When Speech Becomes Malpractice

On 31 March 2026, the Supreme Court sided with a Christian Counselor and struck down Colorado’s ban on “Conversion Therapy,” a practice pushed by conservatives to make LGBTQ+ people straight, reasoning the ban infringed upon the counselor’s first amendment rights. This ruling is deeply troubling. Major medical and psychiatric organizations continue to describe conversion therapy as discredited, not evidence-based, and potentially harmful. The American Psychiatric Association issued a statement emphasizing that LGBTQ+ is not a mental illness or disorder, that conversion therapy is not a legitimate therapeutic treatment, and that leading healthcare entities have concluded these are “discredited practices and are not supported by scientific evidence.” A 2026 Trevor Project research brief found that LGBTQ+ young people with more recent exposure to conversion therapy reported especially high rates of past-year suicidality, with 61% reporting serious consideration of suicide. Earlier peer-reviewed research has also found strong associations between conversion efforts and suicidality, and a 2022 JAMA Pediatrics analysis estimated the annual economic burden of conversion therapy and its associated harms at $9.23 billion in the U.S.

Because of this ruling, people are going to get hurt and some are going to die.

In her dissent, Supreme Court justice Ketanji Jackson wrote, “Not only is conversion therapy ineffective, former participants report that it causes lasting psychological harm… Survivors continue to suffer from PTSD, anxiety, and suicidal ideation… Talk therapy is a medical treatment. So, why wouldn’t such speech-based medical treatments be subject to reasonable state regulation like any other kind of medical care?” Elsewhere, she argued, “no core principle of our First Amendment jurisprudence leads inexorably to the conclusion that it violates the Constitution for a State to prevent its licensed talk therapists from using speech to harm the minors in their care.”

And she is right.

A medical practitioner’s freedom of speech does not allow them to conduct medical malpractice with impunity. As Jackson pointed out, “Like it or not, treatment standards exist in America.” At least until now. If a counselor can use their freedom of speech to employ medical practices that peer-reviewed studies have deemed fatally harmful to patients, especially to minors, then other medical practitioners can do likewise. This decision will have far-reaching consequences that extend well beyond the immediate victims of the LGBTQ+ community.

An Oncologist can tell a patient to abandon chemotherapy and rely on herbal supplements instead. That advice is speech. But it is also malpractice, because medicine is regulated to protect patients from dangerous, discredited treatments. Likewise, a therapist can tell a suicidal teenager to stop taking antidepressants because medication shows a lack of faith. That instruction is speech. But it is also dangerous medical advice, and states have always had the authority to intervene when licensed professionals put patients at risk.

The First Amendment was never meant to shield licensed professionals from accountability when their “treatment” endangers the people in their care. Medicine is regulated because lives depend on it. When courts blur the line between protected speech and professional malpractice, the consequences are not theoretical. They are measured in suffering, in trauma, and in lives that could have been saved.