Tag: Supreme Court

Conversion Therapy on Trial: What Chiles v. Salazar Means for Medical Regulation and LGBTQ+ Protections

The Supreme Court heard arguments on October 7, 2025 to lift Colorado’s ban on “conversion therapy,” a discredited practice which targets LGBTQ+ youth to change their sexual orientation or gender identity. In Chiles v. Salazar, Kaley Chiles, a Colorado-licensed professional counselor, challenged a Colorado state regulation which prohibits providers from engaging in “conversion therapy” with anyone under 18. The practice can include anything from talk therapy to electric shock or pharmaceutical interventions. The Court heard arguments about what therapists may say to their patients—specifically, whether talk counseling is “conduct” or “speech,” and whether it is protected under the First Amendment and the Free Exercise Clause.

There is overwhelming evidence and medical consensus that the efforts to change a child’s sexual orientation or gender identity are unsafe and ineffective. In August 2025, the American Psychological Association, joined by the American Psychiatric Association and 12 other mental health and medical professional organizations, filed an amicus brief in support of the Colorado law. Research consistently demonstrates that “conversion therapy” has long-lasting consequences, including depression, anxiety, suicidality, substance misuse, damaged familial relationships, loss of connection to community, self-blame, guilt, and shame. Twenty-three states have prohibited healthcare providers from subjecting minors to “conversion therapy.” A recent UCLA study shows 698,000 LGBTQ+ adults have undergone “conversion therapy,” with half of them (350,000) receiving the treatment as adolescents.

The central question for the judges in Chiles is whether Colorado’s law interferes with free speech protected by the First Amendment, or whether it is a necessary legal regulation of professional conduct. Chiles argues that “conversion therapy” is speech, not conduct, and thus states “do not have a freer hand to regulate speech simply because the speaker is ‘licensed’ or giving ‘specialized advice.’” Conservative judges shared concerns about the law’s apparent threat to Christianity-informed free speech. Justice Alito called the statute “blatant viewpoint discrimination,” posing two hypotheticals—one in which a boy asks a therapist to help end his attraction to men, and one in which he asks for support to feel comfortable being gay—and stating that the statute requires opposite results depending on the viewpoint expressed. Justice Gorsuch and Justice Barrett also raised concerns regarding how laws justify medical regulations.

Justice Jackson, conversely, noted that states have a long history of regulating medical treatment, and doctors would clearly be liable if they used medication that the state deemed substandard care. Citing the Supreme Court 2024 decision in Skrmetti, which upheld the Tennessee law banning gender-affirming care for minors, Jackson questioned why the Colorado regulation “isn’t just the functional equivalent,” since both prohibit a medical treatment for minors that major medical associations say can lead to an increased risk of depression and suicidal thoughts. Justice Sotomayor was fundamentally concerned with whether Chiles even had standing to challenge the law, noting that “merely having a law on the books is not enough.” She pressed Chiles’ attorney to explain how she was personally harmed by the law, observing she does not face a “credible threat of prosecution.”

There is no clear consensus among circuit courts on First Amendment protections regarding professional speech. For example, the Ninth Circuit has held that there is a continuum, where on one end “public dialogue” gets robust protection, and on the other end, conduct such as individual treatment or professional counseling is not protected. Other courts insist that speech protections apply fully to counseling conversations even in professional settings, while many reaffirm that health professionals must provide treatment consistent with the government-regulated standard of care. In Chiles, the court seemed skeptical of Colorado’s claim that conversion therapy is conduct and not speech, but it remains uncertain if it will be sent back to the lower courts.

Chiles comes amidst a nationwide surge of anti-LGBTQ+ legislation and decisions, including laws that ban or punish gender-affirming care, restrict trans athletes from participating in sports, and create religious exemptions for LGBTQ+ nondiscrimination protections. In two Colorado cases, in 2017 and 2023, the Supreme Court sided with Christian business owners who opposed marriage equality and rebuked LGBTQ+ nondiscrimination laws in the process. Chiles could not only redefine the boundary between speech and conduct and set precedent for medical regulations, but also have wide-ranging consequences on legal safeguards meant to protect LGBTQ+ youth from discrimination and harm.

A Crisis of Accountability: Medical Neglect and Preventable Deaths in Immigration Detention

On September 14, 2025, Hasan Ali Moh’D Saleh, a lawful permanent resident, was arrested by Immigration and Customs Enforcement (ICE) and transferred to Krome Detention Center in Miami, Florida for removal proceedings. On October 10th, Saleh was transported to Larkin Community Hospital due to a fever; the next day, he was dead.

As immigration raids take place in front of cameras across the country, an unseen crisis has developed behind heavily guarded gates. With the escalation of Immigration and Customs Enforcement-Related Operations (ERO) in the United States under the second Trump Administration, there is mounting public outcry and a flurry of legal challenges concerning the lack of due process regarding the arrests of undocumented migrants, asylum seekers, and green card holders like Mr. Saleh. Conflicting narratives have emerged between advocates and authorities regarding the safety and welfare of individuals detained in ICE-related actions. 

As of September 2025, the Trump Administration is holding nearly 60,000 immigrants in ICE detention facilities around the country, not including those held by local authorities under detainer requests from ICE. Seven in ten people detained have no criminal convictions; the majority are working age adults who deny serious medical complaints at intake. Even so, detainees are dying in custody at record speed, most often due to illness, according to reports made public by ICE. 

The agency maintains that relevant details linked to ERO-related deaths are published on its website within two days. However, the “relevant details” connected to the demise of immigrants like Mr. Ismael Ayala-Uribe at age 39 are often cloudy. According to ICE records, Uribe was arrested on August 17th, 2025. On September 18th, nurses noted that Mr. Uribe was in “10 out of 10 pain” near his anus, so a physician ordered a pain reliever and fiber. By September 21st, he was vomiting, sweating, and his heart rhythm was abnormal, having deteriorated to the point that medical staff needed to transfer him to a local hospital. The ICE press release, replete with an account of Uribe’s crimes, arrests, and his DACA status, states that early on September 22nd, he became unresponsive and died.

In the landmark Supreme Court case, Estelle v. Gamble, the Court found that such unnecessary suffering is inconsistent with contemporary standards of decency, codifying the common law view that “[we are] required to care for the prisoner who cannot by reason of the deprivation of his liberty, care for himself.” Given the inmate’s complete reliance on staff for medical treatment, the Court explained that the “deliberate indifference to serious medical needs” constitutes the infliction of cruel and unusual punishment involving the “unnecessary and wanton infliction of pain” forbidden by the Eighth Amendment. The Court further held that such neglect by prison doctors and guards can result in torture or lingering death, and in less severe instances, cause unnecessary pain and suffering which serves no legitimate penological purpose.

Legislators have worked to gain oversight of detention centers for the purpose of investigating welfare complaints and medical standards in settings where patients do not have the autonomy to make informed decisions about their healthcare. NPR received a rare look inside ICE facilities via inspection reports from experts hired by The Department of Homeland Security. In the findings from 2017-2019, inspectors cited negligent medical care that, in some cases, contributed to detainee deaths. 

One inspection revealed that in the Calhoun County Correctional Center, a man in ICE custody was sent into general population with an open wound from surgery and no bandaging, even though he still had surgical drains in place. Jesse Dean, a detainee at the same facility, was never referred to a physician although he had been unable to eat, lost almost 20 pounds in a short time, and suffered from severe nausea; he died in custody from an undiagnosed gastrointestinal hemorrhage.

A joint study published by American Oversight revealed that the overwhelming majority of incidents such as Dean’s could have been prevented if ICE detention medical staff had provided timely and clinically appropriate medical care to include correct, appropriate, and complete diagnoses for detained immigrants.

After 2020, loss of life in ICE custody attributed to chronic or acute medical conditions declined, and spiked recently in correlation to Trump-mandated mass ERO’s:

As ICE arrests surge, concern continues to grow over rising morbidity and mortality rates in immigration detention centers, along with the absence of accountability or consequences for responsible parties. While an analysis of factors contributing to preventable detainee medical deaths cannot cure those who are no longer alive, an honest post-mortem inquiry into systemic failures is vital in order to safeguard the living.

EMTALA in the Age of Rising Abortion Bans

Following the decision in Dobbs v. Jackson Women’s Health Organization in 2022, abortion bans have been popping up in states across the country. Many states have qualified their bans with exceptions based on the gestational age of the pregnancy, assault, or medical necessity. However, for 12 states, the exceptions, if present at all, are narrow, creating near-total abortion bans. This has widespread implications not just for patients, but for medical providers who traditionally provide abortions or greater obstetrics care.

One specific class of providers has found itself in the middle of a clash between state and federal law due to these bans. Emergency medical providers are not just bound by state law, but by the Emergency Medical Treatment and Active Labor Act (EMTALA). EMTALA is a federal act passed in 1986 as a response to a problematic practice of “patient dumping,” where hospitals refuse to treat low-income patients or patients from marginalized communities and transfer them to other hospitals. The primary requirement of the act is that any patient who arrives at an emergency room in a hospital that receives Medicare funding must be screened and stabilized before being transferred or released. The majority of guidance on EMTALA has left the medical decision-making aspect of stabilization and treatment up to the discretion of medical providers within the scope of their capabilities and the current standards of care.

The issue arises in cases where an abortion is determined to be medically necessary for the stabilization of a patient by a provider in an emergency setting. Pregnancy complications are the fifth most common reason that women between 18 and 65 visit the emergency room, with 84% of women visiting the emergency room at some point during their pregnancy. Due to the breadth of procedures that fall under the clinical term “abortion,” many medical procedures required for emergency obstetrics care fall under the abortion umbrella. Often, these procedures are life-saving and needed for even the most basic stabilization of a pregnant patient, such as in the case of ectopic pregnancy.

A few cases reflecting this conflict have made their way to the Supreme Court, hoping to receive a concrete answer as to whether emergency abortion procedures would remain protected. The most recent of these is Idaho v. United States, where the DOJ contended that Idaho’s near-total abortion ban would have to yield to federal law in terms of the provision of necessary stabilizing treatment. However, SCOTUS dismissed the complaint in 2024 without a specific ruling on the interaction between EMTALA and abortion bans, finding that the writ of certiorari was improvidently granted.

Despite this dismissal, the Supreme Court has another chance to hear arguments concerning the interaction between EMTALA and abortion bans due to a recent lawsuit where Texas sued the DOJ in an attempt to force ER compliance with the state’s strict abortion ban. The Fifth Circuit Court of Appeals sided with the state, allowing for the abortion ban to prevail over EMTALA obligations. The DOJ, under President Biden, filed for a review of the decision in 2024, but after the change in administration, it remains to be seen whether the DOJ will continue to pursue the complaint or whether SCOTUS will hear the case.

Without a clear ruling from federal courts, the conflict between the duties of providers under EMTALA and state-based bans leaves providers wary of legal repercussions, no matter which actions they take. Guidance from the Center for Medicare & Medicaid Services, as given in 2022, stated that providers would be protected under EMTALA for the provision of medically necessary abortions for the stabilization of emergent patients. However, that guidance was rescinded under President Trump as of June 3rd, 2025, and subsequent communication from the HHS on June 13th, 2025, was unclear. The lack of clear information and rising legal consequences of providing abortions in certain states have thrust providers and patients alike back into a state of uncertainty and fear.

Domino’s Pizza May Deliver the Supreme Court a Chance to Modernize the ADA

The Supreme Court of the United States could soon provide
greater clarity to the Americans with Disabilities Act’s (ADA) jurisdiction
over websites and mobile apps.

Domino’s Pizza is reportedly preparing a petition for certiorari to appeal a Ninth Circuit decision, Robles v. Domino’s (913 F.3d 898), which held that blind plaintiff, Guillermo Robles, could proceed with a lawsuit against Domino’s after alleging the pizza purveyor’s website and mobile app were inaccessible to him using screen-reading software. On appeal, the Ninth Circuit reversed the decision of the district court and held that the ADA applies to the website and mobile application as services of a place of public accommodation. If the Supreme Court accepts Domino’s “cert petition” for Robles, the Court would have the opportunity to rule on the issue of whether websites and mobile apps must comply with ADA standards.

The ADA was passed in 1990 under
President George H.W. Bush as the “world’s first comprehensive declaration of
equality for people with disabilities.” Since
then, the ADA has been further refined and empowered by a mix of
legislation and landmark Supreme Court cases.
The ADA, at its core, is a law
that “prohibits discrimination against individuals with disabilities in all
areas of public life, including jobs, schools, transportation, and all public
and private places that are open to the general public.”

Although the ADA’s jurisdiction over those places listed
above is clear, its claim over the internet has been tenable at best. The ADA still
does not address digital or online compliance specifically, even as our
lives become increasingly digitized. The current state of the law regarding
online compliance to ADA standards is made up of a patchwork of federal appellate
court decisions, which often have different
or contradicting standards. This legal uncertainty was highlighted in
2018, in which over 2,250 website accessibility lawsuits were filed in the
U.S., increasing from 814 the year before. Still, the Supreme
Court has yet to take up one of these cases to provide clarity in the law
and relief to lower courts. A ruling by the Court on a website accessibility
case could replace the appellate patchwork of case law with a single federal
standard.

In Robles, the district court granted Domino’s summary judgment motion and dismissed the case holding that “imposing […] standards on Domino’s without specifying a particular level of success criteria and without the Department of Justice (DOJ) offering meaningful guidance on this topic … fl[ew] in the face of due process.”

The case was then appealed to the Ninth Circuit, which
reversed the district court’s dismissal, holding
that the ADA applied to websites and mobile apps for operators of places of
public accommodation. This holding reaffirmed the standard “that, to be covered
by the ADA, a website or mobile app must have a
nexus to a physical place of public accommodation.” The court expounded
upon this noting that the ADA applies to services “of a place of public accommodation,” not “in a place of public accommodation.” The distinction by the court broadens
the applicability of the ADA from beyond the physical space to websites and
mobile apps.

The Ninth Circuit stated
there was such a nexus, as the “alleged inaccessibility of Domino’s website and
app impedes access to the goods and services of its physical pizza franchises –
which are places of public accommodation.” Additionally, the Ninth Circuit held
that due process did not require DOJ to issue specific guidelines as Domino’s had
been on notice “since
1996 of DOJ’s position that its website and app must provide effective
communication.”

After the decision by the Ninth Circuit, Domino’s requested
a sixty-day extension to file a petition of certiorari with the Supreme Court,
which was subsequently granted
by Justice Kagan; the petition must now be filed by June 14, 2019. In the
request, Domino’s
states, “[t]he Ninth Circuit’s decision in this case presents important and
complex issues concerning the scope of the ADA, the resolution of which will
have a significant impact on all businesses and institutions seeking to
maintain an online presence.”

The stage is set for an overdue landmark determination of
the extent of ADA’s jurisdiction over websites and mobile applications if a
“cert petition” is filed and granted. A decision
by the Supreme Court, in this case, could have immediate and far-reaching
implications for both businesses and individuals covered under the ADA. Thus, lawyers,
industry leaders, and ADA-covered individuals are closely watching
this case as it develops.

Hobby Lobby Defies Court By Refusing to Cover Morning-After Pill

When the Supreme Court upheld the Affordable Care Act on June 28, 2012, it required employers to provide insurance that covers emergency contraception. The craft store Hobby Lobby refuses cover the morning after pill, citing religious convictions.

In an effort to prevent the $1.2 million daily fines they would be facing, Hobby Lobby took the issue to court. Justice Sotomayor and the Supreme Court refused to grant Hobby Lobby an injunction, and on Friday, December 28, 2012, the company announced its refusal to adhere to the federal order.

Misinformation about the causes and effects of the morning-after pill, often known by the popular brand name Plan B, promulgates the belief that it induces abortions. This is not true.

Hobby Lobby and its sister company, Mardel, have decided to accept whatever fines the government levies against them for failing to follow the law.

Religious organizations that were exempt from implementing the required contraception coverage will no longer be allowed to deny coverage after August 1, 2013. Contraception coverage applies even to organizations and groups run by religious organizations that oppose contraception, including Christian hospitals and charities. This controversial decision was made after the Institute of Medicine found that contraception is medically necessary “to ensure women’s health and well-being”.