80 F.4th 1205
11th Cir.2023Background
- Alabama enacted the Vulnerable Child Compassion and Protection Act, forbidding (as a felony) prescription or administration of puberty blockers and supraphysiologic cross-sex hormones to minors when done to alter or affirm a minor's gender perception inconsistent with biological sex (§§4(a)(1)–(3)).
- Plaintiffs (transgender minors, parents, providers; U.S. intervened) sued, alleging violations of the Fourteenth Amendment's Due Process and Equal Protection Clauses; they sought a preliminary injunction against enforcement of §§4(a)(1)–(3).
- The district court held an expedited evidentiary hearing, credited competing expert testimony and medical guidelines, and preliminarily enjoined enforcement of §§4(a)(1)–(3), finding plaintiffs likely to succeed on (1) a substantive due process claim (recognizing a parental right to obtain transition medications for children) and (2) an equal protection claim (statute classified on the basis of sex via gender nonconformity).
- The State appealed; the Eleventh Circuit reviewed legal conclusions de novo and factual findings for clear error and addressed whether the district court applied the correct level of constitutional scrutiny.
- The Eleventh Circuit concluded the district court erred: plaintiffs had not shown a fundamental parental right to obtain transition medications for children, nor that the statute classifies on the basis of sex; the law is subject to rational basis review, so the preliminary injunction was vacated.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Substantive Due Process: whether parents have a fundamental right to treat children with puberty blockers/cross-sex hormones | Parents assert a fundamental right to "treat their children with transitioning medications subject to medically accepted standards" | Alabama argues no such deeply rooted historic right exists; regulation is within state's authority to protect minors | No fundamental right found; statute is subject to rational basis review |
| Equal Protection: whether §4(a)(1)–(3) classifies on basis of sex or transgender status (triggering heightened scrutiny) | Minors say the law discriminates by sex and by gender nonconformity/transgender status (invoking Bostock/Brumby) | Alabama says the law classifies by age and by procedure/medical purpose, not sex; age-based distinctions get rational basis | Law does not enact a sex-based classification for Equal Protection purposes; regulation is rationally related to legitimate state interests and is subject to rational basis review |
| Preliminary Injunction / Standard of Review: whether the district court abused its discretion by applying heightened scrutiny | Plaintiffs contend heightened scrutiny appropriate, so injunction proper | Alabama contends district court applied wrong standard and abused discretion | District court applied incorrect legal standard (heightened scrutiny); abuse of discretion; preliminary injunction vacated |
Key Cases Cited
- Dobbs v. Jackson Women's Health Organization, 142 S. Ct. 2228 (2022) (substantive-due-process framework; history-and-tradition inquiry; rational-basis presumption)
- Troxel v. Granville, 530 U.S. 57 (2000) (parental right to direct upbringing)
- Pierce v. Society of the Sisters of the Holy Names of Jesus & Mary, 268 U.S. 510 (1925) (parental liberty to direct children's education)
- Parham v. J. R., 442 U.S. 584 (1979) (parental authority in medical/institutionalization decisions; procedural-due-process limits)
- Bostock v. Clayton County, 140 S. Ct. 1731 (2020) (Title VII interpretation regarding sex and transgender status; textual reasoning)
- Glenn v. Brumby, 663 F.3d 1312 (11th Cir. 2011) (gender nonconformity as sex discrimination in employment context)
- City of Cleburne v. Cleburne Living Center, 473 U.S. 432 (1985) (Equal Protection principle that similarly situated persons be treated alike)
- Heller v. Doe, 509 U.S. 312 (1993) (rational-basis presumption for non-fundamental rights)