience.

The Court That Changed

The Supreme Court refused to hear challenges to conversion therapy bans four times before this case. What changed wasn’t the science or the law, it was the Court’s composition. With a 6-3 conservative supermajority, ADF saw an opening and engineered a case designed to expand religious exemptions under the guise of free speech.

Justice Thomas asked about the history of regulating therapists, and Stevenson struggled to provide specific examples of prior restraints on therapeutic speech. But as the Solicitor General pointed out, “there is no long-standing tradition of states imposing this type of categorical prior restraint on the speech of therapists.” That’s true, but it’s also true that conversion therapy as a formalized practice is relatively recent, and states have consistently regulated medical practices that cause harm once the evidence becomes clear.

The question isn’t whether there’s a historical tradition of regulating this specific practice. It’s whether states can protect children from demonstrably harmful treatments delivered by licensed professionals. For decades, the answer was yes. This Court may be about to change that.

The Verdict We’re Waiting For

The Supreme Court’s decision will likely come in summer 2026. When it does, we’ll know whether evidence still matters in American law or whether “sincerely held belief” has become a constitutional trump card that exempts professionals from accountability.

But one thing is already clear from the oral arguments: several Justices are deeply uncomfortable with Colorado’s position that professional regulation completely sidesteps First Amendment scrutiny. At the same time, several others are troubled by the implications of treating all therapeutic speech as protected expression. The Court is fractured, and the outcome is genuinely uncertain.

What isn’t uncertain is the science. Conversion therapy doesn’t work. It causes measurable psychological harm. Every major medical organization in the country agrees. The only question is whether the Supreme Court will prioritize that evidence or sanctify pseudoscience under the banner of religious freedom.

You can believe whatever you want about who people should love or how they should identify. But the moment you turn that belief into a licensed professional practice and offer it to vulnerable kids, you’re not exercising freedom, you’re inflicting harm. And no court should call that protected speech.

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