Introduction to U.S. v. Skrmetti and CMDA’s Involvement

In February 2023, the state of Tennessee passed Senate Bill 1, prohibiting the use of “medical procedures for the purpose of enabling a minor to identify with, or live as, a purported identity inconsistent with the minor’s sex or treating purported discomfort or distress from a discordance between the minor’s sex and asserted identities.”[1] As this is an affront to transgender ideology, the law was immediately challenged, initially by three families with the help of the American Civil Liberties Union (ACLU), and then later by the Biden Administration’s Department of Justice (DOJ). The U.S. Department of Justice asked the U.S. Supreme Court to intervene, and in December 2024, the case was heard before the Court. The question before the Court was ultimately whether the Tennessee law was sex-based and therefore required heightened scrutiny under the U.S. Constitution’s 14th amendment equal protection clause.[2]

 

On June 18, 2025, in a 6-3 decision along ideological lines, the Court ruled in U.S. v. Skrmetti[3] that the Tennessee law did not violate the equal protection clause. Therefore, it upheld Senate Bill 1, allowing the state to protect minors from harmful and life-altering drugs and surgeries. This will go down as a landmark decision in the United States.

 

The outcome of this case was of unique interest for CMDA as we are naturally aligned with the Tennessee law— we are committed to protecting vulnerable children from transgenderism—and so submitted an amicus brief in support of Tennessee, arguing that sound medical ethics demand an end to the use of puberty blockers, cross-sex hormones and gender reassignment surgeries in children and adolescents suffering with gender dysphoria.

 

What is Praiseworthy About This Decision

The fact that Tennessee was vindicated and can take action to protect children from this radical ideology in law is great news. A glimmer of common sense seems to have shown through, which is something several of us had feared may never come as the culture seemed to be giving way to the ideology and decisions like Bostock v. Clayton County[4] made concessions for in law. This decision does not do everything to change the tide of culture, but it may be a catalyst, with revelations like the leaks exposing World Professional Association for Transgender Health’s (WPATH) fraud,[5] the current Administration’s Executive Orders protecting children from chemical and surgical mutilation,[6] and reports like the Cass Review as well as the U.S. Department of Health and Human Services’ Review of Evidence and Best Practices for Treatment for Pediatric Gender Dysphoria.[7] All these examples indicate these ideological treatments are both flawed and dangerous.

 

The decision is no doubt an important win against those bent on shutting down debate on the issue and imposing a revolutionary will. This decision allows for states like Tennessee to pass common sense laws that push back against a dangerous ideology that harms children and society.

 

What is Left to Be Desired by the Decision

Regrettably, the decision was down ideological lines, so a sound consensus on the issue remains. In evaluating the sex discrimination argument, the majority took what could be described as the traditional view, in which an understanding of the human person is rooted in science, common experience and reason. We also understand this to be the theological anthropological view, which aligns with God’s good design for our bodies.

 

Alternatively, the dissent took the transgender view, where the body is subordinate to the mind and the idea of the human person is rooted in feelings and stereotypes. This dissenting view not only misunderstands, if not dismisses, our embodied nature, but it also turns the practice of medicine into something in service of the patient’s fallen will and the healthcare professional into a mere technician satisfying subjective desires. It’s what Dr. Farr Curlin calls the “Provider of Services Model.”[8]

 

The decision allows for Tennessee to pass laws to protect vulnerable children but does not acknowledge medicine is for protecting a patient’s health and returning their mind and body to well-working form. It is lamentable the majority decision says almost nothing about creation order or biology and that boys cannot be girls and vice versa, and it’s worse that the dissenting opinion believes medicine is there to satisfy our fallen desires.

 

The majority decision speaks to the case, that Tennessee’s law does not violate the 14th Amendment, but there is no clear denunciation that the sex-rejecting procedures the plaintiffs seek to defend are in the end mutilating and sterilizing emotionally troubled youth. This lack of moral clarity is consistent with the likes of the Dobbs v. Jackson Women’s Health Organization decision in that the justices determined Roe v. Wade was wrongly decided, but they said nothing about the significance of life in the womb. Whether or not it is their duty, they said nothing in Dobbs v. Jackson Women’s Health Organization or U.S. v. Skrmetti of the moral substance. The U.S. Constitution may not define man and woman and so have nothing to say about transgenderism, but it said nothing of marriage in Loving v. Virginia.[9] The point being, we can, and must, make sound moral judgments.

 

Because the justices chose not to address the more fundamental questions about the human person, the transgender issue will likely resurface in the Court again before long. It also means we must continue to advocate for sound legislation and policy at the state and federal levels, as well as in the influential medical associations.

 

What It Means for CMDA’s Advocacy Work

At the time this article is written, 27 states have passed some sort of protection for vulnerable children struggling with gender dysphoria—this is an encouragement given the state of our politics today. Unfortunately, there are then 23 states that either say nothing about such practices or have elected to become some sort of sanctuary for transgenderism. Of course, organizations like the ACLU have and will continue to challenge some of these state bans, so we hope this ruling validates those bans and means they are not likely to be removed. Since we are dedicated to protecting vulnerable children from transgenderism, we will continue to work with our partners across the country and with state legislators to push for protections in law.

 

The U.S. v. Skrmetti Supreme Court decision is a significant victory in protecting God’s image bearers from an evil and flawed ideology that gets biology and healthcare wrong. However, as there is yet consensus among the states nor a bill awaiting the President’s signature, there remains the necessity to push for robust conscience protections either at the state level with bills like Alliance Defending Freedom’s Medical Ethics Defense (MED) Act[10] or by asking Congress to pass the Conscience Protection Act.

 

Such protections in law remain crucial because, while sound medical ethics demand an end to the use of puberty blockers, cross-sex hormones and so-called gender reassignment surgeries in youth suffering with gender dysphoria (which themselves cause severe physical, mental, emotional and medical harm), organizations are still fighting for the proliferation of these procedures. Healthcare professionals must not be forced to participate in these morally illicit procedures, and their freedom to abstain from participating in and speak out against these procedures will be a testament to truly good medicine and the goodness of the human body.

 

In Conclusion

Again, we are grateful the U.S. Supreme Court saw the legitimacy of Tennessee’s actions and upheld SB 1. Children across this country will be protected as a result of their decision. However, given the ruling does not take up the issue of a flawed anthropology and much confusion still exists in our culture, there remains much for CMDA and our members to do.

 

Some new laws will pass, and we pray others will change to protect vulnerable children and impact the culture, but several will remain permissive and even celebratory of transgenderism until the broader culture changes. This is where Christian healthcare professionals have the unique and powerful gift of a proper anthropology and ethical medicine on their side. They can show with evidence, where the mere “consensus” of certain major medical organizations like American Academy of Pediatrics (AAP) cannot, that biology cannot and should not be changed, and then can point to the Creator for why this is. In this sense, healthcare professionals have an enviable societal position in their ability to impact the world and protect the vulnerable in how they care and guide. They are professionals in the true and original sense.

 

What Christian healthcare professionals can articulate is that the science is abundantly clear; these sex-rejecting procedures are detrimental to the developing human body—but even so, they can underscore how we should not go against God’s design, for this only stands to cause us harm and does not help anyone. The culture may say we should “transition,” but what we do will be a testament to our faith and must be that which brings the most glory and honor to God.

 

Get Involved

If you would like to get involved in our advocacy work on this and other issues, please contact us at [email protected]. To keep up with the latest updates from CMDA’s Advocacy team, by listening to The Voice of Advocacy podcast or reading The Advocacy Report newsletter, visit cmda.org/advocacy.

 

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About The Authors

J.C. Bicek serves as Director of State Policy for CMDA.

 

Nicole Hayes serves as Director of Federal Public Policy for CMDA to help advance the life-affirming, biblical principles of CMDA ethical positions through federal-level legislative advocacy. Nicole is the founder of Voices Against the Grain, a bold counter-culture media and teaching ministry established in 2013 to help audiences successfully navigate societal issues through the Word of God. Nicole has more than 15 years’ experience as a public relations professional who has provided strategic communications and media relations to elevate educational, health, racial and social justice issues for small business, government and non-profit clients, such as the NAACP, the Office of the Chief of Army Public Affairs and the Robert Wood Johnson Foundation. Nicole has been a Voices contributor for The Christian Post and a contributing author to the book The Right to Believe: The New Struggle for Religious Liberty in America. Nicole received her bachelor of arts in broadcast journalism from Washburn University in Topeka, Kansas and her master of public administration from Regent University in Virginia Beach.

 

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[1] https://www.capitol.tn.gov/Bills/113/Bill/SB0001.pdf

[2] https://constitution.congress.gov/constitution/amendment-14/

[3] https://www.supremecourt.gov/opinions/24pdf/23-477_2cp3.pdf

[4] https://www.supremecourt.gov/opinions/19pdf/17-1618_hfci.pdf

[5] https://oversight.house.gov/release/mcclain-probes-biden-administrations-influence-on-removal-of-age-minimums-for-gender-transition-procedures/

[6]https://www.whitehouse.gov/presidential-actions/2025/01/protecting-children-from-chemical-and-surgical-mutilation/

[7] https://opa.hhs.gov/sites/default/files/2025-05/gender-dysphoria-report.pdf

[8] The Way of Medicine. Curlin. (2021) University of Notre Dame Press.

[9] https://supreme.justia.com/cases/federal/us/388/1/

[10] https://adflegal.org/article/med-act-why-we-must-preserve-rights-conscience-medical-professionals/