In an 8–1 ruling on Tuesday, the Supreme Court overturned Colorado’s ban on conversion therapy. In so doing, it not only condemned countless children to a form of psychiatric abuse but also likely consigned the nation to a future of substandard medical care.

I’m not the only one who thinks this. In her solo dissent, Justice Ketanji Brown Jackson summarized the court’s opinion this way: “[T]o put it bluntly, the Court could be ushering in an era of unprofessional and unsafe medical care administered by effectively unsupervised healthcare providers.”

The case at the heart of the ruling is called Chiles v. Salazar, and it involves Colorado’s Minor Conversion Therapy Law (MCTL), which bans conversion therapy for young people. Conversion therapy is the practice of telling gay or transgender children that they’re not really gay or transgender and they can choose to be cis-hetero normative if they just really, really try. The “therapy” has been debunked as a medical practice: It is not only ineffective (turns out, you cannot “pray the gay away”) but it has also been consistently shown to be harmful to children. Colorado is one of more than 20 states that ban conversion therapy from being practiced on children. The ban applies only to state-licensed medical professionals, and leaves religious groups free to shame and abuse children as their gods allow.

Kaley Chiles is a licensed therapist. She is also an evangelical Christian who brought the challenge against Colorado’s MCTL because, notwithstanding the medical evidence, she still wants to practice conversion therapy. She claims that she doesn’t want to “change” or “convert” children but rather “help” them achieve “their own goals.” I cannot speak to Chiles’s intent, because she filed the lawsuit before Colorado even attempted to enforce the law against her. It would have been reasonable to wait for Chiles to practice something banned by the state before hearing this lawsuit. Then we’d be able to look at the facts of her practice rather than rely on mere conjecture about what she’d like to say but allegedly can’t. But the Republicans on the Supreme Court no longer wait for facts when there is a culture war to be won.

Chiles challenged the law on First Amendment grounds. She is a “talk therapist” and argued that the First Amendment protects her right to talk about whatever the hell she wants, including, apparently, debunked, unsound, unscientific, and harmful medical practices.

From a certain point of view, you can see Chiles’s point. The First Amendment protects “speech,” and telling children wrong and horrible things about themselves is, technically, speech. I do not know why people would want to use their speech to abuse children, but the First Amendment does and arguably should protect your right to tell little kids that they suck.

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But Chiles is not using her First Amendment rights to menace children as an ordinary citizen out in the wild. She’s not shouting “Hey, stop being gay!” at little kids unfortunate enough to hit a baseball into her yard. She’s doing it from her position as a medical professional with a license from the state of Colorado. That means that when she tells kids to stop being gay in a therapy session, she’s not merely expressing her personal views or those of her god; she’s speaking as an expert recognized by the state of Colorado.

Colorado, like other0000 states, has a right to regulate what licensed professionals can say to make sure that the treatments they’re providing represent the best and safest ideas the medical and scientific community has come up with. That is the point of requiring medical professionals to get a license in the first place.

Or rather, states had a right to regulate the speech of licensed professionals until the court’s ruling in Chiles v. Salazar. In his majority opinion, Justice Neil Gorsuch ruled that medical professionals have an absolute free speech right, just like everybody else, even when they are speaking as a medical professional. Gorsuch, the originalist-when-convenient, essentially ignored the centuries of history and tradition regarding medical licenses, and instead came up with a brand new formulation of the First Amendment that cannot be saddled by things as petty as “scientific facts” and “best practices” when it comes to medical care. Gorsuch basically erased the distinction between Dr. Sanjay Gupta and Dr. Dre.

That’s why the decision will have such a large impact—even beyond the torture Gorsuch thinks it is acceptable to subject LGBTQ+ children to. The new free speech right Gorsuch has invented will potentially destroy the entire concept of medical licensing. If medical professionals can say whatever they want, it becomes nearly impossible for states to hold medical “advice” to any kind of agreed-upon standard.

Gorsuch says that the First Amendment protects “unpopular” speech, which it certainly does. But, again, we’re not talking about some person spewing unsound and uninformed medical advice on Twitter. We’re talking about a health professional peddling a debunked medical treatment. If Gorsuch and RFK Jr. want to drink raw bear milk, that’s their business, but a licensed doctor should not be allowed to tell you that drinking nonpasteurized products makes your penis stronger.

What really seems to piss Gorsuch off is not just the fact that Colorado’s law bans conversion therapy but that it allows (and in some sense requires) affirmation therapy. Chiles cannot say “don’t be gay” but she can say “it’s OK to be gay.” This, Gorsuch says, is evidence that Colorado’s law is a form of viewpoint discrimination. It means that Colorado is forcing Chiles to accept its viewpoint (that being gay or trans is fine), which is an unconstitutional suppression of Chiles’s viewpoint (that being gay or trans can be changed).

Gorsuch is right, after a fashion. Colorado does have a viewpoint here, and it is counter to Chiles’s. But the key difference is, or should be, that Colorado’s viewpoint is backed up by medical and scientific evidence, while Chiles’s viewpoint is, essentially, quackery. Gorsuch would have you believe that the jury is still out on conversion therapy, but it’s not. The science is in. Gorsuch, Chiles, your priest, and the guy shouting at gay kids from his Ford F-150 are all equally wrong. The only distinction that matters is that Chiles wants to be an idiot-while-licensed—and that is a distinction that Gorsuch entirely misses or doesn’t care about.

The whole point of medical licensing boards is to distinguish acceptable medical viewpoints from conjecture and bunk—and that does, often, require regulating what doctors can and cannot say. You can’t, for instance, tell a child “go kill yourself” as a medical therapy, even if that is your monstrous viewpoint. You can’t tell a kid to start smoking cigarettes to fit in with the other kids at school. You can’t tell a kid who is falling asleep in class to buy some cocaine and have a bump in the bathroom during free period. You can’t do these things even if you are a talk therapist and all you do is talk about it instead of prescribing the smokes or the coke. You can’t give medical advice that is wrong, no matter how much you pray that it is right.

Apparently, the only person on the Supreme Court who understands this is Justice Jackson. She writes:

Stated simply, the majority has failed to appreciate the crucial context in which Chiles’s constitutional claims have arisen. Chiles is not speaking in the ether; she is providing therapy to minors as a licensed healthcare professional.… “[t]here is a long-established history of states regulating the healthcare professions.” And, until today, the First Amendment has not blocked their way. For good reason: Under our precedents, bedrock First Amendment principles have far less salience when the speakers are medical professionals and their treatment-related speech is being restricted incidentally to the State’s regulation of the provision of medical care.

Jackson correctly points out that the court’s decision doesn’t just invalidate the ban on conversion therapy; it opens the floodgates for all manner of junk science and medically unsafe therapies to be carried out under the guise of free speech.

Indeed, it is not at all clear how, or to what extent, state regulation of medical care involving practitioner speech can survive this holding. We are on a slippery slope now: For the first time, the Supreme Court has interpreted the First Amendment to bless a risk of therapeutic harm to children by limiting the State’s ability to regulate medical providers who treat patients with speech. What’s next? In the worst-case scenario, our medical system unravels as various licensed healthcare professionals—talk therapists, psychiatrists, and presumably anyone else who claims to utilize speech when administering treatments to patients—start broadly wielding their newfound constitutional right to provide substandard medical care.

It is baffling that we could now be standing on the edge of a precipitous drop in the quality of healthcare services in America. But the Court sees fit to bring us one step closer to that fate today.

What is baffling to me is that this new right to administer substandard medical care was approved by the court 8–1. Justices Elena Kagan and Sonia Sotomayor signed on to this ruling, with a short concurrence written by Kagan and joined by Sotomayor.

If I squint hard enough, I understand Kagan’s concurrence, because I am afraid of exactly the same thing she is afraid of: If the court gives its blessing to bans prohibiting therapists from trying to convert LGBTQ+ kids, what happens when a red state requires therapists to attempt conversion? If free speech doesn’t protect Chiles, can it protect a therapist who wants to affirm a child’s gender or sexuality? Kagan writes: “Consider a hypothetical law that is the mirror image of Colorado’s. Instead of barring talk therapy designed to change a minor’s sexual orientation or gender identity, this law bars therapy affirming those things. As Ms. Chiles readily acknowledges, the First Amendment would apply in the identical way.… Once again, because the State has suppressed one side of a debate, while aiding the other, the constitutional issue is straightforward.” What she’s saying is that if the First Amendment allows for conversion therapy, it must also allow for affirming therapy.

It’s a noble thought, and I understand her point, but Kagan is wrong in at least two ways. First, she’s making the exact same mistake that Gorsuch is: suggesting that conversion therapy is still a matter of medical “debate.” There is no debate: Conversion therapy is harmful. So say the medical professionals with the authority to draw that conclusion. We shouldn’t have to allow something that is harmful in order to protect something that is helpful. You don’t have to let people bring an emotional-support leopard on a plane because you let them fly with their house cats. Different things are different and can be treated differently.

The other mistake is more subtle, and more classically Kagan if you’ve paid attention to her rulings. She is, in my view, ceding this case (which I simply have to believe she knows is wrong) because she’s keeping her eye on the next one. She’s trying to lock her colleagues into an intellectually consistent position. If the Republicans agree that a medical professional can tell a patient it’s not OK to be trans, then the Republicans must also agree that a medical professional can tell a patient it’s OK to be trans. If a therapist can menace an LGBTQ+ child looking for help, then a different therapist is also constitutionally allowed to help that child, no matter what Texas or Florida or Idaho say in the future.

The problem with this reasoning is that Kagan’s colleagues have proven time and again that they are hypocrites and will reverse themselves on a dime whenever the Republican agenda requires them to. Already, with this very case, we have the same justices who told us that gun licensing laws are invalid unless they can be tied to the history and traditions of gun licensing laws from the 18th century telling us that the history and tradition of medical licensing laws do not matter when it comes to conversion therapy. There’s no intellectual consistency from the Republican justices. They do not care about intellectual consistency. They care about prosecuting their culture war and winning. That’s all they ever care about.

When states begin banning gender-affirming talk therapy, the Republican supermajority will flip their position. Kagan, no doubt, will write a stirring opinion, calling out her colleagues for their hypocrisy. But it will be a dissent. And Gorsuch will dismiss Kagan’s pleadings and laugh at the suffering of others as he always does. Kagan will retain her intellectual honor, but it will not get her to five votes.

Kagan’s Republican colleagues will let her down, again. In the meantime, as Jackson noted, the entire medical profession will enter an era of grave uncertainty and heightened stupidity.

Thanks to this ruling, a medical license means… nothing going forward. Getting the advice of a doctor is now the same as asking the Internet or tuning in to “Dr. Phil.” According to the Supreme Court, doctors have just as much of a First Amendment right to offer untested and untrue medical theories as politicians, Uber drivers, or your grandma from the Old Country.

This ruling will damage the quality of healthcare for all Americans. And it was made because a quack therapist in Colorado really wants to spew abusive claptrap at LGBTQ+ kids forced to sit on her gross couch by their parents. It’s stunning, really, whenever you step back and contemplate how much harm this country is willing to endure in order to protect bigotry.