Today, the U.S. Supreme Court heard Chiles v. Salazar, a challenge to Colorado’s law banning licensed clinicians from providing conversion therapy to minors by attempting to change sexual orientation or gender identity. Counselor Kaley Chiles argues the law violates her First Amendment rights by restricting her ability to offer certain faith-based advice. Lower courts upheld the law, finding it regulates professional conduct, not speech. The Court will now decide whether “talk therapy” itself is protected expression, a ruling with sweeping implications across health care.
The case raises deep questions about when professional speech can be regulated, and it has meaningful implications for how hospitals, health systems, and clinicians design and deliver care, especially in areas of reproductive, mental health, and LGBTQIA medicine.
Core Legal Tension: Professional Speech vs. State Regulation
What the law does and what is challenged
- In 2019, Colorado passed a Minor Conversion Therapy Law (MCTL) as part of its mental health licensing framework, prohibiting licensed mental health professionals from undertaking practices that “attempt or purport to change an individual’s sexual orientation or gender identity” when the client is under 18.
- The statute carves out that it does not prohibit supportive or exploratory therapy (e.g. helping someone explore identity, questions, coping) and explicitly exempts religious ministry practices.
- Kaley Chiles, a licensed professional counselor, brought a pre-enforcement challenge, arguing that the law violates her First Amendment right by censoring certain viewpoints she might offer in therapy (for example, counsel aligned with religious beliefs about “biological sex” or discouraging a LGBTQ identity).
- Lower courts (District Court of Colorado, then 10th Circuit) upheld the law, reasoning that the state may regulate the professional practice of therapy (conduct) even if doing so incidentally affects speech.
The Supreme Court granted review to resolve whether such restrictions are permissible under the Free Speech Clause and to clarify the boundary between regulated professional care and protected expressive speech.
Why hospitals and health systems should care
Although the case is directly about mental health counseling, its ramifications extend far beyond. Here are key axes of concern:
- Precedent for regulating speech in clinical encounters. If the Court leans toward Chiles’s argument, it could constrain the authority of states (and by extension licensing bodies) to regulate how clinicians advise, counsel, or even document in records, particularly on contested issues like reproductive health, gender-affirming care, or end-of-life counseling.
- Professional autonomy and standard of care. Health systems rely on professional standards (e.g. evidence-based guidelines, peer review, credentialing) to govern permissible practices. A sweeping decision protecting broad “speech” rights could undercut the power of boards and oversight mechanisms to intervene when clinicians deviate from accepted standard of care (or cross into fringe/unethical practices).
- Liability and institutional risk. If clinicians are shielded from regulation for “speech-based care,” it may become harder for institutions to discipline, restrict, or guide provider behavior, even if that behavior poses reputational, legal, or patient safety risks.
- Chilling or incentivizing nonstandard treatments. Clinicians might feel emboldened to offer controversial or unvalidated therapies under the banner of “speech,” which could pressure hospitals to respond (e.g. in credentialing, monitoring, or defending clinicians).
The outcome of Chiles could shift the balance of power between clinicians, institutions, and state regulators, not just in mental health, but across all realms of care that implicate values, identity, or contested science. Chiles v. Salazar sits at a junction of free speech, professional regulation, and vulnerable patient populations. For health system leaders, this is not a purely legal curiosity: it could reshape the levers through which institutions govern clinicians, define boundaries of permissible care, and preserve patient safety and trust in high-stakes domains of identity, mental health, and reproductive choice.