The Supreme Court heard oral arguments Wednesday in a high-profile case over whether states can ban minors from receiving gender transition medical care under the 14th Amendment’s Equal Protection Clause — a closely watched case that will impact could affect the care and treatment of young people in at least half of the US states.
The case, United States v. Skrmetti, revolves around a law from Tennessee which bans gender transition treatments for adolescents in the state. The law, which passed in March 2023, also targets health care providers in Tennessee who continue to offer gender transition treatments to transgender minors, leaving them open to fines, lawsuits and other liabilities.
The case centers on whether Tennessee Senate Bill 1 “prohibits all medical treatments intended to” enable a minor to identify with, or live as, a perceived identity that is inconsistent with the sex of the minor” or for “alleged inconvenience or distress from a discordance between the sex of the minor and the asserted identity,” violates the Equal Protection Clause of the Fourteenth Amendment.
Wednesday’s oral arguments marked the first time the Supreme Court has considered restrictions on puberty blockers, hormone therapy and surgery for minors. But it also comes as many other states have moved to ban or restrict medical treatments and procedures for transgender adolescents — with excessive attention paid to the case and oral arguments Wednesday as observers kept a close eye on the back-and-forth looking for clues as to how the judge might decide.
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A student leads a group of demonstrators in Knoxville, Tennessee, to protest the ban on transgender athletes in 2022. (Saul Young/Knoxville News-Sentinel/USA Today)
Petitioners in the case were represented by the Biden administration and the ACLU, which sued on behalf of the parents of three transgender adolescents and a Memphis-based doctor to overturn the Tennessee law.
Wednesday’s oral arguments focused on the level of scrutiny courts should use to assess the constitutionality of state bans on transgender medical treatment of minors, such as SB1, and whether these laws are considered discriminatory on the basis of sex or against a “ quasi-discrimination”. -suspect class,” thereby justifying a higher level of scrutiny under the Equal Protection Clause of the Constitution.
Both sides continued to battle over the level of oversight the court should apply when reviewing laws regarding transgender care for minors, including SB1.
Petitioners argued that the court should use the enhanced scrutiny test, which requires states to identify an important purpose that the law helps achieve, while the state of Tennessee reiterated his contention that the rational basis test, or most deferential test applied by the 6th Circuit Court in reviewing SB1, is sufficient.
Petitioners, represented by U.S. Solicitor General Elizabeth Prelogar, argued that SB1 discriminates against individuals on the basis of gender, which in itself warrants an increased level of scrutiny under the Equal Protection Clause. They argued that SB1 “categorically prohibits treatment when, and only when, it is consistent with the patient’s birth gender.”
In Tennessee, petitioners argued, the way the gender-based classification works is that “from the standpoint of each individual who wants to take these medications, his or her gender determines whether SB1 applies.”
U.S. Attorney General Elizabeth Prelogar quoted one of the unnamed petitioners in the case, whom she referred to only as John Doe. Doe “wants to take puberty blockers to undergo typical male puberty. But SB1 says that because John’s sex was female at birth, he cannot have access to those drugs,” Prelogar argued. “And if you change his gender, the restriction under SB1 is removed and the outcome changes.”
Petitioners also sought to address concerns raised by judges about states’ ability to pass legislation protecting minors as long as the test meets higher standards of scrutiny.
Pressed by Justice Brett Kavanaugh about the impact the ruling could have on other states, Prelogar responded by noting that the court could write a very narrow opinion that only states that when a law prohibits conduct that is “contrary to sex, which is a sex baseline, so you do have to apply increased scrutiny.” “But the court has made it clear that this is an intermediate standard,” she said. “And if the state can come forward with an important interest and can substantiate that he is sexual principles to substantially serve that interest,” it would still be permitted.
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The US Supreme Court building in Washington, DC (AP Photo/Mariam Zuhaib)
Respondents from the state of Tennessee argued Wednesday that SB1 is designed to protect minors from what they describe as “risky and unproven medical interventions.”
The state, represented by Tennessee Attorney General Matthew Rice, argued that SB1 draws a “purpose-based line, not a sex-based line,” and thus does not meet the necessary requirements to trigger enhanced oversight to lead.
The law, Rice said, is “entirely about medical purposes, not about a patient’s sex.” The only way petitioners can point to a sex-based line, he argued, “is to equate fundamentally different medical treatments.”
“Giving testosterone to a boy with a deficiency is not the same treatment as giving testosterone to a girl with psychological problems related to her body,” Rice said.
Yet respondents faced difficult questions from judges about the classification and application of SB1.
On classification issues, Judge Kentaji Brown Jackson cited parallels to the race-based case Loving v. Virginia, which overturned Virginia law banning marriages between persons of different racial categories. In that case a white man and a black woman.
FILE – A flag supporting LGBTQ+ rights adorns a desk on the Democratic side of the Kansas House of Representatives during a debate March 28, 2023, at the Statehouse in Topeka, Kan. The U.S. Supreme Court agreed Monday to consider whether a Tennessee ban on gender transition care for minors is constitutional. (AP Photo/John Hanna, File)
Noting that under SB1, an individual can be prescribed puberty blockers or hormone treatments if it is consistent with their gender, but not if it is inconsistent, and asked Rice, “So how are they different?”
Justice Elena Kagan asked Rice about the application of SB1, noting the text of SB1 and one of its goals, which is to “encourage minors to value their sex and prohibit treatments” that could encourage minors to be held in contempt for their sex. sex.'”
“You spend a lot of time talking about what the classification is here,” Kagan told Rice. “And I think we’ve talked about that a lot. But what this classification has yielded may be relevant to understanding what the classification is about.”
Tennessee has argued that its law can still pass even the test of enhanced supervision, stating in its court order that it has “compelling interests” in protecting the health and safety of minors in the state and “in protecting the integrity and ethics of the state’. medical profession.”
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The controversial case comes at a time in Washington when Republicans are poised to take control of the White House, retain the House and reclaim the Senate, giving them greater influence over the composition of the Senate. federal courts.
The court is expected to rule on the case US v. Skrmetti before July 2025.
