CNA Staff, Jun 18, 2025 /
15:23 pm
In a pivotal 6-3 decision, the U.S. Supreme Court on Wednesday ruled to uphold Tennessee’s ban on medical procedures on transgender-identifying youth.
The June 18 ruling in United States v. Skrmetti marks a significant victory for Tennessee and 25 other states with similar restrictions on transgender medical interventions, such as puberty blockers, hormone therapy, and surgeries for minors.
Tennessee Attorney General Jonathan Skrmetti on X hailed the ruling as a “landmark VICTORY for Tennessee,” emphasizing its role in “defending America’s children.”
Tennessee’s defense was supported by 24 Republican state attorneys general; Republican governors; the U.S. Conference of Catholic Bishops, who issued a statement in 2023 opposing surgeries that mutilate the human body; conservative legal and policy groups; and “detransitioners” who no longer identify as transgender.
Christian legal nonprofit Alliance Defending Freedom (ADF) attorneys filed a friend-of-the-court brief with the Supreme Court in October 2024, urging the court to allow state legislatures to protect children from “experimental medical procedures.”
ADF CEO and President Kristen Waggoner called Wednesday’s decision a “monumental victory for children, science, and common sense.”
She continued: “No one has the right to harm a child. The Biden administration and ACLU asked the court to create a ‘constitutional right’ to give children harmful, experimental drugs and surgeries that turn them into patients for life. This would have forced states to base their laws on ideology, not evidence — to the immense harm of countless children … States are free to protect children from the greatest medical scandal in generations — and that’s exactly what states like Tennessee have done.”
The Biden administration had argued that gender-altering medical interventions are necessary for transgender youth.
Directly opposing the Biden administration’s position, President Donald Trump signed an executive order in January ending federal support for gender transition-related care for minors and, in a March joint address to Congress, called for federal legislation “permanently banning and criminalizing sex changes on children.”
Background and legal arguments
The case stemmed from L.W. v. Skrmetti, where parents argued that the Tennessee law, Senate Bill 1 (SB1), violated the 14th Amendment’s due process clause by infringing on their right to make medical decisions for their children. They also claimed the law violated the equal protection clause by discriminating based on sex.
The 6th Circuit Court of Appeals had previously upheld SB1, finding it constitutional under both due process and equal protection analyses, contrasting with the 8th Circuit’s 2024 ruling striking down a similar Arkansas law on equal protection grounds.
At the Supreme Court, U.S. Solicitor General Elizabeth Prelogar and ACLU attorney Chase Strangio argued for the plaintiffs, asserting that SB1 constituted sex-based discrimination requiring intermediate scrutiny — a standard demanding that the state show the law is substantially related to an important government objective.
They claimed Tennessee failed to meet this burden, as the law targeted treatments specific to transgender minors, effectively discriminating based on sex.
Tennessee Solicitor General J. Matthew Rice countered that SB1 did not discriminate based on sex but instead regulated medical interventions based on age and purpose. He argued for rational basis review, a lower standard requiring only that the law be rationally related to a legitimate government objective, such as protecting minors from unproven medical interventions.
Rice argued in favor of the state’s authority to regulate medical interventions, particularly for children, given ongoing debates about the long-term effects of gender-based medical treatments.
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The Supreme Court’s majority opinion on Wednesday held that SB1 does not constitute sex discrimination warranting heightened scrutiny. The court ruled that the law distinguishes treatments based on their medical purpose, not sex, and thus passes rational basis review.
Chief Justice John Roberts, writing for the majority, echoed his earlier remarks during oral arguments in December 2024: “The Constitution leaves that question to the people’s representatives, rather than to nine people, none of whom is a doctor.”
Justice Sonia Sotomayor, joined fully by Justice Ketanji Brown Jackson and partially by Justice Elena Kagan, filed a dissenting opinion contending that the law targets transgender minors by denying them access to medical treatments available to others for different purposes and warrants heightened scrutiny because the law “singles out transgender youth for unequal treatment, punishing them for their gender identity in violation of equal protection principles.”
Justice Kagan, in a separate dissenting opinion, emphasized the law’s infringement on parental rights under the due process clause and its lack of rational basis given medical evidence supporting gender-affirming care. She also argued that Tennessee’s categorical ban disregards established medical standards and parental decision-making authority without adequate justification.
“By overriding medical consensus and parental choices, this law undermines fundamental liberties and sets a dangerous precedent for state overreach,” Kagan stated.
Amira Abuzeid is a senior editor at Catholic News Agency.
