This is a post authored by Maria Crusey, an intern with Authors Alliance and a third-year law student at Washington University School of Law.
Introduction
Tension between government actions and freedom of speech under the First Amendment is nothing new. Since the adoption of the First Amendment, individuals and entities have alleged government actors violate free speech rights through actions ranging from the establishment of campaign finance laws to the imposition of book bans. In the digital age, allegations of free speech violations by government actors have started to take new forms that are largely made possible by technological developments. Most recently, in Schiff v. U.S. Office of Personnel Management, filed on March 12, 2025 in the District of Massachusetts, the plaintiffs allege direct censorship by the government through the takedown of select publications posted on a government-operated platform. There are few prior lawsuits in which plaintiffs allege direct censorship by the government on a government-operated platform, and most relevant lawsuits instead allege the government engaged in “censorship by proxy” through requiring online platforms to suppress particular kinds of speech and expression. Consequently, we can look to the paradigmatic “censorship by proxy” case, Murthy v. Missouri, to anticipate how a court might assess the legal arguments posited in Schiff.
The Complaint
The alleged First Amendment violation in Schiff arises out of the takedown of the plaintiffs’ scholarly publications from Patient Safety Network (PSNet), an online platform that publishes research articles and resources about patient safety. The plaintiffs argue that the removal only of articles that may “inculcate or promote” the government’s definition of “gender ideology” pursuant to a recent Executive Order imposes a viewpoint-based restriction in a government forum, PSNet, and the removal of such articles is not reasonable in light of the purpose of PSNet. Moreover, the plaintiffs argue they suffer ongoing undue and actual hardship and irreparable injury from the removal of their articles from PSNet and have no adequate remedy at law to correct this injury. As such, the plaintiffs seek to preliminarily and permanently enjoin the defendants from further censoring their research through implementation of the executive order.
PSNet is operated by the Agency of Healthcare Research and Quality (AHRQ), an executive branch agency within the federal government and a part of the Department of Health and Human Services. PSNet is a leading resource for information on patient safety in the United States, and all content is free and accessible to the public. PSNet’s scholarly publication facet is managed by its editorial team, a group of editors and a librarian that review submissions and select content for publication in various PSNet collections.
One such collection is PSNet’s Case Studies series. Publications in the Case Studies series are sourced from online form submissions by healthcare providers that include a case description of a given medical error and a short recommendation for how healthcare providers or systems might prevent similar errors from happening in the future and thus increase patient safety. PSNet’s editorial team selects submissions for publication based on a number of criteria, including clinical interest and educational value. Following selection of a case, the editorial team invites healthcare providers to submit a commentary based on the case. All articles published by PSNet include a disclaimer that “[r]eaders should not interpret any statement in this report as an official position of AHRQ or of the U.S. Department of Health and Human Services.”
Plaintiffs Gordon Schiff, M.D., and Celeste Royce, M.D., are associate professors of medicine at Harvard Medical School who publish research articles about patient safety in their respective medical specialties. Both have separately published articles about patient safety on PSNet. PSNet accepted a commentary written by Dr. Schiff and co-authors for a case on suicide assessment and prevention. In the publication process, the authors and the editorial team exchanged multiple drafts of the commentary. The second draft of the commentary included a sentence describing “high risk groups” for suicide as including individuals who identify as lesbian, gay, bisexual, or queer/questioning. The PSNet editorial team did not substantively modify this part of the sentence prior to publication, and the case commentary was published on PSNet on January 7, 2022 under the title “Multiple Missed Opportunities for Suicide Risk Assessment” and included the aforementioned disclaimer.
In a separate publication cycle, Dr. Royce and a co-author submitted a commentary for publication in the Case Studies series on delayed diagnosis of endometriosis. Like Dr. Schiff, Dr. Royce exchanged multiple drafts of her commentary with the PSNet editorial team in the publication process. The commentary included text stating that “endometriosis can occur in trans and non-gender-conforming people” and that lack of understanding of this fact could make diagnosis more challenging. No substantive comments or changes dealt with the statement that “endometriosis can occur in trans and non-gender-conforming people.” Dr. Royce’s case commentary was published on PSNet on June 24, 2020 under the title “Endometriosis Commentary” and included the aforementioned disclaimer.
On January 2, 2025, President Trump issued Executive Order 14168, which directed government agencies to combat “gender ideology,” which “replaces the biological category of sex with an ever-shifting concept of self-assessed gender identity,” by removing all statements that promote or otherwise inculcate gender ideology from federal platforms. The Office of Personnel Management subsequently issued a memo instructing all agencies, including AHRQ that oversees PSNet, to “take down all outward facing media that inculcate or promote gender ideology” and report all steps taken to implement this instruction. AHRQ removed articles from PSNet that contained words or terms that “inculcate or promote” the government’s definition of “gender ideology” and took down the plaintiffs’ articles on January 31, 2025.
Following the takedowns, PSNet’s editorial team shared separate emails with the plaintiffs explaining that Dr. Schiff’s article was removed due to inclusion of the words “transgender” and “LGBTQ” in his article and that Dr. Royce’s article was removed for its inclusion of the phrase “endometriosis can occur in trans and non-gender-conforming people” and the description that it may make diagnosis in those populations more challenging. AHRQ subsequently offered to repost the plaintiffs’ articles on the condition that the plaintiffs would remove the language in violation of the executive order. Both plaintiffs declined after AHRQ did not agree to their proposed revisions. As of March 12, 2025, both articles remain unavailable on PSNet.
So far as relief, the plaintiffs request that the court declare: (1) that the Office of Personnel Management’s internal direction to “take down all outward facing media . . . that inculcate or promote gender ideology” as applied to speech by private individuals and organizations on government-run forums is unconstitutional and unlawful and (2) that AHRQ’s implementation of the direction by removing or altering speech of private individuals and organizations on government-run forums is unconstitutional and unlawful.
“Censorship by Proxy” in Murthy v. Missouri
In recent years, the government has been sued for engaging in “censorship by proxy” through requiring digital platforms that widely share information to engage in content-moderation practices to comport with government standards. Multiple “censorship by proxy” suits are currently working their way through the federal courts, including one contesting state book bans and another contesting government-promoted “blacklist tools” that allegedly strip media organizations of advertising revenue, and the outcome of the suits appear to be fact-dependent. The most recent Supreme Court decision on “censorship by proxy” in Murthy v. Missouri found the plaintiffs were barred from alleging First Amendment violations due to procedural deficiencies in their claims.
In Murthy v. Missouri, two states and five individual social-media users sued executive branch agencies and officials, alleging that they pressured social-media platforms to suppress protected speech. Specifically, the plaintiffs alleged that, during the COVID-19 pandemic, Facebook and Twitter deleted posts deemed to be false regarding measures to combat the spread of the virus, as well as “conspiracy theories” about the origins of the virus. The plaintiffs also alleged these same content-moderation practices were applied to content related to the 2020 United States presidential election. The district court issued the plaintiffs a preliminary injunction, finding that executive branch and agency actors likely coerced and significantly encouraged platforms to engage in content-moderation decisions that effectively were decisions of the government. The Fifth Circuit affirmed this part of the injunction, finding that both groups of plaintiffs had standing. The individuals had standing because the social media companies had suppressed the plaintiffs’ speech and were likely to do so again in the future, and the states had standing because the platforms limited the states’ “right to listen” to their citizens on social media.
On appeal, the Supreme Court reversed on the basis that neither the individual nor the state plaintiffs had standing. To have standing to bring suit in federal court, a plaintiff must demonstrate they have suffered or will suffer an injury that is concrete, particularized, and imminent; fairly traceable to the challenged action in the suit; and redressable through a favorable ruling by a court. As a preliminary determination, the Court found that the plaintiffs did not seek to enjoin the appropriate parties—the social-media platforms—for their “direct censorship injuries.” Because social-media platforms, not government actors, were alleged to implement the alleged censorship, the Court stated it was incapable of redressing injuries resulting from third party defendants not present in the suit. As to the traceability of the alleged injuries, the Court found the platforms had “independent incentives” to moderate content relating to the COVID-19 pandemic and 2020 presidential election. While the government defendants played some role in the moderation choices, there was no evidence to suggest every content-moderation decision alleged to be censorship was made under government direction. As such, the plaintiffs lacked a fairly traceable injury and did not have standing to sue.
The Court also found that the lower courts improperly enjoined the government defendants given the lack of standing. The fact that the plaintiffs sought forward-looking relief in the form of an injunction made any past alleged injuries relevant only if they were predictive of future censorship activities. The record did not include any specific findings about the causation of discrete instances of content moderation. Rather, the lower courts instead relied on statements that the platforms censored particular viewpoints on issues and the government defendants engaged in “a years-long pressure campaign” to ensure view-point suppression. The Court rejected these assertions as overly broad and unsupported by the record. Additionally, the Court found the plaintiffs misplaced their reliance on past government censorship as evidence that future censorship was likely. Because the plaintiffs failed to trace the alleged censorship by the platforms to the government’s role in the platforms’ content-moderation, their prior harms could not be used to establish standing to seek an injunction to prevent future harms.
The Court concluded by considering, and declining to agree with, the plaintiffs’ counterarguments in turn. First, the Court found the plaintiffs’ allegation that they suffered ongoing harm from having to self-censor on social media did not support standing. Specifically, as provided in precedent caselaw, the plaintiffs could not “manufacture standing merely by inflicting harm on themselves based on their fears of hypothetical future harm that is not certainly impending.” Second, the plaintiffs’ argument that the platforms continued to suppress their speech per policies initially adopted at the direction of the government failed due to a lack of redressability. The Court indicated that the lack of ongoing pressure from the government made the platforms’ continued content-moderation attributable only to the platforms, not the government, even though the practices may have initially been imposed due to governmental coercion. Moreover, as the government scaled back pandemic response measures, the platforms continued to enforce COVID-19 misinformation policies to the same degree as during the pandemic. Collectively, the Court found these facts suggested that the ongoing harm could only be redressed by legal action against the platforms, not the government, and that such redress could not be pursued in the suit.
Implications of Murthy v. Missouri in Schiff
It is difficult to anticipate how a court’s analysis will proceed in Schiff , but similarities and differences between the Supreme Court’s decision in Murthy and the pending suit in Schiff provide insights as to how a court may assess government censorship imposed through a government-owned platform.
Like the plaintiffs in Murthy, the Schiff plaintiffs sued for a preliminary injunction against the government actors in the case. As a result, they undoubtedly must fulfill the standing requirements necessary to bring suit for an injunction. Several aspects of the Schiff plaintiffs’ situation may help them avoid the pitfalls the Murthy plaintiffs faced in their standing analysis on appeal.
First, the harms alleged by the two Schiff plaintiffs appear to be supported by allegations that are more detailed than those of the Murthy plaintiffs. The Murthy plaintiffs alleged sweeping allegations of government censorship on behalf of multiple individuals and states in a single action, and, as noted by the Supreme Court, the Murthy plaintiffs’ amended complaint provided few specifics about the causation of individual instances of censorship by particular government defendants. Conversely, the Schiff plaintiffs plead specific facts about a few particular government agencies and particular government actors who engaged in discrete acts to takedown the plaintiffs’ online publications in accordance with a particular order issued directly by the executive branch. On their face, these facts appear better positioned to allege a “concrete and particularized harm.”
Second, the traceability of the harms to the plaintiffs, as well as their imminency, may be more easily demonstrated in Schiff. The primary pitfall of the Murthy plaintiffs’ standing argument was the lack of traceability of the act of censoring through content moderation to the government defendants because the government was not involved in every content-moderation action taken by the third-party social media platforms. In Schiff, the lack of a non-government third party in the implementation and execution of the publication takedowns may strengthen an argument of traceability and prevent the disconnect between government actors and conduct like that in Murthy. Moreover, the facts that the Schiff plaintiffs’ publications were taken down pursuant to an ongoing executive order; that the plaintiffs were not offered viable alternative methods to restore their online publications in accordance with their protected speech; and that the publications have not been republished on PSNet as of March 12, 2025 could suggest the executive order poses an ongoing First Amendment violation.
Third, redressability of the harms to the plaintiffs through enjoining the defendants may be more successful in Schiff than in Murthy. In Murthy, the Supreme Court found redress could not be achieved through enjoining the government defendants given the defendants’ lack of ongoing involvement in the alleged censorship. Since there was no evidence that the platforms’ current content-moderation practices were pursuant to government directives, enjoining the government would not remedy the plaintiffs’ ongoing First Amendment violations. In Schiff, the fact that the plaintiffs’ alleged ongoing First Amendment violations (removal of their online publications from PSNet) are driven by a government directive (the executive order), enjoining the government defendants from enforcing the executive order may be more likely to redress the plaintiffs’ ongoing harm.
Additional Considerations in Schiff
Another feature of Schiff that warrants discussion is the justification provided by the U.S. Office of Personnel Management for adopting its guidelines that implement the executive order to the operations of the AHRQ. Per the complaint, Charles Ezell, the Acting Director of the U.S. Office of Personnel Management, cited 5 U.S.C. § 1103(a)(1) and (5) as grounds for his authority to provide the guidelines as the Director is charged with “securing accuracy, uniformity, and justice in the functions of the office” and “executing, administering, and enforcing” the civil service rules and regulations of the President and the Office and laws governing the civil service. Both of these responsibilities of the Director may be implicated in the suit as arguments advanced by the government to justify the implementation of the executive order.
First, the government could argue that the Director’s implementation of the guidelines and takedown of the plaintiffs’ publications were appropriate given his charge to secure the “accuracy” of the office. The plaintiffs’ publications that allegedly “promote or inculcate gender ideology” by suggesting there are only two sexes could be argued to be “inaccurate” in the eyes of the executive branch and thus takedown of the articles was necessary to further “accuracy” in the functions of the office.
Second, the government could argue that the Director’s implementation of the guidelines and takedown of the plaintiffs’ publications are necessary as an execution and enforcement of the “civil service rules and regulations of the President and Office.” This argument would hinge upon whether the executive order can be classified as a “civil service rule and regulation.”
If the plaintiffs allege a viable First Amendment claim, both of the above arguments could play into the justification the government would need to provide to excuse the First Amendment violation. The plaintiffs allege the takedown of their publications constitutes a view-point discriminatory restriction on their protected speech. If the executive order is found to be a view-point discriminatory restriction, the First Amendment violation would be assessed under a “strict scrutiny” standard of review, in which the government would have to demonstrate that the executive order is “narrowly tailored” and necessary to achieve a “compelling governmental interest.”
On its face, the executive order appears quite broad with its order that agencies remove all statements that “promote or inculcate gender ideology.” As such, it is uncertain whether it would satisfy the “narrowly tailored” requirement. Moreover, it is uncertain whether combating gender ideology and promoting a policy that there are only two sexes pass muster as a “compelling governmental interest.” The fact that this policy is enshrined in an executive order may heighten the importance of the interest. However, the language justifying the policy in the executive order itself is vague, providing only that “deny[ing] the biological reality of sex . . . is wrong” and “[t]he erasure of sex in language . . . has a corrosive impact not just on women but on the validity of the entire American system.” Consequently, whether the policy advanced by the executive order constitutes a compelling governmental interest may similarly be an open question.
Conclusion
As the Schiff plaintiffs await an appearance from the defendants in the suit, it is uncertain how broadly the executive order will continue to be applied. The plaintiffs in Schiff report that the Office of Personnel Management guidelines resulted in the removal of at least 20 total publications from PSNet, but the number of takedowns attributable to the executive order on other government-operated platforms is unknown. As proceedings in Schiff progress and additional suits may be filed that similarly allege First Amendment violations by the executive order, direct censorship by the government through government-operated platforms is sure to become an even more contentious issue.