In America: Landmark Case on Transgender Youth Medical Care Heads to Supreme Court
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The Supreme Court recently heard oral arguments in the case of United States v. Skrmetti. This potential landmark decision could have an enormous impact on transgender youth medical care in America. The case challenges Tennessee Senate Bill 1, which limits minors' access to gender-affirming medical procedures. The ruling, expected in June, could have far-reaching consequences for transgender youth across the country.
Myth-Busting Gender-Affirming Care
One of the most prevalent myths around gender-affirming care is that it is predominantly surgical. In practice, gender-affirming care for minors often comprises mental health services, puberty blockers, and hormone therapy rather than surgery. Puberty blockers are drugs that delay the onset of puberty, providing transgender adolescents more time to explore their gender identity without the extra stress of developing secondary sex traits.
Gender-affirming hormones, such as estrogen and testosterone, assist an individual's physical characteristics to match their gender identification. Major medical and mental health organizations recognize these interventions as critical to the well-being of transgender adolescents. Contrary to the line taken by some politicians, these are not handed out to children in schools, causing a gender change within a day or overnight. It takes intensive therapy and trials of every other means possible before PBs or surgical intervention.
Case Background and Arguments
The plaintiffs in United States v. Skrmetti, represented by Solicitor General Elizabeth B. Prelogar, contend that Tennessee's SB1 is unconstitutional because it restricts access to drugs based on a patient's gender. They argue that SB1 is a facial sex classification and should be subjected to intermediate scrutiny, which requires the state to demonstrate an important state interest that is significantly served by the sex-based classification. The plaintiffs argue that SB1 is a blanket prohibition on needed medical care for transgender adolescents and that the state has not proven any specific risks connected with cross-sex hormone usage to support such a restriction.
Tennessee, represented by Solicitor General J. Matthew Rice, counters that SB1 is a lawful use of the state's police power to safeguard minors. They argue that the rule does not specifically target transgender people but rather forbids all children from undergoing certain medical treatments. Tennessee contends that the statute should be examined on a reasonable basis and that the state has a legitimate interest in protecting minors from the potential consequences of gender-affirming care, such as infertility and regret.
Legal Precedents and Implications
During oral arguments, the justices pressed the attorneys on both sides about the appropriate standard of review, the medical evidence supporting gender-affirming care, and the case's potential implications for other areas of law, such as parental rights and transgender athletes' participation in sports.
Chief Justice John Roberts emphasized the unique character of the medical inquiry in this case, implying that legislative authorities should make these decisions rather than courts. "This does strike me, whether -- whatever you think about the disagreements between where Europe was some years ago and where Europe is now, where Europe is, where the United States is in that, that it is quite a distinct type of inquiry that involves medical expertise, predictive judgments in medical area than in -- in those cases?" Justice Roberts explained.
Justice Samuel Alito questioned the overwhelming evidence supporting the benefits of gender-affirming treatments, asking, "And so I wonder if you would like to stand by the statement that you made in your petition, or if you think it would now be appropriate to modify that and withdraw the statement that there is overwhelming evidence establishing that these treatments have benefits that greatly outweigh the risks and dangers?"
Justice Sonia Sotomayor underlined the need for intermediate scrutiny in ensuring that minors are only treated to such procedures when necessary. "Isn't the purpose of intermediate scrutiny, the level of scrutiny that we apply, necessary to ensure that whether it's legislatures or this Court, that we don't make those personal judgments but that we subject the judgments about these issues to a heightened review to ensure that those children who are going to suffer all of these consequences will be made to do so only when it's compellingly necessary?" she put forth.
Justice Elena Kagan argued that the rule is inherently about sex, countering Tennessee's claim that it is based on medical reasons rather than gender. "So, is what you're saying that the two are just embedded in each other, or is what you're saying that sex stereotyping is built into our understandings of trans and cis classifications?" Kagan questioned.
Justice Amy Coney-Barrett expressed concerns about intentional discrimination, asking, "Why isn't that more of an Arlington Heights argument about intentional discrimination than if what you're really saying or what the legislature is saying is the burden of this is going to be equally applicable, neither boys nor girls can have access to these drugs, but the reason why is because we want girls to be girls and boys to be boys at least until they're old enough to decide otherwise?"
Justice Ketanji Brown-Jackson wondered if the statute's sex-based line drawing would undercut other important equal protection decisions, such as Loving v. Virginia. "Are they mutually exclusive?" Do we have to pick between these two characterizations? Isn't there a world in which this statute does both of those things the question for equal protection purposes is, if you're correct that there is a sex-based line being drawn, don't we have to apply heightened scrutiny in evaluating the plaintiffs' claims to the extent that line is implicated?" she asked.
State Laws and Election Cycle Misconceptions
The case comes amid a wave of anti-transgender legislation in the United States. According to the Human Rights Campaign, 26 states have banned gender-affirming care, which affects roughly 40% of the country's transgender adolescents. Federal politicians frequently frame the problem of transgender rights in the same way that they phrase abortion rights - "giving the power back to states," but what happens when federal care rules are imprecise or unclear is a pure restriction at the state level.
These legislations have been encouraged by misconceptions and misinformation spread during election campaigns, with some politicians portraying gender-affirming care as experimental and hazardous despite the support of major medical organizations.
Justice Ketanji Brown Jackson expressed concern that a ruling maintaining Tennessee's statute could overturn other significant equal protection clause cases, such as Loving v. Virginia. "I'm worried that we're undermining the foundations of some of our bedrock equal protection cases," Justice Jackson told the court. Chase Strangio of the American Civil Liberties Union, who made history as the first known transgender person to argue before the Supreme Court, echoed this concern, stating, "If Tennessee can avoid heightened scrutiny by asserting from the start that biology justifies the sex-based differential in the law, that would undermine decades of this court's precedent."
Strengths and Weaknesses of Arguments
The transcript of the hearings illustrates both sides' strengths and flaws. The plaintiffs' contention that SB1 is a facial sex classification and should be subject to intermediate scrutiny is plausible, particularly considering past equal protection cases. However, the state's position that the statute is a legitimate use of police power to protect minors from harm has weight, particularly in medical regulation.
As the Supreme Court considers United States v. Skrmetti, the outcome is likely to have far-reaching implications for transgender youth and the larger landscape of gender-affirming care in America. The case emphasizes the significance of knowing and correcting common misconceptions about gender-affirming treatments, as well as the necessity for informed, compassionate legislation that protects transgender people's rights and well-being. The decision, due in June, will be a watershed moment for transgender rights in the United States.