Box Turtle Bulletin

Ninth Circuit Court Upholds California’s Gay Therapy Ban for Minors

The Ninth Circuit Court of Appeals has upheld California’s law banning licensed profesionals from providing Sexual Orientation Change Efforts (SOCE) to minors. The critical point during oral arguments before the court was whether the ban infringes on therapists’ free speech rights or regulates professional conduct. In the unanimous decision by Chief Judge Alex Kozinski and Circuit Judges Susan P. Graber and Margan Christien, the court settled on the latter.

In the opinion written by Judge Graber, the court began by describing what the law, known as SB 1771, does and does not do (PDF: 171KB/36 pages):

Importantly, SB 1172 does not do any of the following:

• Prevent mental health providers from communicating with the public about SOCE
• Prevent mental health providers from expressing their views to patients, whether children or adults, about SOCE, homosexuality, or any other topic
• Prevent mental health providers from recommending SOCE to patients, whether children or adults
• Prevent mental health providers from administering SOCE to any person who is 18 years of age or older
• Prevent mental health providers from referring minors to unlicensed counselors, such as religious leaders
• Prevent unlicensed providers, such as religious leaders, from administering SOCE to children or adults
• Prevent minors from seeking SOCE from mental health providers in other states

Instead, SB 1172 does just one thing: it requires licensed mental health providers in California who wish to engage in “practices . . . that seek to change a [minor’s] sexual orientation” either to wait until the minor turns 18 or be subject to professional discipline. Thus, SB 1172 regulates the provision of medical treatment, but leaves mental health providers free to discuss or recommend treatment and to express their views on any topic.

The court drew on several precedents, including a case involving unlicensed psychoanalysts, who had claimed that being sanctioned by the state for being unlicensed amounted to an infringement on their free speech rights because, after all, they were only talking in their counseling sessions. Prior courts held that “communication that occurs during psychoanalysis is entitled to constitutional protection, but it is not immune from regulation.” The court also drew on another case in which a doctor’s prescribing privileges were beign revoked because he recommended medical marijuana for his patient. That court drew a distinction between the doctor’s recommendation — a discussion that occured in the office — and the doctor’s prescribing it — which had not occurred — in its ruling in the doctor’s favor. Based on those two cases:

We distill the following relevant principles from NAAP and Conant: (1) doctor-patient communications about medical treatment receive substantial First Amendment protection, but the government has more leeway to regulate the conduct necessary to administering treatment itself; (2) psychotherapists are not entitled to special First Amendment protection merely because the mechanism used to deliver mental health treatment is the spoken word; and (3)
nevertheless, communication that occurs during psychotherapy does receive some constitutional protection, but it is not immune from regulation.

The only remaining question before this court, then, was “whether or how the First Amendment applies to the regulation of specific mental health treatments.” The court chose to approach that question by “view(ing) this issue along a continuum.” At one end is where a professional is speaking publicly as an advocate. At that end, First Amendment protections are at their greatest. But moving toward a middle ground are laws which require doctors to “disclose truthful, nonmisleading information to patients about certain risks of abortion.” In that setting, a previous court had found that “the physician’s First Amendment rights not to speak are implicated, but only as part of the practice of medicine, subject to reasonable licensing and regulation by the State.” (Emphasis in the original.) Also, doctors do not enjoy First Amendment protections for giving negligent medical advice to their patients:

Thus, the First Amendment tolerates a substantial amount of speech regulation within the professional-client relationship that it would not tolerate outside of it. And that toleration makes sense: When professionals, by means of their state-issued licenses, form relationships with clients, the purpose of those relationships is to advance the welfare of the clients, rather than to contribute to public debate.

The far end of the court’s continuum is in the regulation of professional conduct, were that conduct is the provision of a medical service, even if that service is in the form of speech.

Most, if not all, medical treatment requires speech, but that fact does not give rise to a First Amendment claim when the state bans a particular treatment. When a drug is banned, for example, a doctor who treats patients with that drug does not have a First Amendment right to speak the words necessary to provide or administer the banned drug. …

Senate Bill 1172 regulates conduct. It bans a form of medical treatment for minors; it does nothing to prevent licensed therapists from discussing the pros and cons of SOCE with their patients. Senate Bill 1172 merely prohibits licensed mental health providers from engaging in SOCE with minors.

Moving from First Amendment considerations, the court then ruled that California’s legislature had a rational basis for regulating SOCE for minors, that SB 1172 is not unconstitutionaly vague or overly broad, and that it does not infringe on parents’ fundamental rights to determine the care their children would recieve:

We are unaware of any case that specifically addresses whether a parent’s fundamental rights encompass the right to choose for a child a particular type of provider for a particular treatment that the state has deemed harmful, but courts that have considered whether patients have the right to choose specific treatments for themselves have concluded that they do not.

…[T]o recognize the right Plaintiffs assert would be to compel the California legislature, in shaping its regulation of mental health providers, to accept Plaintiffs’ personal views of what therapy is safe and effective for minors. The aforementioned cases lead us to conclude that the fundamental rights of parents do not include the right to choose a specific type of provider for a specific medical or mental health treatment that the state has reasonably deemed harmful.

Therefore, SB 1172 does not infringe on the fundamental rights of parents.

The Ninth’s ruling settled two conficting lower-court rulings. In one case brought by the PAcific Justice Institute on behalf of two NARTH-associated therapists and a student who claimed to have benefited from SOCE, the lower court granted a very limited preliminary injunction against the state of California from enforcing the law. In a second case brought by Liberty Counsel on behalf of NARTH member David Pickup and backed by NARTH, the lower court denied their petition for an injunction.

NARTH has issued a statement saying that it plans to appeal the Ninth Circuit’s ruling:

At a time when adolescents who experience themselves as being the wrong biological sex are allowed to pursue sexual reassignment surgery, licensed therapists who are willing to assist youth with unwanted same-sex attraction and behaviors will be prohibited from even talking to minors in a manner that could be construed as promoting the pursuit of change.

Politicians and non-elected judges have seen fit to approve of such encroachments on personal and professional freedoms in spite of the fact that the American Psychological Association admits the exact causes of same-sex attractions are not known, virtually no research exists directly addressing the modification of same-sex behaviors and attractions with minors, and the prevalence of harm from such change efforts is unknown and has therefore not been established as being any greater than the rates of harm documented for psychotherapy in general. Furthermore, much research has documented that fluidity in sexual attractions and identity often occurs naturally and is particularly pronounced in adolescence and early adulthood, which suggests the viability of therapeutic change efforts for some youth.

These facts make it clear that science is not at the forefront of this effort to restrict freedoms. If that were the case, gaps in our knowledge of this area would be addressed through a bipartisan program of research, not by the heavy hand of government squelching professional practice in order to appease powerful interests of activists within professional associations and lobbying groups. NARTH sincerely hopes that these crucial facts will be considered by a more receptive judicial audience in the future.

NARTH Counselor Admits Failure in Changing Sexual Orientation, Blames Patient, Sues California for the Right to Try Again

The American Medical Association’s publication American Medical News has a very good article about efforts in California and New Jersey to regulate Sexual Orientation Change Efforts (SOCE). The article opens with a vignette about a patient who has undergone SOCE, failed to change his sexual orientation (predictably), and now has to come to terms with that failure:

After attending a religious-based therapy six times a week and experiencing no change in his sexuality, the patient was left feeling ashamed, depressed and suicidal, Dr. Drescher said.

“I felt sad[ness] and also anger, because sometimes a therapist would say things that were very hurtful to the patient,” said Dr. Drescher, an author and medical expert on gay conversion therapy. He also is president of the Group for the Advancement of Psychiatry, a think tank that analyzes issues in the field of psychiatry. “It’s distressing when you see professionals, regardless if they are well-meaning or otherwise, deliver intentional or inadvertent harm to a patient.”

For an example of just what kind of harmful statements, the article points to Psychiatrist Anthony Duk,  who is a plaintiff in one of the lawsuits challenging California’s ban on SOCE for minors:

“With this bill, what’s really at stake is the definition of masculinity as well as the entire basis of civilization,” he said. “When men don’t act like men, you have a breakdown of traditional family roles and weakening of the entire human race.”

Dr. Duk said he sees about three patients a year who he said need help fighting same-sex attractions. His treatment of such patients has not resulted in the desired outcomes, he said.

“I was not successful with the ones I had because they did not stay long enough,” he said. “The major factor is whether the patient really wants to heal. The ones who want to get better, those are the ones” able to change.

What you will notice is 1) Duk has been unsuccessful in trying to change the sexual orientation of his patients 2) he blames them for their failures, and 3) he wants the State of California to allow him to continue to inflict this same harm onto others — I guess in the vain hope that some day he might get it right?

Judge Issues Temporary Injunction Against California’s Gay Therapy Law

U.S. District Court Judge William Shubb has issued a very limited temporary injunction which bars the state of California from enforcing its ban on Sexual Orientation Change Efforts (SOCE) for minors when the law goes into effect on January 1. Judge Shubb limited the injunciton’s effectivity to the three ex-gay therapists who have sued to overturn the measure. According to the Associated Press:

U.S. District Court Judge William Shubb made a decision just hours after a hearing on the issue, ruling that the First Amendment rights of psychiatrists, psychologists and other mental health professionals who engage in “reparative” or “conversion” therapy outweigh concern that the practice poses a danger to young people.

“Even if SB 1172 is characterized as primarily aimed at regulating conduct, it also extends to forms of (conversion therapy) that utilize speech and, at a minimum, regulates conduct that has an incidental effect on speech,” Shubb wrote.

The judge also disputed the California Legislature’s finding that trying to change young people’s sexual orientation puts them at risk for suicide or depression, saying it was based on “questionable and scientifically incomplete studies.”

The injunctions applies only to the three plaintiffs: psychiatrist Anthony Duk, marriage and family therapist Donald Welch, and student Aaron Blitzer who is studying to become an SOCE provider and who claims that he is now heterosexual after having undergone ex-gay therapy. Duk was a speaker at NARTH’s 2011 convention in Phoenix. Blitzer claims that he is now heterosexual after having undergone ex-gay therapy. The three plaintiffs are being represented by the Pacific Justice Institute.

In granting the injunctions, Judge Shubb indicated that the plaintiffs stand a good chance of getting the law struck down on constitutional grounds.

Last October, Gov. Jerry Brown signed S.B. 1172, making California the first in the nation to prohibit licensed professionals in the state from providing SOCE for minors. Therapists who violate the ban will be subject to discipline by the professional organization responsible for their licensing. The bill does not prohibit therapists from providing SOCE to adults, nor does it affect unlicensed counsellors, pastors, and other ex-gay therapy providers such as religious-based ex-gay ministries.

NARTH co-founder Joseph Nicolosi recently admitted that about half of all NARTH clients are teens. NARTH and Liberty Counsel have also joined forces to fight the ban in a separate case in Federal Court.

Update:  Judge Shubb’s ruling is available here (via Scribd).