Are American Religious Institutions Required to Refer Patients Who Request Euthanasia?

In its August 14, 2026, decision regarding the French law establishing the “right to aid in dying,” the Constitutional Council ruled that private institutions have the right to refuse to allow the “aid in dying” procedure to take place on their premises when such a procedure is contrary to their mission.[1] By attaching an interpretive reservation to the new legislation, the Council thus recognized the freedom of religious congregations and healthcare institutions whose ethics are based on religion to refrain from participating in practices that directly threaten their moral integrity. This freedom is of fundamental importance, particularly for Catholic institutions, for which “any formal or immediate material cooperation” in an act of euthanasia or assisted suicide is “a grave sin against human life” (Letter Samaritanus bonus).[2]

While the interpretive reservation issued by the Constitutional Council should be welcomed, insofar as it guarantees the continued operation in France of “sanctuaries” where vulnerable people are protected from the threat of death, the fact remains that its actual scope will be determined by subsequent measures: first, by the decrees implementing the law that will be adopted by the government in the coming months, and second, by the practical application of the new “aid in dying” framework. Indeed, even now, some commentators are pointing out that the right of religious institutions, as enshrined in the Council’s decision, will have to be “narrowly interpreted” and that it cannot apply, for example, to “patients whose medical condition is too severe” to allow them to be transported to another healthcare facility that accepts the practice of “aid in dying.”[3]

Given the uncertainty surrounding the future of the practical implementation of the “Law on the right to aid in dying” it is necessary to remain vigilant and to recall that religious congregations and institutions are not defenseless, even in the face of government measures aimed at undermining the very foundations of their mission. Fortunately, the latest news from across the Atlantic indicates that a growing number of healthcare institutions are prepared to enter the legal battleground to preserve their moral integrity in response to legislative reforms that undermine their ethos and the effectiveness of their apostolate.

Indeed, as we reported last July, in New York State, several religious congregations have mobilized against the implementation of new legislation that imposes various obligations on healthcare facilities regarding medical “aid in dying.” Under New York law, which took effect on August 5, 2026, healthcare facilities—including religious institutions—are required, among other things, to inform patients about the option of “aid in dying” and, where appropriate, to refer them to entities that permit the practice of assisted suicide.

Aware of the clear incompatibility of the new provisions with their mission and internal bylaws, on July 17, 2026, four orders of Catholic nuns (the Carmelite Sisters  for the Aged and Infirm, the Dominican Sisters of Hawthorne, the Missionary Sisters of St. Benedict, the Little Sisters of the Poor), supported by Bishop John Oliver Barres of Rockville Centre and the Diocese of Rockville Centre, filed a lawsuit in the U.S. District Court for the Northern District of New York to challenge the requirement to participate in assisted suicide.[4] On July 30, with the agreement of the State of New York, a federal judge ordered the state not to enforce its assisted-suicide mandate against the four affected congregations and several Catholic healthcare facilities, pending the outcome of their legal action. The temporary measures protect Catholic institutions from any obligation to assist terminally ill patients in ending their lives by suicide. The main proceedings are ongoing.

Meanwhile, in Illinois, the euthanasia law took effect on September 12. This new legislation goes even further than New York’s in terms of the requirements designed to ensure access to “aid in dying.” In addition to requiring healthcare facilities to provide information and refer patients to entities that provide assisted suicide, the Illinois law specifies that any attempt by healthcare personnel to dissuade a patient from ending their life may be subject to criminal prosecution. The bishops of Illinois had already opposed the new legislation during its review in 2025.

In light of these circumstances, two lawsuits have recently been filed in Illinois courts. First, in August, Bishop Thomas Paprocki of Springfield, along with four doctors and the Lutheran Care Center, filed a lawsuit against the State of Illinois.[5] On August 21, the state agreed to temporarily suspend the application of certain provisions against the plaintiffs while the litigation continues. Second, on September 3, Cardinal Blase Cupich, Archbishop of Chicago, the Carmelite Sisters for the Aged and Infirm, and the Little Sisters of the Poor also filed a complaint in the U.S. District Court for the Northern District of Illinois.[6] In their lawsuits, the institutions argue that the new law compels them to participate in the process leading to the death of their patients. On September 11, 2026, one day before the law was set to take effect, the federal court issued a temporary restraining order prohibiting the State of Illinois from enforcing the contested provisions against the plaintiffs. The litigation is ongoing.

The granting of injunctions in the cases in New York and Illinois marks a first victory in the fight to preserve the integrity of the mission of health care institutions founded on a religious ethos. It also raises legitimate expectations that the disputes will be resolved in favor of the congregations involved. Indeed, it must be acknowledged that it would be quite difficult for U.S. judges to categorically reject all of the claims submitted by the plaintiffs without seriously examining the principle of institutional autonomy of churches and institutions whose ethics are based on religion. In this regard, it is worth recalling that the principle of autonomy, long applied by the U.S. Supreme Court, is widely recognized in international and European law. Indeed, in her recent submission to the French Constitutional Council, the United Nations Special Rapporteur on Freedom of Religion or Belief emphasized that “[r]espect for institutional autonomy falls within the broader framework of the protection afforded to religious communities under international human rights law.”[7] In the Special Rapporteur’s view, “[r]eligiously affiliated hospitals, hospices, and nursing homes should not be compelled to permit or facilitate aid in dying on their premises if doing so would fundamentally contradict their religious ethics or prevent them from continuing their operations.”[8]

The legal disputes surrounding the implementation of the new “aid in dying” laws are part of a broader framework of similar legislative developments concerning the application of conscientious objection and the institutional dimension of religious freedom in the context of abortion. Indeed, like entities subject to requirements to cooperate in the “aid in dying” process, many healthcare facilities in the United States have been directly confronted with legal obligations to provide information and referrals in connection with their refusal to perform abortions. While the laws of certain states (e.g., Massachusetts) provide that facilities whose ethics are based on religious or moral convictions cannot be subject to the obligation to refer patients to another facility that performs abortions, in other states, such as Illinois, the moral integrity of such facilities is not always respected.

This situation has led several parties to challenge the information and referral requirements in court. One of the lawsuits in question was filed specifically against Illinois legislation that imposes very broad information requirements on healthcare facilities, which in practice amount to promoting abortion. The case, which originated from a complaint filed by several pregnancy support centers and doctors in 2016, is currently pending before the U.S. Court of Appeals for the Seventh Circuit.[9] In December 2025, the Illinois Catholic Conference and the Illinois Catholic Health Association, together with the Orthodox Church in America and the Serbian Orthodox Diocese, filed an amicus curiae brief in the case, denouncing the manifest incompatibility of the patient information and referral requirements with Christian morality. In January 2026, without waiting for the outcome of the litigation, the U.S. Department of Health and Human Services (HHS) issued an official statement finding that the State of Illinois is violating federal law by requiring facilities to refer women to abortion services.[10] This firm stance by the federal government regarding the need to safeguard institutional freedom in the health care sector may inspire some optimism among institutions that work to ensure respect for the rights of the most vulnerable.

The progress of these legal proceedings in the United States warrants close attention, as it offers valuable insights into the courts’ approach to the imperative of protecting the essence of institutional religious freedom. Regardless of the outcome of the legal disputes across the Atlantic, the stance taken by religious congregations that remain faithful to their calling to serve life offers great hope in the fight for the rights of religious institutions in France and Europe.

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[1] Constitutional Council, August 14, 2026, No. 2026-910 DC; see, in particular, §188.

[2] Congregation for the Doctrine of the Faith, Samaritanus bonus. on the care of persons in the critical and terminal phases of life, Vatican City, September 14, 2020, section 5.1.

[3] Martine Lombard, “Do the Constitutional Council’s Interpretive Reservations on the Law Concerning the Right to Aid in Dying Undermine Patients’ Rights? By Martine Lombard” (JP blog, August 24, 2026) <http://blog.juspoliticum.com/2026/08/24/les-reserves-dinterpretation-du-conseil-constitutionnel-sur-la-loi-relative-au-droit-a-laide-a-mourir-fragilisent-elles-les-droits-des-malades-par-martine-lombard/> accessed September 21, 2026 (free translation).

[4] “Carmelite Sisters for the Aged and Infirm v. Letitia James” <https://becketfund.org/case/carmelite-sisters/> accessed September 21, 2026.

[5] “Mary Keen Kirchoff, M.D., et al. v. Treto, Jr.” <https://www.thomasmoresociety.org/case/mary-keen-kirchoff-m-d-et-al-v-treto-jr> accessed September 21, 2026.

[6] “Carmelite Sisters for the Aged and Infirm v. Prince” <https://becketfund.org/case/carmelite-sisters-for-the-aged-and-infirm-v-prince/> accessed September 21, 2026.

[7] External contribution by Nazila Ghanea, United Nations Special Rapporteur on Freedom of Religion or Belief, to the French Constitutional Council, para. 15; available at <https://www.conseil-constitutionnel.fr/sites/default/files/as/root/
bank_mm/decisions/2026910dc/2026910dc_contrib.pdf> accessed September 21, 2026.

[8] Ibid., para. 14.

[9] ‘National Institute of Family and Life Advocates v. Treto’ <https://becketfund.org/case/national-institute-of-family-and-life-advocates-v-treto/> accessed September 21, 2026.

[10] Office for Civil Rights (OCR), “Fact Sheet: HHS Takes Comprehensive Action to Enforce Conscience Rights and Protect Human Life” (January 21, 2026) <https://www.hhs.gov/press-room/fact-sheet-announcements-on-conscience-and-life.html> accessed September 21, 2026.