On December 12, 2025, Illinois Governor Jay R. Pritzker signed into law the End-of-Life Options for Terminally Ill Patients Act which was scheduled to take effect on September 12, 2026. The act would legalize physician-assisted dying for terminally ill adults, and the law contained protections for healthcare providers who declined to participate. However, healthcare providers who declined to participate were still required to inform patients about legally available treatments, and either refer them to alternative providers or provide information about where those services could be accessed. The Carmelite Sisters, a Roman Catholic congregation of religious sisters dedicated to caring for the sick and frail elderly nearing the end of their lives, filed a lawsuit against Illinois state officials on September 3, 2026, (just nine days before the law would become active) on the grounds that it violated their First Amendment right to Free Exercise; the Carmelite Sisters state that they reject participation in physician-assisted dying, including referrals, because it directly conflicts with their religious beliefs and mission. The question is now this: Does the End-of-Life Act violate the Carmelite Sisters’ First Amendment right to Free Exercise by requiring them to provide information or referrals for physician-assisted dying despite their religious beliefs prohibiting participation in assisted suicide?
So far in the legal process, there has only been a formal complaint by the plaintiffs, which initiates the lawsuit, but no complete briefs from either side— other than the facts and early arguments provided by the Carmelite Sisters. Both parties have also agreed to a temporary restraining order (TRO) allowing for no penalties to be imposed on the Carmelite Sisters, and also (since there was no contesting by Illinois government officials) no brief with arguments submitted by the defendants. This case is being argued in federal court, meaning that legal precedent affecting federal issues from the Supreme Court will most likely be applied to the decision. With that in mind, the plaintiffs are arguing points that specifically conform to various tests established in the Supreme Court cases Sherbert v. Verner (1963); Employment Division v. Smith (1990); and Church of the Lukumi Babalu Aye v. Hialeah (1993).
The first argument that the Carmelite Sisters make is that there is a substantial burden being imposed upon them by the law, preventing them from freely exercising their religion and would trigger strict scrutiny. This stems from the precedent in Sherbert, where the Court developed the Sherbert test of strict scrutiny; if there is a perceived substantial burden imposed on a religious group by a law, then the government must demonstrate a compelling state interest in defense of the law. If the government fails to do so, the law is struck down.
However, the precedent of Sherbert changed in Smith raising the bar at which strict scrutiny may be activated. Although the Carmelite Sisters feel that their religion has been substantially burdened, they must argue that the End-of-Life Act is not a generally-applicable and/or not a neutral law (these two criteria are additions from Smith). This means that they must refute either of the following 1) The law can be broadly applied with few exceptions (general-applicability); and 2) The law has hostile intent or language against religion (neutrality). The Carmelite Sisters argue that because the law has exceptions for certain healthcare providers who object on religious grounds to providing physician-assisted dying themselves (not including a mandate to refer), that this is not generally applicable. In addition, they argue that the law is aggressive towards religion, encouraging a type of “religious gerrymander[ing]” (67). And because it does not meet the criteria, they believe it must be analyzed with strict scrutiny.
The application of strict scrutiny from Sherbert was adjusted in the ruling of Lukumi, refining a higher standard for governments to prove constitutionality of original laws in the post-Smith era. In Lukumi, the Court majority confirmed that if either general-applicability or neutrality were violated, then strict scrutiny would be applied. The test would require both a compelling state interest and a showing that the law was applied through the least restrictive means possible; the government must prove that a law was implemented in the least burdensome way possible. The Carmelite Sisters claim that the defendants don’t have a compelling state interest and that the government has not “selected the least-restrictive means of furthering any alleged government interest” (66). Hence, they find the Illinois law completely unconstitutional.
I agree with the Carmelite Sisters that they shouldn’t be compelled to comply with the End-of-Life Act and that the court should rule the law unconstitutional, however, I don’t agree with all aspects of their arguments. Starting with the Smith test of neutral and generally-applicable. They claim that the End-of-Life Act isn’t either neutral or generally-applicable; I disagree on fully committing to the idea that the law was absolutely hostile towards religion. I think this because it made clear attempts to be inclusive in their language to allow for healthcare providers to abstain from administering the program. And if anything, I think the law was intended, and shown in its language, to be neutral. However, I agree with the Carmelite Sisters that the existence of exceptions makes the law not generally-applicable, advancing it to the next tests established by Lukumi. Looking at strict scrutiny, I think that only one half of the test is satisfied; is there a compelling state interest in providing residents of Illinois with the types of healthcare they require, and in giving them control over their own being? I certainly think so. However, I don’t think that the law was narrowly tailored enough to be seen as the least restrictive implementation; why can’t the state operate the referral program instead of pushing it onto religious healthcare providers? Because I think it fails the second half of the test, I believe the court should rule the law unconstitutional. It falls on the Illinois legislature to come up with valid legislation.
Sources:
https://becketfund.org/case/carmelite-sisters-for-the-aged-and-infirm-v-prince/?section=caseDetail
https://becketfund.org/case/carmelite-sisters-for-the-aged-and-infirm-v-prince/?section=caseLegal
https://dockets.justia.com/docket/illinois/ilndce/1:2026cv10665/507202
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