TH10608: Ethics and a Life of Meaning - Reflection Paper
Christopher Schouten
July 7, 2025
Introduction
The recent Supreme Court decision in United States v. Skrmetti, No. 23-477, decided June 18, 2025, and written about in an article in the New York Times the same day, represents a terrible setback for transgender rights and the bodily autonomy of young people. In the case, the Court upheld Tennessee's Senate Bill 1 (SB1), a law that “prohibits healthcare providers from prescribing, administering, or dispensing puberty blockers or hormones to minors experiencing gender dysphoria for the purpose of enabling them to identify with, or live as, an identity inconsistent with their biological sex.” While the law permits the very same treatments for other conditions like congenital defects or precocious puberty, it specifically singles out gender dysphoria and gender incongruence as now being legally untreatable for minors.
The United States Attorney General (which launched the case during the Biden administration) intervened in the private case for "general public protection" of the U.S. Constitution's equal protection clause), and believed the case warranted higher scrutiny from the Supreme Court due to sex and transgender status discrimination. However, the Court applied a much easier legal test called "rational basis review," typically reserved for simple economic laws and rarely used in cases concerning basic human rights, thereby refusing to view the case as a question of human rights.
This approach ignores what most doctors agree on about gender-affirming care and the real-life struggles and lived experiences of transgender people. The Court sided with the defense, who argued that SB1 was about the State’s interest in protect kids, pointing to worries about the risks associated with gender-affirming treatment and the question of whether minors are mature enough to make life-altering decisions. The prosecution, arguing for trans families, posited that the law unfairly singles out a vulnerable group by taking away their access to important medical care which many medical professionals consider “lifesaving”. This decision is seen by medical experts as harming an already marginalized population by denying them care for a medically diagnosed condition, thereby making mental health problems worse, increasing suicidality, and hurting the dignity and well-being of transgender youth. These two markedly contrasting perspectives offer an interesting opportunity to look at this case through different ethical systems.
Ethical Positions on the Supreme Court Decision on Transgender Youth Healthcare
With these facts established, this paper will delve into the complex ethical dimensions of the Supreme Court's decision in United States v. Skrmetti. I will explore three distinct positions, drawing from dialogical/liberative ethics (Traci C. West) and the "goals" and "rules" approaches (Robin W. Lovin).
1. Goals Approach (Lovin)
A "goals" approach to ethics, or teleological ethics, focuses on the achievement of “goods”. Not physical goods but things that are good. This definition has changed over time, but for instance, utilitarianism champions that we should always do the thing that “results in the greatest happiness for all those whose interest is in question”. But the goods we as humans attempt to pursue “are different, and the moral task, whether it is between ourselves and other persons or just within our individual lives, is to strike a balance between these irreducibly different goals, to find some way of putting them together that enables us to live good lives individually and together (Lovin, page 25).
The State of Tennessee, viewed through a goals-based ethical lens in this case, aims to achieve the good of protecting minors' health and welfare. The state's stated goals include shielding minors from potential medical risks associated with gender dysphoria treatments, addressing concerns about minors' maturity to make irreversible decisions, responding cautiously to scientific uncertainty in this evolving field, and promoting an appreciation of biological sex.
Underneath the explicit arguments against gender-affirming surgery for transgender youth, there are likely unstated goals rooted in society’s discomfort with gender being non-binary or fluid. These biases manifest as a resistance to individuals stepping outside of rigid gender expectations, sometimes framed as men 'abandoning' masculine power or women 'usurping' traditional male domains, rather than recognizing gender affirming treatment as an authentic expression of self. The highest unstated goal is therefore likely “to maintain rigid gender roles and identities at all costs”.
Conversely, the defense in United States v. Skrmetti, representing transgender minors, parents, and doctors, seeks the good of access to medically necessary healthcare and equal protection under the law. Their objectives center on alleviating the severe psychological and physical harms caused by untreated gender dysphoria, enabling transgender adolescents to align their physical appearance with their gender identity for self-esteem and self-respect, ensuring access to treatments supported by major medical associations, and upholding the principle of equal protection to prevent discrimination against transgender individuals. The primary goal here is therefore to align physical reality to self-perception.
This creates two very different sets of goals and goods that the two parties clearly do not agree on.
2. Rules Approach (Lovin)
A "rules" approach to ethics, or deontological ethics, also explored by Robin W. Lovin, emphasizes moral duties, principles, and rights that should be adhered to regardless of the consequences. Actions are judged as right or wrong based on their adherence to these universal moral laws or duties, whether divine commands, natural law, contracts in covenant.
In the case, Tennessee asserts a duty to protect minors, and establishes rules that prohibit certain medical procedures for those under 18 for gender dysphoria in order to carry out that duty. It also makes explicit a rule that biological sex must be respected at all costs, and reserves state discretion in areas of medical and scientific uncertainty, reflecting a cautious medical approach where long-term effects of gender-affirming treatment are not fully known. In essence, Tennessee prioritizes legislative control and paternalistic protection of minors through clearly defined rules, aligning with the idea that rules provide a "stable and certain starting point for our moral evaluations".
Conversely, the plaintiffs' rules-based position emphasizes fundamental principles of equal protection and access to medically necessary healthcare. They argue that SB1 violates the Equal Protection Clause of the Fourteenth Amendment by discriminating based on sex and transgender status, asserting a rule that government must treat all citizens equally regardless of protected characteristics. They assert that gender dysphoria is a recognized medical condition, and that established medical associations support puberty blockers and hormones as "appropriate and medically necessary" treatments, thus advocating for a rule that individuals should have access to accepted, medically necessary care to prevent severe harm. Their stance further defends the rule of parental and doctor autonomy in medical decisions, contending that such choices should be guided by careful, individualized medical assessment and consent (using existing methodologies such as the Dutch Protocol) rather than blanket state prohibitions.
Judge Sotomayor, in her dissent, decries the rules-based approach of the majority and even says that it has been incorrectly applied. Though she spends most of her final paragraph highlighting this fault in the majority’s logic, she ends with a much more liberative perspective, lamenting that the Court is failing to prevent harm to a marginalized class:
“This case presents an easy question: whether SB1’s ban on certain medications, applicable only if used in a manner “inconsistent with . . . sex,” contains a sex classification. Because sex determines access to the covered medications, it clearly does. Yet the majority refuses to call a spade a spade. Instead, it obfuscates a sex classification that is plain on the face of this statute, all to avoid the mere possibility that a different court could strike down SB1, or categorical healthcare bans like it. The Court’s willingness to do so here does irrevocable damage to the Equal Protection Clause and invites legislatures to engage in discrimination by hiding blatant sex classifications in plain sight. It also authorizes, without second thought, untold harm to transgender children and the parents and families who love them. Because there is no constitutional justification for that result, I dissent.”
This analysis again highlights the that both goals and rules in a particular situation can differ widely depending on who is advocating for them.
3. Dialogical/Liberative Ethics (Traci C. West)
The dialogical and liberative ethical perspective provides the most unequivocal view of the case. Through this lens, the Supreme Court's decision to uphold SB1 can be seen as a profound moral injustice that perpetuates oppression against a marginalized group. Because West's work emphasizes the importance of centering the experiences and voices of those who are systematically disempowered and subject to structural violence, the clear winner in this ethical “battle” is the trans kids who are being denied affirming care.
Because the liberative approach focuses on lived Experience and Oppression: This perspective would highlight the testimonies of transgender minors and their families, who in the case detail the severe distress of gender dysphoria and the life-saving nature of gender-affirming care. It would critique the Court's dismissal of these experiences by applying a deferential "rational basis review" and by failing to recognize transgender individuals as a protected class.
Liberative ethics would call the lack of genuine dialogue between the Court and affected communities in the judicial process a failure of true ethical engagement. It ethic would see SB1 not as a neutral health regulation, but as an exercise of state power that reinforces a rigid, binary understanding of sex and gender, policing identities that deviate from societal norms. It would expose how the law, despite its purported aim to "protect minors' health," effectively denies agency and self-determination to transgender youth, aligning with historical patterns of discrimination against vulnerable populations.
Public Comments on The Supreme Court Upholding United States v. Skrmetti
Though it is difficult to definitively categorize both simple and complex personal commentaries on this article, it is possible to derive a general sense of the ethical system the commenter is attempting to apply. In this section, I attempt to analyze each one of six Facebook comments in order to discern the approach each person is explicitly or implicitly applying.
Comments Source: https://www.facebook.com/nytimes/posts/from-the-new-york-times-opinion-section-when-the-supreme-court-ruled-6-3-to-upho/1107997321182730/
1. Betty Hearne – Betty comes from a goals-based perspective, with the goal being the happiness and the wellbeing of the young trans person. She is essentially stating that the positive outcome is the most important factor here.
2. Tee Whitecloud – Tee also seems to argue for a goals-based approach, as she is stating the “before and after” of transitioning with a positive outcome justifies the right to gender-affirming healthcare.
3. “Knowledge and Information” – Well, the name says it all, doesn’t it? This person advocates for a rules-based approach, applying a blanket prohibition against anyone under 18 making an independent (or even adult-assisted) decision about any aspect of their life. Their final statement drives justifies this rule by saying that their identity may change, thereby identifying a risk of not following the rule.
4. Margy Lee Turner – Margy Lee uses a rules-based assertion that all people have a right to privacy and lack of interference in their medical care.
5. Thomas Impelluso – This is a complex argument, but I believe it ultimately expresses a liberative social ethical perspective because it recognizes the varied lived experiences of different peoples across cultures and times in an effort to counter an oppressive, normative gender binary.
6. Loretta Wheatley – By expressing solidarity and empathy with trans children mentioned in this article, Loretta manages – in a single word – to express a liberative social ethic.
