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Texas Supreme Court Says Parental Rights Don’t Extend to Gender-Affirming Care

The court ruled that parents only have the right to seek medical care for their children that is “legally available.”

Student protest against Katy ISD's transgender policy outside the school districts educational support complex on August 30, 2023 in Katy, Texas. The students protested a policy by the district where parents of students in the Katy ISD school system must be notified if their child asks to be identified as transgender.

The Texas Supreme Court found that parents in the state do not have the constitutional right to seek gender-affirming care for their children.

The court on Friday upheld the state’s ban on gender-affirming care for transgender youth in a ruling that pushed the state’s interpretation of parental rights into a more limited scope when it comes to medical decision-making. Texas parents are guaranteed the right to raise their children without political interference — a right that includes decisions on medical care — but the court deemed restrictions on gender-affirming care to be a permissible exception.

“Fit parents have a fundamental interest in directing the care, custody, and control of their children free from government interference. But we have never defined the source or precise scope of this interest,” the court’s ruling read. “Our precedents make clear that this interest is not absolute.”

The court said using gender-affirming care to treat gender dysphoria is a nascent form of medicine, a finding at odds with the actual history of gender-affirming medical care. It also pointed out that Texas has the right to regulate the practice of medicine within its borders.

Texas’ gender-affirming care ban had already gone into effect last September when the state Supreme Court denied plaintiffs’ request for emergency relief. The law blocks the provision of hormone therapy and puberty blockers to minors and mandates that medical professionals will have their licenses revoked if they provide trans adolescent patients with gender-affirming care.

The ACLU, alongside national LGBTQ+ legal groups including Lambda Legal and the Transgender Law Center, sued the state over its gender-affirming care ban last summer on behalf of families and health care workers. They accused Texas of violating the state constitution, which guarantees the right to parental autonomy, arguing that the law discriminates against parents who are exercising a fundamental right to make decisions about the care and custody of their child.

As The 19th previously reported, at least one of the families in the lawsuit had split up in order to secure medical care for their trans child; the mom temporarily moved with her two children and the dad stayed in Texas for his job.

Parental authority is not a constitutionally mandated absolute, the Texas Supreme Court said in its ruling on Friday. According to the court, the state’s law banning gender-affirming care for trans youth “does not sever parents’ control or autonomy to make medical decisions for their children” or displace parents’ role as the ultimate decision maker for their children.

“The law merely restricts the availability of new treatments with which medical providers may treat children diagnosed with a newly defined medical condition, gender dysphoria,” the court’s ruling reads. However, gender dysphoria — the intense sense of discomfort or anxiety felt when one’s physical gender is out of sync with their gender identity — is not a new medical condition. The first formal studies and research into gender dysphoria were conducted in Germany in 1920, while specialized health care for transgender adolescents began in the 1980s, according to The World Professional Association for Transgender Health (WPATH).

In its ruling, the Texas Supreme Court said that parents only have the right to seek medical treatments for their children “that are legally available,” and that parental rights “at times give way to other competing interests such as the interest in protecting children from harm.”

Although the new state Supreme Court ruling doesn’t change the reality on the ground for trans youth and their families, it relies on a limited interpretation of parental rights at a time when states across the country have cited parental rights as reason to curtail LGBTQ+ topics in schools, and to limit support for trans students.

LGBTQ+ advocates and legal experts denounced the court’s ruling on Friday. Karen Loewy, senior counsel and director of constitutional law practice at Lambda Legal, said that it would be “impossible to overstate the devastating impact of this cruel and arbitrary ruling” on Texas transgender youth and their families.

“Instead of leaving medical decisions concerning minor children where they belong, with their parents and their doctors, the court here has elected to let politicians — in blatant disregard for the overwhelming medical consensus — determine the allowed course of treatment, threatening the health and the very lives of Texas transgender youth,” Loewy said in a statement.

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