The U.S. Supreme Court on Wednesday upheld a Tennessee law prohibiting transgender treatments on children in a landmark case impacting a growing debate over minors, medical ethics, and the government's role in protecting the nation's youth. In a 6-3 decision joined by the court's conservative bloc, Chief Justice John Roberts ruled that Tennessee lawmakers had a legitimate, logical reason -- a legal concept known as "rational basis" -- for passing a law banning surgery and hormones/puberty blockers on individuals under 18.

The law is "plainly rationally related to … the State's objective of protecting minors' health and welfare," Roberts wrote. Justices Clarence Thomas, Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett joined the opinion, while Justice Samuel Alito joined it in part. Thomas, Barrett, and Alito all wrote concurring opinions.

The law is known as SB1.

"There is a rational basis for SB1's classifications," Roberts wrote. "Tennessee concluded that there is an ongoing debate among medical experts regarding the risks and benefits associated with administering puberty blockers and hormones to treat gender dysphoria, gender identity disorder, and gender incongruence. SB1's ban on such treatments responds directly to that uncertainty."

The Supreme Court, Roberts wrote, gives States "wide discretion to pass legislation in areas where there is medical and scientific uncertainty." The issue "is a matter for legislative, rather than judicial, consideration," he added.

Tennessee Attorney General Jonathan Skrmetti applauded the court's decision.

"In today's historic Supreme Court win, the common sense of Tennessee voters prevailed over judicial activism," Skrmetti said. "A bipartisan supermajority of Tennessee's elected representatives carefully considered the evidence and voted to protect kids from irreversible decisions they cannot yet fully understand."

Doctors who violate the law can be fined and disciplined. The law also allows children to sue doctors if they later regret their treatments.

Roberts cited the text of the law. Tennessee legislators asserted that puberty blockers and hormone treatments on children "can lead to the minor becoming irreversibly sterile, having increased risk of disease and illness, or suffering from adverse and sometimes fatal psychological consequences." Further, "not all harmful effects associated with these types of medical procedures when performed on a minor are yet fully known," the law stated. Also, "minors lack the maturity to fully understand and appreciate the life-altering consequences of such procedures and that many individuals have expressed regret for medical procedures that were performed on or administered to them for such purposes when they were minors."

Roberts also cited debate on the issue within European countries, which have adopted conservative medical guidelines.

"After Tennessee enacted SB1, a report commissioned by England's National Health Service (NHS England) characterized the evidence concerning the use of puberty blockers and hormones to treat transgender minors as 'remarkably weak,' concluding that there is 'no good evidence on the long-term outcomes of interventions to manage gender-related distress,'" Roberts wrote.

NHS England has since enacted prohibitions on transgender treatments on children, he noted.

The lawsuit was brought by Tennessee families and a doctor who opposed the law. More than 20 states have enacted similar legislation.

Justice Sonia Sotomayor wrote a dissent for the court's liberal bloc, asserting that the law "plainly discriminates on the basis of sex."

"By retreating from meaningful judicial review exactly where it matters most, the Court abandons transgender children and their families to political whims," Sotomayor wrote.

Roberts, though, said the issue should be decided by legislators, not the courts.

"We leave questions regarding its policy to the people, their elected representatives, and the democratic process," he wrote.

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