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Supreme Court Case on Transgender Youth Medical Care May Impact Schools

In a separate case, the justices decline to consider a challenge to Connecticut鈥檚 end to medical exemptions for school vaccines
By Mark Walsh 鈥 June 24, 2024 5 min read
FILE - The Supreme Court is seen under stormy skies in Washington, June 20, 2019. In the coming days, the Supreme Court will confront a perfect storm mostly of its own making, a trio of decisions stemming directly from the Jan. 6, 2021 attack on the U.S. Capitol. (AP Photo/J. Scott Applewhite, File)
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The U.S. Supreme Court on Monday agreed to decide whether a state law that bars medical treatment for gender dysphoria in transgender adolescents violates the U.S. Constitution鈥檚 equal-protection clause. The court鈥檚 decision will likely hold implications for equal-protection claims for transgender and other LGBTQ+ students in schools.

Separately, the justices turned away the appeal of two groups and several parents who sued over Connecticut鈥檚 2021 decision to end religious exemptions to vaccination requirements for students to attend school.

In the transgender-care case, , the court agreed to hear the appeal of the Biden administration, which had intervened in lawsuits challenging a 2023 Tennessee law that forbids puberty blockers, hormones, or surgeries for the purpose of 鈥渆nabling a minor to identify with, or live as, a purported identity inconsistent with the minor鈥檚 sex鈥 or 鈥渢reating purported discomfort or distress from a discordance between the minor鈥檚 sex and asserted identity.鈥

The case marks the first time the justices will take up on the merits of the issue of medical care for transgender youth. The Tennessee law, one of 21 similar state measures across the country, was challenged by three transgender teenagers, along with their parents and one doctor who treats gender dysphoria.

A federal district court blocked the law, ruling that it likely violates the equal-protection clause because it discriminates based on sex. But in a 2-1 ruling last September, a panel of the U.S. Court of Appeals for the 6th Circuit, in Cincinnati, rejected the equal-protection claim. The Tennessee law 鈥渞egulates sex-transition treatments for all minors, regardless of sex,鈥 the court said.

The court said transgender people were not entitled to have laws targeting them subjected to a higher degree of scrutiny because they did not have 鈥渋mmutable鈥 characteristics that defined them as a discrete group and they were not politically powerless.

鈥淭he novelty of these treatments also undercuts any claim of animus,鈥 the court said.

The 6th Circuit majority also rejected arguments that the Supreme Court鈥檚 2020 decision in governed the analysis of the Tennessee law. In Bostock, the high court held that the main federal job-discrimination law鈥檚 prohibition on sex discrimination covered bias on the basis of sexual orientation and gender identity.

The Biden administration and the private plaintiffs appealed to the Supreme Court, as did a group challenging a similar Kentucky law that was upheld in the same 6th Circuit opinion.

鈥淭he 6th Circuit鈥檚 decision implicates multiple circuit conflicts about the application of the equal-protection clause to laws that target transgender individuals,鈥 U.S. Solicitor General Elizabeth B. Prelogar said in .

She noted that the 6th Circuit decision conflicted with rulings by the U.S. Courts of Appeals for the and circuits that held that school district policies restricting the choice of restroom by transgender students violated the equal-protection clause. And she said the U.S. Court of Appeals for the 9th Circuit, in San Francisco, relied on Bostock last year in a that bars transgender women and girls from female school athletics.

Tennessee, not to take up the case, said some of the school cases relied alternatively on Title IX of the Education Amendments of 1972, which bars sex discrimination in federally funded schools.

The Supreme Court 鈥渄oes not take cases to opine about broad social issues, such as gender identity,鈥 the state said. 鈥淭ennessee acted rationally, reasonably, and compassionately to protect its children, and the act survives any level of review.鈥

The court granted review of the Biden administration鈥檚 appeal after considering it at six consecutive private conferences. The court did not grant review in the appeals by the private challengers to the Tennessee and Kentucky laws, each of which included a claim that the state laws violated the rights of parents to direct the medical care of their children. That is a bit of a twist on the parental-rights claims asserted by those who have challenged some school district policies that support transgender students. But the high court is not taking up that question, and it held the other appeals in abeyance for now.

The court will hear arguments in the case in the next term.

Justices decline review on religious exemptions to school vaccinations

The court declined a review of , which involved the challenge to the state鈥檚 removal of religious exemptions for its school vaccination requirement.

Like most if not all other states, Connecticut has long required students to be vaccinated for such communicable diseases as measles and pertussis as a condition of school enrollment. The state added a medical exemption in 1923 and a religious exemption in 1959. But after a nationwide measles outbreak in 2018, the state in 2020 ended the religious exemption, except for 鈥渓egacy鈥 students who had claimed the exemption and were allowed to keep it until they left the state school system.

鈥淭he number of claimed religious exemptions rose to the point that many schools fell below the herd immunity threshold, with many more in jeopardy of following suit,鈥 the state said .

The state became the fifth to cease allowing religious exemptions for school vaccinations, joining California, Maine, Mississippi, and New York.

The decision was challenged by several parents and two groups as a violation of their First Amendment free exercise of religion rights. Some of the parents objected to the use of fetal tissue in vaccine products, while a Muslim family objected on religious grounds to the use of pork products in some vaccines.

A federal district court dismissed their claims, and the U.S. Court of Appeals for the 2nd Circuit, in New York City, affirmed, noting that it was joining a 鈥渃onsensus鈥 among state and federal appellate courts holding that 鈥渢he absence or repeal of a religious exemption鈥 does not make a school vaccination law unconstitutional.

In , the challengers argued that the absence of a religious exemption made the state鈥檚 vaccination rule not neutral and generally applicable, and thus problematic under the free-exercise clause.

In its response, the state said there was no true circuit split on any issues in the case, and the medical exemption is claimed by only a 鈥渘egligible number鈥 of children.

鈥淪o eliminating the religious exemption gave the state the best chance to vindicate its interest in improving student and community health by safeguarding herd immunity,鈥 the state said.

The Supreme Court declined the challengers鈥 appeal without comment.

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