Free Speech, Professional Judgment, and Medical Standards after Chiles

Medicine is not a marketplace of ideas. Its legitimacy rests on the ability of licensed professionals to distinguish helpful interventions from harmful ones and to act on that distinction. Chiles v. Salazar threatens that lifeblood of medical practice. In Chiles, the Supreme Court held that state laws prohibiting licensed therapists from providing conversion therapy to minors violate the First Amendment. The Court reasoned that conversion therapy consists of protected speech rather than professional conduct subject to ordinary health-and-safety regulation. This essay argues that the Court's analysis misconstrues the nature of clinical practice and threatens the foundations of professional self-governance. In many therapeutic settings, conversation is not merely a vehicle for expressing ideas but the clinical intervention itself. By treating professional counseling as ordinary speech, Chiles weakens the authority of professional judgment and undermines the long-standing social compact under which licensed clinicians receive exclusive privileges in exchange for adherence to clinical norms. Medicine must not remain neutral among competing viewpoints about evidence-based practice. The essay proposes professional, legislative, and judicial responses to preserve accountability for harmful departures from standards of care.