The Body as Policy

On June 18, 2025, the Supreme Court built something on it. In United States v. Skrmetti, a 6–3 majority upheld Tennessee's ban on gender-affirming care for minors, holding that the law does not violate the Equal Protection Clause. The majority reasoned that the statute draws its lines around age and medical procedure rather than sex, which earns it the most forgiving level of judicial review. The dissent read the same law and saw a specific group singled out, and called the majority's framing a careful way of not looking.

Set down, for one paragraph, whichever side you reached for on reflex. Look at what the case is actually about underneath the briefs. It's about who holds the pen when something gets written onto a body that isn't theirs.

Now watch the move that actually decided it — because it wasn't the medicine, and it wasn't even the morality. The same statute can be two different laws depending on what you call it. Call Tennessee's line a sex-based classification and the court has to squint hard: heightened scrutiny, the level of review most laws don't survive. Call it a line about age and medical procedure and the same statute strolls through under rational-basis, the most forgiving look the law offers. Nothing in the text changed between those two readings. Only the name did. That's where the power in this case actually lives — not in the exam room but in who gets to fix the label, because changing what you call a thing changes which rules apply to it.

That trick has a plain-language twin, and you can watch it run on the word care. Tennessee says it is protecting children. The parents who challenged the law say they are protecting their children. The doctors say they are providing care. Everyone in the frame holds up the same word — but not as the same claim. The parents are asserting authority over their own child; the state is asserting authority over someone else's. That's not one jurisdiction, it's two, and they are not equivalent. Care is precisely the word that sands the difference down — the shield that lets the state's reach pass as the same homely thing as a parent's, so nobody has to say out loud which authority they're actually claiming.

This is the machinery worth naming, and it's the same lever in both rooms: rename a contested claim of authority — as "age and procedure" in the opinion, as "care" in the argument — and the question of jurisdiction goes invisible. We stop asking who decides and start asking who loves the child more — a question with no answer and infinite emotional fuel. The legal mechanism and the moral performance prop each other up. One supplies the certainty; the other supplies the cover.

Coherenceism would point to where the cost actually lands. The doctor-patient relationship runs on presence and trust — two people in a room, one of them frightened, working out what to do with a particular life. Write legislative intent into that room and you've added a third party who will never meet the patient, never carry the outcome, and never be wrong in any way they have to feel. And this holds whichever way the statute cuts: a law compelling the treatment would seat the same stranger in the same room. The distortion isn't that the legislature chose the wrong answer. It's that it pulled up a chair at all.

So I'll own the one position I'm actually taking, since pretending to have none would be its own kind of shield: the exam room is worse for having a legislature in it, whichever instruction the legislature writes. That's a claim about the room, not about the medicine — how Skrmetti should have come out is a fight I'm not holding the mirror to. The mirror is this: whatever you believe about this particular treatment, notice how comfortable it is to be certain you're the one doing the protecting. That certainty is available to everyone in the dispute, in equal supply — which is exactly why it settles nothing. The body stays contested. The pen keeps changing hands. And every hand that holds it is sure it's the one keeping the child safe.

The question the ruling doesn't answer — the one no ruling can — is the one we keep dressing up as compassion so we never have to say it plainly: whose body is it, and who told you it was yours to write on?