Religious Conscience and Compelled Speech: A Closer Look at Schroeder v. Treto

In a case that underscores the ongoing tension between religious conscience and state-mandated health care regulations, a federal court in Illinois recently struck down part of the state’s Health Care Right of Conscience Act (HCRCA). The case - Schroeder v. Treto - involves pro-life pregnancy centers and doctors who challenged an amendment to the HCRCA that required them to discuss the risks and benefits of abortion and childbirth in order to qualify for liability protections. These healthcare providers (physicians and otherwise) argued that this requirement violated their First Amendment rights, both in terms of freedom of speech and free exercise of religion.

The case was brought by attorney Thomas Schroeder, who represented several Illinois pregnancy centers and medical professionals with religious objections to abortion. They filed suit against Dr. Sameer Treto, the Director of the Illinois Department of Public health, in his “official capacity”. Schrooeder and the plaintiffs argued that Illinois’ amended law unlawfully compelled speech and punished conscience-based refusals to promote or refer abortions.

The federal district court agreed, in part. While it struck down the broader speech requirement, it also upheld a more limited provision: if a patient explicitly asks about abortion services, the provider must either refer, transfer, or give them a list of providers - but only if they intend to use the HCRCA as a defense in a malpractice suit. The court reasoned that this narrower requirement was a reasonable, triggered obligation and did not violate constitutional rights.

What’s at Stake: The Speech vs. Religion Debate

This case sits at the intersection of compelled speech and religious liberty, and to me, that’s what makes it so compelling. It raises the question: can the state force religious providers to speak about something they morally and religiously object to? And if so, where is the line between public interest and individual conscience? The constitutional issues is two-fold, and involves both Free Speech and Free Exercise:

1. Free Speech: Under NIFLA v. Becerra (2018), the Supreme Court held that the government cannot compel pro-life pregnancy centers to deliver state-scripted messages about abortion services. The logic from NIFLA applies almost directly to Schroeder. The Illinois law required doctors and clinics to deliver a government-approved message - even if it contradicted their values. That’s not informed consent - it’s compelled ideology.

2. Free Exercise of Religion: For many of the doctors and staff at these clinics, opposition to abortion isn’t just a political view - it’s a religious conviction. Compelling them to speak positively about a practice they consider morally wrong not only violates their conscience, but pressures them to participate in what they see as a sinful act. While the court didn’t find the Free Exercise claim as compelling here, I personally think the claim deserves more attention. Even if the law is “neutral and generally applicable,” as seen in Employment Division v. Smith (1990), when speech and religion overlap, the burden is hard to ignore.

Constitutional Analysis and Broader Implications

The constitutional tensions in Schroeder v. Treto are directly tied to both the Free Speech Clause and the Free Exercise Clause of the First Amendment. What makes this case so interesting - and in my eyes, important - is the way it forces courts to reason through what counts as a “burden” on religious conscience when that burden comes through compelled professional speech instead of direct religious conduct.

Relating to Previous Decisions

This case builds on the foundation laid by National Institute of Family and Life Advocates (NIFLA) v. Becerra (2018), in which the Supreme Court held that the state could not compel pro-life clinics to post government-mandated notices about abortion services. The Court in NIFLA emphasized that even “professional speech” is protected speech, and the government cannot override that protection simply because it thinks certain information is important. The speech required by Illinois’ HCRCA amendment - especially the section the court struck down - mirrors the flawed logic in NIFLA: that the state can mandate disclosure to be ideologically loaded under the banner of “neutral information.”

In terms of religious freedom, the case also raises questions under the framework of Employment Division v. Smith (1990), which held that neutral and generally applicable laws do not violate the Free Exercise Clause, even if they incidentally burden religious practice. However, more recent cases like Fulton v. Philadelphia (2021) and Masterpiece Cakeshop v. Colorado Civil Rights Commission (2018) (which has been seen in a previous blog post) have chipped away at Smith, especially when laws aren’t truly neutral in practice or allow for secular exceptions. While the Illinois law might look neutral on its face, it’s religious providers who are disproportionately affected - and who are being asked to violate their core beliefs or lose legal protection. To me, this feels more targeted than incidental.

Implications for Religion and Law

The biggest implication of this case is that it tests the limits of religious conscience in a post-Dobbs landscape (Dobbs v. Jackson Women’s Health Organization overturned Roe v. Wade, allowing states far more control over abortion regulation). As states regulate abortion more aggressively, they will inevitably clash with individuals and institutions that hold deeply religious objections. Cases like Schroeder remind us that these clashes aren’t just about physical conduct (like refusing to provide a service), but also about forced participation in speech and messaging.

If states can compel speech about abortion - even just in “neutral” clinical settings - this threatens the constitutional protection that insulates private religious conviction from governmental control or endorsement. The line between public regulation and private religious conviction gets more blurred, which jeopardizes the integrity of our society, which is pluralistic and built on a variety of different values. Once we accept that conscience can be overridden for the sake of "informational balance," we open the door to compelled speech in any profession where religious views diverge from state policy.

Why This Case Is Important

This case is important, to me, because it points to a deeper shift in both our laws and broader cultural dynamics. In an increasingly polarized world, courts are being asked to balance competing rights: the right to access information (and abortion), and the right to abstain from ideological expression. But constitutional protections - especially around speech and religion - don’t disappear just because the speaker works in health care.

Religious freedom doesn't just mean the right to worship; it also means the right to live out those beliefs in professional and civic life. If religious providers are forced to speak words that directly contradict their beliefs, that isn’t neutrality - it’s coercion. And when the government conditions legal protection on compliance with compelled speech, it’s effectively punishing religious dissent.

So the deeper constitutional question isn’t just whether Illinois’s law “helps” patients - the real question is whether the First Amendment stops the state from using individuals to push its own message. And based on the reasoning in NIFLA, Masterpiece Cakeshop, and Fulton, the answer should be yes.

Links to Cases Referenced:

https://www.christianpost.com/news/mandate-for-pro-life-centers-to-promote-abortions-struck-down.html

https://www.oyez.org/cases/2021/19-1392

https://www.oyez.org/cases/2017/16-111

https://www.oyez.org/cases/2017/16-1140

https://www.oyez.org/cases/2020/19-123

https://www.oyez.org/cases/1989/88-1213

https://www.oyez.org/cases/1971/70-18