On Tuesday, in an 8-1 ruling, the Supreme Court sided with a Christian counselor in Colorado over the state's law that bans conversion therapy. Though Justice Ketanji Brown Jackson was the sole dissenting judge.

The ruling turned what appeared to be a First Amendment case into a broader fight over free speech, medical regulation, and protections for LGBTQ+ kids.

According to The Hill, the court sent the case back to lower courts after siding with counselor Kaley Chiles, who argued that Colorado’s law on talk therapy violates her free-speech rights. Writing for the majority, Justice Neil Gorsuch said the state was regulating “speech as speech.” At the same time, Jackson warned in a 35-page dissent that the ruling could open the door to “unprofessional and unsafe medical care.” 

“To do anything else opens a dangerous can of worms,” Jackson wrote. “It threatens to impair States’ ability to regulate the provision of medical care in any respect. It extends the Constitution into uncharted territory in an utterly irrational fashion. And it ultimately risks grave harm to Americans’ health and wellbeing.”

Colorado and other states have defended these bans as necessary protections, pointing to a medical consensus that conversion therapy is ineffective and harmful, especially for minors.

Jackson’s solo dissent stood out not just because she was alone, but because she read it from the bench, a move that signals deep disagreement and usually draws attention in major cases. 

Her argument centered on the idea that Chiles was acting as a licensed healthcare provider, not simply speaking in public, and that states still have broad power to regulate medical care to protect public health.

“Ultimately,” Jackson concluded, “because the majority plays with fire in this case, I fear that the people of this country will get burned. Before now, licensed medical professionals had to adhere to standards when treating patients: They could neither do nor say whatever they want. Largely due to such State regulation, Americans have been privileged to enjoy a long and successful tradition of high-quality medical care. Today, the Court turns its back on that tradition.”

The ruling is likely to energize both sides of the national debate. Opponents of conversion therapy say the decision weakens protections for young people, while supporters frame it as a free-speech victory for counselors and faith-based providers.