Medicine, states’ rights won at Supreme Court, Skrmetti says

Tennessee Attorney General Jonathan Skrmetti said the Supreme Court’s Wednesday ruling on transgender treatments for minors was a big win for evidence-based medicine and for states’ rights to determine their own laws. The Supreme Court ruled 6-3 that a Tennessee law protecting children from medical attempts to change their sex characteristics was constitutional. The law bars healthcare providers from giving children puberty blockers or cross-sex hormones to change their gender identity. However, it permits doctors to prescribe those treatments to address physical defects, diseases, or injuries.

Chloe Cole, a woman who has testified to a House committee about how she underwent transgender procedures before eventually accepting her sex, said the decision made every American child safer. U.S. Attorney General Pam Bondi also applauded the decision and encouraged other states to pass similar laws.

How did critics of the law respond? Chase Strangio, a lawyer for the American Civil Liberties Union who argued for the plaintiffs before the Supreme Court, called the decision a devastating loss for transgender people. Strangio is a woman who identifies as a man. Court precedent in other cases still gives transgender people room to argue that they’re being discriminated against, Strangio said. The Interfaith Alliance advocacy group accused the court of siding with Christian nationalists against LGBTQ people.

What were the exact details of the Supreme Court’s decision? Chief Justice John Roberts penned the majority opinion in United States v. Skrmetti, writing that the law doesn’t violate the equal protection clause of the Constitution. The clause in the 14th Amendment requires that people in similar circumstances be treated the same legally. The law doesn’t rely on sex-based categories or transgender identity but applies to all minors, Roberts said. He also rejected the plaintiffs’ claim that the law was discriminatory. The court affirmed that there’s a rational basis for the Tennessee law, given the adverse risks of transgender treatments and the possibility that children will regret them.

Justices Clarence Thomas, Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett joined fully in Roberts’ opinion. Justice Samuel Alito joined in several parts of the opinion as well as the concluding judgment. Thomas, Barrett, and Alito also filed concurring opinions. Justices Sonia Sotomayor and Elena Kagan filed dissenting opinions. Justice Ketanji Brown Jackson joined with Sotomayor’s dissent. 

What’s the background of the case? Several children, as well as their parents and a doctor, sued Tennessee’s attorney general over the law. A federal district court in 2023 ruled that the law likely violated the equal protection clause. The court blocked Tennessee from enforcing the law. After an appeals court paused that injunction, the Biden administration intervened on the plaintiffs’ behalf and asked the Supreme Court to hear the case.

What did the court’s minority say in dissenting opinions? Sotomayor wrote that the law discriminated on the basis of sex and therefore it was subject to a higher standard of legal scrutiny. She claimed that the majority of justices were swayed by political whims. She also argued that some transgender treatments were similar to those used to help children with medical issues align with their birth sex. Kagan also said the Tennessee law should face a higher standard of judicial scrutiny. 

What did conservative justices add in their concurring opinions? Thomas wrote that the plaintiffs wrongly claimed overwhelming expert consensus in favor of transgender procedures for children. Many experts have been politically influenced or have changed their minds, he said. Courts should defer to legislatures, not experts, in areas of medical uncertainty, he said.

Barrett’s concurring opinion addressed a separate issue: whether transgender identity should be considered a protected class on the level of race and sex. Barrett said it should not. 

Alito’s concurrence addressed a similar question to Barrett’s. He wrote that the Supreme Court should have decided whether a transgender classification warrants heightened scrutiny, rather than saying the law wasn’t based on that classification. He took the position that such a classification did not warrant higher scrutiny. 

What were the main points of the oral arguments the court heard in December? U.S. Solicitor General Elizabeth Prelogar argued for the plaintiffs, saying that the law was discriminatory because it disallowed treatments that were inconsistent with an individual’s birth sex. She disagreed with Justice Thomas’ suggestion that the law was based on age classification for treatments, not sex.

Matthew Rice, arguing for Tennessee, said the law distinguished between different medical purposes, not sex categories. He said that hormones and puberty blockers shouldn’t be used to address children’s gender dysphoria because they can cause irreversible consequences like infertility and reduced bone density. Tennessee had an interest in protecting children from these effects, Rice said.