Amicus Curiae Brief — Edward Allyn Hudacko, Petitioner v. Regents of the University of California, et al.

NO. 26-180

IN THE

Supreme Court of the United States

EDWARD ALLYN HUDACKO,

Petitioner,

v.

REGENTS OF THE UNIVERSITY OF CALIFORNIA, ET AL.,

Respondents.

ON PETITION FOR A WRIT OF CERTIORARI TO THE

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

BRIEF OF NC VALUES INSTITUTE AS AMICUS

CURIAE IN SUPPORT OF PETITIONER

TAMI FITZGERALD

NC VALUES INSTITUTE

9650 Strickland Rd.

Suite 103-226

Raleigh, NC 27615

DEBORAH J. DEWART

Counsel of Record

111 Magnolia Lane

Hubert, NC 28539

(910) 326-4554

lawyerdeborah@outlook.com

Counsel for Amicus Curiae

i

TABLE OF CONTENTS

TABLE OF CONTENTS ............................................. i

TABLE OF AUTHORITIES ..................................... iii

INTEREST OF AMICUS CURIAE ............................1

INTRODUCTION AND SUMMARY OF THE

ARGUMENT ...............................................................1

ARGUMENT ...............................................................2

I.

THE UCSF MEDICAL PROVIDERS ARE NOT

ENTITLED TO QUALIFIED IMMUNITY ..........2

II. IT IS “CLEARLY ESTABLISHED” “BEYOND

DEBATE” THAT PARENTAL RIGHTS ARE

INALIENABLE AND FUNDAMENTAL, AS

RECOGNIZED

BY

DECADES

OF

JURISPRUDENCE ..............................................5

A. Parental rights fit comfortably within judicial

definitions of “fundamental” rights ...............8

B. Each individual parent retains these

fundamental rights, regardless of custody or

other separation .............................................9

C. Parental rights are increasingly threatened

by

the

proliferation

of

transgender

ideology .........................................................11

ii

III. THE PARENTAL RIGHT TO MAKE MEDICAL

DECISIONS FOR A CHILD IS “CLEARLY

ESTABLISHED” BY JUDICIAL PRECEDENT

AND “BEYOND DEBATE.” ...............................13

A. The Custody Order undermines parental

rights by granting significant independent

authority to the minor child.........................15

B. Even social transitioning is treated by courts

as medical treatment ...................................18

C. The irreparable harm caused by sex

transition procedures is increasingly well

established and known.................................19

CONCLUSION ..........................................................25

iii

TABLE OF AUTHORITIES

Page(s)

Cases

Abay v. Ashcroft,

38 F.3d 634 (6th Cir. 2004)..................................20

Anderson v. Creighton,

483 U.S. 635 (1987) ................................................3

Ashcroft v. al-Kidd,

563 U.S. 731 (2011)...............................................3

Barnes v. Felix,

605 U.S. 73 (2025).................................................3

Bellotti v. Baird,

443 U.S. 622 (1979).............................................14

Boddie v. Connecticut,

401 U.S. 371 (1971) ..............................................10

B.P.J. v. West Virginia,

225 L. Ed. 1040 (2026) ........................................13

Brown v. Entertainment Merchants Ass’n,

564 U.S. 786 (2011)...............................................7

Buck v. Bell,

274 U.S. 200 (1927) ..............................................19

iv

Carroll v. Carman,

574 U.S. 13 (2014) ..................................................3

Chiles v. Salazar,

146 S. Ct. 1010 (2026) ............................ 5-6, 12, 13

Clark v. Quiros,

2024 U.S. Dist. LEXIS 132251

(D. Conn. 2024) ....................................................18

Edmo v. Corizon, Inc.,

935 F.3d 757 (9th Cir. 2019)................................18

Hudacko v. Regents of Univ. of Cal.,

2025 U.S. App. LEXIS 27380,

2025 WL 2965766 (9th Cir. 2025) ...............2, 5, 15

Janiah v. Meeks,

584 F. Supp. 3d 643 (S.D. Ill. 2022) ...................18

Janus v. AFSCME, Council 31,

585 U.S. 878 (2018) ..............................................11

John & Jane Parents 1 v.

Montgomery Cnty. Bd. of Educ.,

78 F.4th 622 (4th Cir. 2023),

cert. denied WL 2262333 (May 20, 2024)………12

Kovacs v. Cooper,

336 U.S. 77 (1949)...............................................10

Lamb v. Norwood,

899 F.3d 1159 (10th Cir. 2018).....................18, 19

v

Lee v. Poudre Sch. Dist. R-1,

146 S. Ct. 26 (2025)...............................................4

Little v. Hecox,

Docket No. 24-38,

104 F.4th 1061 (9th Cir. 2023)……………………13

May v. Anderson,

345 U.S. 528 (1953)...............................................9

Meyer v. Nebraska,

262 U.S. 390 (1923) .................................. 6, 7, 9, 10

Mirabelli v. Bonta,

607 U.S. 492 (2026).......................................7, 8, 9

M.L.B. v. S.L.J.,

519 U.S. 102 (1996).......................................10, 11

Moore v. East Cleveland,

431 U.S. 494 (1977)...............................................8

Newmark v. Williams,

588 A.2d 1108 (Del. 1990)....................................14

Palko v. Connecticut,

302 U.S. 319 (1937) ................................................8

Parents Protecting Our Child., UA v.

Eau Claire Area Sch. Dist.,

145 S. Ct. 14 (2024)................................................4

Parham v. J. R.,

442 U.S. 584 (1979) ........................ 8, 14, 15, 16, 17

vi

Pierce v. Society of Sisters,

268 U.S. 510 (1925) ................................................7

Pinson v. Hadaway,

2020 U.S. Dist. LEXIS 170246

(D. Minn. 2020) ....................................................19

Planned Parenthood v. Casey,

505 U.S. 833 (1992), overruled on other

Grounds by Dobbs. Jackson Women’s Health Org.,

597 U.S. 215 (2022)…………………………….….18

Plumhoff v. Richard,

572 U.S. 765 (2014) ............................................ 3-4

Porter v. Allbaugh,

2019 U.S. Dist. LEXIS 83633 (2019) ...................19

Prince v. Massachusetts,

321 U.S. 158 (1944)...............................................6

Roper v. Simmons,

543 U.S. 551 (2005) ..............................................17

Santosky v. Kramer,

455 U.S. 745 (1982).............................................10

Skinner v. Oklahoma,

316 U.S. 535 (1942) ................................................8

Stanley v. Illinois,

405 U.S. 645 (1972) ..............................................10

vii

Tingley v. Ferguson,

144 S. Ct. 33 (2023)...............................................6

Tirrell v. Edelblut,

748 F. Supp. 3d 19 (D.N.H. 2024) ......................18

Troxel v. Granville,

530 U.S. 57 (2000)……………………………5, 6, 7, 9

United States v. Skrmetti,

605 U.S. 495 (2025) ........................................16, 17

Wallis ex rel. Wallis v. Spencer,

202 F.3d 1126 (9th Cir. 1999)..............................15

Washington v. Glucksberg,

521 U.S. 702 (1977) ................................................8

West Virginia v. B.P.J.,

Docket No. 24-43, 98 F.4th 542 (4th Cir. 2024)…….13

Wisconsin v. Yoder,

406 U.S. 205 (1972).......................................13, 14

Statutes and Regulations

42 U.S.C. § 1983 ..........................................................3

42 CFR § 1001.2 ........................................................21

Tenn. Code Ann. § 68-33-101(h) ...............................16

viii

Other Authorities

Claudia Bihar, Let Them Be Children: How the Law

Should Support Parents in Protecting Their Children

From the Harmful Effects of Gender Affirming

Treatment,

21 Ave Maria L. Rev. 108 (Spring 2023) ............19

Declaration of the Secretary of the Department of

Health and Human Services, RE: Safety,

Effectiveness, and Professional Standards of Care for

Sex-Rejecting

Procedures

on

Children

and

Adolescents (Dec. 18, 2025) ......................................21

“Dutch Protocol” - The European Journal of

Endocrinology ............................................................23

W. Posser & W. Keeton, The Law of Torts

(5th ed. 1984) .............................................................14

“Psychiatric Morbidity Among Adolescents and

Young Adults Who Contacted Specialised Gender

Identity Services in Finland in 1996–2019:

A Register Study” (March 26, 2026) ..................24

Treatment for Pediatric Gender Dysphoria: Review of

Evidence and Best Practices

(“HHS Report”) (Nov. 19, 2025).............. 21, 22, 23

Wolves in White Coats: How Doctors and Hospitals

Pushed and Profited from the Fraud of “Gender

Medicine” (U.S. Dept. of Health and Human

Services), August 13, 2026…………………………….25

1

INTEREST OF AMICUS CURIAE1

Amicus curiae respectfully urges this Court to

grant the Petition and reverse the Ninth Circuit

ruling.

NC Values Institute, formerly known as the

Institute for Faith and Family, is a North Carolina

nonprofit corporation that works in various arenas of

public policy to protect faith, family, and freedom,

including parental rights. See https://ncvi.org.

INTRODUCTION AND SUMMARY OF THE

ARGUMENT

Transgender ideology is invading American life at

an alarming rate. This case is another variation on

that theme, another permutation with potentially

tragic results. Like numerous other current cases,

this one involves parental rights to be informed and

to make medical decisions on behalf of their children.

In this case, parental authority is split between the

mother, who has custody, and the father, whose rights

have been restricted. But parental rights are

fundamental, and each individual parent must be

considered in situations where the parents are split,

as they are here.

1 Counsel of record for all parties received notice at least 10 days

prior to the due date of amicus curiae's intention to file this brief.

Amicus curiae certifies that no counsel for a party authored this

brief in whole or in part and no person or entity, other than

amicus, its members, or its counsel, has made a monetary

contribution to its preparation or submission.

2

This case is complicated by a custody order that

allows great latitude to the child to receive gender

identity treatments recommended by certain medical

providers. The order grants sole medical decisionmaking authority to the mother but requires the

written consent of both parents before the child may

receive “gender identity related surgery.” Hudacko v.

Regents of Univ. of Cal., 2025 U.S. App. LEXIS 27380,

at *8 (9th Cir. 2025). This provision ostensibly

protects the parental rights of the father (Petitioner

Hudacko), but he was excluded from discussions and

had no voice in the ultimate decision for his child to

receive a “gender affirming” implant. The Ninth

Circuit granted qualified immunity to the UCSF

medical providers, despite the abundant precedent

that “clearly establishes” the fundamental nature of

parental rights, because the court wasn’t certain the

implant qualified as “surgery.”

ARGUMENT

I.

THE UCSF MEDICAL PROVIDERS ARE

NOT

ENTITLED

TO

QUALIFIED

IMMUNITY.

In America today, any reasonably educated

member of the general public would understand the

nation’s robust commitment to parental rights. And

any person with a modicum of common sense—and

even minimal exposure to current events—would be

aware of the raging, contentious debate over

transgender ideology, particularly where minor

children are concerned. Yet the Ninth Circuit found it

reasonable for the UCSF medical providers (state

3

actors) to presume that the “gender-affirming implant

procedure” performed on Hudacko’s child did not fall

within the “any gender identity related surgery” that

required his signature. Based on that questionable

assumption, they excluded Hudacko from discussions

about the implant. Nevertheless, the court concluded

the providers were entitled to qualified immunity.

“A government official sued under §1983 is

entitled to qualified immunity unless the official

violated a statutory or constitutional right that was

clearly established at the time of the challenged

conduct.” Carroll v. Carman, 574 U.S. 13, 16 (2014)

(emphasis added). To be “clearly established,” the

right must be clear enough that “a reasonable official

would understand that what he is doing violates that

right.” Ibid., quoting Anderson v. Creighton, 483 U.S.

635, 640 (1987). “[E]xisting precedent” must place the

constitutional question “beyond debate.” Carroll, 574

U.S. at 16, quoting Ashcroft v. al-Kidd, 563 U.S. 731,

741 (2011), so that officials have “breathing room” to

make decisions that are reasonable even though

mistaken. Id. at 743.

Courts must consider whether “any reasonable

official in the defendant’s shoes would have

understood that he was violating it.” Plumhoff

v. Richard, 572 U.S. 765, 778-779 (2014).

Reasonableness is determined under the “totality of

the circumstances,” which may include “earlier facts

and circumstances” relevant to the government

official’s understanding and response. Barnes v. Felix,

605 U.S. 73, 73-74 (2025). Plumhoff involved a

dangerous high speed car chase that ended in two

4

deaths. The reasonableness of the officer’s actions was

impacted by critical earlier facts, including a car zigzagging down a busy roadway at high speed to flee

from police. 572 U.S. at 778-779.

As this Court’s precedents unambiguously

demonstrate, a reasonable official would understand

that parental rights are clearly established and

encompass decisions about a child’s medical care—

especially in the context of novel procedures virtually

certain to cause irreparable harm. A similar and

“particularly contentious constitutional question”

came to this Court’s attention recently in a school

context—"whether a [state actor] violates parents’

fundamental rights when, without parental

knowledge or consent, it encourages a student to

transition to a new gender or assists in that process.”

Parents Protecting Our Child., UA v. Eau Claire Area

Sch. Dist., 145 S. Ct. 14, 14 (2024) (Alito, J.,

dissenting from denial of certiorari) (cleaned up).

Three Justices subsequently recognized it is both

“troubling . . . and tragic” when state actors

“purposefully interfere with parents’ access to critical

information about their children’s gender-identity

choices.” Lee v. Poudre Sch. Dist. R-1, 146 S. Ct. 26,

26 (2025) (statement by Alito, J., joined by Thomas &

Gorsuch, JJ.).

Regardless of the custody order, the UCSF

medical providers “purposefully interfere[d] with

[Hudacko’s] access to critical information about [his]

child[]’s gender-identity choices.” This is both

“troubling . . . and tragic.” Even as a noncustodial

parent with restricted parental rights, Hudacko is

5

still a parent who deserved to be included in such a

major medical decision with life-altering, potentially

tragic consequences.

Any reasonable person—particularly a medical

provider—would understand that excluding Hudacko

entirely violated his parental rights, a fundamental

liberty that is “clearly established” “beyond debate” by

abundant legal precedent in this Court. Hudacko’s

parental rights have been severely restricted

(“stripped . . . of almost all,” Hudacko, at *5) but not

terminated. The medical providers blithely ignored

his remaining rights and are not entitled to qualified

immunity. Their conduct is particularly troubling in

the context of intense disagreement about the

legitimacy and efficacy of so-called “gender-affirming”

(really sex-rejecting) medical treatments.

II. IT IS “CLEARLY ESTABLISHED” “BEYOND

DEBATE” THAT PARENTAL RIGHTS ARE

INALIENABLE AND FUNDAMENTAL, AS

RECOGNIZED

BY

DECADES

OF

JURISPRUDENCE.

This case presents a grave threat to time-honored

fundamental parental rights to the care, custody, and

control of their children, including decisions about

their medical care. Parental rights are “perhaps the

oldest of the fundamental liberty interests recognized

by this Court.” Troxel v. Granville, 530 U.S. 57, 65

(2000). As this Court recently acknowledged, the

question “how best to help minors” struggling with

gender identity or sexual orientation is presently a

subject of “fierce public debate.” Chiles v. Salazar, 146

6

S. Ct. 1010, 1029 (2026) (quoting Tingley v. Ferguson,

144 S. Ct. 33 (2023) (Thomas, J., dissenting from

denial of certiorari)). This case must be examined

under the spotlight of that debate. Any “reasonable

person” – indeed, any person not living under a rock

– would be aware of both the “fierce public debate”

and the relevance of parental involvement.

There is abundant precedent on point showing

indisputably that “the Due Process Clause of the

Fourteenth Amendment protects the fundamental

right of parents to make decisions concerning the

care, custody, and control of their children.” Troxel,

530 U.S. at 66. Due process rights to life, liberty, and

property encompass “not merely freedom from bodily

restraint but also the right of the individual to . . .

marry, establish a home and bring up children, to

worship God . . . .” Meyer v. Nebraska, 262 U.S. 390,

399 (1923). These rights to establish a family are

“essential.” Ibid.; see Troxel, 530 U.S. at 65.

In upholding a child labor law, this Court

explained that “the family itself is not beyond

regulation in the public interest” but simultaneously

reaffirmed the paramount importance of parental

rights: "It is cardinal with us that the custody, care

and nurture of the child reside first in the parents,

whose primary function and freedom include

preparation for obligations the state can neither

supply nor hinder." Prince v. Massachusetts, 321 U.S.

158, 166 (1944) (emphasis added).

Parental rights are not created by statute or even

constitutions but are natural, inalienable rights

7

uniformly recognized by courts throughout American

history. Even in dissenting from the analysis of the

other justices in Troxel, Justice Scalia vigorously

affirmed that the “right of parents to direct the

upbringing of their children is among the unalienable

Rights with which the Declaration of Independence

proclaims all Men . . . are endowed by their Creator."

Troxel, 530 U.S. at 91 (Scalia, J., dissenting) (internal

quotation marks omitted). The sex transitioning of

children, facilitated with secrecy by a growing

number of public officials—and now through the

efforts of medical doctors aligned with one of a child’s

two parents—assaults these fundamental rights so

severely as to essentially obliterate them. The doctors

openly flout Due Process while surreptitiously

providing dangerous “gender-affirming care” that is

virtually guaranteed to cause irreparable harm.

History reveals “a founding generation that

believed parents to have complete authority over their

minor children and expected [them] to direct the

development of those children.” Brown v.

Entertainment Merchants Ass’n, 564 U.S. 786, 834

(2011) (Thomas, J., dissenting). “[E]xtensive

precedent” establishes beyond doubt that the Due

Process Clause protects fundamental parental rights

“to make decisions concerning the care, custody, and

control of their children.” Troxel, 530 U.S. at 66.

“[P]arents—not the State—have primary authority”

for these decisions. Mirabelli v. Bonta, 607 U.S. 492,

497 (2026), citing Pierce v. Society of Sisters, 268 U.S.

510, 534-535 (1925); Meyer, 262 U.S. at 399-400.

These precedents encompass “the right not to be shut

out of participation in decisions regarding their

8

children’s mental health.” Mirabelli, 607 U.S. at 497,

citing Parham v. J. R., 442 U.S. 584, 602 (1979)

(emphasis added). Hudacko has unquestionably been

“shut out of participation” in critical decisions about

his child’s medical care.

A. Parental rights fit comfortably within

judicial definitions of “fundamental”

rights.

“Marriage and procreation are fundamental to the

very existence and survival of the race.” Skinner v.

Oklahoma, 316 U.S. 535, 541 (1942) (emphasis

added). Skinner struck down a sterilization

requirement, stressing the potentially “far-reaching

and devastating effects” of depriving the individual of

“a basic liberty.” Ibid. The often repeated language

used to recognize fundamental rights easily applies to

the parental rights at stake in this case—“deeply

rooted in this Nation's history and tradition," Moore

v. East Cleveland, 431 U.S. 494, 503 (1977) (plurality

opinion); "so rooted in the traditions and conscience of

our people as to be ranked as fundamental,” and

"implicit in the concept of ordered liberty," such that

"neither liberty nor justice would exist if they were

sacrificed," Palko v. Connecticut, 302 U.S. 319, 325,

326 (1937). See Washington v. Glucksberg, 521 U.S.

702, 720-721 (1977) (discussing the criteria to

recognize fundamental rights beyond those

enumerated in the Bill of Rights). “Relevant here, the

doctrine of substantive due process has long embraced

a parent’s right to raise her child, which includes the

right to participate in significant decisions about [his]

9

child’s mental health.” Mirabelli, 607 U.S. at 499

(Barrett, J., concurring).

B. Each individual parent retains these

fundamental

rights,

regardless

of

custody or other separation.

Each individual’s due process rights to life,

liberty, and property encompass “not merely freedom

from bodily restraint but also the right . . . to marry,

establish a home and bring up children, to worship

God . . . .” Meyer, 262 U.S. at 399. These rights to

establish a family are “essential.” Ibid.; see Troxel,

530 U.S. at 65. As noted in a child custody dispute, a

parent’s “right to the care, custody, management and

companionship” of his or her children is a “right[]

more precious . . . than property rights” and even

more important than financial support from a former

spouse. May v. Anderson, 345 U.S. 528, 533 (1953). In

May, a state “where [the] mother [wa]s neither

domiciled, resident nor present” could not lawfully

issue an ex parte decree (as requested by the father

residing in another state) that would “cut off her

immediate right to the care, custody, management

and companionship of her minor children.” Ibid.

Because parental rights are fundamental, the

state must jump a high hurdle to remove a child from

the custody of his/her parents or to terminate a

parent’s rights entirely. Parental rights, like other

“liberties of the individual which history has attested

as the indispensable conditions of an open as against

a closed society . . . come to this Court with a

momentum for respect lacking when appeal is made

10

to liberties which derive merely from shifting

economic arrangements.” Stanley v. Illinois, 405 U.S.

645, 651 (1972) (quoting Kovacs v. Cooper, 336 U.S.

77, 95 (1949) (Frankfurter, J., concurring)). The

unwed father in Stanley was entitled to a fitness

hearing before termination of his parental rights,

after the child’s mother had died. “The rights to

conceive and to raise one's children have been deemed

‘essential.’” Stanley, 405 U.S. at 651, citing Meyer, 262

U.S. 15 399.

Hudacko does not have custody of his child and

his parental rights have been severely limited—but

not wholly terminated. Even where parents “have not

been model parents,” or “blood relationships are

strained,” or they have “temporarily lost custody to

the State,” fundamental parental rights “do not

evaporate.” Santosky v. Kramer, 455 U.S. 745, 753

(1982). Due Process is required and the state must

present “clear and convincing evidence” to

“completely and irrevocably” terminate a natural

parent’s rights. Id., 455 U.S. at 747-748. When the

state intervenes “to destroy weakened familial bonds,

it must provide the parents with fundamentally fair

procedures.” Id. at 753-754. Choices about raising

children “are among associational rights . . . sheltered

by the Fourteenth Amendment against the State's

unwarranted usurpation, disregard, or disrespect."

M.L.B. v. S.L.J., 519 U.S. 102, 116 (1996). These

rights are ranked as “of basic importance in our

society.” Boddie v. Connecticut, 401 U.S. 371, 376

(1971). In M.L.B., where the mother lacked funds to

pay the costs of the record she needed to appeal a

decision terminating her parental rights, this Court

11

held that, “Mississippi may not deny M.L.B., because

of her poverty, appellate review of the sufficiency of

the evidence on which the trial court found her unfit

to remain a parent.” M.L.B., 519 U.S. at 107. Parental

rights were “sufficiently strong to require the state to

pay those costs.” Ibid.

C. Parental

rights

are

increasingly

threatened by the proliferation of

transgender ideology.

There is hardly a more contentious “matter of

public concern” than gender identity, “a controversial

[and] sensitive political topic[] . . . of profound value

and concern to the public.” Janus v. AFSCME,

Council 31, 585 U.S. 878, 913 (2018) (cleaned up). It

is not the business of any government official to coerce

any person’s viewpoint on this matter. Yet the

onslaught of transgender ideology in American

society has reached epidemic proportions, with

seemingly endless permutations in attempted

coercion. Ideological disagreement and attempts at

compulsion occur in many different contexts.

Following are a few examples.

Secret sex transitioning in public schools.

Transgender rights are exalted at the expense of

those who reject the ideology. This trend is nowhere

more evident than in the alarming multitude of public

school policies that facilitate gender transitions for

minor schoolchildren. These policies demand the use

of a child’s preferred name and pronouns without

parental consent or even knowledge, typically

requiring school personnel to actively deceive

12

parents. The lawsuits filed by shocked, angry parents

are legion. There are legal challenges throughout the

country. Examples abound—sadly. Parents in

Maryland sued their local Board of Education over the

schools’ secret social transitioning of children to the

opposite sex and deliberately withholding that

information from parents. The School Board had

adopted “Gender Identity” guidelines specifically

providing that parents were not to be informed when

a child identified as transgender, and furthermore,

that school personnel had to take affirmative steps to

hide that information from parents by reverting to

given names (and correct pronouns) when

communicating with them. The Fourth Circuit held

that the parents did not allege sufficient injuries to

establish legal standing. John & Jane Parents 1 v.

Montgomery Cnty. Bd. of Educ., 78 F.4th 622 (4th Cir.

2023), cert. denied WL 2262333 (May 20, 2024).

Professional counseling. Chiles v. Salazar

addressed the free speech rights of professional

counselors speaking with minors who want to

overcome same-sex attractions or live in accordance

with their biological sex. This Court rightly held that

Colorado’s ban on “sexual orientation change efforts”

was unconstitutional as applied, based on the law’s

blatant viewpoint discrimination. A counselor could

affirm a young client’s preferred, non-biological

“gender identity” but could not assist a client whose

goal was to accept and live consistently with his/her

birth sex.

As Chiles demonstrates, dissenting voices must

be heard—otherwise “any professional speech that

13

deviates from ‘current beliefs about the safety and

efficacy of various medical treatments’ could be

silenced with relative ease.” Chiles, 146 S. Ct. at 1029.

In Chiles, Colorado “freely acknowledge[d]” this sort

of censorship and “the dissent embrace[d]” it. Ibid.

Women’s sports. On January 13, 2026, this

Court heard oral arguments in two consolidated cases

related to the exclusion of “transgender women”—

biological men—from women’s sports team. Little v.

Hecox, Docket No. 24-38, 104 F.4th 1061 (9th Cir.

2023); West Virginia v. B.P.J., Docket No. 24-43, 98

F.4th 542 (4th Cir. 2024). In its opinion on June 30,

2026, the Court affirmed that under Title IX, “schools

may maintain women’s and girls’ sports teams for

biological females.” B.P.J. v. West Virginia, 225 L. Ed.

1040, 1047 (2026).

III. THE PARENTAL RIGHT TO MAKE

MEDICAL DECISIONS FOR A CHILD IS

“CLEARLY ESTABLISHED” BY JUDICIAL

PRECEDENT AND “BEYOND DEBATE.”

Parental rights follow the child everywhere,

extending broadly to public and private life—medical

care, education, religion, custody, and associations.

Judicial precedent touches them all. Parental rights

follow the child into the doctor’s office. Courts must

safeguard the rights of parents to make medical

decisions for their children. These rights are critical

to the health, safety, and life of children across the

nation. The Ninth Circuit should have considered the

fundamental nature of the rights at stake.

This Court addressed parental rights at length in

Wisconsin v. Yoder. "The history and culture of

14

Western civilization reflect a strong tradition of

parental concern for the nurture and upbringing of

their children. This primary role of the parents in the

upbringing of their children is now established

beyond debate as an enduring American tradition."

406 U.S. 205, 232 (1972). Yoder’s rationale logically

extends to the paramount interest of parents in

making important decisions about their children’s

medical care. This is especially true where the

decision—a transition from one sex to the other—has

such obviously radical implications for the child’s

future.

Historically, American jurisprudence “reflects

Western civilization concepts of the family as a unit

with broad parental authority over minor children”

and “cases have consistently followed that course.”

Parham, 442 U.S. at 602. In Parham, this Court

upheld Georgia’s statutory procedure for parents to

voluntarily commit a minor to a hospital for mental

health treatment, reversing the state court’s

conclusion that the law was unconstitutional.

Common law has long recognized that “the only party

capable of authorizing medical treatment for a minor

in normal circumstances is usually his parent or

guardian.” Newmark v. Williams, 588 A.2d 1108,

1115-1116 (Del. 1990) (child’s parents declined

chemotherapy); see W. Posser & W. Keeton, The Law

of Torts § 118 at 114-115 (5th ed. 1984).

“[T]he tradition of parental authority is not

inconsistent with our tradition of individual liberty.”

Bellotti v. Baird, 443 U.S. 622, 638-39 (1979)

(plurality).

Under

normal,

non-emergency

15

circumstances, parents have a “liberty interest in

family association to be with their children while they

are receiving medical attention” and children have “a

corresponding right to the love, comfort, and

reassurance of their parents. . . .” Wallis ex rel. Wallis

v. Spencer, 202 F.3d 1126, 1142 (9th Cir. 1999). The

associational rights of both parents and children are

especially critical in a context where medical

decisions will likely have irreparable, life-altering

consequences. The custody order here tends to place

the parent and child in the position of “adversaries,”

an action “at odds with the presumption that parents

act in the best interests of their child.” Parham, 442

U.S. at 610.

A. The Custody Order undermines parental

rights

by

granting

significant

independent authority to the minor

child.

The Custody Order, while purportedly protecting

Hudacko’s right to a voice in his child’s medical care,

has been interpreted in a manner that seriously

impedes his ability to exercise his parental rights. The

child (“Minor”) is authorized "to pursue the services

provided by UCSF as to [Minor's] gender identity, and

shall be permitted to commence hormone therapy, if

recommended by UCSF," subject to the restriction on

“gender identity related surgery,” which required the

written consent of both parents. Hudacko, at *7-8.

Children lack the maturity to make their own

medical decisions, particularly where irreparable

harm is threatened. Medical decisions require

16

evaluating the risks and benefits of a proposed

treatment and then either giving or withholding

informed consent. A child lacks the "maturity,

experience, and capacity for judgment” required in

“making life's difficult decisions.” Parham, 442 U.S.

at 602. The law presumes that “parents possess what

a child lacks in maturity, experience, and capacity for

judgment required for making life's difficult

decisions." Ibid. “Simply because the decision of a

parent is not agreeable to a child or . . . involves risks

does not automatically transfer the power to make

that decision from the parents to some agency or

officer of the state.” Id. at 603. The UCSF medical

providers violated this principle, usurping Hudacko’s

rights as a parent to even be heard concerning his

child’s decision to seek a procedure of such

magnitude.

It is difficult to imagine a more critical application

of parental rights than basic medical decisions

necessary to preserve a child’s life and health. In

United States v. Skrmetti, Tennessee concluded that

minors lack “maturity to fully understand and

appreciate the life-altering consequences” of the

prohibited procedures. 605 U.S. 495, 541 (2025),

citing Tenn. Code Ann. §68-33-101(h). This Court

upheld the Tennessee law at issue, which enables the

“nonconsenting parent of an injured minor to sue a

healthcare provider for violating the [state] law” that

prohibited certain medical treatments for minors.

Skrmetti, 605 U.S. at 507 (emphasis added). The law,

which expressly protects the rights of a

“nonconsenting parent,” removed certain conditions—

"gender dysphoria, gender identity disorder, and

17

gender incongruence—from the range of treatable

conditions.” Id. at 519. “Mounting evidence” supports

the conclusion that children are unable to provide

informed consent to “irreversible sex-transition

treatments.” Id. at 547 (Thomas, J., concurring). A

child’s “lack of maturity” and “underdeveloped sense

of responsibility” can lead to “impetuous and illconsidered actions and decisions.” Ibid., citing Roper

v. Simmons, 543 U.S. 551, 569 (2005) (internal

quotation marks omitted). The voices of a “growing

number of detransitioners” echo the commonsense

conclusion that children are unable to comprehend

and consent to sex transition treatments. Skrmetti,

605 U.S. at 542 (Thomas, J., concurring).

Skrmetti is a landmark victory, not only for

general parental rights to make medical decisions—

but specifically as related to the gender identity

issues presented in this case. It is imperative that

courts respect the rights of either one of a child’s

parents to be informed and consent when a child asks

to socially transition or requests “gender-affirming”

treatments. These are the first steps on a journey

likely to end in deep regret and disaster. "The law's

concept of the family rests on the presumption that

parents possess what a child lacks in maturity,

experience, and capacity for judgment required for

making life's difficult decisions." Parham, 442 U.S. at

602. In Parham, this Court upheld Georgia’s

statutory procedure for parents to voluntarily commit

a minor to a hospital for mental health treatment,

reversing the state court’s conclusion that the law was

unconstitutional. A child “lacks the maturity,

experience, and capacity for judgment” required to

18

make such a difficult decision. Ibid. In Planned

Parenthood v. Casey, this Court upheld laws

requiring parental notification or consent prior to a

minor's obtaining an abortion, “based on the quite

reasonable assumption that minors will benefit from

consultation with their parents and that children will

often not realize that their parents have their best

interests at heart.” 505 U.S. 833, 895 (1992),

overruled on other grounds by Dobbs v. Jackson

Women's Health Org., 597 U.S. 215 (2022).

B. Even social transitioning is treated by

courts as medical treatment.

Courts consistently recognize even social

transitioning as a “medically necessary component” of

gender dysphoria treatment. Janiah v. Meeks, 584 F.

Supp. 3d 643, 678 (S.D. Ill. 2022) (prisoner’s “housing

in a facility matching one's gender identity and access

to gender-affirming clothing and other items”); Edmo

v. Corizon, Inc., 935 F.3d 757, 770 (9th Cir. 2019)

(“[t]reatment options” for gender dysphoria include

“changes in gender expression and role,” such as

“living part time or full time in another gender role,

consistent with one’s gender identity”); Lamb v.

Norwood, 899 F.3d 1159, 1161 (10th Cir. 2018)

(same). “Treatment” typically includes “a social

transition in which the person adopts a new name,

pronouns, appearance, and clothing” combined with

surgical interventions. Tirrell v. Edelblut, 748 F.

Supp. 3d 19, 25-26 (D.N.H. Sept. 10, 2024) (girls’

sports); Clark v. Quiros, 2024 U.S. Dist. LEXIS

132251, *13 (D. Conn. July 26, 2024) (prisoner)

(noting “four broad categories” of “gender affirming

19

care” —"mental healthcare, social transition, medical

or somatic treatments, and surgical interventions”);

Pinson v. Hadaway, 2020 U.S. Dist. LEXIS 170246,

*2

(D.

Minn.

July

13,

2020)

(“social

transition, hormone therapy, psychotherapy, or

surgery”); Porter v. Allbaugh, 2019 U.S. Dist. LEXIS

83633, *3 n. 3, citing Lamb, 899 F.3d at 111 (in

addition to hormones, surgeries, and psychotherapy,

current treatments include “social transition . . .

dressing and grooming oneself as well as taking on

gender roles consistent with one's gender identity”).

C. The irreparable harm caused by sex

transition procedures is increasingly

well established and known.

The dangers of sex transitioning procedures are

increasing known and well publicized. The harm

perpetrated by these treatments is particularly

egregious because it involves radical procedures with

irrevocable, life-altering complications. “The current

use of puberty blockers and sex-reassignment surgery

is an unethical human experimentation on our most

vulnerable members of society.” Claudia Bihar, Let

Them Be Children: How the Law Should Support

Parents in Protecting Their Children From the

Harmful Effects of Gender Affirming Treatment, 21

Ave Maria L. Rev. 108, 119-120 (Spring 2023). The

experiment is not warranted by “reflexive deference

to currently prevailing professional views”—such

deference does “not always end well.” See, e.g., Buck

v. Bell, 274 U.S. 200, 207 (1927) (coerced

sterilization—“[t]hree generations of imbeciles are

enough”).

20

A Sixth Circuit asylum case, Abay v. Ashcroft,

concerned

“female

genital

mutilation,”

an

excruciating practice “‘nearly universal’ in Ethiopia

and to which an estimated 90% of women are

subjected.” 38 F.3d 634, 636 (6th Cir. 2004). This

procedure is “extremely painful, permanently

disfigures the female genitalia, and exposes the girl

or woman to the risk of serious, potentially lifethreatening complications, including bleeding,

infection, urine retention, stress, shock, psychological

trauma, and damage to the urethra and anus." Id. at

638 (cleaned up). Such bodily mutilation is eerily

similar to the transgender procedures that cause

permanent, irreparable damage. In Abay, a mother

and minor daughter sought asylum in the United

States to escape the practice. The Sixth Circuit

credited their “well-founded fear” and overturned an

immigration judge’s denial of their claim. Id. at 636.

The U.S. Department of Health and Human

Services (“HHS”) sounded the alarm in issuing the

following Declaration:

Sex-rejecting procedures for children and

adolescents are neither safe nor effective as a

treatment modality for gender dysphoria,

gender incongruence, or other related

disorders in minors, and therefore, fail to

meet professional recognized standards of

health care. For the purposes of this

declaration, “sex-rejecting procedures” means

pharmaceutical or surgical interventions,

including

puberty

blockers,

cross-sex

21

hormones,

and

surgeries

such

as

mastectomies, vaginoplasties, and other

procedures, that attempt to align an

individual’s physical appearance or body with

an asserted identity that differs from the

individual’s sex.

Declaration of the Secretary of the Department of

Health and Human Services, RE: Safety,

Effectiveness, and Professional Standards of Care for

Sex-Rejecting

Procedures

on

Children

and

Adolescents (Dec. 18, 2025). Prior to the Declaration,

HHS released its final, comprehensive peer reviewed

report, Treatment for Pediatric Gender Dysphoria:

Review of Evidence and Best Practices (“HHS Report”)

(Nov. 19, 2025).

This Declaration is comprehensive as to the

procedures it covered and most assuredly would

include the implant at issue in this case.

The Declaration is authorized by 42 CFR § 1001.2,

which vests the HHS Secretary with legal authority

to declare a “treatment modality not to be safe and

effective” (emphasis added). The Regulation further

provides that "when the Department has declared a

treatment modality not to be safe and effective,

practitioners who employ such a treatment modality

will be deemed not to meet professionally recognized

standards of health care." Although the Declaration

does not recommend a particular treatment, the

Report “points to psychotherapy (talk therapy) as a

noninvasive alternative to sex-rejecting procedures.”

See HHS Report, 256.

22

In its “Ethical Analysis and Conclusions,” the

Declaration concludes that because these “medical

interventions pose unnecessary, disproportionate

risks of harm, healthcare providers should refuse to

offer them even when they are preferred, requested,

or demanded by patients,” citing HHS Report, 15. The

Report also concluded that the procedures fail to show

evidence of improved mental health, and there is

increasing recognition that they pose a plausible risk

of serious harms—cancer, cardiac disease, sexual

dysfunction, infertility, etc. HHS Report, 227-228.

Sex-rejecting procedures violate the corresponding

“duties of nonmaleficence and beneficence” –

practitioners must do no harm and must provide a

benefit.

The Declaration, citing the HHS Report, states

that:

U.S. medical associations played a key role in

creating a perception that there is

professional consensus in support of pediatric

medical transition. This apparent consensus,

however, is driven primarily by a small

number of specialized committees, influenced

by WPATH. It is not clear that the official

views of these associations are shared by the

wider medical community, or even by most of

their members. There is evidence that some

medical and mental health associations have

suppressed dissent and stifled debate about

this issue among their members.

23

HHS Report, 15 (emphasis added). Contrary to this

alleged consensus, the Declaration concluded that the

“standards of care recommended by certain medical

organizations are unsupported by the weight of

evidence and threaten the health and safety of

children with gender dysphoria.”

Specifically, “certain medical organizations”

include the World Professional Association for

Transgender Health (WPATH) and the Endocrine

Society (ES). There has been a “substantial increase

in gender dysphoria diagnoses among young people”

and an increase in sex-rejecting medical interventions

following endorsements by these two organizations.

Such

endorsements

“demonstrate

significant

variation in methodological rigor and quality,” and

“current medical evidence does not support a

favorable risk/benefit profile for these procedures.”

HHS Declaration.

International concerns about transgender

procedures have also escalated. Pediatric medical

interventions increased substantially following the

2006 publication of the “Dutch Protocol” in The

European Journal of Endocrinology. But now, the

HHS Declaration notes “growing international

concern

regarding

hormonal

and

surgical

interventions for pediatric gender dysphoria among

countries conducting rigorous, independent, evidencebased evaluations.” Independently commissioned

reviews in Sweden, Finland, and the United Kingdom

have all concluded that the risks likely exceed the

benefits. The United Kingdom’s Cass Review (April

2024), a four-year independent assessment of

24

pediatric ender medicine, is the most influential of

these reviews. Denmark, Norway, and other countries

have adopted conservative approaches favoring noninvasive treatment (counseling) over risky,

experimental surgeries. Decl., n. 68 – 73. ASPS also

notes that a number of international health systems

and professional bodies have examined clinical

practice assumptions, with growing uncertainty

about the benefits of medical and surgical

interventions.

Just recently, a landmark study released from

Finland demonstrates conclusively that outcomes are

far worse for those who medically transition than for

those who do not. See “Psychiatric Morbidity Among

Adolescents and Young Adults Who Contacted

Specialised Gender Identity Services in Finland in

1996–2019: A Register Study” (March 26, 2026).2

Unlike many other studies, this one included both

follow-up and consistent control groups. Adolescents

referred for “gender-affirming care” were significantly

more likely to receive specialist-level psychiatric

treatment than control groups both before (45.7%

vs.15.0%) and more than two years after diagnosis

and referral (61.7% vs. 14.6%). The increase in

psychological

problems

during

follow-up

is

particularly astounding, rising from 9.8% to 60.7%

among men trying to appear female and from 21.6%

to 54.5% among women trying to appear male.

“Gender-affirming care” escalates the problems

https://onlinelibrary.wiley.com/doi/epdf/10.1111/apa.70533

(March 26, 2026) (last visited 04/13/26).

2

25

rather than solving them. Psychiatric needs do not

subside after medical gender reassignment.

The risks associated with gender identity

procedures are substantial.3 The UCSF medical

providers circumvented the two-parent signature

requirement—a protection that provided a stronger

possibility that the risks would be considered.

CONCLUSION

This Court should grant the petition and reverse

the Ninth Circuit ruling.

3 Indeed, the U.S. Dept. of Health and Human Services has just

released a new report: Wolves in White Coats: How Doctors and

Hospitals Pushed and Profited from the Fraud of “Gender

Medicine” (August 13, 2026).

26

Respectfully submitted,

Deborah J. Dewart

Counsel of Record

111 Magnolia Lane

Hubert, NC 28539

(910) 326-4554

lawyerdeborah@outlook.com

Tami Fitzgerald

NC Values Institute

9650 Strickland Rd.

Ste. 103-226

Raleigh, NC 27615

Counsel for Amicus Curiae

NC Values Institute