First Amendment

Eleventh Circuit Enjoins Local Ordinances Barring "Conversion Therapy"

A divided panel concludes that such ordinances run afoul of the First Amendment, creating a split with other circuits.


Today, in Otto v. Boca Raton, a divided panel of the U.S. Court of Appeals for the Eleventh Circuit concluded that local bans on "sexual orientation change efforts (SOCE)" (aka "conversion therapy") are unconstitutional under the First Amendment. The laws in question, which had been adopted by Boca Raton and Palm Beach County, Florida, prohibited (in the words of the latter ordinance):

the practice of seeking to change an individual's sexual orientation or
gender identity, including but not limited to efforts to change behaviors,
gender identity, or gender expressions or to eliminate or reduce sexual
or romantic attractions or feelings toward individuals of the same
gender or sex.

The ordinances exempted clergy and "counseling that provides support and assistance to a person undergoing gender transition."

Splitting 2-1, the Eleventh Circuit panel concluded these laws were content- and viewpoint-based restrictions on speech that could not satisfy the requirements of strict scrutiny. The panel majority also rejected the localities' arguments that the laws were permissible regulations of "professional speech." (Note that the restrictions at issue were not imposed by the state licensing board, but by individual localities.]

Judge Grant wrote the opinion for the court, joined by Judge Lagoa. Judge Grant's opinion begins:

Boca Raton and Palm Beach County prohibit therapists from engaging in counseling or any therapy with a goal of changing a minor's sexual orientation, reducing a minor's sexual or romantic attractions (at least to others of the same gender or sex), or changing a minor's gender identity or expression—though support and assistance to a person undergoing gender transition is specifically permitted. These restrictions apply even to purely speech-based therapy. Two therapists argue that the ordinances infringe on their constitutional right to speak freely with clients. They appeal the district court's denial of their motion for a preliminary injunction. We understand and appreciate that the therapy is highly controversial. But the First Amendment has no carveout for controversial speech. We hold that the challenged ordinances violate the First Amendment because they are content-based regulations of speech that cannot survive strict scrutiny.

On whether the ordinances were content-based and viewpoint-based restrictions, Judge Grant wrote:

We cannot see how the regulations here can be applied without considering the content of the banned speech. Indeed, and as we said in Wollschlaeger, "this is not a hard case in that respect." 848 F.3d at 1307. The regulations are plainly "speaker-focused and content-based restrictions on speech": they limit a category of people—therapists—from communicating a particular message. Id. Consider again the similarities to Wollschlaeger. There, a Florida law prevented doctors from speaking to their patients about firearm ownership. See id. at 1302–03. Whether a doctor violated that law turned solely on the content of the message conveyed to the patient. Here too. Whether therapy is prohibited depends only on the content of the words used in that therapy, and the ban on that content is because the government disagrees with it. And whether the government's disagreement is for good reasons, great reasons, or terrible reasons has nothing at all to do with it. All that matters is that a therapist's speech to a minor client is legal or illegal under the ordinances based solely on its content. . . .

So the ordinances discriminate on the basis of content—at a minimum. They also discriminate on the basis of viewpoint. After all, the plaintiffs' counseling practices are grounded in a particular viewpoint about sex, gender, and sexual ethics. The defendant governments obviously hold an opposing viewpoint—one that they surely have the  right to promote. . . . But they cannot engage in "bias, censorship or preference regarding [another] speaker's point of view." . . .

That the defendants did precisely that becomes even more obvious when considering the "exception" outlined in both ordinances. The exception expressly allows "counseling that provides support and assistance to a person undergoing gender transition." No such carveout exists for sexual orientation. The ordinances thus codify a particular viewpoint—sexual orientation is immutable, but gender is not—and prohibit the therapists from advancing any other perspective when counseling clients. That viewpoint may be widely shared in the communities that passed the ordinances, but widespread agreement is beside the point; the question is whether a speaker's viewpoint determines his license to speak. Here, the answer is yes.

Judge Grant's opinion concludes:

This decision allows speech that many find concerning—even dangerous. But consider the alternative. If the speech restrictions in these ordinances can stand, then so can their inverse. Local communities could prevent therapists from validating a client's same-sex attractions if the city council deemed that message harmful. And the same goes for gender transition—counseling supporting a client's gender identification could be banned. It comes down to this: if the plaintiffs' perspective is not allowed here, then the defendants' perspective can be banned elsewhere. People have intense moral, religious, and spiritual views about these matters—on all sides. And that is exactly why the First Amendment does not allow communities to determine how their neighbors may be counseled about matters of sexual orientation or gender.

"If there is a bedrock principle underlying the First Amendment, it is that the government may not prohibit the expression of an idea simply because society finds the idea itself offensive or disagreeable." Texas v. Johnson, 491 U.S. 397, 414 (1989). The challenged ordinances violate that principle, and the district court should have enjoined their enforcement. We therefore REVERSE the district court's order and REMAND for entry of a preliminary injunction consistent with this opinion.

Judge Martin dissented from the Court's decision. Her dissent began:

Today's majority opinion puts a stop to municipal efforts to regulate "sexual orientation change efforts" (commonly known as "conversion therapy"), which is known to be a harmful therapeutic practice. The majority invalidates laws enacted to curb these therapeutic practices, despite strong evidence of the harm they cause, as well as the laws' narrow focus on licensed therapists practicing on patients who are minors. Although I am mindful of the free-speech concerns the majority expresses, I respectfully dissent from the decision to enjoin these laws.

Later on, she writes:

The majority is correct to say this case implicates sensitive considerations about when and how government bodies may regulate speech. Instances in which a speech restriction is narrowly tailored to serve a compelling interest are deservedly rare. But they do exist. See Williams-Yulee, 575 U.S. at 444, 135 S. Ct. at 1665–66. I believe the Localities' narrow regulation of a harmful medical practice affecting vulnerable minors falls within the narrow band of permissibility. I would therefore affirm the District Court's denial of a preliminary injunction on the Therapists' free speech claim.

Given that laws prohibiting various forms of conversion therapy have been upheld in other circuits, there is now a circuit split on the constitutionality of such laws. This means that if a petition for certiorari is filed, it should stand a reasonable likelihood of being granted. If the localities here do not wish to pursue the issue, however, the existence of a circuit split should make it easier for others to bring this question before the Supreme Court.

NEXT: Merrick Garland for Attorney General?

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  1. Trying to talk the gay out of a consenting adult: SICK AND WRONG
    Mutilating a child with surgery and sex change hormones: STUNNING AND BRAVE

    1. I’m skeptical of this conversion therapy…but it appears to have worked on Michelle Bachman’s husband.

      1. Many people who are subjected to such treatment end up committing suicide or self-harming in some other way. I guess voluntarily marrying Michelle Bachman isn’t that strange, in that context.

        1. Well, duh. Have you looked at the baseline suicide rate here? It’s something like three times higher than heterosexuals for homosexuals, and ten times higher for transgenders.

          All that’s established here is that conversion therapy doesn’t greatly lower suicide risk, since it was high to begin with.

          1. Have you looked at the baseline suicide rate here? It’s something like three times higher than heterosexuals for homosexuals,

            Wonder why?

            1. People who go through transgender reassignment have a higher suicide rate because the evil cisgendered patriarchy tried to discourage them not because sjws encouraged them to do it.

              People who go through conversion therapy have a higher suicide rate because the evil cisgendered patriarchy encouraged them to do it not because the sjws tried to discourage them.

              Tails I win heads you lose.

            2. Well, I’m sure you’ll say it’s because they’re oppressed, but you’d clearly be wrong, because transexuals who get gender reassignment surgery and attempt to pass actually have increased, not diminished, suicide risk.

              Oh, and liposuction doesn’t cure anorexia, either.

              1. I heard that Mother Pence once walked in on Mike engaging in unnatural behavior while watching Magnum PI…and so she clutched his sticky hand and they prayed those evil thoughts right out of his head! Prayer works and Mike probably avoided several viruses thanks to those prayers…and that is why I have been praying away the coronavirus since the dastardly Chinese first unleashed it on this earthly world!

                1. what is up with progs and their tendency towards vividly detailed grotesque sexual fantasies many times with children involving their opponents?

                  1. I’m pro-life and hate progressives…but keep voting for globalist Republicans like Loeffler and Perdue because they have an R next to their name.

              2. because transexuals who get gender reassignment surgery and attempt to pass actually have increased, not diminished, suicide risk

                I think we need to take all these sort of statistics with a large handful of salt, because of selection bias.

                Thus, the more you feel a disjunction between your mind and your body, the more distressed you are likely to be, and so the more likely you are to try to do something – like surgery – about it, and the more likely you are to be suicidal.

                Hence those who have gender reassignment surgery are likely to be taken from a population that is more likely to be suicidal anyway.

                Which is not to say that I reject the notion that gender reassignment surgery may make some people more suicidal than they might otherwise have been – merely that it is doubtful that we have any reliable statistics that reliably show such a thing.

                1. Oh, I agree that the statistics are not terribly good. My point is just that the statistics we do have, for what they’re worth, show that gender reassignment surgery doesn’t seem to have any particular long term positive consequences.

                  But in regards to stating that people who’ve had conversion therapy have committed suicide… As you say, they’re drawn from a high suicide level population, so all that does is demonstrate that it’s no cure-all.

        2. ” I guess voluntarily marrying Michelle Bachman isn’t that strange, in that context.”

          Not a fate worse than death?

          1. The guy was a self loathing closet case…so he wanted to punish himself for having unnatural thoughts about Magnum PI and the Bandit.

  2. “…changing a minor’s gender identity or expression—though support and assistance to a person undergoing gender transition is specifically permitted…”

    Parent: I’d like you to help my son feel comfortable as a boy.

    Dr: Sorry, I can’t help you.

    Parent: Uh, I mean, I’d like you to help my daughter undergo a gender transition.

    Dr: OK, that I can do!

  3. This is a horrible decision. These children are not going to this therapy voluntary, they are forced to be there by their parents. This is not “therapy”, it is medical malpractice and is shown to be harmful to the minors.

    Also, I do not see how “conversion therapy” is protected speech, while at the same time it is legal to force abortion doctors to read state mandated statements to the woman.

    1. So much for medical decisions being up to patients and their doctors, I guess.

      1. I agree, but lets go back to the part where the patient has no say because their parents are forcing them to do it.

        1. “I agree, but lets go back to the part where the patient has no say because their parents are forcing them to do it.”

          You’d prefer that the patient have no say because the government is preventing them from doing it? Parents are rightly surrogate decision makers for children, not governments.

          1. 1. These are mostly teens who are forced into this. 2. Parents do not have the right to abuse their children, and this is very much abuse.

            1. “Parents do not have the right to abuse their children, and this is very much abuse.”

              Just because you don’t agree with a parenting decision doesn’t make it abuse.

              1. And sometimes it is abuse, this is one of those times.

                1. Nope. Nothing malicious going on, just parents making decisions that you don’t like.

                2. Right.

                  Conversion therapy is abusive and destructive. It’s no different than a medical treatment that actively harms the patient.

                  1. If there’s evidence that the parents think it actively harms the patient and do it anyway, sure. Otherwise you just have parents making decisions you disagree with.

                    1. It’s no different than other cases where parents make medical decisions that clearly are harmful to their children.

                      That they may have no intent to harm doesn’t change the facts.

                    2. Again, parents making decisions that you disagree with isn’t abuse, either in this context or any other.

                    3. The state thinks conversion therapy is harmful regardless of what the parents think.

        2. My parents forced me to do lots of things, like going to school. For a while, my brute mother even forced me to make my bed. And when they found a bag of marijuana in my bedroom, they threw it out. Capitalist imperialism in action. Where was the Constitution then, when I needed it?

    2. Molly. Stop being so biased. You are over generalizing, and suppressing religious freedom.

    3. In National Institute of Family and Life Advocates v. Becerra, the Court invalidated California’s requirement that pregnancy centers must post a notice that California provides abortion services and a phone number for more information. The Court distinguished state requirements for abortion providers to inform women consenting to an abortion about the nature of the procedure (designed to deter her from having an abortion) as regulations of professional conduct that incidentally burden speech (“the law regulated speech only as part of the practice of medicine”).

      The Eleventh Circuit’s decision rejected this law as a regulation of conduct that incidentally burdens speech, but did not analyze it compared to the above informed-consent laws on abortion.

  4. Is there anything in this decision that speaks to the level of coercion that it permissible in such counseling?

  5. Trump judges.

    Lagoa is the nut case who almost got appointed to the Supreme Court instead of Barrett.

    1. Not okay to talk the gay out of someone yet you’re perfectly fine with physically and chemically mutilating kids in a procedure that doesn’t work by definition. And Lagoa is the ‘nutcase’ here.

      1. ” And Lagoa is the ‘nutcase’ here.”

        Hardly the only one.

      2. Not okay to talk the gay out of someone

        You can’t “talk the gay” out of someone. All you can do is make them depressed and suicidal.

  6. A know nothing Supreme Court will again decide. This case is about yet the unknown, complicated, unsettled, brain based, neurophysiology of sexual preference. The Supreme Court is totally out of control, and must be impeached for its decisions.

    1. It’s cute that you think a 6-3 conservative court would not strike down such laws. OTOH, it’s puzzling that you think there is anything unsettled about the evidence about how much these treatments screw people up.

      1. If we cared so much about verbal diarrhea that screwed people up we’d ban the Democrat Party, social media, and the nonsense ethnic studies and LGBDKFDdKDFLKDLFLKDLKDLFDIER courses.

        1. Amos. There are 540 ways to love. You left out several hundred from your initials, and diversity sensitivity training.

      2. Many sexual decisions are merely fashionable today. Those are subject to a therapy remedy. Nothing is settled.

        1. Agree completely that there is a great deal of kids following the current fashion. Anxiety, and depression are universal expressions of adolescence, and how they manifest vary; anorexia, gender dysphoria, whatever.
          The depressing part is that the health care system has embraced this folly, and every major children’s hospital has a welcoming gender clinic, and chemical and surgical changes abound.
          We are treating outward signs of anxiety and depression with permanent body, and reproductive altering effects. This will take another group of researchers a decade or more to discover that the mentally ill remain mentally ill, and are just as unhappy within their new bodies.

      3. According to Psychiatric Times these people are already screwed up:

        “There is strong evidence of elevated rates of suicide attempts in sexual minorities. Lifetime suicide attempts, on average, are 4-fold higher in gay and bisexual men, and twice as high in lesbian and bisexual women, compared with heterosexuals.7 Among adolescents, those who are LGB report making a lifetime suicide attempt at 3 times the rate of heterosexual youths.8 Moreover, LGB youths report 4 times as many medically serious attempts. Recent research suggests adolescent suicide risk is more strongly associated with LGB identity than with same-sex sexual behavior and is higher in behaviorally bisexual youths than in those with exclusively same-sex sexual behavior.9,10

        Surveys of transgender adults likewise suggest high rates of suicidal behavior in gender minorities: lifetime suicide attempts have been reported by 25% to 43% of respondents.”

        I am skeptical of conversion therapy, however I think trying to inform transgender identifying people that hormone therapy and or surgery doesn’t improve long term wellbeing, suicide rates, etc. Is appropriate.

  7. “The ordinances exempted clergy and “counseling that provides support and assistance to a person undergoing gender transition.”

    Honestly, in the event this is upheld, it sounds like the white mutiny here is to “work to rule.”

    “Officer, I swear that I was trying to prepare this young man for gender conversion. But in the course of doing so, I inadvertently made him attracted to women and he decided not to do the gender conversion. Funny how that works, medicine is an inexact science…”

  8. “I believe the Localities’ narrow regulation of a harmful medical practice affecting vulnerable minors falls within the narrow band of permissibility. I would therefore affirm the District Court’s denial of a preliminary injunction on the Therapists’ free speech claim.”

    You’d think that to survive strict scrutiny you’d have to ban particular practices that have been found to be harmful, not any treatment with a particular goal.

    1. You’d think that to survive strict scrutiny you’d have to ban particular practices that have been found to be harmful, not any treatment with a particular goal.

      Conversion therapy meets your requirement.

      1. “Conversion therapy meets your requirement.”

        No, just the opposite. The ban is on the general practice of “…seeking to change an individual’s sexual orientation or gender identity…”. That is not a specific practice, but any treatment with the goal of changing an individual’s desires.

        1. Such as the re-education camps for Trump supporters, right?

          1. ?? If parents want to try and want to have their kids re-educated, that’s up to them. But no government run gay conversion camps or Trump reeducation camps please.

    2. Yep, this just shows, along with the fact that they’re all for the flipside of mutilating kids with transgender reassignment that its all ideological for them rather than genuine concern about anyones well being.

  9. Is there any evidence that conversion therapy actually works? I’m under the impression it does not. If it doesn’t, then how is it any different from banning other therapies that don’t work either? I can’t legally tell you that my snake oil will cure your cancer, so why should I be able to legally tell a homosexual that he has a bright future ahead of him as husband and father to a dozen kids when that’s almost certainly not going to be true either?

    Or, put another way, we ban other kinds of fraud; why is this one special?

    1. What gave you the impression that we ban stuff that doesn’t work as a general rule? If that was the case there’d be tons of things specifically in the health field that affect far more people to target than conversion therapy that haven’t been banned yet. One particular thing being gender reassignment. Wacking off your penis and taking a couple hormones obviously doesn’t turn you into a woman and it only ‘works’ because it was decreed as such as a legal fiction.

      We could get together a bunch of rightwing judges and ‘experts’ to decree conversion therapy works in the same way if that makes you feel better.

      1. I dare you to find me one single health care professional who believes that “wacking off your penis and taking a couple hormones” turns you into a woman. That statement is so completely divorced from what any expert in the field would believe or say, that you could equally as well be arguing that the history professors all think Hitler won the second world war.

        1. Are you arguing against any of my points? Or are you just picking one minor unrelated stylistic aspect to go on a tangent about? Current methods to turn into the opposite sex don’t work any more than conversion therapy therefore it is absurd to ban one and keep the other on the basis of effectiveness. EOT

          1. OTOH, conversion therapy ranks pretty low on the surgical complications scale.

            1. conversion therapy ranks pretty low on the surgical complications scale.

              And pretty high on the damage to mental health scale.

              Come on, Brett. Show some integrity instead of reflexively supporting these crackpots.

            2. Brett, mental health is about as important as physical health.

              1. I wonder what the mental health consequences are of having your woke mom and crank therapist pressure you to get your wiener chopped off compared to someone trying to talk the gay out of you.

          2. I’m saying that your point is so manifestly stupid, and such a gross misrepresentation of what anyone on the other side believes, that I’m skeptical you actually believe it yourself. You’re either deliberately lying about what doctors believe, or you’re completely nuts. Either way, I have no further time for you.

        2. Mayo Clinic actually pioneered gender reassignment surgery. A few years later after following up on the original patients they stopped doing it, because it had no measurable benefits, and was associated with increased mortality and morbidity.

          Then just a few years ago they resumed doing it, although there wasn’t any new evidence that it had medical benefits. The political pressure had just become enough to over-ride normal medical considerations.

          1. For the record I would like if you could point me to some sources for that. I agree with you but I want to back up my arguments and ensure they are correct unlike the other side.

    2. “Or, put another way, we ban other kinds of fraud; why is this one special?”

      We can certainly ban providers from making false claims about conversion therapy, but that’s not what this law does.

      1. The state claims conversion therapy is medical quackery. Does it violate the constitution for the state to ban what it thinks is medical quackery, when that quackery includes speech?

    3. At 7, I wanted to a fireman, at 10 a jet pilot. I became neither. It is not quackery to promote reality and maturity in psychotherapy. Today, with media promotion of depraviry, many sexual identity decisions by young people would benefit from review in psychotherapy.

    4. I’m not sure if we even agree on what it is that it supposedly does. Does this promise to “repair and replace” a homosexual orientation with a heterosexual one? If that’s the claim, there is no evidence that it works.

      Or is it like having an anxiety disorder or bipolar, where you are promising to help an individual “maintain” the problem?

  10. In a more sane time, if someone were to say “what we need to do is mutilate that child’s genitals and flood their body with artificial hormones” that person would have been put in jail for a very long time…

    1. Oh I don’t know, Jimmy. Circumcision has been with us a for a very long time. Granted, that doesn’t involve hormones, but by any reasonable definition of the term it’s child genital mutilation. And it’s an interesting thought experiment: Suppose circumcision were being introduced as a custom today, for the very first time, rather than being enshrined by thousands of years of history and tradition. Would it be permitted, or would those advocating it be considered child abusers and jailed?

      And there is a larger point: Most people believe the same things, they just have different names for them, and different views on which actor plays which role. For example, voodoo practitioners invoke the help of the spirits; Catholics invoke the help of the saints. They’re both invoking the help of those who have gone before, whom they believe to still be interested in human affairs.

      Likewise, you and gender reassignment activists are both fine with mutilating the genitals of children; you in the form of circumcision, they in the form of gender reassignment. Your given reasons may be different, but as to the bottom line, you’re both fine with child genital mutilation.

      1. Krychek’s ill-concealed hostility to religion shines again!

        1. Religion doesn’t give you a free pass to engage in what would otherwise be unacceptable behavior.

      2. Funny I didn’t say anything about circumcision up there, but you would think from your comment I did. Instead you just created this giant strawman out of nothing then typed three paragraphs up about it. That is impressive, but not in a good way.

        1. But you did mention child genital mutilation which circumcision is

          1. No, it isn’t.
            Your attempt to pretend that circumcision is the same as genital mutilation is like those idiots that claim that an unwanted look is the same as rape.

            Can you really not understand the difference between the removal of the foreskin and the removal of the penis or clitoris? If so, I suggest you go study some human biology for a bit before returning to this conversation.

            1. For the record, the definition of FGM is much broader than what you seem to assume:

  11. Transgender Surgery Isn’t the Solution

    “How to respond? Psychiatrists obviously must challenge the solipsistic concept that what is in the mind cannot be questioned. Disorders of consciousness, after all, represent psychiatry’s domain; declaring them off-limits would eliminate the field. Many will recall how, in the 1990s, an accusation of parental sex abuse of children was deemed unquestionable by the solipsists of the “recovered memory” craze.
    You won’t hear it from those championing transgender equality, but controlled and follow-up studies reveal fundamental problems with this movement. When children who reported transgender feelings were tracked without medical or surgical treatment at both Vanderbilt University and London’s Portman Clinic, 70%-80% of them spontaneously lost those feelings. Some 25% did have persisting feelings; what differentiates those individuals remains to be discerned.

    We at Johns Hopkins University—which in the 1960s was the first American medical center to venture into “sex-reassignment surgery”—launched a study in the 1970s comparing the outcomes of transgendered people who had the surgery with the outcomes of those who did not. Most of the surgically treated patients described themselves as “satisfied” by the results, but their subsequent psycho-social adjustments were no better than those who didn’t have the surgery. And so at Hopkins we stopped doing sex-reassignment surgery, since producing a “satisfied” but still troubled patient seemed an inadequate reason for surgically amputating normal organs.

    It now appears that our long-ago decision was a wise one. A 2011 study at the Karolinska Institute in Sweden produced the most illuminating results yet regarding the transgendered, evidence that should give advocates pause. The long-term study—up to 30 years—followed 324 people who had sex-reassignment surgery. The study revealed that beginning about 10 years after having the surgery, the transgendered began to experience increasing mental difficulties. Most shockingly, their suicide mortality rose almost 20-fold above the comparable nontransgender population. This disturbing result has as yet no explanation but probably reflects the growing sense of isolation reported by the aging transgendered after surgery. The high suicide rate certainly challenges the surgery prescription.

    There are subgroups of the transgendered, and for none does “reassignment” seem apt. One group includes male prisoners like Pvt. Bradley Manning, the convicted national-security leaker who now wishes to be called Chelsea. Facing long sentences and the rigors of a men’s prison, they have an obvious motive for wanting to change their sex and hence their prison. Given that they committed their crimes as males, they should be punished as such; after serving their time, they will be free to reconsider their gender.

    Another subgroup consists of young men and women susceptible to suggestion from “everything is normal” sex education, amplified by Internet chat groups. These are the transgender subjects most like anorexia nervosa patients: They become persuaded that seeking a drastic physical change will banish their psycho-social problems. “Diversity” counselors in their schools, rather like cult leaders, may encourage these young people to distance themselves from their families and offer advice on rebutting arguments against having transgender surgery. Treatments here must begin with removing the young person from the suggestive environment and offering a counter-message in family therapy.

    Then there is the subgroup of very young, often prepubescent children who notice distinct sex roles in the culture and, exploring how they fit in, begin imitating the opposite sex. Misguided doctors at medical centers including Boston’s Children’s Hospital have begun trying to treat this behavior by administering puberty-delaying hormones to render later sex-change surgeries less onerous—even though the drugs stunt the children’s growth and risk causing sterility. Given that close to 80% of such children would abandon their confusion and grow naturally into adult life if untreated, these medical interventions come close to child abuse. A better way to help these children: with devoted parenting.

    At the heart of the problem is confusion over the nature of the transgendered. “Sex change” is biologically impossible. People who undergo sex-reassignment surgery do not change from men to women or vice versa. Rather, they become feminized men or masculinized women. Claiming that this is civil-rights matter and encouraging surgical intervention is in reality to collaborate with and promote a mental disorder.”

    1. Say you are a surgeon. A patient sincerely believes, and has lived for 2 years as if he had no legs. He requests the amputation of his healthy legs at the upper thigh, so he can fulfill his dream of living as a legless person. What is your reply?

      Those amputations are far less drastic than a sex change. If you amputate both healthy legs, and get paid cash, should a licensing board get involved? One element of medical fraud is carrying out a procedure that is not medically necessary. Medically necessary means, to improve health. Are those amputations of 2 healthy legs medically necessary or medically fraudulent?

      Would or should doctors carry out other patient false beliefs? Say a patient is afraid for his safety, and wants to kill his parents to defend himself. Say, a patient feels rich, but is not. He wants to give you all his life savings, $50000, as a tip for your excellent care. Say, a patient cannot see his girlfriend, and believes his life is over, will be jumping from a tall building. All those false beliefs are treatable. They are also less extreme than the belief one is the opposite sex. What is your response as a doctor?

      1. BIID. Body image integrity disorder. The medical establishment has for decades had a name for this mental disorder, and fully recognizes that it is a mental disorder.
        I’m not really on board, as a taxpayer, for turning a mental cripple into a physical cripple who will draw disability payments for life.

    2. Given that they committed their crimes as males, they should be punished as such; after serving their time, they will be free to reconsider their gender.

      I fail to see how this opinion has anything to do with what otherwise appears to be a recitation of the studied statistical failures of reassignment surgery.

  12. “At the heart of the problem is confusion over the nature of the transgendered. “Sex change” is biologically impossible.”

    This is confounded by the post-modernists who have infested our education system trying to use the very real problem of gender-dysphoria to “deconstruct” gender.

    Kids in kindergarten are taught that “Grown-ups look at a baby’s body when they are born and make a guess.” about the kid’s gender, but that the kid can be any combination of genders they want based to how they feel about the traits associated with that gender (scarves, dresses, etc).

    If the kindergartener decides that they feel like something different than they are, they are told that they are trans.

    This is a far cry from actual gender dysphoria.

    1. *close-link tag.

  13. Suppose I am a physician in private practice who firmly believes that a teaspoon of potassium cyanide will be good for my patients and I go about prescribing that, including by providing directions to the local chemistry supply shot. It is unclear under this decision that a locality could regulate my free speech in that regard.

    1. Say what you want. Give people poison, you should be stopped.

      1. Perhaps the directions are protected speech (I’m not sure), but the prescription strikes me as speech (the written word is speech) which is integral to a crime, and thus unprotected.

        The Eleventh Circuit summarily rejected the argument that the speech involved in conversion therapy was integral to a crime. And that conclusion is certainly correct as to separate crimes. However, the court did not discuss that the crime is conversion therapy itself which has aspects of speech.

    2. Reminds me of a person I discussed Libertarian concepts of utilities being in private hands with, who was always coming up with things like “Suppose I bought up all the water rights in California, and raised the price 10 times over the current price”. You’re arguing something so unlikely that it’d never actually happen.

      1. It never bothers such hecklers to libertarian concepts to consider: What if, not a private person, but government, took control of drug prices, and forbade higher prices, decreasing the reward for development of new drugs, slowing their development, and costing tens of millions of lives over subsequent decades as treatments are delayed, with a cumulative effect similar to compounding interest, but of the total of lives, rather than dollars.

        It’s trivially vastly greater than lives saved due to omniprovident government…of an ever further-lagging medical technology.

  14. Professional psychologists are occasionally asked to treat people who are unsure about their sexual orientation or gender identity. After speaking at length with such patients, at least some of these psychologists might conclude that some of the patients who are unsure about their sexual orientation are in fact homosexual and that some others are in not fact homosexual but are suffering from some unrelated psychological disorder. Such patients would then be given counseling in accordance with their diagnosis. Likewise, professional psychologists might take the same approach with patients unsure of their genders. As far as I can tell, these laws would appear to allow such psychologists to treat patients who they believe are actually gay or misgendered at birth, but prohibit them from counseling those who they believe are actually straight or assigned the correct gender when born but suffering from a psychological disorder that warrants treatment. I’m nor sure if that kind of prohibition violates the First Amendment, but at least to me it seems to be bad social policy and anti-scientific.

    1. Surgical castration and wound dilation as treatment for dysphoria seems pretty anti-scientific and bad social policy. Yet here we are. Conversion therapy isn’t 1/1000th as socially and personally harmful as gender reassignment.

  15. Okay let’s have ordinances that criminalize mothers who insist that their 2 year old son identifies as a homosexual and their 6 year old freely chose to be chemically castrated. Literally incarcerate these women.

  16. There is no good state remedy for low levels of parental ignorance, negligence, superstition and general magical thinking. But we sure as hell can regulate fake therapists who take money to abuse children.

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