Texas Supreme Court Upholds Ban on Gender Transition Care for Minors

The Texas Supreme Court upheld a state law on Friday that bans gender-transition medical treatment for minors, overturning a lower-court ruling that had temporarily blocked the law and dealing a blow to parents of transgender children.

The court, whose nine elected members are all Republicans, voted 8 to 1 in favor of allowing the law, which passed last year, to remain in effect. It bars doctors from prescribing certain medications to minors, like hormones and puberty blockers, and forbids them from performing certain surgical procedures, like mastectomies, on minors.

Parents of transgender youths, along with gay and transgender advocacy groups, argued that the ban should be blocked because it violated the Texas Constitution, in part by preventing parents from making what they felt were the best medical decisions for their children.

The argument is a powerful one in Texas, where protecting parental rights from government intervention has been an important goal, particularly for conservatives. But the court found that the argument fell short.

“We have never held that a fit parent’s interest in caring for her child free from government interference, though weighty, triggers heightened scrutiny of every statute,” Justice Rebeca A. Huddle wrote in the court’s opinion.

She wrote that the Legislature had made “a permissible, rational policy choice to limit the types of available medical procedures for children, particularly in light of the relative nascency of both gender dysphoria and its various modes of treatment.”

The court compared the law to limits on child labor and laws preventing minors from getting tattoos.

In the lone dissent, Justice Debra Lehrmann wrote that the law, which bans treatments that have been accepted by major medical groups, was “cruel,” “unconstitutional” and threw away years of effort by the court to enshrine “a robust conceptualization of parental autonomy.”

“This particular parental right — to make potentially lifesaving medical decisions for one’s children — certainly does not fall within the same category as tattooing, tobacco use or even child labor,” she wrote.

The Texas law, known as Senate Bill 14, is part of a wave of legislation that Republican-controlled states have passed targeting transgender rights, including limits on bathroom use and sports participation and bans on gender-transition care for minors. About two dozen states have passed bans or severe restrictions. Under the Texas law, physicians who offer the treatments may have their medical licenses revoked.

The attorney general of Texas, Ken Paxton, who defended the law on behalf of the state, has been seeking access to documents held by PFLAG National, an L.G.B.T.Q. advocacy organization, related to transgender minors and their medical care. The organization, which is fighting in court to not release the documents, was one of the plaintiffs in the suit seeking to strike down the ban.

“The Texas Supreme Court got it wrong today by ruling against families, against doctors and against Texas’s future,” Brian K. Bond, the chief executive of PFLAG National, said in a statement. “Every Texan, transgender or not, deserves the freedom to access the health care they need when they need it.”

The plaintiffs also included physicians who provide gender-transition care and the parents of several transgender children. They challenged S.B. 14 before it was scheduled to go into effect last year and obtained a temporary injunction from a lower district court. The Texas Supreme Court allowed the law to go into effect in September while Mr. Paxton appealed the lower court’s ruling.

On Friday, the high court said that the district court had erred in issuing its injunction and refused to reinstate it. That was not a final decision on the merits of the challenge to the law, but it made clear where the Supreme Court justices would stand on it.

A spokesman for Lambda Legal, an L.G.B.T.Q. advocacy group whose lawyers represented the plaintiffs, said the group was considering how to proceed with the case.

The high court found that the law did not deprive parents of “any constitutionally protected right or undermine a custom embedded in our history or traditions,” nor did it amount to unconstitutional sex discrimination.

In a sign of how much the justices in the majority wrestled with how to balance parental rights with the State Legislature’s action, there were three concurring opinions.

Justice Jimmy Blacklock, in his concurrence, presented the issues involved in the case as a fundamental moral conflict between what he called the “traditional vision” and the “transgender vision,” when it comes to questions of sex and gender.

“The divergence is unbridgeable,” he wrote, adding: “By and large, those who hold the traditional vision proceed from a sincere conviction that the transgender vision is, in the end, make-believe.”

In her dissent, Justice Lehrmann discussed the positive impact that gender treatments had for the children who were plaintiffs in the case, and took issue with the majority’s dismissal of the treatments as “novel” simply because they had been only recently developed.

“The court fails to acknowledge the unfortunate reality that relatively new medical procedures and treatments are often the only options available to loving parents who are desperately seeking to help their children,” she wrote.

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