I’m thrilled to sit down with James Maitland, a renowned legal scholar with deep expertise in First Amendment rights and healthcare policy. With a career dedicated to analyzing the intersection of law and medicine, James has closely followed pivotal Supreme Court cases that shape state regulations and individual freedoms. Today, we’re diving into the high-stakes challenge to Colorado’s ban on conversion therapy for minors, a case that raises critical questions about free speech, state authority, and the protection of vulnerable populations. Our conversation will explore the controversies surrounding this practice, the legal arguments on both sides, and the broader implications for healthcare policy and constitutional rights.
Can you walk us through what conversion therapy entails, especially for minors, and why it has become such a polarizing issue?
Conversion therapy is a practice aimed at changing an individual’s sexual orientation or gender identity, often rooted in the belief that being gay or transgender is something that can or should be “fixed.” For minors, this can involve counseling sessions, behavioral techniques, or even more extreme measures like aversion therapy, all designed to push them toward a heterosexual or cisgender identity. The controversy stems from overwhelming evidence that it doesn’t work and can cause severe psychological harm. Major medical organizations, like the American Psychiatric Association, have condemned it as pseudoscience, pointing to increased risks of depression, anxiety, and suicide among those subjected to it. On the other side, some practitioners and groups argue it’s a matter of personal choice or religious belief, which fuels the debate over whether banning it infringes on individual rights.
Why have major medical groups taken such a strong stance against conversion therapy, and what specific harms have they highlighted?
Medical groups like the American Psychological Association and the American Medical Association have been vocal because their stance is grounded in decades of research. They’ve found no credible evidence that sexual orientation or gender identity can be changed through therapy, and instead, the practice often inflicts deep emotional and mental damage. Studies show that individuals, especially minors, who undergo conversion therapy are significantly more likely to experience self-harm, substance abuse, and suicidal ideation. The consensus is that it’s not just ineffective—it’s actively dangerous, particularly for young people who are already grappling with identity and societal pressures.
Turning to the legal challenge in Colorado, what’s the central argument from those opposing the state’s ban on conversion therapy?
The plaintiffs, including a therapist named Kaley Chiles and supported by a conservative legal group, argue that the ban violates their First Amendment right to free speech. Their position is that therapy, even when it involves controversial practices like conversion therapy, is fundamentally a form of expression. They believe therapists should be able to discuss any topic with their clients, including minors, without state interference. They frame the ban as an overreach that stifles their ability to provide counsel based on their beliefs or the client’s wishes, asserting that the government shouldn’t dictate what can be said in a private therapeutic setting.
How does Colorado justify its law banning this practice for minors, and what historical precedent do they lean on?
Colorado defends the ban by emphasizing its long-standing authority to regulate healthcare providers to protect the public, especially vulnerable groups like minors. The state argues that conversion therapy falls under professional conduct, not pure speech, and thus can be regulated like any other medical practice. They point to centuries of precedent where states have set standards to prevent substandard or harmful treatments, whether those treatments involve words or actions. Their position is that banning conversion therapy is no different from prohibiting other discredited medical practices—it’s about safeguarding patients from harm, not censoring speech.
What broader implications could the Supreme Court’s decision in this case have for state regulations and medical care?
This case could redefine how much power states have to regulate mental health professionals and healthcare practices in general. If the court sides with the plaintiffs and deems conversion therapy a form of protected speech, it might weaken states’ ability to set guardrails on counseling or other medical treatments, opening the door to practices that lack scientific backing. Medical professionals have expressed concern that labeling substandard care as free speech could undermine patient safety across various fields. Beyond conversion therapy, a ruling in favor of the plaintiffs might challenge other regulations, like licensing requirements or bans on unproven treatments, creating a ripple effect through healthcare policy.
How does this case tie into the Supreme Court’s recent decision to uphold Tennessee’s ban on gender-affirming care for minors?
There’s a clear connection in terms of state authority over medical practices. In the Tennessee case, decided in June 2025, the court upheld the state’s right to ban gender-affirming care for minors, reasoning that lawmakers could intervene when they believed the risks of a treatment outweighed the benefits. That decision leaned heavily on deferring to state legislatures and the democratic process. In the Colorado case, we see a similar tension between state power and individual rights, though the free speech angle adds a different layer. The court’s willingness to affirm state authority in Tennessee might suggest a lean toward upholding Colorado’s ban, but the First Amendment argument could complicate that consistency.
What role does the current administration’s stance play in shaping the narrative around this legal challenge?
The Trump administration has actively supported the challenge to Colorado’s ban by filing a brief that disputes the harms of conversion therapy and questions the reliance on professional consensus to regulate what therapists can say. Their position is that therapists should have the freedom to offer such counseling without state interference, aligning with a broader push to prioritize individual and professional autonomy over regulatory oversight. This backing adds a significant political dimension to the case, framing it as part of a larger debate about government overreach and personal belief systems in healthcare.
Looking ahead, what is your forecast for how this case might influence the balance between free speech and state regulation in healthcare?
I think this case will be a defining moment for how we interpret the First Amendment in professional settings like healthcare. If the court prioritizes free speech over state regulation, we could see a wave of challenges to other medical laws, potentially eroding protections against unproven or harmful practices. On the other hand, if the court upholds Colorado’s ban, it would reinforce the state’s role as a gatekeeper for patient safety, even when speech is involved. Given the current composition of the court and recent rulings favoring state authority, I lean toward a decision that upholds the ban, but the free speech argument is a wildcard that could sway key justices. The outcome will likely set a precedent that shapes healthcare policy for decades.
