Big win at the United States Supreme Court today in United States v. Skrmetti where the Justices decided (6-3) in favor of a Tennessee law (SB 1) that, as an increasing number of states have done, restricts sex transitioning treatments for minors. The law was being challenged by the American Civil Liberties Union (ACLU) which argued that it violated the Equal Protection Clause of the Fourteenth Amendment.
The district court partially enjoined the law, but the Sixth Circuit reversed and upheld it. Oral arguments were held on December 4, 2024, and today the Supreme Court has affirmed the Sixth Circuit ruling, giving parents and the rule of law a big win in their efforts to protect families and preserve liberty.
Chief Justice John Roberts wrote the opinion of the Court, which was joined by Justices Clarence Thomas, Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett. Justice Samuel Alito concurs in judgment and joins the majority opinion partially but filed a separate concurring opinion to make some distinctions. Justices Thomas and Barrett also filed concurring opinions clarifying some matters.
In dissent, Justices Sonia Sotomayor wrote a dissenting opinion joined by Justice Ketanji Brown Jackson, and partially by Justice Elena Kagan, who filed a separate dissenting opinion.
The Court held that, “Tennessee’s law prohibiting certain medical treatments for transgender minors is not subject to heightened scrutiny under the Equal Protection Clause of the Fourteenth Amendment and satisfies rational basis review.”
The law makes classifications based on age and medical treatment uses and not based on race or sex or other prohibited category. “SB1 prohibits healthcare providers from administering puberty blockers or hormones to minors for certain medical uses, regardless of a minor’s sex,” clarified the Chief Justice. He made clear that mere reference to sex is not enough to trigger the Court’s heightened scrutiny. “While SB1’s prohibitions reference sex, the Court has never suggested that mere reference to sex is sufficient to trigger heightened scrutiny. And such an approach would be especially inappropriate in the medical context, where some treatments and procedures are uniquely bound up in sex.”
Applying “rational basis” review then, the Court will uphold a law where there is “any reasonably conceivable state of facts that could provide a rational basis for the classification.”
Summarizing Tennessee’s reasoning, Chief Justice Roberts makes clear, it is more than rational and reasonable:
Tennessee determined that administering puberty blockers or hormones to minors to treat gender dysphoria, gender identity disorder, or gender incongruence carries risks, including irreversible sterility, increased risk of disease and illness, and adverse psychological consequences. The legislature found that minors lack the maturity to fully understand these consequences, that many individuals have expressed regret for undergoing such treatments as minors, and that the full effects of such treatments may not yet be known. At the same time, the State noted evidence that discordance between sex and gender can be resolved through less invasive approaches. SB1’s age- and diagnosis-based classifications are rationally related to these findings and the State’s objective of protecting minors’ health and welfare.
He also makes sure lower courts understand they must proceed with reasonable skepticism when presented with hot medical debates. He wrote, “Recent developments demonstrate the open questions that exist regarding basic factual issues before medical authorities and regulatory bodies in this area, underscoring the need for legislative flexibility.”
Justice Thomas also addressed this crucial issue in his concurring opinion, writing that, “contrary to the representations of the United States and the private plaintiffs, there is no medical consensus on how best to treat gender dysphoria in children.” He said that frankly, “there are particularly good reasons to question the expert class here, as recent revelations suggest that leading voices in this area have relied on questionable evidence and have allowed ideology to influence their medical guidance.” This is something the American people have experienced in many areas of the medical field recently. It is a real issue that Courts must address. Justice Thomas concludes, “Taken together, this case serves as a useful reminder that the American people and their representatives are entitled to disagree with those who hold themselves out as experts, and that courts may not ‘sit as a super-legislature to weigh the wisdom of legislation.’”
Behind these conclusions is a proper understanding of the Court’s role in the life of the American people that should be encouraging to all of us, regardless of political ideology. Chief Justice Roberts summarized the issue very well writing:
This case carries with it the weight of fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field. The Equal Protection Clause does not resolve these disagreements. The Court’s role is not “to judge the wisdom, fairness, or logic” of SB1, but only to ensure that the law does not violate equal protection guarantees. It does not. Questions regarding the law’s policy are thus appropriately left to the people, their elected representatives, and the democratic process.” (Internal citation omitted)
Justice Amy Coney Barrett’s concurring opinion is also important because she makes clear that the court “does not resolve[d] whether transgender status constitutes a suspect class,” which would trigger strict scrutiny. But she wrote separately “to explain why, in [her] view, it does not.” This will be increasingly important in future litigation. Justice Alito also writes with an analysis that assumes the law has classified based on transgender status, and yet still reaches the same conclusion that the law is permissible under the Constitution.
Overall, this is a great step forward towards the protection of children from this harmful ideology that is confusing and consuming too many of them. Let us continue to pray for more states to take steps to protect them from these radical, harmful, and unnatural medical interventions.
