religious exemption essay

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• v.57(5); 2016 Oct

Religious exception for vaccination or religious excuses for avoiding vaccination

Gordana pelčić.

1 Healh Care Center of Primorsko-Goranska County, Rijeka, Croatia

2 Department of Social Sciences and Medical Humanities, University of Rijeka School of Medicine, Rijeka, Croatia

Silvana Karačić

3 Hotel Sveti Križ, Čiovo, Croatia

Galina L. Mikirtichan

4 Saint-Petersburg State Paediatric Medical University of Healthcare Ministry of the Russian Federation, Saint-Petersburg, Russian Federation

Olga I. Kubar

5 Saint-Petersburg Pasteur Institute, Saint-Petersburg, Russian Federation

Frank J. Leavitt

6 Kushiro International Summer School and Conference in Bioethics, Kushiro, Hokkaido, Japan

Michael Cheng-tek Tai

7 Chair professor, Medical Humanities/Bioethics, Chungshan Medical University, Taichung, Taiwan

Naoki Morishita

8 Hamamatsu University School of Medicine, Hamamatsu, Japan

Suzana Vuletić

9 Department of Moral Theology, University of Osijek, Catholic Faculty of Theology, Osijek, Croatia

Luka Tomašević

10 Department of Moral Theology, University of Split, Catholic Faculty of Theology, Split Croatia

Vaccination is considered to be one of the greatest public health achievements in the 20th century, which has helped to build a society free of vaccine preventable diseases and save lives of millions children across the globe ( 1 ). However, in the 21st century, pediatric practice in the western world witnesses an era of vaccination refusal ( 2 ). Pediatricians, infectious disease experts, and public health professionals ask themselves why and how “the greatest achievement of public health” became a medical procedure that frightens parents across the globe. Many parents are seeking a legal way to avoid vaccinating their children. The legal systems of some countries predict legal vaccination exemptions. One of the most usual reasons for exemption are medical reasons, followed by the religious, social, and philosophical reasons (personal belief, conscience objection) ( 3 - 7 ).

2013 and 2015 were marked by an outbreak of vaccine-preventable diseases such as measles and pertussis ( 2 , 8 - 11 ). These events triggered a worldwide debate regarding vaccination and legal exemption of vaccination and its possible consequences such as social distancing, exclusion from school during a disease outbreak, absence from work, etc ( 12 , 13 ).

Religion influences decisions on vaccination ( 14 - 16 ), and religious objection is often used by parents as an excuse to avoid the vaccination of their children ( 5 , 17 ). Some studies show that the number religious exemptions has been increasing ( 18 ), leading to vaccine preventable disease outbreaks ( 10 ) such as mumps outbreak in a protestant orthodox group in The Netherlands. Shrivastwa et al ( 19 ) found religion as predictive factor of children’s vaccination status in India. Compared to Hindus, Muslim children had greater chance of being under-vaccinated or unvaccinated compared with the vaccinated children.

In this article we would like to explore whether different religious beliefs are, in itself, real exception for vaccination or they are just a parents’ excuse to avoid vaccination.

The view of Catholicism

The most morally questionable issue regarding vaccination in Catholicism is using cell lines derived from a voluntary aborted fetus. The Moral Reflection On Vaccines published by the Pontifical Academy for Life ( 20 ) suggests that these vaccines should be avoided and proposes a search for alternatives. The examples of such vaccines are cell lines WI-38 (Winstar Institute 38) and MRC-5 (Medical Research council 5), several live vaccines against rubella (Meruvax, Rudivax, M-R-VAX), and vaccines against hepatitis (A-VAQTA and HAVRIX), chicken pox (Varivax), smallpox (AC AM 1000), and poliomyelitis (Polivax) ( 20 , 21 ). In the case where no alternative vaccine is available, the use of the existing vaccine is morally acceptable in order to avoid serious risks for children and for the whole population (especially pregnant women). The moral acceptability of using this vaccine should be comprehended as “passive material cooperation” and “active material cooperation” too, which is cooperation with immoral action without evil intention, permitted only in the case of “ extrema ratio ,” that is in the case of extreme situations such as saving the lives of children. The document also suggests to parents to oppose participation in such medical procedures by their appeal by “objection of conscience” or to seek alternative sources of effective vaccines. Besides this document, the Catholic Church's Magisterium discusses bioethical issues with respect to forbidden sources of human biological materials in two further documents. Dignitas personae ( 22 ), n. 34-35 speaks of the illicit origin of human sources of biological material, founding its opinions on the dignity of the person, emphasized in the documents Donum vitae ( 23 ) (I, 4) and Evangelium Vitae ( 24 ). In the case where ethically acceptable sources of vaccines are not available, it is necessary to weigh the vital importance and the risk of no vaccination. In these cases it becomes also allowed to use, even the, “morally inadvisable” vaccines ( 21 ).

The Catechism of the Catholic Church ( 25 ) does not cover the topic of vaccination directly. Indirectly, there are a few canons that could be applied to vaccination issue. The Church recognizes the ability of human intellect to meet the God (canon 39), which is the foundation for the dialog with other religions, philosophy, and science. The canons 1939-1943 emphasize the virtue of solidarity in the world. By spreading spiritual values, the Church has throughout the centuries helped to create better social and cultural conditions for living among different nations. Catholicism should emphasize the importance of taking the risk of side effects of vaccination to strengthen solidarity with other humans. By taking this risk, people participate in the protection of the entire society, including those who cannot be vaccinated because of medical contraindications or have been vaccinated but without adequate immunogenic response ( 20 ).

Orthodox view

To clarify the Orthodox view on the vaccination process, we chose the example of Russia, a country where the orthodox religion is the leading religion and where historical perspective plays a special role in public, social, and cultural life. The Russian Orthodox Church absolutely acknowledges that vaccination is the main way to achieve progress. However, according to official statistics in Russia, annually 3%-5% of the population refuse to be vaccinated.

Refusal of vaccination and its causes cannot be clear without being familiar with the history of the anti-vaccination lobby. This history begins in 1988 with the article “Well, You Will Think, That It Is Only a Prick?” ( 26 ). This article claims that vaccination is not just a prick and that it causes serious complications. A t present, the tribune of the anti-vaccination movement is the internet, which can provide access to the general population without demanding a true scientific assessment of efficiency and risks of vaccination. One of the motives used by opponents of vaccination is speculation in religious beliefs. Recently the anti-vaccination movement began to spread actively in monasteries, churches, and through a video production. An essentially medical question became “a bone of contention” among the believing people.

This all prompted the official Russian Church to issue an opinion about the topic of vaccination. In September 2008, the department of church charity and social service, the Synod organized a round table “Vaccine’s Prevention of Paediatric Problems and Ways of Making the Decision” ( 27 , 28 ). The Synod’s final document states: “Vaccination is a powerful tool of prevention of infectious diseases, some of which are extremely dangerous. In some cases inoculations really cause complications that are most often connected with violation of the rules of vaccination, such as its use on weakened children.” The Russian Orthodox Church condemned anti-vaccination promotion and forbade the distribution of anti-vaccination literature and audio-video material in its monasteries and temples ( 29 ).

The position of orthodox doctors and philosophers was reflected in the statement of Church Public Council on Biomedical Ethics of the Moscow Patriarchy and in the statement of the Department of Church Charity and social service of the Moscow Patriarchy and the Ministry of Health and Social Development of the Russian Federation ( 30 ). These documents unambiguously state that vaccination is a necessary modern measure of infectious diseases prevention, the refusal of which can lead to serious consequences.

At the same time it was noted that some aspects of vaccination demand additional attention. The Russian public has shown concern regarding vaccines against rubella, hepatitis A, and chicken pox, which are produced from the diploidic cells from aborted embryos. There are alternative (so-called “ethical”) rubella vaccines received from the cellular line of a rabbit (Japan), hepatitis A vaccines, made from the cellular culture of the monkey (Vero, Japan). However, application of these vaccines is only beginning and it is not widely available, so the diploidic vaccines against these diseases are mostly used.

Protestant view

In Protestantism, there are various denominations without a supreme leading moral figure, such as the Pope in the Catholic Church. Protestantism accentuates individual freedom and gives parents the right to decide whether to vaccinate their children or not. According to Ruijs ( 16 , 17 ), Orthodox Protestant parents who refuse vaccination on religious grounds ( 17 ) claim that vaccination is an act of interfering with divine providence. Those who actually vaccinated their children consider the side-effects of vaccination as a God’s sign that they made a wrong decision. On the other hand, pro-vaccine parents believe vaccination to be a gift of God ( 17 ). Rujis also found that the religious leaders from the same denomination had different standpoints on vaccination: some do not address the topic of vaccination because it is generally accepted, the others deliberately leave the choice to the members of their congregation, and the third address the negative connotation regarding vaccination in their religious work ( 16 ).

Jewish view

Israeli legislation has been traditionally influenced by religious law in the matters of birth, marriage, and death. However, Jewish theology tells us nothing explicit about today's medicine. Vaccination was unknown in Biblical and Talmudic times, but methods for preserving health and life, particularly cleanliness, were known. God made the man not only to His physical image and likeness, but to His mental image and likeness. When God commanded mankind to “be fruitful and multiply,” He left it up to people to decide how to do this. It is clear, however, that we cannot be fruitful and multiply unless we are healthy. We must use our minds, our power of thinking to decide how to preserve our health. These were the seeds of preventive medicine. We use the intelligence that God gave us to go beyond the raw nature which God created, and to preserve the health which we need to obey His commandments. Vaccination is one of the practices we developed from these seeds. It should be considered in the sense of Pikuakh nefesh – the act that saves lives ( 31 ), or the protection of the children and neighbors.

The distinguished religious Jewish organization, the Orthodox Union “strongly urges all parents to vaccinate their healthy children on the timetable recommended by their pediatricians” ( 32 ).

Although the Israeli law does not require vaccination, the government is trying to exercise pressure by denying child allowance payments to parents who do not vaccinate their children. This step has attracted opposition on the grounds of interference with individual rights. It is, however, not a matter of parents’ rights, but of the children’s right to health. The controversy has not yet been settled ( 33 ). When children are concerned, and serious risks to health or life are involved, it is irresponsible to ignore the almost universal weight of medical opinion. Children should be vaccinated, as almost all Israeli parents agree with it ( 34 ).

Islamic view

The Qur'ān and the Islamic tradition forbid the use of certain food – haram (pig flesh). Other animals are licit – halal – depending on how they die ( 31 ). This problem is reflected in medicine regarding the use of gelatin in medical products. If gelatin is derived from halal animal it is permissible to use it. If someone finds him or herself in a situation where there is no halal alternative, the person is not guilty of using no- halal option based on the “law of necessity.” The vaccines are important for medical purpose, not for diet, therefore haram ingredients could be permitted (transformation of haram components to halal products). According to Islamic tradition, vaccination serves to protect life, to respect the principle of preventing harm ( izalat aldharar ), and public interest ( maslahat al ummah ). Vaccination protects others, which is why the law of necessity should be considered. It has a purpose in prevention, therefore its components cannot be judged as a diet ( 31 ).

Buddhist view

Buddhism claims that life is one, which means that all forms of life are essentially related to one another and share a common essence. Even though there are different expressions of life, their lives are basically the same and they only differ in their external forms of being. Buddhism also believes in the Wheel of Rebirth, meaning that all forms of life will be reincarnated according to the karma they accumulated while living. Someday, in the process of reincarnation when all karma has been completely exhausted, the wheel of rebirth can be stopped. In order to reach this Nirvana , every Buddhist must carefully observe the 8-fold Path and the Ten Precepts that help prevent any accumulation of karma. These precepts include: not taking life, not stealing, being chaste, not lying, not drinking intoxicants, etc ( 35 ). The first of the five precepts in Pali reads as Panatipata veramani sikkhapadam samadiyami meaning that “I undertake the training rule to abstain from taking life.” Here the word pana refers to any living being that has breath and consciousness.

The Mahayana Brahajala Sutra explains the first precept in this way: “A disciple of the Buddha shall not himself kill, encourage others to kill, kill by expedient means, praise killing, rejoice at witnessing killing, or kill through incantation or deviant mantras. He must not create the causes, conditions, methods, or karma of killing, and shall not intentionally kill any living creature” ( 36 , 37 ).

Modern Buddhists will generally use vaccines to make sure their health is protected. But according to the essential teaching of Buddhism, if the vaccine is derived from any life form its use is debatable. The first of the Ten Buddhist Precepts is “not taking life.” However, early Buddhism was never confronted with the question whether a fetus is a life form. Buddhism basically forbids any act that will lead to the destruction of any potential life. Therefore, Buddhism requires its followers to treat all life kindly ( 38 ).

On the other hand, Buddhist biomedical researchers who experiment on life forms believe that the purpose of biomedical research is to save rather than to sacrifice life. Buddhist biomedical researchers do the experiments for the love of life, for instance, they experiment on the donated tissues or samples, thereby accumulating no bad karma. The modern view of Buddhism will stress the importance of saving life rather than taking life ( 39 ). Generally speaking, Buddhist teaching is rather conservative in terms of using any life form to create vaccine.

Japanese view

There have been many religious forms in Japan. However, Japanese people do not have a clear belief system called “religion.” So that “Japanese religion” means “Japanese metaphysical common sense.” This metaphysical sense has been formed by integrating and mixing Buddhism, Taoism, and Confucianism, based on the indigenous Shinto ( 40 - 42 ). Here “metaphysical” means “a way of seeing or thinking of the universe or the total reality,” which is the core of religion. Religious forms are various, but their metaphysical core is consistent.

The universe for Japanese people is a moving network of various relations of things and actions, like an infinite living system. They believe in an unknowable and willful entity reflecting the universe like a virtual focus in a mirror, which has been called Kami (gods), Hotoke (Buddha), or Ten (Heaven). This mysterious entity orders and gives people the whole necessary connections of universe, which is called Michi (Tao or Way) or Ri (Logos or Ratio). Based on their religious common sense background, Japanese people accept all relations of things and actions as they are and feel very familiar with everything relating to them. Moreover, with gratitude, they hold memorial services for used tools or for sacrificed laboratory animals ( 43 ). Therefore, they tend to reject all biomedical practices, technologies, or effects considered as unnatural. This is very obvious in the case of organ-transplant and vaccination. This “unnatural” implies the complex feelings of certain deviation or excess from the standard course of things.

Since Meiji Revolution (1868), Japanese people have basically acknowledged modern biomedicine, and they have gradually accepted vaccination as its symbol. In 1948, new Japanese government made vaccination mandatory. Thus, after 1962, vaccination has been practiced collectively and compulsory. But, in 1994, it was suddenly proclaimed optional under the pressure of the public taking side effects as dangerous.

Concluding remarks

Vaccination refusal among the parents of pediatric population is emerging globally, regardless of religious or political background or geographical location. In many countries legal systems advise how to react to vaccination refusal ( 44 ). For example, in Croatia vaccination is mandatory, the law is clear, but the practice of vaccination and the court judgments are not standardized. The legislators are unlikely to enact legal limitations of religious or philosophical exemption ( 4 , 5 ).

The number of vaccination refusals based on religious exemption is increasing. The question is whether religious freedom is a threat to public health, in this case to the vaccination system ( 45 ).

There are many publications regarding the religious exception of vaccination ( 6 , 14 , 15 ) based on the rights of religious freedom. Most of these publications refer to religious exemption for immunization. However, religion can provide perspectives on vaccination that are rarely used in debates on this topic. For example, the notions of solidarity, risk sharing, or taking the risk of vaccination for those who cannot be vaccinated because of medical contraindication or because of their conditions.

Although in this paper the authors did not cover all religions, they reflect on religions and social environment of the society which they come from. The majority of religions respect life as a basic value and therefore oppose the use of vaccines derived from aborted human fetuses (Catholicism) or any form of life (Buddhism). But if these vaccines serve to protect many more lives they are permitted. Regarding this, we should not consider vaccination opposed to the theological base and values. Following this idea, religion is not in contradiction with vaccination and public health. It is only individual parents or religious leaders and their questionable interpretation of religious practices that are opposed to vaccination, no religion as such. In order to protect vaccination from the questionable religious interpretation we should bring closer to the public the basic theological perspective. The society of the 21st century, just as many societies and cultures in the history of human civilization, use religion as an excuse for wars, discrimination, and now for vaccination refusal. The question is whether the public is aware of the teachings of their religion on these issues. One of the first steps in resolving the situation should be the appropriate communication ( 46 - 48 ) to illuminate the essence of theological perspectives regarding vaccination.

COVID-19 Vaccination Religious Exemption Requests: 5 Key Takeaways From the EEOC’s Updated Technical Assistance

On october 25, 2021, the u.s. equal employment opportunity commission (eeoc) updated its technical assistance related to the covid-19 pandemic. the updated and expanded covid-19 technical assistance adds a new section with information related to requests by applicants or employees seeking to be excused from covid-19 vaccination requirements due to sincerely held religious beliefs, practices, or observances..

On October 25, 2021, the U.S. Equal Employment Opportunity Commission (EEOC) updated its technical assistance related to the COVID-19 pandemic. The updated and expanded COVID-19 technical assistance, “ What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws ,” adds a new section (section L) with information related to requests by applicants or employees seeking to be excused from COVID-19 vaccination requirements due to sincerely held religious beliefs, practices, or observances.

Here are five key takeaways from the updated technical assistance:

1. Employee Notification

The EEOC’s COVID-19 technical assistance confirms that an employee or applicant must notify his or her employer if the employee or applicant is requesting an exception to a COVID-19 vaccination requirement due to a sincerely held religious belief. The EEOC has set forth no specific language for the notice.

2. Assessing Religiousness and Sincerity

The technical assistance continues to take the EEOC’s prior position that “[g]enerally, under Title VII [of the Civil Rights Act of 1964], an employer should assume that a request for religious accommodation is based on sincerely held religious belief.” If an employer has an “objective basis” for questioning the religious nature or sincerity of a belief, then it “would be justified” in making a “limited factual inquiry” and “seeking additional supporting information.” The technical assistance explains that although Title VII protection extends to “nontraditional religious beliefs,” it does not require accommodation for “social, political, or economic views, or personal preferences.” (Emphasis added.)

3. Considering Alternative Arrangements

The technical assistance indicates that “[i]n many circumstances, it may be possible [for an employer] to accommodate [an unvaccinated employee] seeking reasonable accommodations for [his or her] religious beliefs, practices, or observances,” without it imposing an undue hardship, by considering accommodations such as telework and reassignment to a vacant position.

4. Undue Hardship

The technical assistance also discusses when it might be an undue hardship under Title VII to accommodate an unvaccinated employee. The EEOC explains that deciding whether an undue hardship exists depends on “the particular facts of each situation” and that an employer “will need to demonstrate how much cost or disruption the employee’s proposed accommodation would involve.” The technical assistance suggests that potential considerations might include whether the employee requesting a religious accommodation works outdoors or indoors, works in a solitary or group work setting, or works in close contact with other employees or members of the public (“especially medically vulnerable individuals”).

Another relevant consideration, according to the technical assistance, is the number of employees seeking a similar accommodation and the cumulative cost or burden on the employer. Although an undue hardship because of cumulative cost or burden of granting accommodations is not one to be readily anticipated and an immediate basis upon which to deny an accommodation, it may become a fact that changes the burden as the number of requested accommodations increases.

5. Further Consideration

The technical assistance confirms that if an employer grants a religious accommodation to an employee, it may reconsider the accommodation later and “has the right to discontinue a previously granted accommodation if it is no longer utilized for religious purposes” or poses an undue hardship “due to changed circumstances.”

The EEOC’s latest update to the technical assistance comes as the Occupational Safety and Health Administration’s COVID-19 emergency temporary standard , which would require vaccination or weekly testing of workforces with 100 or more employees, remains under review at the Office of Information and Regulatory Affairs.

Ogletree Deakins will continue to monitor and report on developments with respect to the COVID-19 pandemic and will post updates in the firm’s Coronavirus (COVID-19) Resource Center as additional information becomes available. Important information for employers is also available via the firm’s webinar and podcast programs.

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What’s the law on vaccine exemptions? A religious liberty expert explains

Professor of Law, School of Law, University of Virginia

Disclosure statement

I have represented four clients in the Supreme Court who were seeking religious exemptions, but not from vaccination laws. I have filed many friend-of-the-court briefs in support of litigants seeking religious exemptions in the Supreme Court, but again, not from vaccination laws. I have filed only one brief in the Supreme Court opposing a request for religious exemptions. That was in Zubik v. Burwell, where claimants tried to get their secular insurers exempted from providing free contraception to their employees. I have repeatedly testified in Congress and state legislatures in support of religious exemptions. But I have never filed a brief or testified to a legislature about vaccination exemptions.

University of Virginia provides funding as a member of The Conversation US.

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For Americans wary of COVID-19 vaccine mandates, like the sweeping requirements President Joe Biden announced Sept. 9, 2021 , it seems there are plenty of leaders offering ways to get exemptions – especially religious ones.

No major organized religious group has officially discouraged the vaccine, and many, like the Catholic Church, have explicitly encouraged them . Yet pastors from New York to California have offered letters to help their parishioners - or sometimes anyone who asks – avoid the shots.

These developments point to deep confusion over how to win a religious exemption. So what are they, and is the government even required to offer the exemptions in the first place?

Many schools, businesses and governments requiring vaccination have offered religious exemptions. Some are loath to challenge people’s claims that getting the shot goes against their beliefs for fear of being sued , but organizations have come up with a variety of ways to assess claimants’ sincerity.

But the legal basis of Americans’ supposed right to a religious exemption to vaccination is less clear than such policies’ popularity would suggest.

As a lawyer and scholar who focuses on religious liberties , I have supported religious exemptions for a baker who refused to create a cake for a same-sex wedding, a family-owned business that refused to provide emergency contraception to its employees, a Muslim prisoner who was obligated to grow a beard and many others .

Even so, I believe that under the general law of religious liberty – including the Constitution and state and federal religious freedom laws – the government has an easy case to refuse religious exemptions from vaccines against infectious disease.

Proving ‘interest’

There are a variety of ways to present a religious liberty claim, each with a different set of rules.

The most stringent standard is that the government should not require people to violate their conscience without a compelling reason .

The Supreme Court has never been clear about the full range of what counts as “compelling,” but some cases are clear. The government has a compelling interest in preventing significant threats to other people’s health, and especially so in a pandemic. The unvaccinated endanger people who are immunosuppressed or cannot be vaccinated because of their age or any other medical reason. The unvaccinated also endanger people who are vaccinated because no vaccination is 100% effective, as is evident from the number of breakthrough COVID-19 infections in the U.S.

Until last month, no state or federal court had ever granted a religious exemption when the government had to demonstrate compelling interest in requiring a vaccine. Now, a federal judge has granted a temporary restraining order to prevent Western Michigan University, a public school, from requiring its student-athletes to be vaccinated. This is a preliminary opinion and seems unlikely to stand up through further proceedings and appeal, since every judge to encounter such an issue in the past has ruled the other way.

The Supreme Court’s current interpretation of the Constitution does not always require a compelling interest.

Under the current law of the Constitution, people have no right to a religious exemption from a rule unless there is also a secular exception or gap in coverage that would undermine the government’s interests just as much. If there isn’t such a secular exception, the government doesn’t have to show any reason at all to refuse religious exemptions .

Usually the only secular exception to vaccine requirements is for “ medical contraindications ,” meaning that a vaccine would harm the recipient - for example, if someone is allergic to an ingredient in the vaccine.

But these medical exceptions don’t undermine the government’s interest in saving lives, preventing serious illness or preserving hospital capacity. By avoiding medical complications, those exceptions actually serve the government’s interests.

Offering exemptions

In some states, however, the situation is more complicated. Most states explicitly authorize religious exemptions to vaccination, and sometimes philosophical exemptions as well – regardless of the government’s compelling interests.

Those state laws could not protect anyone from a federal vaccine mandate, and many of them only apply to certain groups – usually schoolchildren . But they could protect people from mandates from their state or local government.

Many private employers requiring vaccines offer religious exemptions, too. Title VII of the Civil Rights Act requires businesses to accommodate workers’ religious practice as long as they do not cause “undue hardship” to the employer. But the Supreme Court has interpreted “ undue hardship ” to mean anything more than a minimal expense, meaning employers don’t need a reason anywhere near as strong as a compelling interest. So employers do not have to allow religious exemptions to their employees.

Still, many employers and governments alike have been reluctant to challenge religious exemption claims. When it comes to vaccines against childhood diseases, where the danger did not seem great or immediate, many groups have just taken people’s word for it if they say their religious views prevent vaccination.

Backing up beliefs

There is evidence that many claims of religious objections to vaccination are false, particularly given the large anti-vaccine movement in the U.S.

Law professor Dorit Rubinstein Reiss has compiled anecdotal and survey evidence that most claims for refusing school vaccination requirements on religious grounds are false. The objectors really do object to vaccination, but their reasons are not religious. Meanwhile, opposing COVID-19 vaccinations has become a matter of political identity for many on the political right.

These factors could mean a flood of false religious claims. And whenever that situation arises under the federal law of religious exemptions, the Supreme Court has refused them.

The court rarely talks about this explicitly, but there is a compelling interest in not having a general policy’s effectiveness undermined by thousands or millions of claimed religious objections. That’s part of the reason why the court has refused constitutional protection for religious objections to paying taxes , or serving in the military , or, back in the desegregation era, integrating restaurants .

It is very hard for judges to determine religious sincerity , and mostly they don’t try. But when there are likely to be many exemption claims – both true and false – courts reject them because the difficult task of judging the sincerity of one or a few claimants becomes impossible when there are thousands or millions.

Challenges ahead?

Still, some claims are probably sincere. One question to ask people claiming religious objections to the COVID-19 vaccines - whether on cross-examination in a courtroom or arguing at a meeting of your local school board – is whether they or their children are vaccinated against other diseases. Even if the answer is “no,” however, that may point to longstanding anti-vaccination views rather than sincere religious objections.

Some Catholics object to COVID-19 vaccinations because decades-old fetal cell lines were used in the vaccine research. If that is their sincere religious belief, it doesn’t matter that Pope Francis disagrees .

[ Over 100,000 readers rely on The Conversation’s newsletter to understand the world. Sign up today .]

Still, even when religious objections are sincere, the government has a compelling interest in overriding them and insisting that everyone be vaccinated. And that overrides any claim under state or federal constitutions or religious liberty legislation. It is irrelevant to state statutes that explicitly grant vaccine exemptions with no exceptions for compelling government interests. But federal vaccination requirements override those state laws .

With mandates – and vocal objections – looking poised to grow, the United States could see vaccination requirements more and more put to the test in court this fall. But how far can challenges go? Unless governments mandating vaccines do not defend their rules, or the Supreme Court changes the law, the answer is likely, “Not far.”

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Expert Commentary

Religious exemptions and required vaccines: Examining the research

How often do students and employees claim vaccine mandates conflict with their religious beliefs? What are schools doing to discourage exemptions to required childhood vaccines? We look at the research.

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This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License .

by Denise-Marie Ordway, The Journalist's Resource September 29, 2021

This <a target="_blank" href="https://journalistsresource.org/health/religious-exemptions-covid-vaccine-research/">article</a> first appeared on <a target="_blank" href="https://journalistsresource.org">The Journalist's Resource</a> and is republished here under a Creative Commons license.<img src="https://journalistsresource.org/wp-content/uploads/2020/11/cropped-jr-favicon-150x150.png" style="width:1em;height:1em;margin-left:10px;">

Even as national surveys show Americans drawing away from religion , more American children are using religion to skip required school vaccinations. 

Even before some California school districts ordered students in certain age groups to get immunized against COVID-19, research showed the percentage of kindergarteners whose parents claim vaccines conflict with their religious beliefs was on the rise.

A December 2019 analysis published in Pediatrics finds an estimated 1.7% of kindergarteners nationwide received religious exemptions to vaccination during the 2017-18 academic year. Four years earlier, 1.1% of kindergarteners did.

Schools, employers and higher education institutions with vaccination mandates typically permit exemptions based on religion or medical reasons. In many states, public and private schools serving kids in kindergarten through 12 th grade also allow exemptions based on personal beliefs or philosophies, which generally allow parents to opt out of vaccines simply because they oppose them.

The American Academy of Pediatrics supports the elimination of childhood vaccine exemptions, except for medical reasons. Six states — California, Connecticut, Maine, Mississippi, New York and West Virginia — prohibit K-12 schools from granting exemptions on religious grounds, according to the National Conference of State Legislatures.

Research, however, suggests that banning one type of exemption leads to an increase in another.

States that offer religious exemptions but do not provide personal belief exemptions are four times as likely to have kindergartners with religious exemptions, compared with states that grant both types of exemption, the December 2019 paper in Pediatrics reveals.  

The authors of that paper note that after Vermont eliminated personal belief exemptions in schools in 2016, the share of kindergartners with religious exemptions increased sevenfold to 3.7%. Scholars call this a “replacement effect,” meaning families seek a different exemption when the type they had been using no longer is available.

“Religious exemptions may be an increasingly problematic or outdated exemption category, and researchers and policy makers must work together to determine how best to balance a respect for religious liberty with the need to protect public health,” write the authors, led by Joshua T. B. Williams , a pediatrician at Denver Health Medical Center and assistant professor of pediatrics at the University of Colorado School of Medicine.

Researchers from Emory University in Atlanta found evidence of a replacement effect when schools prohibit all “nonmedical” exemptions — an umbrella term that applies to religious, philosophical and personal belief exemptions. In 2016, California enacted a law banning nonmedical exemptions in schools. By the second year, medical exemption rates jumped.

“The unintended consequence of an increase in medical exemption rates — which notably tripled in California — highlights a potential pitfall with this approach,” researchers write in the Expert Review of Vaccines in 2019.  

They add that it appears students’ parents and legal guardians “may seek out physicians who are more willing to attest to medical contraindications in the absence of a non-medical exemptions allowance.”

In the wake of the coronavirus pandemic, an increasing number of schools and higher education institutions are ordering students to get inoculated against COVID-19 . Dozens of companies, including Delta Airlines, Facebook, Uber and Walmart, have mandated COVID-19 vaccinations for employees .

Government officials nationwide also have announced COVID-19 immunization requirements for government workers. Earlier this month, President Joe Biden signed an executive order directing federal employees to get COVID-19 shots.

Immediately after mandates were announced, students and employees started seeking religious and medical exemptions, even as high-ranking faith leaders worldwide urge people to get their shots .

This week, the Los Angeles Police Department drew criticism after news outlets reported that 2,651 of its employees plan to file for religious exemptions to its new vaccine requirement.

In Oregon, 2,284 state employees requested exemptions to the governor’s COVID-19 vaccine mandate — about 5% of the 42,000 employees affected by the requirement. About 90% of those requests were for religious exemptions.

Administrators at hospitals and nursing homes across the country worry the new immunization requirement will lead to staffing shortages as some employees might quit or let themselves be fired rather than get COVID-19 shots. Earlier this month, a hospital in upstate New York announced it planned to shut down its maternity ward because dozens of staff members quit over the vaccine mandate.

To help journalists get a better understanding of how common religious exemptions are among students and workers and get up to speed on schools’ efforts to improve childhood vaccination rates, we’ve gathered and summarized a sampling of academic studies that examine these topics.

The evidence to date suggests:

• A small percentage of employees and students receive religious or medical exemptions.
• When schools stop letting kids skip vaccines for philosophical reasons, more kids seek religious exemptions. When schools ban all exemptions except for medical exemptions, medical exemptions increase.
• Kindergarteners are less likely to get vaccine exemptions for religious or philosophical reasons when schools require their parents to get medical counseling and a signed form from a health care provider before they can be considered for exemptions.

For more on these findings, keep reading.

———

Prevalence of religious exemptions

Current Landscape of Nonmedical Vaccination Exemptions in the United States: Impact of Policy Changes Robert A. Bednarczyk, Adrian R. Kinga, Ariana Lahijania and Saad B. Omer. Expert Review of Vaccines, January 2019.

This paper looks at exemption trends among kindergarten students at public and private schools nationwide between academic years 2011-12 and 2017-18. A main takeaway: Not only are nonmedical exemptions much more common than medical exemptions, a growing percentage of kindergarteners have received nonmedical exemptions.

Nationally, the proportion of kindergarteners who skipped vaccines for reasons connected to religion, philosophy or personal beliefs increased from 1.4% to 1.9% over the study period. The nonmedical exemption rate varied considerably across states. In 2017-18, it ranged from 0.7% of kindergarteners in Indiana to 7.5% in Oregon.

Meanwhile, the percentage of kindergartners with medical exemptions has remained constant — rising by one-tenth of a percentage point between 2011-12 and 2017-18.

The researchers note that private schools historically have higher rates of both types of exemption than have public schools.

They cite three earlier studies to help explain why nonmedical exemptions are on the rise. Those studies, which examine data spanning from 1999 to 2016, indicate a greater number of students obtain nonmedical exemptions when the administrative process is less difficult.

“In three studies, encompassing over 25 years of surveillance, consistent associations were found with higher nonmedical exemption prevalence in states categorized as ‘easy’ or ‘medium’ difficulty for obtaining non-medical exemption, relative to states with higher difficulty … ,” the researchers write.

A Systematic Review of Mandatory Influenza Vaccination in Healthcare Personnel Samantha I. Pitts; et al. American Journal of Preventive Medicine, September 2014.

For this paper, researchers reviewed 12 observational studies on mandatory flu vaccinations for employees of hospitals, outpatient clinics, surgical centers and other health care facilities. While the paper does not focus on exemptions, it does provide insights into their prevalence in the workplace.

Six of the studies report on the percentage of health care personnel who received religious or medical exemptions to the flu vaccine requirement, finding that religious exemptions were less common than medical exemptions at the health care facilities studied. Most of the 12 studies, published or released between 2006 and 2013, look at vaccine requirements at a single hospital or health system.

The percentage of employees who obtained religious exemptions ranged from 0.02% to 2.3%. Meanwhile, 0.3% to 2.6% received medical exemptions.

Efforts to boost child immunization

Evaluating the Effects of Vaccine Messaging on Immunization Intentions and Behavior: Evidence From Two Randomized Controlled Trials in Vermont Katherine Clayton; et al. Vaccine, September 2021.

After Vermont stopped allowing kindergarten students to obtain philosophical exemptions to required vaccines in 2015, the percentage of kindergarten students with religious exemptions swelled sevenfold. In this paper, researchers examine the effectiveness of two communication strategies aimed at encouraging vaccine-hesitant parents to immunize their kids and parents whose children are behind on their vaccines to catch up.

What the researchers learned: Parents did not change their attitudes toward vaccines or indicate they would behave differently after reading a message from the state health department promoting immunization as a social norm or after reading a message correcting common misperceptions about vaccines.

The researchers also determined that the pro-vaccine message Vermont public health officials had been promoting to residents statewide was ineffective.

“These findings corroborate previous research finding limited evidence that messaging strategies change how people think about emotionally charged health issues like vaccinations,” they write.

A total of 678 parents with at least one child aged 10 years and younger and who expressed high levels of vaccine hesitancy participated in the first study. The second study focused on 613 parents of children aged 8 months or 20 months who had not yet received all their scheduled immunizations.

The 2016 California Policy to Eliminate Nonmedical Vaccine Exemptions and Changes in Vaccine Coverage: An Empirical Policy Analysis Sindiso NyathiI; et al. PLOS Medicine, December 2019.

In 2017, the year after California banned nonmedical exemptions in K-12 schools, 3.3% more students entered kindergarten with their measles, mumps and rubella (MMR) vaccinations statewide, compared against states that did not eliminate nonmedical exemptions in schools, this paper finds.

Researchers also learned that while nonmedical exemptions fell in California, the percentage of kindergarteners obtaining medical exemptions grew 0.4%.

“Although the rise in medical exemptions could indicate that some children who may have received nonmedical exemptions in the past are now receiving medical exemptions, the net effect following the California policy was still an increase in vaccination coverage,” the researchers write.

They note that even small increases in vaccine coverage can help communities achieve herd immunity levels of 90% to 95% vaccine coverage. In 2015, 24 counties in California had MMR coverage levels below the range needed for herd immunity, according to the analysis, based on state-level data from the CDC and county-level data provided by state departments of health. In 2017, 12 counties had coverage levels that fell short of herd immunity levels.

Exemptions From Mandatory Immunization After Legally Mandated Parental Counseling Saad B. Omer; et al. Pediatrics, January 2018.

Fewer students make requests for vaccine exemptions when the process for obtaining one becomes more difficult, this study suggests. The number of Washington kindergarteners who obtained any type of vaccine exemption dropped considerably after the state began requiring parents to get medical counseling and a signed form from a licensed health care provider before kids could be considered for exemptions.

The authors examined exemption rates for kindergarteners statewide from the 1997-98 academic year through 2013-14. After the state enacted Senate Bill 5005 in 2011, the vaccine exemption rate fell 2.9 percentage points statewide and stayed there through the end of the study period.

“This highlights the importance of more stringent polices for obtaining immunization exemptions,” the authors write.

They point out that discussions between health care providers and parents help correct misinformation about vaccines. However, they add that “the effect of this policy change might be caused by an increase in administrative difficulty of obtaining an exemption, rather than by persuasive interpersonal communications.”

Looking for more on COVID-19 vaccines? The Journalist’s Resource also has gathered research on vaccine hesitancy , COVID-19 vaccines during pregnancy and the role teachers and staff play in COVID-19 outbreaks on campus.

Also, please check out our tip sheet on covering religious exemptions .

We obtained this image from the Flickr account of  Pamela Drew . It is being used under a  Creative Commons license . No changes were made.

About The Author

Denise-Marie Ordway

Berkley Center

Berkley Forum

Charting the Legality of Religious-Based Exemptions to COVID-19 Vaccinations

By: James G. Hodge, Jr. Emily Carey

February 16, 2021

Religion, Bioethics, and COVID-19 Vaccination

On January 21, 2021, newly inaugurated President Joe Biden introduced his National Strategy for the COVID-19 Response and Pandemic Preparedness . This comprehensive plan represents an extreme departure from the prior administration’s approach to the pandemic that has infected more than 27 million Americans and taken in excess of 460,000 lives .

Mobilizing federal agencies, resources, and personnel in a “ war-like ” effort, the strategy centers on seven premier goals to quell the pandemic through best practices led by science and data, not politics. 

Notable among these goals is a national COVID-19 vaccination campaign. Operation Warp Speed , launched by President Trump, helped produce efficacious vaccines to combat most variants of COVID-19. Yet the December 2020 rollout of two initial, FDA-authorized vaccines by Pfizer/BioNTech and Moderna has been tepid and chaotic. 

President Biden seeks to address these failures. “The United States will spare no effort to ensure Americans can get vaccinated quickly, effectively, and equitably.” He conservatively promised 100 million free vaccinations for Americans in his first 100 days in office, and pledged to purchase 200 million more doses by summer. Immunizations will be administered through multiple distribution points undergirded by safety monitoring and substantial public education. 

Vaccines for All—But Are All Willing to be Vaccinated?

Assuring rapid, equitable access to COVID-19 vaccines presupposes that every American can and wants to be vaccinated. Some populations (children and immuno-compromised persons, for example) are ineligible or unfit candidates. Millions of other Americans may resist vaccinations for additional reasons. 

Fueled by reckless misinformation, extensive government distrust, and divergent political ideologies, vaccine hesitancy runs rampant. For decades, people have resisted being told, cajoled, or required to be vaccinated. National guidelines do not mandate COVID-19 vaccinations among specific groups, but state/local-based requirements are possible. Some private health care employers are already requiring vaccines among employees and volunteers. Other mandates may surface as immunization increasingly becomes one’s active pass to work, travel, or attend public activities. 

Fueled by reckless misinformation, extensive government distrust, and divergent political ideologies, vaccine hesitancy runs rampant.

A national vaccine push coupled with rising mandates may lead many Americans to claim potential violations of religious freedoms absent accommodations. Exclusions from existing, non-COVID vaccination requirements already apply to (1) child day-care enrollment; (2) school attendance ; (3) matriculation at institutes of higher education ; (4) specific occupations ; and (5) interstate travel . 

Existing exceptions are legally premised on a respect for sincerely held religious beliefs via judicial interpretations of the First Amendment’s Free Exercise Clause and corresponding legislative enactments (federal Religious Freedom Restoration Act [RFRA] and state equivalents). Under RFRA , general laws burdening broadly defined religious exercises must be (1) supported by government’s compelling interests; and (2) furthered through least restrictive means. It is a demanding proof that many routine laws cannot survive. 

However, religious free exercise does not include rights to engage in harmful behaviors, such as child abuse or spreading infectious diseases. As a result, content-neutral emergency laws are constitutional so long as they promote communal health and do not unjustifiably target specific religious groups or locales. 

Supreme Court Divisiveness on Free Exercise Rights

Such was the finding initially by the U.S. Supreme Court on May 29, 2020 in South Bay United Pentecostal Church v. Newsom . The Court rejected a church’s First Amendment claim against California’s COVID-19 assembly limitations impacting multiple enterprises. “Although California’s guidelines place restrictions on places of worship,” opined Chief Justice John Roberts , “those restrictions appear consistent with the Free Exercise Clause....” Under the Court’s guidance, the notion that religious freedoms might outweigh temporary emergency public health measures seemed largely settled. 

The tables were turned just six months later. On November 25, the Court (with its newest member, Associate Justice Amy Coney Barrett) decided Roman Catholic Diocese of Brooklyn v. Cuomo . Religious entities challenged Governor Cuomo’s executive order restricting the number of persons permitted at their institutions during the COVID-19 pandemic. 

The tables were turned just six months later. On November 25, the Court decided Roman Catholic Diocese of Brooklyn v. Cuomo.

The Court’s unsigned 5-4 Opinion expressed profound concerns regarding the disparate treatment of religious establishments, suggesting they were singled-out for “ especially harsh treatment ” compared to other essential businesses. Employing strict scrutiny, the Court concluded New York’s order was not narrowly tailored to curb COVID-19 infections since less restrictive alternatives were available. In a sharp concurrence, Justice Gorsuch voiced concern over the erosion of First Amendment freedoms in crisis. Taking aim at South Bay , he admonished the Court to not “ cut the Constitution loose during a pandemic .” Justice Sotomayor dissented that even though religious principles are among our “ most treasured and jealously guarded constitutional rights ,” they are still subject to reasonable, temporary emergency restrictions.

Then, on February 5, 2021, the Court issued its second Opinion in a reprisal of the California case, South Bay United Pentecostal Church v. Newsom ( South Bay II ). This time, a majority of the Court struck down California’s blanket ban on indoor religious ceremonies as violative of free exercise rights. Despite considerable public health evidence supporting the measure, Chief Justice Roberts asserted California’s restriction “...appears to reflect not expertise or discretion, but insufficient appreciation or consideration of the interests at stake.” Justice Kagan blasts in dissent “...this foray into armchair epidemiology cannot end well.”

Forthcoming Recognition of Religious Exemptions to Vaccinations?

The Court’s decisions in Cuomo and South Bay II signal a possible transformation in the constitutional recognition of religious exemptions to vaccinations. To date the Court has allowed governments to offer religious exemptions (without violating the First Amendment’s Establishment Clause ), but has not required government to recognize exemptions under the Free Exercise Clause.

Should a divided Supreme Court soon require religious exceptions to COVID-19 vaccinations, substantial public health repercussions may follow. Multiple states/localities have already quickly adjusted or abandoned their temporary closure measures applied to religious enterprises , following the Court’s recent orders. If Free Exercise exceptions apply to COVID-19 vaccinations, pandemic controls may be mitigated to the detriment of public health and safety. 

Should a divided Supreme Court soon require religious exceptions to COVID-19 vaccinations, substantial public health repercussions may follow.

There is a legally defensible pathway out of this conundrum, though it may be politically unpopular. Even if the Court recognizes religious exclusions to COVID-19 vaccinations, exercising exemptions may still carry collateral consequences. For example, unvaccinated students may be temporarily denied access to school when outbreaks of vaccine-preventable diseases like measles, mumps, and rubella arise. Principles of harm avoidance allow government to impose limited restrictions when the health or safety of others is at risk. 

To the extent Americans avoid COVID-19 vaccinations on religious grounds, they may ultimately face coextensive limits on their freedoms to assemble, travel, or engage in other activities. Resulting legal challenges may fall aside given scant constitutional bases for allowing persons to directly harm others in society.

About the Authors

James G. Hodge, Jr.

James G. Hodge, Jr., J.D., LL.M., is the Peter Kiewit Foundation Professor of Law at the Sandra Day O'Connor College of Law, Arizona State University, where he directs the Center for Public Health Law and Policy.

Emily Carey

Emily Carey is a senior legal researcher with the Center for Public Health Law and Policy and a J.D. candidate at the Sandra Day O’Connor College of Law, Arizona State University.

What do you think? Leave a respectful comment.

Nsikan Akpan Nsikan Akpan

Gretchen Frazee Gretchen Frazee

Courtney Norris Courtney Norris

• Copy URL https://www.pbs.org/newshour/health/what-the-new-religious-exemptions-law-means-for-your-health-care

What the new religious exemptions law means for your health care

A regulation allowing individuals and health care organizations to opt out of providing health care services if they object on religious or moral grounds has been finalized by the Department of Health and Human Services. That exemption can pertain to abortion, sex reassignment surgery and assisted suicide, among other procedures.

In unveiling the final rule, the Trump administration insisted it does not allow discrimination against women, LGBTQ people or religious minorities. But advocates for reproductive rights and LGBTQ rights are questioning whether the administration’s rule is constitutional, and worry it will lead to women and LGBTQ people being denied health care.

WATCH: Trump touts new religious exemption allowing clinicians to refuse abortions

On Thursday, San Francisco City Attorney Dennis Herrera brought a lawsuit against the Trump administration claiming the new rule would reduce access to critical health care.

“People’s health should not be a political football. The intent of this new rule is clear: it’s to prioritize religious beliefs over patient care, thereby undermining access to contraception, abortion, HIV treatment and a host of other medical services,” Herrera said in a statement.

Herrera has asked the U.S. District Court for the Northern District of California to postpone the rollout until further judicial review.

This reversal of an Obama-era policy is part of a larger push by conservatives to ramp up anti-abortion efforts and enshrine in law so-called “religious liberties” that allow people to deny services to LGBTQ Americans.

How did we get here?

Opponents of abortion have pushed for decades to recognize the religious rights of health care workers, and to address conflicts between their beliefs and professional requirements related to abortion. The landmark Roe v. Wade ruling that made abortion legal nationwide in 1973 also inspired the rise of conscience clauses in response, starting with the Church Amendment that Congress passed the same year.

This latest conscience rule is part of a larger effort by the Trump administration and conservatives to implement policies focused on “religious liberty.”

“My administration has strongly defended religious liberty — two words you haven’t heard too much about, but now you are hearing it all the time,” Trump said Thursday when he announced the new rules during a National Day of Prayer service.

In May 2017, Trump signed an executive order to expand protections around religious liberty. Shortly after, the Office of Conscience and Religious Freedom was created within the Department of Health and Human Services to “more vigorously and effectively enforce existing laws protecting the rights of conscience and religious freedom.”

Vice President Mike Pence has been an advocate for religious liberty arguments, even before he joined Trump’s campaign, and he’s a driving force behind the administration’s efforts.

When Trump announced the change affecting “physicians, pharmacists, nurses, teachers, students and faith-based charities,” he motioned toward the vice president, saying, “They’ve been wanting to do that for a long time, right, Mike?”

As Indiana’s governor, Pence signed a law in 2015 that prohibited the state government from impinging on someone’s religious beliefs. The law was later scaled back after an outcry from gay rights advocates who argued it could be used to discriminate against the LGBTQ community.

That same year, conservatives made a nationwide push to pass religious freedom bills after the Supreme Court’s Burwell v. Hobby Lobby decision ruled that for-profit companies could refuse to follow an Affordable Care Act mandate covering contraceptives based on religious grounds.

Under the federal health law, a medical office or insurance company provider also had to provide their services to everyone, regardless of their race, color, sex, national origin, age, disability or sex — and former President Barack Obama extended the protections to include gender identity months before he left office. Christian Medical & Dental Associations, other faith-based organizations, and five states sued, and an injunction has been in place since early 2017 .

“It wasn’t that we weren’t willing to take care of transgender patients. They said that if we provided a service or a medication for anyone, we had to provide it for a transgender patient on demand,” Dr. David Stevens, CEO of the Christian Medical & Dental Associations, said. “If you gave hormones for birth control, you had to give hormones to an 11-year-old [for transition therapy]. If you didn’t do this, then you lost all your Medicaid and Medicare funding and the patient could sue you.“

What has changed under the new rule?

The new rule generally restores regulations from the George W. Bush era, but also changes definitions to allow health care providers to refuse services on broader grounds.

A health worker can object to not only performing an abortion, for example, but also to participating in anything “with a specific, reasonable and articulable connection” to an abortion procedure. That could include counseling, referrals, or even scheduling appointments for abortions, for example.

The same concept could apply to health care providers’ decisions not to treat transgender patients seeking sex reassignment surgery or hormone therapy.

AIDS United warned the exemptions could also extend to HIV treatments and naloxone, which is used as a reversal drug for opioid overdoses.

Conscience protections are now technically enforceable for those who object to comprehensive approaches to combating HIV/AIDS, which can include medical recommendations for condoms. Members of the LGBTQ community fear the rule may extend even further and make health care harder to come by.

“It encourages discrimination in health care against already vulnerable patient populations, which includes LGBTQ people, people living with HIV and women seeking reproductive services,” said Dr. Gal Mayer, president of GLMA: Health Professionals Advancing LGBTQ Equality. “This would have a large impact in places where homophobia and transphobia and misogyny are the features of the community.”

Many health care workers automatically opt out of performing personally objectionable services by going into specialties that avoid such situations altogether. But other workers do find themselves being asked to perform services contrary to their beliefs. In Oregon, where assisted suicide is becoming more common, a doctor might be directed to provide euthanasia medication, for example. Likewise, faith-based medical workers might object to providing contraceptives such as Plan B. But under Trump’s rule, providers and institutions could decline.

Organizations within the U.S. that receive federal funds from Health and Human Services, through programs like Medicare and Medicaid, are affected, as well as international organizations such as United Nations agencies. HHS also has the ability to enforce the rule as it would other civil rights abuses, by withholding funding or referring the case to the Department of Justice if an organization is not seen as adequately accommodating employees’ beliefs.

Federal law, specifically Title VII of the Civil Rights Act, already requires employers to reasonably accommodate religious objections unless it would impose an undue hardship on the employer. The HHS rule does not take employers’ needs or access to care into consideration, said University of Pittsburgh bioethics professor Mark Wicclair. If a patient lives in a rural area where all providers object to abortion, for example, no one would be required to provide that procedure. The rule is vague about whether a worker could opt out of a medically necessary procedure, even in an emergency situation.

Forty-six states already have laws or policies in place that allow some health care providers to refuse an abortion, according to the Guttmacher Institute , a research institution that advocates for abortion rights.

Researchers say that while these regulations are important for ensuring health care workers are not betraying their personal beliefs, they risk prioritizing providers’ rights over patients’ rights.

Does the conscience rule violate a doctor’s duty?

Though conscience rules have multiplied since the 1970s, supporters of these early laws said they weren’t being enforced, meaning medical professionals could still be called on to perform procedures to which they objected.

“A right of conscience isn’t really about refusing to treat someone because you don’t like or approve of that patient’s behavior, their attitudes and their beliefs,” said Stevens, the Christian Medical & Dental Associations CEO. “You exercise right of conscience when you’re being asked or required to participate in or facilitate an action that violates your ethical, moral and religious beliefs.”

In 2009, Christian Medical & Dental Association sponsored a nationwide survey that found 39 percent of faith-based medical professionals reported feeling pressure from, or discrimination by, faculty or administrators related to their moral, ethical and religious beliefs. Ninety-one percent said they would stop practicing medicine altogether rather than violate their conscience.

HHS cites this survey as part of the rationale behind the new rule, which outlines the scenarios where set religious and moral objections can be applied. This legal journey started with the debates around abortion and sterilizations decades ago, but the new conscience rule extends into other realms of health care.

For example, the rule now offers enforcement for federally funded providers of pediatric vaccines who want to comply with state laws that allow religious or other exemptions for immunizations. That provision means a doctor’s office could lose its access to federal funds from Medicaid if the head of a clinic calls on its employees to administer vaccinations and one of its doctors refuses.

The new conscience rule also covers medical referrals — meaning a health worker who objects to providing care can also forgo recommending another doctor who might be able to perform the procedure. Dr. Donna Harrison, executive director of the American Association of Pro-Life Obstetricians and Gynecologists, compared the situation to asking a doctor to write a morphine prescription when they know the patient has an opioid addiction.

“We are not denying care to anyone. But to participate in referring [abortions] would be like the doc saying ‘O.K., I’m not going to write you the prescription for morphine, but here’s the name of a drug dealer,’” Harrison said. “That’s material cooperation in an act that is directly harmful to the patient.”

Harrison added that the conscience rule does not prevent separating a mother and a fetus at any gestational age as long as the mother’s life is at stake. She objects to elective abortions. Stevens made the same argument for LGBTQ care, saying under the rule faith-based doctors would take care of all people, but object to elective procedures like gender transition therapy.

Nancy Berlinger, a research scholar at the bioethics research institution the Hastings Center, said even if a patient is provided care, broadly applied conscience objections can lead to certain medical procedures becoming stigmatized, leading to worse treatment or deterring patients from seeking treatment at all.

“Conscience objections need to be balanced with equivalent rights to patients and providers because every person is meant to be equal under the law,” Berlinger said.

Mayer echoed that the burden will fall hardest on patients who live in rural places, where a medical refusal could cause disruption in medication and delays in diagnosis. He cited the 2001 documentary “Southern Comfort,” wherein a transgender man in Georgia developed ovarian cancer and was denied medical services. By the time, he found a doctor who was willing to treat him, the cancer was too advanced to cure.

But Mayer said the denial of referrals in any context — whether for abortions or LGBTQ health care — “speaks volumes to the underlying hatred of this kind of policy.” He cited surveys that show transgender people are more likely to be at risk for suicide if they’ve had a discriminatory experience in health care.

What doctors are saying is not that they deserve “protections from treating [patients] equally,” but that these patients do not deserve to get care, Mayer said.

Nsikan Akpan is the digital science producer for PBS NewsHour and co-creator of the award-winning, NewsHour digital series ScienceScope .

Gretchen Frazee is a Senior Coordinating Broadcast Producer for the PBS NewsHour.

Courtney Norris is the deputy senior producer of national affairs for the NewsHour. She can be reached at [email protected] or on Twitter @courtneyknorris

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Getting a religious exemption to a vaccine mandate may not be easy. Here's why

Shannon Bond

The waiting area of a pop-up vaccination site at the Cathedral of St. John the Divine in New York City sits empty as the rush for vaccinations winds down in June. David Dee Delgado/Getty Images hide caption

The waiting area of a pop-up vaccination site at the Cathedral of St. John the Divine in New York City sits empty as the rush for vaccinations winds down in June.

More and more employers are ordering workers to get vaccinated against COVID-19 without the option of getting tested instead. Now workers are pushing back.

In Washington, D.C., more than 400 fire and emergency medical workers applied for religious exemptions to the city's vaccine mandate. In Los Angeles, roughly a quarter of the police department is expected to seek religious exemptions.

How many of those requests will ultimately be approved is unknown. Already, some employers are taking a harder line than others. Under the law, employers have a lot of discretion when granting religious exemptions.

What are employer obligations to workers when it comes to religious exemptions?

The right to request a religious exemption stems from Title VII of the Civil Rights Act of 1964 , which protects workers from discrimination on the basis of religion, among other things. The Equal Employment Opportunity Commission says employers must provide reasonable accommodations for workers who have sincerely held religious beliefs — unless doing so poses an undue hardship.

There's a lot to unpack there.

The Coronavirus Crisis

'love your neighbor' and get the shot: white evangelical leaders push covid vaccines.

First, employers may probe whether an employee's religious belief is in fact sincere. They may ask questions about that employee's vaccination history or church attendance. If the employer determines the belief is not sincere, it may deny the exemption request.

But even if an employee's religious belief is determined to be sincere, it's the employer who decides what the reasonable accommodation will be. It does not have to be the accommodation requested by the employee.

What's reasonable when it comes to a reasonable accommodation?

What one employer deems to be reasonable, another may not.

In Conway, Ark., Matt Troup, CEO of Conway Regional Health System, has granted 45 religious exemptions to employees who refused to get a COVID-19 vaccine. Their objections were largely based on the employees' beliefs that vaccines that used fetal cells in research, testing or production should not be put in their bodies.

Coronavirus Updates

Vatican oks receiving covid-19 vaccines, even if research involved fetal tissue.

( Public health officials say fetal cell lines developed decades ago in the laboratory were used to develop and test the Pfizer and Moderna vaccines — a common practice in pharmaceutical research. Other fetal cell lines are being used in the production of the Johnson & Johnson vaccine. But the vaccines themselves do not contain any fetal cells.)

Before granting the religious exemptions, Troup sent the employees a list of 28 commonly used medicines that also used fetal cells in their research, testing or development — a list that includes Tylenol, Motrin, Tums, Ex-Lax and other medicine cabinet staples. He asked employees to attest to not be using any of those medicines.

As part of an education campaign, Conway Regional Health System sent this form out to employees who requested religious exemptions to the hospital's COVID-19 vaccine mandate. Conway Regional Health System hide caption

"They need to know that if they're going to be consistent in their beliefs, that applies to a lot of different things other than the COVID vaccine," Troup says.

Presented with the list, the employees who had requested religious exemptions still declined the vaccines. So Troup informed them they'd have to undergo regular COVID-19 testing. With 95% of his workforce vaccinated, he felt it was a reasonable accommodation.

"I feel like we've accomplished our goal to protect our staff, our patients and our community," he says. "We want to respect people's religious freedoms and their ability to make these decisions to the point that we can."

But already, there are employers who have been less accommodating.

The NBA has announced the following: pic.twitter.com/6t1spKMU35 — NBA Communications (@NBAPR) September 24, 2021

The NBA recently denied a religious exemption request from Golden State Warriors forward Andrew Wiggins, announcing that the athlete will not be able to play at any home games in San Francisco, which has a vaccine mandate for large indoor events, until he fulfills the city's vaccination requirements.

United Airlines has granted religious exemptions to a small number of employees, but the reasonable accommodation the airline has provided is to put the employees on indefinite unpaid leave without regular benefits. A handful of United employees have sued, saying unpaid leave is not a reasonable accommodation but rather an adverse employment action.

Román Hernández, a labor and employment attorney with Troutman Pepper in Portland, Ore., says historically, courts have upheld unpaid leave as a reasonable accommodation in religious exemption cases.

"It's probably not the accommodation that those workers wanted, but that is something that the employer is providing," Hernández says.

What's considered an undue hardship when it comes to religious exemptions?

Remember that under the law, employers must provide reasonable accommodations to workers seeking religious exemptions — unless doing so poses an undue hardship.

It's important to look at how the EEOC defines undue hardship.

Unvaccinated United Airlines employees to be put on temporary leave

In religious exemption cases, undue hardship is defined as "more than a de minimis ," or minimal, cost or burden on the operation of the employer's business. Hernández points out that an accommodation that involves shift changes could constitute more than a minimal burden to an employer, allowing the employer to deny such an accommodation.

In its defense, United has argued that allowing unvaccinated employees to continue working in customer-facing roles on-site "would impose extraordinary — not just de minimis — costs on United and the public." The airline says it would have to implement a coronavirus testing program at more than 100 domestic airports and offices. Running such a program would cause a heavier workload for vaccinated co-workers — and United notes that 97% of its employees are now vaccinated.

Does it matter what the head of my religion says about the COVID-19 vaccines?

Vaccination is a simple way of promoting the common good and caring for each other, especially the most vulnerable. https://t.co/j9prRxvpoi — Pope Francis (@Pontifex) August 18, 2021

Probably not, because religious exemptions ultimately come down to an employee's personal belief and whether an employer can find a reasonable accommodation.

So far, no major religion has come out in opposition to the COVID-19 vaccines. In fact, prominent religious leaders are endorsing them. Pope Francis has told Catholics that getting vaccinated is "an act of love," for example.

Even the Christian Science Church, which counsels prayer rather than medical care, says it doesn't have an official policy on vaccinations. It leaves it up to individuals to make that decision.

What about all the tips being shared online for getting a religious exemption?

Mentions of religious mandates on social media and traditional media outlets have jumped ninefold since June, with most of that spike coming after the White House announced vaccine mandates for federal employees in early September, according to an analysis by media tracking firm Zignal Labs.

Untangling Disinformation

Facebook's most viewed article in early 2021 raised doubt about covid vaccine.

In Facebook groups opposed to vaccine mandates, members frequently ask about how to obtain a religious exemption and what to say when petitioning their employers.

In these groups, members regularly cite misleading claims that vaccines contain fetal cells. Others share links to online churches and self-described "consultants" offering signed exemption letters. One company offering these services charges $175 for phone consultations, research, sample forms and a signed letter from a pastor.

But keep in mind, the employer really has a lot of discretion in granting these exemptions whether or not you have one of these signed letters. So people should probably think twice about paying for these services.

• workplace safety
• Civil Rights Act of 1964
• vaccine mandates
• religious exemption

Religious Exemptions to Vaccines and the Anti-Vax Movement

By Dorit Rubinstein Reiss

Two major problems with granting religious exemptions to vaccine mandates are that they are very hard to police, and that they are routinely gamed.

Religious freedom is a core value in the United States. This makes policing religious exemptions to vaccination hard – and rightly so. The government policing people’s religion raises a number of thorny issues.

The problem is that the same people who eagerly promote anti-vaccine misinformation are just as eager to misuse religion to avoid vaccinating, and have no hesitation or compunction about coaching others to do the same. And without policing, it is easy for those misled by anti-vaccine misinformation to use the religious exemption.

In a recent hearing on a bill to remove Massachusetts’ religious exemption, a witness said that she used the religious exemption, “Not because it goes against my religion, but because I do not believe that it is necessary to put additional chemicals into my child’s body for an illness that she would fully recover from. You are proposing to take away my right as a parent and for what? To protect other people?”

This anecdote is not exceptional. In a previous paper , I pointed out that quite a bit of evidence suggests there is widespread misuse of religious exemptions.

This includes: statements from anti-vaccine activists who state publicly that they lied to get religious exemptions; surveys on the reasons people do not vaccinate; and the fact that most religions do not prohibit vaccines (in fact, many actively encourage or support them).

Sincere beliefs?

But cracking down on the misuse of religious exemptions is quite difficult. Employers, universities, or states offering religious exemptions cannot limit them to organized religion, because that would discriminate against those with sincere beliefs that are not part of an organized religion .

This makes sense, because the validity of your religious exemption should not depend on belonging to a religion that opposes vaccines. But it removes one tool that would help distinguish between those with sincere religious objections, and those using religion to cover other objections to vaccines.

Additionally, states cannot refuse an exemption to those whose interpretation differs from their religion’s doctrine regarding vaccination. It’s not the state job to enforce a religion’s rules on its believers, the state is tasked simply with assessing whether the religious objection is sincere . This too makes sense, but again, makes it harder to challenge religious exemption claims by members of religions that support vaccines. Assessing sincerity is tricky grounds. And dedicated anti-vaccine activists are exploiting these ambiguities to help people get religious exemptions.

While it is hard to examine closely, there is no reason to think most, or even a large share, of religious exemption requests to COVID-19 vaccines are from people whose opposition is religious. In fact, given the amount of misinformation about vaccine safety and the virus, chances are that most of the exemption requests are from people who do not want to get COVID-19 vaccines because of safety concerns or misinformation about the pandemic.

Granting exemptions on the basis of religion incentivizes these people to lie, and exemptions are more likely to be given to people who have lied well — for example, by getting input from anti-vaccine activists teaching others to game the system.

Gaming exemptions

For example, Rita Palma, a New York-based anti-vaccine activist, has been actively promoting her site, My Kids, My Choice , which links to several resources on how to get an exemption, on her Facebook page.

Attorney Kevin Barry has, in a Facebook Live , promoted a Zoom webinar he is offering on how to get the religious exemption “right.”

“Later, we are going to have to see, if the religious exemption is approved, whatever restrictions the university might throw at you,” he explained during the live event. “We can find ways around that, but you’re have to get the religious exemption approved first and we are going to give you some strategies on how to do that.”

A relative newcomer, a student named Cait Corrigan, offered her followers five rules for getting a religious exemption, which include the following :

RULE #4 in writing a religious exemption: Do not mention c0v-id 19, side effects, or scientific data! Do not mention the V is under E-U-A. Your RE is a statement on your RELIGIOUS BELIEFS. Write about scripture, your religious history, & faith!

Finally, attorney Jim Mermigis has been touting the religious exemptions he wrote, calling for potential plaintiffs, and encouraging people not to vaccinate.

The tenor of all of these posts is to help people seeking exemptions get one. There is no emphasis on sincerity, instead, the advice is geared towards gaming the system.

I have said it before, and will say it again. A public policy that encourages people to lie and advantages the better liars — or those who have access to those who can teach them what to say — is a bad policy. In this case, the policy also benefits anti-vaccine activists exploiting the situation.

Implications for public universities

At present, the Supreme Court has not yet ruled that public universities requiring vaccines have to give a religious exemption. The Supreme Court has been tightening protection of religious freedom, but the guiding principle is still Employment Division v. Smith , which does not require a religious exemption from a generally applicable, neutral-on-its-face law. Universities may want to consider, on this background, not offering a religious exemption. Yes, there is a risk the Supreme Court will strike down such a rule. But, given the context — that it’s highly likely most exemption requests are from people without religious objections, and that many are selling services to help game exemptions — the Supreme Court may consider that universities are justified in not offering such an exemption.

If universities do offer religious exemptions, they may want to consider the need for careful enforcement, including examining, in detail, the advice of anti-vaccine activists, keeping a list of those openly working to game religious exemptions and looking for their involvement, and potentially interviewing individuals whose exemption requests raise red flags. They also can require a detailed exemption letter, and, in cases that raise questions, require independent corroboration — though they cannot limit that corroboration to organized religion. At the least, universities should plan how to reduce misuse of religious exemption, to avoid having exemptors undermine campus safety.

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Dorit Reiss

Dorit Rubinstein Reiss is a professor of law at the University of California, Hastings College of the Law. Increasingly, her research and activities are focused on legal issues related to vaccines, including exemption laws and tort liability related to non-vaccination. She published law review and peer reviewed articles and many blog posts on legal issues related to vaccines. She received an undergraduate degree in Law and Political Science (1999, Magna cum Laude) from the Faculty of Law in the Hebrew University of Jerusalem. She received her Ph.D. from the Jurisprudence and Social Policy program in UC Berkeley. She is a member of the Parents Advisory Board of Voices for Vaccines, and active in vaccine advocacy in other ways. She is also a Member of the Vaccine Working Group on Ethics and Policy (https://vaccineworkinggroupethics.org/).

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Religious Exemptions and the Family

A response to.

abstract. This Essay highlights the threat claims for religious exemptions to antidiscrimination laws pose to the diverse family arrangements that now populate society. It argues we should not abide efforts to thwart, undermine, and ultimately overturn advances in equality norms in the family based on religious belief. The promise of nondiscrimination laws for our families and our ability to move freely in the public sphere is undercut if LGBTQ+ people and women must confront actual or metaphorical, embraced by the courts, “Your kind of family is not welcome here.”

Introduction

For many years, the American family trope resembled a kind of L eave It to Beaver mythical archetype, featuring a white male head of household, his white stay-at-home wife, and their two children. This trope was false and exclusionary in many respects. To begin, the family was white. Single parents, working mothers, and intergenerational families—all of which are more likely to be or consist of people of color 1 —are missing from the picture. One parent can afford to stay at home, and the family lives in a detached house that they own. The family roles are gendered and the couple heterosexual. While we all now know this trope stands for few families and perhaps even fewer aspirations, it persists to this day, with the assumption still being that women are the primary caregivers; that if a woman wearing a wedding ring buys two coffees, one is for her husband, not her wife; 2 that chosen families include two adults; and that women are wanting—perhaps even monsters—if they do not embrace motherhood. 3

There are, of course, significant advances that have begun to broaden our understanding of the family. Today, as a matter of law, same-sex couples can marry, be foster parents, and adopt. 4 Assisted reproduction has facilitated parenthood for same-sex couples and people seeking to single-parent. People have a greater ability to decide whether and when to parent, and women who parent continue to work out of need, as always, but also out of desire. Culture is making this change possible, as is law, even if the law may not always appear in family-law casebooks.

These legal developments, and the freedom they represent, are, however, under attack. Specifically, these advances are challenged in the name of religious freedom, with the avowed goal of returning to the Leave It to Beaver trope. These religious-freedom arguments are most often discussed as challenges to civil rights. 5 This Essay highlights the less-often discussed threat that religious exemptions to antidiscrimination laws pose to the diverse family arrangements that populate our society. Part I discusses current religious-freedom challenges, and Part II speaks to the courts’ changing response to these challenges. Finally, Part III argues that we should not abide efforts to thwart, undermine, and ultimately overturn advances in equality norms in the family based on religious belief.

This Essay focuses on claims for religious exemptions made by institutions, most often institutions that serve the public, whether businesses, foster care agencies, or hospitals. This is the space most regulated, subject to antidiscrimination rules, and thus the focus of legal disputes about religious exemptions. It is also the space in which the religious exemptions to antidiscrimination rules will do the most harm. 6

I. the current contest

The cultural and legal vision of the family is undergoing profound change. Gone are the bans on same-sex couples marrying and adopting and fostering children. One in three children live in a single-parent household, 7 the percentage of women who have never married and who have children is increasing, 8 stay-at-home parents are increasingly fathers, 9 and most children live in families in which all the adults work. 10

But these changes are resisted in the name of religious freedom. The United States Conference of Catholic Bishops’ amicus brief in Obergefell v. Hodges , for example, left no doubt about their vision of appropriate family and gender roles: “If same-sex partnerships were recognized as marriages . . . no civil institution would any longer reinforce the notion that children need both a mother and father; [and] that men and women on average bring different gifts to the parenting enterprise . . . .” 11 The Bishops warned of what would come were the Court to recognize, as it did, a federal constitutional right for same-sex couples to marry. They promised “church-state conflict for generations to come” that would embroil the federal courts, “pitting claims of constitutional right squarely against one another . . . until one or the other is diminished.” 12 The conflict, they predicted, “may be even greater than [that surrounding] abortion.” 13

The conflict between religious rights and LGBTQ+ equality is charged and consequential. Citing their religious beliefs, institutions object to recognizing the marriages of same-sex couples. Businesses—most famously the Masterpiece Cakeshop bakery—claim a right to refuse to provide wedding-related services to same-sex couples. 14 Religiously affiliated schools assert a right to fire teachers and other staff if they marry someone of the same sex. 15 County clerks and civil judges object to recognizing marriages of same-sex couples. 16 And employers assert a right not to comply with state laws requiring insurance coverage for partners in same-sex marriages on the same terms as for different-sex couples. 17

Institutions are also refusing to serve same-sex couples seeking to parent. Catholic Social Services (CSS) and other agencies object to complying with requirements that—as a condition of securing a government contract to screen foster parents—they not discriminate against same-sex couples. 18 And medical institutions have argued that they have a right to refuse to provide artificial insemination to a woman because her partner was a woman. 19 In these and other cases, institutions have argued that their faith ensures their right not to comply with antidiscrimination laws.

Institutions also resist more longstanding precedents aimed at advancing women’s independence and equality, both within and outside the family. For example, religiously affiliated institutions argue that they have a right to fire women who are pregnant and unmarried, or who have used assisted reproductive technologies, in violation of federal laws prohibiting sex discrimination, including pregnancy discrimination. 20

Central to the family-law context is resistance to abortion and contraception access. Rules requiring insurance coverage for contraception as part of the Affordable Care Act met with fierce resistance in the name of religion, with more than one-hundred lawsuits filed challenging the rules. 21 State laws requiring insurance plans to cover abortion where they already cover other pregnancy-related care have similarly given rise to lawsuits predicated on religious freedom. 22 Providers have even challenged on religious-freedom grounds laws that require them to inform patients of treatment options and provide referrals if they refuse to provide services based on their religious beliefs. 23

These are family-law issues for several reasons. The ability to decide whether and when to have children is fundamental to the ability to define one’s family. Laws providing access to contraception and abortion—and resistance to those laws—are also central to family law because of their import for disrupting traditional gender roles within families. 24 They are about control, a promise of independence, and resistance to the longstanding centrality of motherhood in any vision of women. The Supreme Court has recognized:

The mother who carries a child to full term is subject to anxieties, to physical constraints, to pain that only she must bear. Her suffering is too intimate and personal for the State to insist, without more, upon its own vision of the woman’s role, however dominant that vision has been in the course of our history and our culture. 25

Contraception and abortion have played a critical role in liberating women from the traditional conception of the family in which only the (white) man had a right to vote because he was to represent the interest of the family (and those he owned). 26 As the Casey Court stated, “ The ability of women to participate equally in the economic and social life of the Nation has been facilitated by their ability to control their reproductive lives.” 27

These cases are about the family, the changing norms our laws reflect and foster, and a concerted effort to revert to “laws and precedent that recognize the important differences between men and women and honoring God’s design for marriage between one man and one woman.” 28

II. the legal landscape

For decades, courts have rejected religious resistance to emerging antidiscrimination rules affecting the family. 29 For example, in Loving v. Virginia , the Supreme Court struck down Virginia’s ban on marriage for interracial couples. 30 The Loving Court quoted— and repudiated —the trial court’s faith-based reasoning about bans on interracial marriage:

Almighty God created the races white, black, yellow, malay and red, and he placed them on separate continents. And but for the interference with his arrangement there would be no cause for such marriages. The fact that he separated the races shows that he did not intend for the races to mix. 31

Several years later, the Court rejected Bob Jones University’s claim that the government infringed on its free-exercise rights when it denied the university tax-exempt status as a charitable institution because it barred students who advocated or engaged in interracial dating. 32 The Court reasoned that the government had “a fundamental, overriding interest in eradicating racial discrimination in education—discrimination that prevailed, with official approval, for the first 165 years of this Nation’s constitutional history.” 33 That interest outweighed whatever “burden denial of tax benefits places on petitioners’ exercise of their religious beliefs.” 34

Courts also rejected free-exercise arguments that threatened gender equity inside and outside the family. They dismissed arguments that Bible teachings, which assert that “ the husband is the head of the house, head of the wife, head of the family,” justified lower pay for women. 35 More recently, the highest courts of New York and California rejected free-exercise challenges to state laws requiring employer-based insurance plans that covered prescription drugs to include prescription contraceptives. 36 And the Ninth Circuit found wanting a pharmacy’s faith-based challenge to a law requiring that it fill prescriptions for contraception. 37

The initial trend was also promising for diverse family arrangements. In Hawaii, New Mexico, Oregon, and Washington, state courts ruled against businesses arguing that antidiscrimination laws requiring them to serve same-sex couples violated their religious freedom. 38 The California Supreme Court rejected a medical practice’s assertion that it had a free-exercise right to refuse to artificially inseminate a woman in a same-sex relationship. 39 A number of state courts similarly rejected landlords’ claims of a free-exercise right to refuse housing to unmarried couples. 40 And federal courts rejected employers’ claims of a religious right to fire women who were unmarried and pregnant. 41

Time and again, courts recognized the state’s interest in advancing equality and rejected claims for religious exemptions. They did so even before the Supreme Court in Employment Division v. Smith stopped applying heightened scrutiny to incidental burdens on religious exercise. 42 Diverse visions of family—most rooted in the Constitution—retained robust protection in the law.

But the pattern is changing. In Burwell v. Hobby Lobby Stores, Inc. , the Supreme Court held that the Affordable Care Act rule requiring insurance to cover contraception violated the Religious Freedom Restoration Act where it did not allow objecting businesses to opt out by signing a form noting their objection, and then the insurance company would provide coverage. 43 In Zubik v. Burwell , the Court did not reject employers’ even more audacious and attenuated claim that simply signing such a form violated their religious rights. 44 In Our Lady of Guadalupe School v. Morrissey-Berru , the Court construed the ministerial exemption to bar teachers’ claims of employment discrimination, even where the job did not require the teacher to be of the faith. 45 In Masterpiece Cakeshop , the Court invalidated the state’s enforcement action under its Anti-Discrimination Act where it found that the state had demonstrated hostility toward a bakery that refused to provide a cake for the wedding reception of a same-sex couple. 46 And most recently, in Fulton v. City of Philadelphia , the Court ruled that the City violated the free-exercise rights of CSS when it denied the agency a contract to screen foster families because the agency refused to comply with the antidiscrimination rule, rejecting the notion that the City’s interest in enforcing its antidiscrimination policy satisfied strict scrutiny. 47

The Court’s recent shadow-docket rulings further suggest that it may be moving toward a standard that favors religious-exercise claims. 48 In the context of COVID-19 restrictions, the Court stated that government regulations are not neutral and generally applicable, and therefore trigger strict scrutiny under the Free Exercise Clause, “whenever they treat any comparable secular activity more favorably than religious exercise.” 49 It struck down COVID-19 restrictions on gatherings for in-home worship—no different from those for any in-home gathering—because the same limitations did not apply to hair salons, retail stores, and other businesses. 50

These decisions are often described as narrow. 51 They make no bold announcement, for example, that the Free Exercise Clause requires exemptions for institutions that object to complying with antidiscrimination rules. Their holdings do not announce a constitutional right to discriminate. At the same time, the Court’s recent jurisprudence on religious exemptions to antidiscrimination rules is radical for the change it suggests. The Court in Fulton , for example, makes no mention that what is at stake is government funding of discrimination. 52 The Court suggests that there would be no harm in an agency refusing to serve a same-sex couple as long as it referred them elsewhere, brushing aside considerations of the dignitary and stigmatic harm of being turned away (not to mention that many may well be dissuaded from seeking service at all). 53 The Court appears ready to indulge religious-freedom violations claims that rest on being complicit in an action far removed, often requiring other actors for realization. 54 And the Court may be quicker to see discrimination in state efforts to enforce equality principles against those objecting than in the denial of equality to those the law was meant to protect.

For the purpose of this Essay, these decisions suggest that the work the law has done to reflect and protect diverse family arrangements is at risk.

III. the threat of religious exemptions to emerging visions of the family

At their core, today’s religious exemption cases present fundamental questions about the family. At stake is whether our laws will regress to privileging one kind of family—the white, heterosexual, gender-differentiated family—over others. This Part argues that these religious-exemption claims should be rejected—a position seemingly advanced less often as the threat to emerging visions of the family increases. 55 This Essay offers five points in support of this argument.

First, it is important to remember that the family arrangements at stake enjoy constitutional protection. As a matter of constitutional law, the Supreme Court has recognized unmarried couples as families, and rejected notions that unwed fathers are unfit to parent. 56 It has also rejected the notions that marriage is for procreation, 57 women are to mother, 58 and marriages of interracial 59 and same-sex couples 60 are illegitimate. Antidiscrimination laws codify the constitutional directives not only for the so-called public sphere, but also for the family.

The break from the LeaveIttoBeaver trope in constitutional law—a break from longstanding traditions that often aligned with dominant Christian values—is now decades old. In many cases, the recognition of these family configurations fosters profound changes in relationships outside the family as well. They further, and are furthered by, other equality norms. Drawing on its earlier decision in Planned Parenthood v. Casey , the Court made this point plainly in Lawrence v. Texas : “[O]ur laws and tradition afford constitutional protection to personal decisions relating to marriage, procreation, contraception, family relationships, child rearing, and education. . . . ‘These matters . . . are central to the liberty protected by the Fourteenth Amendment.’” 61 No vision of racial justice or gay rights, for example, can be complete if it means that the law upholds segregation in love or accords a second-class status in law to some relationships. There can be no gender justice if people have no capacity to control whether and when to parent and if family must mean a woman being with a man. Thus, advocates propose to erode constitutional protections—and their enforcement through antidiscrimination laws —with religious exemptions.

Second, religious exemptions threaten the promise, both in law and in culture, to diverse families that they will no longer be punished for who they love, whether they marry, or whether and how they have children. The protections promised in Obergefell and antidiscrimination laws are undercut if the law allows businesses to refuse to sell flowers to a same-sex couple for their wedding or allows government-funded agencies to turn away couples that want to foster because of who they are. Protections for women’s independence in family are undermined if employers have a right to refuse to provide insurance coverage for contraception and abortion otherwise required by law, if the law protects firings of women who have a child while unmarried, if women can be paid less than men for reasons of religion, and if the law protects ambulances that refuse to transport people needing an abortion. 62 Religious exemptions simply mean that the promise antidiscrimination laws hold for the family is punched through with holes.

Melissa Murray, too, sees the threat, characterizing religious exemptions as “shrink[ing] the public sphere—and the domain of state-endorsed laws and norms—while expanding the private sphere and the authority of private actors who operate outside of the state’s reach.” 63 In that private sphere, old norms are enforced, and deviation is punished. In other words, the issue is not an objector like Masterpiece Cakeshop being kicked out of the public sphere, but rather an objector laying claim to shrink the reach of antidiscrimination rules and thus, in Murray’s words, undermine the “public apparatus structured to vindicate the public values of liberty and equality.” 64

The threat has a particular bite because the discrimination sanctioned by religious exemptions comes with the blessing of the government. When it grants exemptions, the government is authorizing private parties to discriminate and thus continuing to privilege some families over others. As Douglas NeJaime and Reva Siegel have remarked, “A legal system that provides expansive conscience exemptions . . . will align the public order with the belief system of the objector and against the rights to which the objector objects.” 65 That comes with a great cost, as Justice Kennedy described in Obergefell : “ [W]hen that sincere, personal opposition becomes enacted law and public policy, the necessary consequence is to put the imprimatur of the State itself on an exclusion that soon demeans or stigmatizes those whose own liberty is then denied.” 66 And it is worse still when the government funds private actors—like foster care agencies— to engage in discrimination or itself engages in discrimination. In short, there is no way to understand exemptions as not posing a threat to diverse families and the promise of equality they represent.

The proposals for compromise often highlight the very problems of exemptions. Alexander Dushku advances a case for what he calls “creative pluralism” or a “sustainable settlement.” 67 At the end of the day, the proposal is, broadly speaking, simply a call for religious exemptions. Even in public spaces, where he states that antidiscrimination proposals “should generally prevail,” Dushku asserts the exemptions should be “narrow and relatively rare.” 68 But he also describes Masterpiece Cakeshop as a case of “true religious hardship” where equality must yield. If a main-street bakery qualifies, then Dushku offers no proposal for a limiting principle — and requires us to accept the idea that “just a little discrimination” is okay. 69

The proposal that Dushku does spell out — the one specific to foster care and adoption services embodied in the Fairness for All bill — again highlights the harm of exemptions. The bill would require all states that accepted federal funding for foster - care and adoption services to permit foster - care agencies to discriminate — this is indeed what happens when an agency turns a couple away because they are same-sex—and to support that discrimination with government funds. 70 Under the proposal, federal dollars to states for foster - care services would be conditioned on the states agreeing to a voucher model, by which families would receive a certificate from the federal government to use at foster - care agency. Foster-care agencies could turn families away based on sexual orientation, gender identity, or faith, as long as they provided a “reasonable referral.” 71 The state would be responsible for ensuring that that there was at least one agency in the area or neighboring catchment that would accept the voucher and serve the family. 72

Dushku suggests that this proposal is appropriate because foster care and adoption from foster care are “hybrid spaces,” meaning a mix of the public and the sacred. 73 But foster care is a government function . The government has removed children from their homes and is responsible for their care until they return to their families or are adopted. Agencies receive taxpayer dollars to fulfill that government function; 74 it is not any less a government function because many state and local governments choose to contract out this service to private agencies. Understood this way, it is hard to imagine a more direct challenge to diverse families than to sanction discrimination expressly in the government’s name. 75

It is no answer that the agency that will not serve a same-sex couple must provide a referral. There is no way for the agency to send away a couple without communicating , “We don’t serve your kind here.” Moreover, such a system would mean that some families (e.g., those headed by heterosexual Christian couples) could choose from multiple agencies, permitting them to select the agency they like best and that is well-suited for their needs, while other families (e.g., those headed by same-sex couples or members of minority faiths) would have more limited options , possibly just one. Sanctioning such unequal treatment in government programs is stigmatizing for families and could deter them from pursuing foster care or adoption, undermining efforts to find families for children. 76

There is no way around it. Exemptions undercut antidiscrimination measures; they sanction discrimination. It is not tolerance to build into our laws a right to discriminate. 77

Third, make no mistake about the ultimate aim of the push for exemptions we now see. The aim is not to create a quiet enclave to which some people may retreat to live according to religious values no longer enshrined in the law. It is to contest the very change in family norms that the laws and policies being challenged aim to advance, and ultimately undermine and overturn the gains of the last half century for diverse family formulations. As NeJaime and Siegel expound, “[A]ccommodating religious objections may . . . enable the conflict to persist in a new, revitalized form. . . . [C]omplicity-based conscience claims can function as part of a long-term effort to contest society-wide norms.” 78

In other words, the claims for religious exemptions ensure a continued challenge to the antidiscrimination rules and decisions that protect diverse family arrangements. Refusals to register marriages of same-sex couples, keep on staff those who marry a partner of the same sex, permit same-sex couples to foster, and provide goods and services to such couples are all ways of contesting the legitimacy of Obergefell and the protections afforded by laws barring discrimination based on sexual orientation. Refusals to provide abortion services, referrals, insurance, aftercare, 79 and even ambulance services contest the legitimacy of the line of cases—federal and state—that afford constitutional protection for abortion. They contest the control, independence, and sexual freedom for women in constituting family. Exemptions keep alive a very public debate about the legitimacy of the new norms and the morality of those they protect. That’s the aim; few say it.

Fourth, religious exemptions do not foster peace or strengthen antidiscrimination norms by quieting those now loudly objecting. 80 The history of abortions and exemptions is illustrative. In 1973, just months after the Supreme Court decided Roe v. Wade , 81 Congress passed a law providing that neither institutions nor individuals can, by virtue of receiving federal funds, be required to perform abortions or sterilizations if such performance is contrary to the institution’s or an individual’s religious beliefs. 82 Forty-four states currently permit healthcare institutions to refuse to provide abortion services, and forty-six states permit healthcare providers to similarly refuse. 83 Many of these laws have been in place for decades. Since 2005, federal law has provided that federal, state, and local government agencies and programs now risk losing federal dollars if they “subject[] any institutional or individual health care entity to discrimination on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions.” 84 While many factors contribute to the tenor of the modern debate over the abortion right, these accommodations have neither quieted the debate surrounding abortion nor resulted in a gentle change in attitude. Instead, there is litigation opposing even referrals, aftercare, and emergency services. And the demands for exemptions now extend to contraception. The storm will only quiet when there is no longer constitutional protection for abortion.

A similar pattern is emerging with LGBTQ+ rights. The complicity claims abound. There is now even a case of a funeral home refusing cremation services because the deceased was married to a man. 85 Just as the U.S. Conference of Bishops warned, the efforts to undercut and undo marriage equality threaten to be as fierce as those surrounding abortion, and it will not stop until one side is “diminished.” 86

Finally, we must return to that classic legal analytical exercise of asking, if we accept exemptions in the contexts of LGBTQ+ families and women’s role in families, would we accept them in other contexts? In particular, if the courts and culture rejected the notion of exemptions in the context of race and of women’s pay, why accept them in the context of the family formations discussed here?Of course, the history of Black people in America is not the same as that of LGBTQ+ people (and these categories are not exclusive). Nor is the history of women the same (and again these categories intersect). And the issue for this Essay is not whether the religious objections to the Civil Rights Act, to interracial marriage, to same-sex marriage, or to single women parenting, are honorable. 87 The issue is, accepting that claims to exemptions on the grounds of religious belief are sincere, on what grounds would we reason differently about LGBTQ+ families or those making decisions about family size and timing than we did about free-exercise claims for race and women’s wages? 88

IV. religious exemptions: the debate

This Essay may be cast as another piece that casts those of deep religious conviction as bigots, as a way of both affirming the sincerity of the beliefs addressed in this piece and directing anger at the critique of religious exemptions to increased protections for diverse family configurations. Those with sincere faith objections to marriage for same-sex couples, to women who parent without men, and to contraception and abortion surely struggle with changing norms and legal doctrines, and with charges that they are discriminating. But what is harder than change is not changing, given the stigma, violence, criminal penalties, and prejudice so long attending many of the family formations discussed in this Essay. As NeJaime has posited,

[T]hose defending views that society may soon come to condemn, but that are still debated, invoke the idea of bigotry in defense—as a way both to discredit their opponents (that their opponents unfairly brand them bigots) and to establish their own position as worthy of legal protection (that not treating them with respect and accommodating them through law is itself bigoted). 89

We need to respect the sincerity of beliefs, but not cower in defense of protections for the many families that are not gender differentiated.

This Essay does not cower in the face of Dushku’s critique, nor does it offer a point-by-point response. Rather, I offer one reflection on his remarks. Dushku credits me with honesty. I wish he had been similarly candid about his approach. His “creative pluralism” is little more than a call to accept religious exemptions, cloaked in the language of civility to sound more palatable and to mask the uncivil consequences. 90 His Essay advocates for the right of businesses that serve the public and agencies that receive government dollars to provide services to refuse to comply with antidiscrimination laws when an increasing number of such laws protect LGBTQ+ people. It is not civil for a retail store employer to deny you a health benefit guaranteed by law. It is not civil for women to be fired from religious schools if they are pregnant and unmarried when no men are fired for premarital sex. It is not civil to propose that the government create a list of those foster care agencies it funds where LGBTQ+ people can know they will not be turned away. There can be no honest debate or dialogue without greater candor about the consequences of these proposals.

“The personal is political” was a feminist cry of my youth, one that highlighted the connection between gender inequity in the family and broader political structures. 91 Basic norms—men as heads of household, women as caregivers, rules of the home and workplace fostering women’s financial dependence—prevented any notion of equality in the home and outside. Today’s debate about religious exemptions and civil rights raises many of the same issues: They are about gender roles and norms in the family and the connection to broader equality norms, as well as our ability to move in the public sphere as LGBTQ+ people and women. The issue is whether we will break free, or whether religious exemptions to civil rights protections will leave us with the promise of equality yet facing metaphorical signs, “Your kind of family is not welcome here.”

Louise Melling is a Deputy Legal Director of the American Civil Liberties Union (ACLU) and the Director of its Ruth Bader Ginsburg Center for Liberty. The author would like to thank her ACLU colleagues from the Religious Refusals team for insights over the years that make this analysis possible; Leslie Cooper, Dan Mach, Douglas NeJaime, Ria Tabacco Mar, and Rose Saxe for comments on this Essay; and Ariana Arzani, Alie Bornstein, Grant Gebetsberger, Duncan Hosie, and Ricca Prasad for assistance with research. Thank you also to the editors of the Yale Law Journal who organized this Collection for their focus on family law and their editorial suggestions on this Essay.

Volume 133’s Emerging Scholar of the Year: Robyn Powell

Announcing the eighth annual student essay competition, announcing the ylj academic summer grants program, this essay is part of a forum collection, the contemporary family.

This Collection explores how the law treats the modern family. From divorced families to LGBTQ+ families to chosen families, these Essays suggest ways that the law should evolve to match emerging family structures. Two debating Essays illustrate the clash between religious beliefs about family and antidiscrimination law after the Supreme Court's decision in Fulton .

Chosen Family, Care, and the Workplace

The case for creative pluralism in adoption and foster care, ridding the family-law canon of the relics of coverture: the due process right to alternative fee arrangements in divorce.

Gretchen Livingston, The Changing Profile of Unmarried Parents , Pew Rsch. Ctr. (Apr. 25, 2018), https://www.pewresearch.org/social-trends/2018/04/25/the-changing-profile-of-unmarried-parents [https://perma.cc/GN9D-Z7S7] (reporting that nearly sixty percent of solo mothers are people of color); A Snapshot of Working Mothers , Nat’l Women’s L. Ctr. (Apr. 2017), https: ‌ //nwlc.org/wp-content/uploads/2017/04/A-Snapshot-of-Working-Mothers.pdf [https://perma.cc/ZY9C-V29F] (“Black mothers are more likely to be in the labor force than mothers of any other race.”); D’vera Cohn & Jeffrey S. Passel, A Record 64 Million Americans Live in Multigenerational Households , Pew Rsch. Ctr. (Apr. 5, 2018), https://www.pewresearch.org/fact-tank/2018/04/05/a-record-64-million-americans-live-in-multigenerational-households [https://perma.cc/PA27-KBZV] (showing that white people are less likely than other racial or ethnic groups to live in multigenerational households).

Ria Tabacco Mar, Opinion, Longing for the Freedom Not to Hide Myself , Wash. Post (Apr. 15, 2018), https://www.washingtonpost.com/opinions/longing-for-the-freedom-to-not-hide-myself/2018/04/15/201c7680-3f30-11e8-a7d1-e4efec6389f0_story.html [https://perma.cc/9BZP-U9A8].

E.g. , Mary Katharine Tramontana, Women Who Said No to Motherhood , N.Y. Times (May 3, 2021), https://www.nytimes.com/2021/05/03/style/childfree-women.html [https://perma.cc/X2K3-XC4V].

See Obergefell v. Hodges, 135 S. Ct. 2071 (2015); Fulton v. City of Philadelphia, 141 S. Ct. 1868 (2021).

The titles of many recent books in the field are illustrative. The Conscience Wars: Rethinking the Balance Between Religion, Identity, and Equality (Susanna Mancini & Michel Rosenfeld eds., 2018); Nelson Tebbe, Religious Freedom in an Egalitarian Age (2017); John Corvino, Ryan T. Anderson & Sherif Girgis, Debating Religious Liberty and Discrimination (2017).

Claims for exemptions must always be considered with several lenses in mind. Is this a claim by an institution or an individual? If an institution, does it open its doors to and serve members of the public? Or does it hire and serve principally members of the faith? Does it receive government funding or perform a government function? If an individual, is the person a public official? The questions help assess the extent to which an exemption will impose harm on others. A rule permitting discrimination in the hiring of a priest, for example, is different from one permitting discrimination in wages by an arts-and-crafts chain or in services by a hospital. Alexander Dushku and I thus agree that different rules are appropriate for different contexts. See Alexander Dushku, The Case for Creative Pluralism in Adoption and Foster Care , 131 Yale L.J.F. 246, 261 (2021) (“The architecture of pluralism is not complex, but it does require an understanding that different spaces involve different values and thus require different legal approaches.”). We disagree, however, about how spaces are categorized and what rules should apply.

Gretchen Livingston, About One-Third of U.S. Children Are Living with an Unmarried Parent , Pew Rsch. Ctr . (Apr. 27, 2018), https://www.pewresearch.org/fact-tank/2018/04/27/about-one-third-of-u-s-children-are-living-with-an-unmarried-parent [https://perma.cc/9DWH-PWUA].

Gretchen Livingston, They’re Waiting Longer, but U.S. Women Today More Likely to Have Children than a Decade Ago , Pew Rsch. Ctr . (Jan. 18, 2018), https://www.pewresearch.org/social-trends/2018/01/18/theyre-waiting-longer-but-u-s-women-today-more-likely-to-have-children-than-a-decade-ago [https://perma.cc/H79Z-FGNP].

Gretchen Livingston & Kim Parker, Eight Facts About American Dads , Pew Rsch. Ctr. (June 12, 2019), https://www.pewresearch.org/fact-tank/2019/06/12/fathers-day-facts [https://perma.cc/AA6M-JDD8].

Raising Kids and Running a Household: How Working Parents Share the Load , Pew Rsch. Ctr . (Nov. 4, 2015), https://www.pewresearch.org/social-trends/2015/11/04/raising-kids-and-running-a-household-how-working-parents-share-the-load [https://perma.cc/7TFE-C3N2].

Brief Amicus Curiae of United States Conference of Catholic Bishops in Support of Respondents and Supporting Affirmance at 9, Obergefell v. Hodges, 576 U.S. 644 (2015) (Nos. 14-556, 14-562, 14-571, 14-574) (quoting Sherif Girgis, Robert P. George & Ryan T. Anderson, What Is Marriage? , 34 Harv. J.L. & Pub. Pol’y 245, 263 (2011)).

Id. at 4-5.

See, e.g. , Masterpiece Cakeshop Ltd. v. Colo. C.R. Comm’n, 138 S. Ct. 1719 (2018); Arlene’s Flowers, Inc., v. Washington, 441 P.3d 1203 (Wash. 2019), cert. denied , 141 S. Ct. 2884 (2021); Petition for Rehearing, Arlene’s Flowers, Inc. , 141 S. Ct. 2884 (No. 19-333). As Jack Phillips, the owner of Masterpiece Cakeshop, has plainly stated, “ I believe the Bible is very clear on what God intended marriage to be—the union between one man and one woman—so I don’t create cakes for same-sex weddings.” Jack Phillips, Masterpiece Cakeshop Owner Jack Phillips: How I B ecame the F ace of ‘ R ights of Conscience’ L itigation in U.S. , Fox News (May 17, 2021), https://www.foxnews.com/opinion/masterpiece-cakeshop-owner-rights-conscience-jack-phillips [https://perma.cc/8LS9-2RLB].

See, e.g. , Starkey v. Roman Cath. Archdiocese of Indianapolis, Inc., 496 F. Supp. 3d 1195 (S.D. Ind. 2020). Schools have also asserted a right to fire staff who use in vitro fertilization, a position with implications for LGBTQ+ family formation. Herx v. Diocese of Fort Wayne-South Bend, Inc., 48 F. Supp. 3d 1168 (N.D. Ind. 2014).

See, e.g. , Umphress v. Hall, 500 F. Supp. 3d 553 (N.D. Tex. 2020), appeal filed , No. 20-11216 (5th Cir. Dec. 11, 2020); Ermold v. Davis, 936 F.3d 429 (6th Cir. 2019), cert. denied , 141 S. Ct. 3 (2020).

Complaint, Texas Values v. City of Austin, No. D-1-GN-18-006108 , 2018 WL 4896373 (Tex. Dist. Ct. Oct. 6 , 2018) .

See Fulton v. City of Philadelphia, 141 S. Ct. 1868 (2021); Buck v. Gordon, 429 F. Supp. 3d 447 (W.D. Mich. 2019); Verified Complaint for Declaratory Judgment and Injunctive Relief, Cath. Charities W. Mich. v. Mich. Dep’t of Health & Hum. Servs., No. 2:19-cv-11661 (E.D. Mich. Apr. 24, 2019); Complaint, Welch v. U.S. Dep’t of Health & Hum. Servs., No. 6:19-cv-01567-TMC (D.S.C. May 30, 2019). For religious reasons, agencies have also refused to certify unmarried couples, see Fulton v. City of Philadelphia , 922 F.3d 140, 148 (3d Cir. 2019) (recounting Catholic Social Services’ recent practice), and turned families away based on their faith, see Complaint, Maddonna v. U.S. Dep’t of Health & Hum. Servs., No. 6:19-cv-03551-TMC (D.S.C. Dec. 20, 2019).

See N. Coast Women’s Care Med. Grp. v. San Diego Cnty. Superior Ct., 189 P.3d 959, 963 (Cal. 2008).

See, e.g. , Crisitello v. St. Theresa Sch., 242 A.3d 292 (N.J. Super. Ct. App. Div. 2020), cert. granted , 250 A.3d 1129 (N.J. 2021); Hamilton v. Southland Christian Sch., Inc., 680 F.3d 1316, 1320 (11th Cir. 2012); Vigars v. Valley Christian Ctr., 805 F. Supp. 802, 808-10 (N.D. Cal. 1992); Ganzy v. Allen Christian Sch., 995 F. Supp. 340, 350 (E.D.N.Y. 1998).

See, e.g ., Burwell v. Hobby Lobby Stores, 573 U.S. 682 (2014); Mary Tschann & Reni Soon, Contraceptive Coverage and the Affordable Care Act , 42 Obstetrics & Gynecology Clinics of N. Am. 605, 611 (2015) (“To date, 101 cases have been filed challenging the mandate.”); HHS Case Database , Becket , https://www.becketlaw.org/research-central/hhs-info-central/hhs-case-database [https://perma.cc/JGP2-SYQR] (listing cases filed challenging the rule on religious grounds).

See, e.g. , Cedar Park Assembly of God v. Kreidler, 458 F. Supp. 3d 1290, 1292 (W.D. Wash. 2020), rev’d in part , 2021 WL 3087873 (9th Cir. July 22, 2021); Skyline Wesleyan Church v. Cal. Dep’t of Managed Care, 968 F.3d 738 (9th Cir. 2020); Roman Cath. Diocese of Albany v. Vullo, 127 N.Y.S.3d 171 (App. Div. 2020), pet. for cert. filed sub nom. Roman Cath. Diocese of Albany v. Lacewell, No 20-1501 (U.S. Apr. 23, 2021); Complaint at 1-2, Ill. Baptist State Ass’n v. Ill. Dep’t of Ins., No. 2020MR000325 (Ill. Cir. Ct. June 10,2020).

See, e.g. , Complaint, Nat’l Inst. of Fam. & Life Advocs. v. Rauner, No. 3:16-cv-50310 (N.D. Ill. Sept. 29, 2016).

Access to abortion and contraception are, of course, central also to the lives of transgender men and some nonbinary people. This Essay talks of abortion and contraception for women because, to date, the Court’s conversation about their import, and the push for exemptions in this context, has focused on women. The threat to transgender people is much more frontal: It is a fight over transgender people’s right to exist and have rights. Questions of religious exemptions only arise after the core rights are established.

Planned Parenthood of Southeastern Pennsylvania v. Casey , 505 U.S. 833, 852 (1992) .

Reva Siegel has documented how suffrage met religious resistance based on women’s proper role in the family. Antisuffragists spoke of suffrage as “a revolt against the position and sphere assigned to woman by God himself.” Reva B. Siegel, She the People: The Nineteenth Amendment, Sex Equality, Federalism, and the Family , 115 Harv. L. Rev . 947, 981 n.96 (2002); see also id. at 978 (detailing faith-based objections to women’s suffrage).

Casey , 505 U.S. at 835.

Alliance Defending Freedom, a Christian legal organization that brings many suits pressing for religious exemptions and opposes LGBTQ+ and abortion rights, defines its vision of family in this way. See Marriage & Family , Alliance Defending Freedom , https://adflegal.org/issues/marriage/overview [https://perma.cc/8A4X-C82R].

The story was different in the nineteenth and early-twentieth centuries, when courts cited religious beliefs to justify slavery and segregation, as well as restrictions on women’s roles. For a recounting of this history, see Brief for Julian Bond et al. as Amici Curiae Supporting Petitioner at 10-27, Burwell v. Hobby Lobby Stores, Inc., 573 U.S. 682 (2014) (Nos. 13-354, 13-356); see also Brief for NAACP Legal Defense & Educational Fund, Inc. as Amici Curiae Supporting Respondents at 6-12, Masterpiece Cakeshop, Ltd. v. Colo. C.R. Comm’n, 138 S. Ct. 1719 (2018) (No. 16-111) (explaining how religious beliefs have historically been used to justify racial discrimination).

388 U.S. 1 (1967).

Id. at 3. One year later, the Court in Newman v. Piggie Park Enterprises, Inc. rejected faith-based objections to serving Black customers, in violation of the Civil Rights Act. 390 U.S. 400, 401 n.5 (1968).

Bob Jones Univ. v. United States, 461 U.S. 574, 580-81, 602-04 (1983).

Id . at 604 (footnote omitted).

Dole v. Shenandoah Baptist Church, 899 F.2d 1389, 1392 (4th Cir. 1990); see id. at 1393-99 (holding that a religious school’s policy of paying a head-of-household bonus only to men violated the Fair Labor Standards Act and rejecting the school’s free-exercise defense); EEOC v. Fremont Christian Sch., 781 F.2d 1362, 1364-69 (9th Cir. 1986) (holding that a religious school’s provision of health insurance only to heads of household, which excluded married women, violated Title VII and the Equal Pay Act and rejecting the school’s free-exercise defense).

Cath. Charities of Diocese of Albany v. Serio, 859 N.E.2d 459 (N.Y. 2006), cert. denied , 552 U.S. 816 (2007); Cath. Charities of Sacramento v. Superior Court, 85 P.3d 67 (Cal. 2004), cert. denied , 543 U.S. 816 (2004).

Stormans, Inc. v. Wiesman, 794 F.3d 1064, 1071 (9th Cir. 2015), cert. denied , 136 S. Ct. 2433 (2016).

Cervelli v. Aloha Bed & Breakfast, 415 P.3d 919, 923 (Haw. Ct. App. 2018); Elane Photography, LLC v. Willock, 309 P.3d 53, 58-59 (N.M. 2013), cert. denied , 572 U.S. 1046 (2014); Klein v. Or. Bureau Lab. & Indus., 410 P.3d 1051, 1056-57 (Or. Ct. App. 2019), vacated by 139 S. Ct. 2713 (2019); Washington v. Arlene’s Flowers, Inc., 441 P.3d 1203, 1210 (Wash. 2019), cert. denied , 141 S. Ct. 2884 (2021); Petition for Rehearing, supra note 14 .

N. Coast Women’s Care Med. Grp. v. Superior Ct., 189 P.3d 959, 962 (Cal. 2008).

See Swanner v. Anchorage Equal Rts. Comm’n, 874 P.2d 274, 278 n.4 (Alaska 1994); Smith v. Fair Emp. & Hous. Comm’n, 913 P.2d 909, 912 (Cal. 1996). But see Att’y Gen. v. Desilets, 636 N.E.2d 233, 234-35 (Mass. 1994) (remanding at the summary-judgment stage for the state to make a showing of compelling state interest).

See cases cited supra note 20.

Employment Division v. Smith , 494 U.S. 872, 881-90 (1990), changed the test used to evaluate free-exercise claims. Under Smith , burdens on religious exercise must serve a compelling state interest only if the law imposing the burden is not neutral and generally applicable. Id. at 885-86. Many recent petitions for certiorari that call for religious exemptions also ask the Court to overrule Smith . E.g. , Petition for Rehearing, supra note 14, at 9-11; Petition for a Writ of Certiorari at 31-34, Fulton v. City of Philadelphia, 141 S. Ct. 1868 (2021) (No. 18-2574).

573 U.S. 682, 690-91 (2014). In so ruling, the Court emphasized that the decision should result in zero harm to the intended beneficiaries of the contraceptive coverage rule. Id. at 693. The Court also indicated that the rule would not have been the least restrictive alternative, where the government could simply pay for contraceptives for employees of objecting entities, id. at 728-31, an approach markedly different from that of decisions from California and New York cited in note 36 supra .

578 U.S. 403 (2016). Nor did the Court embrace the claim. The point is that the decision is break from the earlier trend recounted above.

Our Lady of Guadalupe Sch. v. Morrissey-Berru, 140 S. Ct. 2049, 2071-72 (2020) (Sotomayor, J., dissenting).

138 S. Ct. 1719, 1725, 1729 (2018). This approach contrasts with that of the Court when confronted with racially biased statements of a juror, where there must be a showing that bias “cast serious doubt on the fairness and impartiality of the jury’s deliberations and resulting verdict,” Peña-Rodriguez v. Colorado, 137 S. Ct. 855, 869 (2017), or when confronted with statements of religious bias in the context of President Trump’s travel ban order, where the Court said it would “uphold the policy so long as it can reasonably be understood to result from a justification independent of unconstitutional grounds.” Trump v. Hawaii, 138 S. Ct. 2392, 2420 (2018).

141 S. Ct. 1868, 1874 (2021).

See, e.g. , Tandon v. Newsom, 141 S. Ct. 1294, 1296 (2021) ( per curiam ); Roman Cath. Diocese of Brooklyn v. Cuomo, 141 S. Ct. 63 (2020); but see Does 1-3 v. Mills, No. 21A90 (U.S. Oct. 29, 2021) (denying to enjoin the vaccination mandate for those who objected on religious grounds pending a decision on the petition for certiorari.).

Tandon , 141 S. Ct. at 1296.

Id. at 1297; see also id. at 1298 (Kagan, J., dissenting) (noting that the law does not require “that the State treat equally apples and watermelons”).

E.g. , Andrew R. Lewis, The Supreme Court Handed Conservatives a Narrow Religious Freedom Victory in Fulton v. City of Philadelphia, Wash. Post (June 18, 2021), https://www.washingtonpost.com/politics/2021/06/18/supreme-court-handed-conservatives-narrow-religious-freedom-victory-fulton-v-city-philadelphia [https://perma.cc/89KW-4TRM].

Compare Fulton , 141 S. Ct. 1868, with Bob Jones Univ. v. United States, 461 U.S. 574, 591 (1983) (emphasizing that government subsidies in the form of tax exemptions cannot support organizations that are “illegal or violate established public policy”).

See Fulton , 141 S. Ct. at 1886 (Alito, J., concurring) (“As far as the record reflects, no same-sex couple has ever approached CSS, but if that were to occur, CSS would simply refer the couple to another agency that is happy to provide that service.”). Compare id. (failing to acknowledge the stigmatic harm of being denied service on account of sexual orientation), with Price Waterhouse v. Hopkins, 490 U.S. 228, 265 (1989) (recognizing the stigmatic harm of being treated as inferior by virtue of the person’s race or sex), and J.E.B. v. Alabama ex rel. T.B., 511 U.S. 127, 142 (1994) (noting how discrimination can be an “assertion of . . . inferiority” that “denigrates the dignity of the excluded” (citation omitted)), and Heart of Atlanta Motel v. United States, 379 U.S. 241, 250 (1964) (emphasizing that the denial of service undermines human dignity).

Compare Burwell v. Hobby Lobby Stores, 573 U.S. 682 (2014) (finding a corporation’s religious freedom substantially burdened by facilitating contraception via providing insurance coverage, without regard for need for intervening action by provider and user), with Zelman v. Simmons-Harris, 536 U.S. 639, 654-55 (2002) (“[N]o reasonable observer would think a neutral program of private choice, where state aid reaches religious schools solely as a result of the numerous independent decisions of private individuals, carries with it the imprimatur of government endorsement.” (emphasis omitted)).

Some prominent proponents of LGBTQ+ rights call for compromise on questions of exemptions. William N. Eskridge, Jr. & Robin Fretwell Wilson, Prospects for Common Ground: Introduction , in Religious Freedom, LGBT Rights, and the Prospects for Common Ground ( William N. Eskridge, Jr. & Robin Fretwell Wilson eds., 2019); see also Andrew Koppelman, Gay Rights, Religious Accommodations, and the Purposes of Antidiscrimination Law , 88 S. Cal. L. Rev. 619 (2015). Notably, to the best of my knowledge, prominent advocates for reproductive rights make no such call.

Stanley v. Illinois, 405 U.S. 645 (1972).

Griswold v. Connecticut, 381 U.S. 479 (1965).

Roe v. Wade, 410 U.S. 113 (1973); Planned Parenthood of Southeastern Pennsylvania v. Casey , 505 U.S. 833 (1992).

Loving v. Virginia, 388 U.S. 1 (1967).

Obergefell v. Hodges, 576 U.S. 644 (2015).

Lawrence v. Texas, 539 U.S. 558, 574 (2003) (quoting Casey , 505 U.S. at 851).

New York v. U.S. Dep’t Health & Hum. Servs., 414 F. Supp. 3d 475, 539 (S.D.N.Y. 2019), appeal filed , No. 20-31 (S.D.N.Y. Jan. 3, 2020).

Melissa Murray, Consequential Sex: #MeToo, Masterpiece Cakeshop , and Private Sexual Regulation , 113 Nw. U. L. Rev. 825, 880 (2019) (emphasis omitted).

Id. at 881.

Douglas NeJaime & Reva Siegel, Conscience Wars in the Americas , 5 Latin Am. L. Rev. 1, 19 (2020). NeJaime and Siegel suggest limits on exemptions in an effort to ensure they do not function this way. The limits they propose—limiting exemptions to individuals who are directly involved in a service (as distinct from facilitating one)—would foreclose the exemptions discussed in this paper, as they involve claims made by institutions and facilitation. Id. at 20-21.

Obergefell v. Hodges, 576 U.S. 644, 672 (2015).

Dushku, supra note 6 , at 246-48.

Id. at 261-62.

Id. at 261. A look at the cases currently pending in the courts belies the notion that objections are rare, and there is no reason to assume that the number of entities refusing to comply with an antidiscrimination rule would not increase were the Court to say that it violates free exercise to require an institution to comply with a public-accommodations law, for example.

Id. at 264. Child-welfare experts reject a core premise underlying the proposal—that a “pluralistic solution” that permits agencies that discriminate to stay in the foster-care system is in the interest of foster children. The amicus brief in Fulton filed by major child-welfare professional groups strongly opposed permitting discrimination in the public child-welfare system and explained that jurisdictions that have enforced nondiscrimination provisions were able to meet the needs of children in foster care. Further, they wrote, permitting discrimination can reduce the number of families available for children. See Brief for Voice for Adoption et al. as Amici Curiae Supporting Respondents at 8-19, Fulton v. City of Philadelphia, 141 S. Ct. 1868 (2021) (No. 18-2574).

Dushku, supra note 6, at 266.

Id. at 262.

In that respect, government grants to houses of worship to further security are not comparable, nor are analogies to the protection houses of worship retain in hiring clergy even if they receive public funds. See id. at 263.

Of course, that is why the proposal calls for indirect funding of the scheme—to mask what is happening and to avoid the law that could otherwise govern. An indirect scheme of this nature is a radical departure from the foster-care system as it is currently funded. In the current system, states get federal money that they pay to agencies to perform government services; prospective foster and adoptive families do not pay any money to agencies.

Dushku’s Essay does not tangle with the prospect that the referral requirement will surely be challenged on free-exercise grounds.

When talking about exemptions, Dushku and others often focus on the challenges for people with faith-based objections to LGBTQ+ rights. One question is whether those calling for exemptions in this context similarly support exemptions for those who refuse to train women employees if doing so requires them to be alone with women for some period, contrary to their religious beliefs, see Complaint, Torres v. Carter, 2021 U.S. Dist. LEXIS 30145 (E .D.N.C. Feb. 18, 2021), or who object for reasons of faith to serving Muslims, see Complaint, Fatihah v. Neal, 2017 WL 2559943 ( E .D. Okla. Feb. 17, 2016).

Douglas NeJaime & Reva Siegel, Conscience Wars: Complicity-Based Conscience Claims in Religion and Politics , 124 Yale L.J. 2516, 2563 (2015); see also Ryan T. Anderson, The Defense of Marriage Isn’t Over , Daily Signal (Oct. 7, 2014), https://www.dailysignal.com/2014/10/07/defense-marriage-isnt [https://perma.cc/KRQ7-9VQ8]; Bishop James Conley, Hobby Lobby Decision Is Also a Mandate , S. Neb. Reg . (July 11, 2014), http://www.lincolndiocese.org/op-ed/bishop-s-column/2093-hobby-lobby-decision-is-also-a-mandate [http://perma.cc/L2F2-L88C]; Manhattan Declaration: A Call of Christian Conscience , Manhattan Declaration (Nov. 20, 2009), http://manhattandeclaration.org/man_dec_resources/Manhattan_Declaration_full_text.pdf [http://perma.cc/MGW8-7WTE].

See generally Settlement, Danquah v. Univ. of Med. & Dentistry N.J., No. 2:11-cv-06377-JLL-MAH (D.N.J. 2011) (featuring nurses objecting on religious grounds to providing services to patients pre- and post-abortion, including checking patients in and checking patient’s vital signs ).

I have advanced this argument previously . See Louise Melling, Religious Refusals to Public Accommodations Laws: Four Reasons to Say No , 38 Harv. J.L. & Gender 177, 185 (2015).

410 U.S. 113 (1973).

Health Programs Extension Act of 1973, Pub. L. No. 93-45, § 401, 87 Stat. 91, 95 (codified as amended at 42 U.S.C. § 300a-7 (2018)) (Church Amendments).

Refusing to Provide Health Services , Guttmacher Inst. (Sept. 1, 2021), https://www.guttmacher.org/state-policy/explore/refusing-provide-health-services [https://perma.cc/LRT6-UMAC].

Weldon Amendment, Consolidated Appropriations Act, 2021, Pub. L. No. 116-260, § 507(d)(1) (2020), 134 Stat 1182, 1622 (2020); see also, e.g. , 2017 Ill. Laws 099-0690 (codified as amended at Health Care Right of Conscience Act, 745 Ill. Comp. Stat. 70 /1-13 (2021)) (prohibiting liability for health-care professionals who refuse “to perform, assist, counsel, suggest, recommend, refer or participate in any way” because of conscience). NeJaime and Siegel trace this expansion of refusal measures to what they refer to as complicity-based conscience claims. See NeJaime & Siegel , supra note 78 , at 2516.

Complaint, Zawadski & Gaspari v. Brewer Funeral Servs., (Cir. Ct. Pearl River Cnty. Miss. Mar. 7, 2017), https://www.lambdalegal.org/sites/default/files/legal-docs/downloads/012_2017-03-07_first_amended_complaint.pdf [https://perma.cc/PY84-7RFH].

Brief Amicus Curiae of U.S. Conf. of Cath. Bishops, supra note 11 , at 5.

As Alexander Dushku details, the Supreme Court has recently taken care to emphasize the honorable premise of objections to marriage for same-sex couples. At the same time, others have sought to distance themselves from objections to racial integration and intermarriage on the ground those objections were racist and dishonorable. Recent work by Kyle Velte and Linda McClain show how the objections to racial integration were also sincere and mainstream. See Kyle C. Velte, Reclaiming the Race Analogy in Fulton v. City of Philadelphia, Balkinization (Nov. 13, 2020), https://balkin.blogspot.com/2020/11/reclaiming-race-analogy-in-fulton-v.html [https://perma.cc/WL2C-5DS4]; Kyle C. Velte, Recovering the Race Analogy in LGBTQ Religious Exemption Cases , 42 Cardozo L. Rev. 67 (2020); Linda C. McClain , Who’s the Bigot?: Learning from Conflicts over Marriage and Civil Rights Law (2020). The amicus briefs, supra note 30, detail how the courts as late as 1955 invoked religion to justify segregation.

Andrew Koppelman offers an answer that boils down to numerosity: So many institutions would have objected to racial integration on religious grounds that exempting objectors would have defeated the purpose of the Civil Rights Act. Andrew Koppelman, Gay Rights, Religious Liberty, and the Misleading Racism Analogy , 2020 BYU L. Rev. 1 (2020). That may well be the rationale that animated Congress at the time. But the stance raises many questions if we consider its implications now. Koppelman offers nothing to explain how much discrimination in a community is acceptable such that exemptions should be denied or granted. The question remains: What coherent story can be told to argue that the interest in nondiscrimination was compelling in cases addressing interracial marriage, integration of public accommodations, and women’s wages but not in cases concerning insurance coverage (which is a wage issue), access to public accommodations for same-sex couples, and access to government services for same-sex couples and people of other faiths ? See Roberts v. United States Jaycees, 468 U.S. 609, 624 (1984) (“[T]he State’s strong historical commitment to eliminating discrimination and assuring its citizens equal access to publicly available goods and services  . . .  plainly serves compelling state interests of the highest order .”).

Douglas NeJaime, Bigotry in Time: Race, Sexual Orientation, and Gender , 99 B.U. L. Rev. 2651, 2654-55 (reviewing McClain , supra note 87).

In other writings, Dushku has been more candid, for example, urging the Supreme Court to reject constitutional protection for marriage for same-sex couples and stating that any decision recognizing the right would convey “hostility toward religion.” Brief for Major Religious Orgs. as Amici Curiae Supporting Employers, Obergefell v. Hodges, 135 S. Ct. 2580 (2015). Supra note 90 (internal quotation omitted).

See Christopher J. Kelly, The Personal Is Political , Encyclopedia Britannica , https://www.britannica.com/topic/the-personal-is-political [https://perma.cc/SF8R-69F4].

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Religious Exemptions from Mandatory Vaccinations

All states require children to be immunized or to be in the process of receiving immunizations against certain contagious diseases before a child care facility or a school may admit them. For each state, the immunization schedule may be found in the state code or its administrative regulations, usually in the sections governing education (for schools) or public health (for child care facilities). Besides specific vaccine requirements, these schedules may also refer to the schedules provided by the United States Department of Health and Human Services , American Academy of Family Physicians , or American Academy of Pediatrics .

Where states significantly differ is in their recognition of exemptions from vaccination. All states grant a medical exemption to children who cannot be immunized for health reasons. For example, the administration of a vaccine may be contraindicated in children who are allergic to a component of the vaccine or have a suppressed immune system. These exemptions are specific to the vaccine and health condition, and remain so long as the contraindication lasts.

Additionally, 48 states and the District of Columbia permit parents to claim a non-scientific exemption, such as if their religious tenets or practices conflict with immunization or if their personal, philosophical or moral beliefs are opposed to immunization. The lone holdouts are Mississippi and West Virginia. However, in the event of an outbreak, child care facilities and schools may exclude children who have not been vaccinated against the disease until the end of the outbreak.

Verdict offers some insightful analysis into the issue of religious exemptions:

• How to Craft a Religious Exemption Regime Guaranteed to Be Dangerous for Children: The Case of Idaho . By Professor Marci A. Hamilton.
• The Deep Roots of the Left/Right Anti-Vaxxer Coalition . By Professor Michael C. Dorf.
• The Vaccine for Pollyanna Attitudes Toward Public Health and Religious Beliefs: Religious Exemptions for Vaccinations and Medical Neglect Need to Be Repealed Now and the Federal Government (and the Insurance Industry) Need to Incentivize the States to Do So . By Professor Marci A. Hamilton.

Below, you will find links to state codes, statutes and regulations governing the immunization of children who attend day care, child care, elementary schools, private schools and colleges.

Alabama School Immunization Law – AL Code § 16-30-1

• Medical Exemption : Certification by a competent medical authority providing individual exemption from the required immunization or testing is presented the admissions officer of the school.
• Religious Exemption : In the absence of an epidemic or immediate threat thereof, the parent or guardian of the child shall object thereto in writing on grounds that such immunization or testing conflicts with his religious tenets and practices.

Alabama School Immunization Regulations – Ala. Admin Code, Regulation 420-6-1

• Religious Exemption : A written objection from the parent or guardian of a student or child based on religious tenets and practices shall be submitted in person by the parent or guardian to the County Health Department for issuance of a Certificate of Religious Exemption from the required immunizations or testing.
• Medical Exemption : A written objection from the parent or guardian of a student or child based on religious tenets and practices shall be submitted in person by the parent or guardian to the County Health Department for issuance of a Certificate of Religious Exemption from the required immunizations or testing.

Alaska School Immunization Law – 4 AAC 06.055

• Medical Exemption: This section does not apply if the child has a statement signed by a doctor of medicine (M.D.), doctor of osteopathy (D.O.), physician assistant, or advanced nurse practitioner licensed to practice in this state, stating that immunizations would, in that individual’s professional opinion, be injurious to the health of the child or members of the child’s family or household.
• Religious Exemption: This section does not apply if the child has an affidavit signed by his parent or guardian affirming that immunization conflicts with the tenets and practices of the church or religious denomination of which the applicant is a member.

Arizona Child Care Immunization Law – AZ Rev Stat § 36-883

• Religious Belief Exemption : Any rule that relates to educational activities, physical examination, medical treatment or immunization shall include appropriate exemptions for children whose parents object on the ground that it conflicts with the tenets and practices of a recognized church or religious denomination of which the parent or child is an adherent or member.

Arizona School Immunization Law – AZ Rev Stat § 15-872

• Medical Exemption : The school administrator receives written certification that is signed by the parent or guardian and by a physician or a registered nurse practitioner, that states that one or more of the required immunizations may be detrimental to the pupil’s health and that indicates the specific nature and probable duration of the medical condition or circumstance that precludes immunization.
• Personal Belief Exemption : The parent or guardian of the pupil submits a signed statement to the school administrator stating that the parent or guardian has received information about immunizations provided by the department of health services and understands the risks and benefits of immunizations and the potential risks of nonimmunization and that due to personal beliefs, the parent or guardian does not consent to the immunization of the pupil.

Arizona Child Care and School Immunization Regulations – Ariz. Admin. Code R9-6-701

Arizona Child Care Immunization Regulations – Ariz. Admin. Code R9-5-305

Arkansas School Immunization Law – AR Code § 6-18-702

• Medical Exemption : If in the discretion of the health authority having jurisdiction or of any physician licensed to practice by the Arkansas State Medical Board any person to whom this section applies shall be deemed to have a physical disability that may contraindicate vaccination, a certificate to that effect issued by the health officer may be accepted in lieu of a certificate of vaccination, provided that the exemption shall not apply when the disability shall have been removed.
• Religious or Philosophical Beliefs Exemption : This section shall not apply if the parents or legal guardian of that child object thereto on the grounds that immunization conflicts with the religious or philosophical beliefs of the parent or guardian.

California School Immunization Law – CA Health & Safety Code § 120325

• Medical Exemption : If the parent or guardian files with the governing authority a written statement by a licensed physician to the effect that the physical condition of the child is such, or medical circumstances relating to the child are such, that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances that contraindicate immunization, that person shall be exempt from the requirements of Chapter 1 (commencing with Section 120325, but excluding Section 120380) and Sections 120400, 120405, 120410, and 120415 to the extent indicated by the physician’s statement.
• Personal Belief Exemption . Immunization of a person shall not be required for admission to a school or other institution listed in Section 120335 if the parent or guardian or adult who has assumed responsibility for his or her care and custody in the case of a minor, or the person seeking admission if an emancipated minor, files with the governing authority a letter or affidavit that documents which immunizations required by Section 120355 have been given and which immunizations have not been given on the basis that they are contrary to his or her beliefs.

California College Immunization Law – CA Health & Safety Code § 120390.5

• Medical Exemption : If a person seeking enrollment in an institution of higher education to which subdivision (a) is applicable, or the parent or guardian of a person seeking enrollment, files with the governing body a written statement by a physician and surgeon that the physical condition of the person or medical circumstances relating to the person are such that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances that contraindicate immunization, that person shall be exempt from the requirements of subdivision (a).
• Personal Belief Exemption : Immunization of a person shall not be required for admission to an institution of higher education to which subdivision (a) is applicable if any of the following persons files with the governing body of the educational institution a letter or affidavit stating that the immunization is contrary to the beliefs of either of the following: (1) The parent, guardian, or adult who has assumed responsibility for the care and custody of the person seeking admission, if that applicant is a minor who is not emancipated or who is 17 years of age or younger. (2) The person seeking admission, if that applicant is an emancipated minor or is 18 years of age.

Colorado School Immunization Law – CO Rev. Stat. § 25-4-901

Colorado College Immunization Law – CO Rev. Stat. § 25-4-902.5

• Medical Exemption : By submitting to the student’s school certification from a licensed physician or advanced practice nurse that the physical condition of the student is such that one or more specified immunizations would endanger his or her life or health or is medically contraindicated due to other medical conditions.
• Religious or Personal Belief Exemption : By submitting to the student’s school a statement of exemption signed by one parent or guardian or the emancipated student or student eighteen years of age or older that the parent, guardian, or student is an adherent to a religious belief whose teachings are opposed to immunizations or that the parent or guardian or the emancipated student or student eighteen years of age or older has a personal belief that is opposed to immunizations.

Colorado Immunization Regulations – 6 CCR 1009-2

• Medical Exemption : By submitting to the student’s school a Certificate of Immunization with the statement of medical exemption signed by an advanced practice nurse or physician licensed to practice medicine or osteopathic medicine in any state or territory of the United States indicating that the physical condition of the student is such that immunizations would endanger his/her life or health or is medically contraindicated due to other medical conditions.
• Religious Exemption : By submitting to the student’s school a Certificate of Immunization with the statement of religious exemption signed by the parent(s) or the emancipated student indicating that the parent(s) or emancipated student is an adherent to a religious belief whose teachings are opposed to immunizations.
• Personal Belief Exemption : By submitting to the student’s school a Certificate of Immunization with the statement of personal exemption signed by the parent(s) or the emancipated student indicating that the parent(s) or emancipated student has a personal belief that is opposed to immunizations.

Connecticut School Immunization Law – CT Gen Stat § 10-204a

• Medical Exemption : Any such child who presents a certificate from a physician, physician assistant or advanced practice registered nurse stating that in the opinion of such physician, physician assistant or advanced practice registered nurse such immunization is medically contraindicated because of the physical condition of such child shall be exempt from the appropriate provisions of this section.
• Religious Belief Exemption : Any such child who presents a statement from the parents or guardian of such child that such immunization would be contrary to the religious beliefs of such child shall be exempt from the appropriate provisions of this section.

Connecticut Child Care Immunization Law – CT Gen Stat § 19a-79

• Medical and Religious Belief Exemption : Including appropriate exemptions for children for whom such immunization is medically contraindicated and for children whose parents object to such immunization on religious grounds.

Connecticut College Immunization Law – CT Gen Stat § 10a-155

• Medical Exemption : Any such student who (1) presents a certificate from a physician or an advanced practice registered nurse stating that in the opinion of such physician or advanced practice registered nurse such immunization is medically contraindicated, shall be exempt from the appropriate provisions of this section.
• Religious Belief Exemption : Any such student who provides a statement that such immunization would be contrary to his religious beliefs shall be exempt from the appropriate provisions of this section.

Delaware School Immunization Law – 2 DE Code § 131

• Medical Exemption : Provision for exemption from any or all of the immunization program prescribed for a particular enrollee upon a written statement from a physician, i.e., medical doctor or doctor of osteopathy, stating that the enrollee should not receive the prescribed immunization or immunizations required in the basic series because of the reasonable certainty of a reaction detrimental to that person.
• Religious Belief Exemption . Provision for exemption from the immunization program for an enrollee whose parents or legal guardian, because of individual religious beliefs, reject the concept of immunization.

Delaware Child Care Immunization Law – 16 DE Admin. Code 4202

• Medical Exemption : Immunization requirements pursuant to sections 7.1.1 – 7.1.2 shall be waived for children whose physicians have submitted, in writing, that a specific immunizing agent would be detrimental to that child
• Religious Belief Exemption : Immunization requirements pursuant to sections 7.1.1 – 7.1.2 shall be waived for children whose parents or guardians present a notarized document that immunization is against their religious beliefs.

District of Columbia School Immunization Law – DC Code § 38-501

• Medical Exemption : No certification of immunization shall be required for the admission to a school of a student for whom the school has written certification by a private physician, his or her representative, or the public health authorities that immunization is medically inadvisable.
• Religious Belief Exemption : No certification of immunization shall be required for the admission to a school of a student for whom the responsible person objects in good faith and in writing, to the chief official of the school, that immunization would violate his or her religious beliefs.

Florida School Immunization Law – FL Stat § 1003.22

• Medical Exemption : A physician licensed under the provisions of chapter 458 or chapter 459 certifies in writing, on a form approved and provided by the Department of Health, that the child should be permanently exempt from the required immunization for medical reasons stated in writing, based upon valid clinical reasoning or evidence, demonstrating the need for the permanent exemption.
• Religious Belief Exemption : The provisions of this section shall not apply if the parent of the child objects in writing that the administration of immunizing agents conflicts with his or her religious tenets or practices.

Florida Child Care Immunization Law – FL Stat § 402.305

Florida College Immunization Law – FL Stat § 1006.69

• Exemption : An individual enrolled in a postsecondary educational institution who will be residing in on-campus housing shall provide documentation of vaccinations against meningococcal meningitis and hepatitis B unless the individual, if the individual is 18 years of age or older, or the individual’s parent, if the individual is a minor, declines the vaccinations by signing a separate waiver for each of these vaccines, provided by the institution, acknowledging receipt and review of the information provided.

Georgia School Immunization Law – O.C.G.A. 20-2-771

• Medical Exemption : If, after examination by the local board of health or any physician licensed under the laws of this state or of any other state having comparable laws governing the licensure of physicians, any child to whom this Code section applies is found to have any physical disability which may make vaccination undesirable, a certificate to that effect issued by the local board of health or such physician licensed under the laws of this or such other state may be accepted in lieu of a certificate of immunization and shall exempt the child from the requirement of obtaining a certificate of immunization until the disability is relieved.
• Religious Belief Exemption : This Code section shall not apply to a child whose parent or legal guardian objects to immunization of the child on the grounds that the immunization conflicts with the religious beliefs of the parent or guardian; however, the immunization may be required in cases when such disease is in epidemic stages. For a child to be exempt from immunization on religious grounds, the parent or guardian must first furnish the responsible official of the school or facility an affidavit in which the parent or guardian swears or affirms that the immunization required conflicts with the religious beliefs of the parent or guardian.

Georgia College Immunization Law – O.C.G.A. 31-12-3.2

Hawaii School Immunization Law – HI Rev Stat § 302A-1154

• Medical Exemption : A child may be exempted from the required immunizations if a licensed physician or physician assistant certifies that the physical condition of the child is such that immunizations would endanger the child’s life or health.
• Religious Belief Exemption : A child may be exempted from the required immunizations if any parent, custodian, guardian, or any other person in loco parentis to a child objects to immunization in writing on the grounds that the immunization conflicts with that person’s bona fide religious tenets and practices. Upon showing the appropriate school official satisfactory evidence of the exemption, no certificate or other evidence of immunization shall be required for entry into school.

Hawaii Immunization Law – HI Rev Stat § 325-32

• Medical Exemption : Section 325-32 shall be construed not to require the vaccination or immunization of any person for three months after a duly licensed physician, physician assistant, or an authorized representative of the department of health has signed two copies of a certificate stating the name and address of the person and that because of a stated cause the health of the person would be endangered by the vaccination or immunization, and has forwarded the original copy of the certificate to the person or, if the person is a minor or under guardianship, to the person’s parent or guardian, and has forwarded the duplicate copy of the certificate to the department for its files.
• Religious Belief Exemption : No person shall be subjected to vaccination, revaccination or immunization, who shall in writing object thereto on the grounds that the requirements are not in accordance with the religious tenets of an established church of which the person is a member or adherent, or, if the person is a minor or under guardianship, whose parent or guardian shall in writing object thereto on such grounds, but no objection shall be recognized when, in the opinion of the director of health, there is danger of an epidemic from any communicable disease.

Idaho School Immunization Law – ID Code § 39-4801

• Medical Exemption : Any minor child whose parent or guardian has submitted to school officials a certificate signed by a physician licensed by the state board of medicine stating that the physical condition of the child is such that all or any of the required immunizations would endanger the life or health of the child shall be exempt from the provisions of this chapter.
• Religious or Other Belief Exemption : Any minor child whose parent or guardian has submitted a signed statement to school officials stating their objections on religious or other grounds shall be exempt from the provisions of this chapter.

Idaho Child Care Immunization Law – ID Code § 39-1118

• Medical Exemption : Any minor child whose parent or guardian has submitted to officials of a licensed daycare facility a certificate signed by a physician licensed by the state board of medicine stating that the physical condition of the child is such that all or any of the required immunizations would endanger the life or health of the child shall be exempt from the provisions of this section.
• Religious or Other Belief Exemption : Any minor child whose parent or guardian has submitted a signed statement to officials of the daycare facility stating their objections on religious or other grounds shall be exempt from the provisions of this section.

Illinois School Immunization Law – 105 ILCS 5/27-8.1

• Medical Exemption : If the physical condition of the child is such that any one or more of the immunizing agents should not be administered, the examining physician, advanced practice nurse, or physician assistant responsible for the performance of the health examination shall endorse that fact upon the health examination form.
• Religious Belief Exemption : Parents or legal guardians who object to health, dental, or eye examinations or any part thereof, or to immunizations, on religious grounds shall not be required to submit their children or wards to the examinations or immunizations to which they so object if such parents or legal guardians present to the appropriate local school authority a signed statement of objection, detailing the grounds for the objection.

Illinois Child Care Immunization Law – 225 ILCS 10/7

• Religious Belief Exemption : Any standards involving immunization shall include appropriate exemptions for children whose parents object thereto on the grounds that they conflict with the tenets and practices of a recognized church or religious organization, of which the parent is an adherent or member, and for children who should not be subjected to immunization for clinical reasons.

Indiana School Immunization Law – IC 20-34-4-1

• Medical Exemption : If a physician certifies that a particular immunization required by this chapter or IC 20-34-4 is or may be detrimental to a student’s health, the requirements of this chapter or IC 20-34-4 for that particular immunization is inapplicable for the student until the immunization is found no longer detrimental to the student’s health.
• Religious Exemption : Except as otherwise provided, a student may not be required to undergo any testing, examination, immunization, or treatment required under this chapter or IC 20-34-4 when the child’s parent objects on religious grounds.

Indiana Child Care Center Immunization Law – IC 12-17.2-4-18.1

• Medical Exemption : A licensee meets the requirement of subsection (a) if the child’s physician provides documentation of a medical reason the child should not be immunized.
• Religious Belief Exemption : A licensee meets the requirement of subsection (a) if a child’s parent objects to immunizations for religious reasons; and provides documentation of the parent’s objection.

Indiana Child Care Homes Immunization Law – IC 12-17.2-5-18.1

Indiana Child Care Ministries Immunization Law – IC 12-17.2-6-11

• Medical Exemption : If a physician certifies that a particular immunization required by this section is or may be detrimental to the child’s health, the requirements of this section for that particular immunization are inapplicable to that child until the immunization is found to be no longer detrimental to the child’s health.
• Religious Belief Exemption : A child enrolled in a child care ministry may not be required to undergo an immunization required under this section if the parents object for religious reasons. The objection must be (1) made in writing; (2) signed by the child’s parent or guardian; and (3) delivered to the child care ministry.

Iowa Immunization Law – IA Code § 139A.8

• Medical Exemption : The applicant, or if the applicant is a minor, the applicant’s parent or legal guardian, submits to the admitting official a statement signed by a physician, advanced registered nurse practitioner, or physician assistant who is licensed by the board of medicine, board of nursing, or board of physician assistants that the immunizations required would be injurious to the health and well-being of the applicant or any member of the applicant’s family.
• Religious Belief Exemption : The applicant, or if the applicant is a minor, the applicant’s parent or legal guardian, submits an affidavit signed by the applicant, or if the applicant is a minor, the applicant’s parent or legal guardian, stating that the immunization conflicts with the tenets and practices of a recognized religious denomination of which the applicant is an adherent or member.

Kansas Child Care Immunization Law – KS Stat § 65-508

• Medical Exemption : The immunization requirement of subsection (d) shall not apply if one of the following is obtained: (1) Certification from a licensed physician stating that the physical condition of the child is such that immunization would endanger the child’s life or health.
• Religious Belief Exemption : The immunization requirement of subsection (d) shall not apply if one of the following is obtained: (2) a written statement signed by a parent or guardian that the parent or guardian is an adherent of a religious denomination whose teachings are opposed to immunizations.

Kansas School Immunization Law – KS Stat §72-5209

• Medical Exemption : As an alternative to the certification required, a pupil shall present an annual written statement signed by a licensed physician stating the physical condition of the child to be such that the tests or inoculations would seriously endanger the life or health of the child.
• Religious Belief Exemption : As an current to the certification required, a pupil shall present a written statement signed by one parent or guardian that the child is an adherent of a religious denomination whose religious teachings are opposed to such tests or inoculations.

Kentucky Student Immunization Law – KY Rev Stat § 158.035

Kentucky Immunization Law – KY Rev Stat § 214.034

• Medical Exemption : Nothing contained in KRS 158.035, 214.010, 214.020, 214.032 to 214.036, and 214.990 shall be construed to require the testing for tuberculosis or the immunization of any child at a time when, in the written opinion of his attending physician, such testing or immunization would be injurious to the child’s health.
• Religious Belief Exemption : Nothing contained in KRS 158.035, 214.010, 214.020, 214.032 to 214.036, and 214.990 shall be construed to require the testing for tuberculosis or the immunization of any child at a time when, in the written opinion of his attending physician, such testing or immunization would be injurious to the child’s health.

Louisiana School Immunization Law – LA Rev Stat § 17:170

• Medical, Religious and Philosophical Exemption. Medical, religious, and philosophic exemptions will be allowed for compliance with regulations concerning day care attendees and school enterers.

Louisiana College Immunization Law – LA Rev Stat § 17:170.1

• Medical Exemption : The provisions of Subsection A of this Section shall not apply to the following persons: (3) Any person who has submitted a written statement from a physician stating that the procedure is contraindicated for medical reasons or, if a minor, any person whose parent, tutor, or legal guardian has submitted such a statement.
• Religious or Personal Belief Exemption : The provisions of Subsection A of this Section shall not apply to the following persons: (1) Any person who is eighteen years of age or older and who signs a waiver provided by the postsecondary education institution stating that the person has received and reviewed the information provided pursuant to Subsection B of this Section and has chosen not to be vaccinated against meningococcal disease for religious or other personal reasons. (2) Any person who is a minor and whose parent, tutor, or legal guardian signs a waiver stating that the person has received and reviewed the information provided pursuant to Subsection B of this Section and has chosen for the student not to be vaccinated against meningococcal disease for religious or other personal reasons.

Maine Child Care Immunization Law – 10-148 CMR 32 § 17.

• Religious or Personal Belief Exemption : No child shall be required under this rule to have any such immunization if his/her parent(s) states in writing a sincere religious or philosophical belief that it is contrary to the immunization requirements of this rule.
• Medical Exemption : No child shall be required under this rule to have any such immunization if the child’s physician submits documentation that immunization against one or more of the diseases is medically inadvisable.

Maine School Immunization Law – ME Rev Stat § 6352

• Medical Exemption : The parent or the child provides a physician’s written statement that immunization against one or more of the diseases may be medically inadvisable.
• Philosophical or Religious Exemption . The parent states in writing a sincere religious belief that is contrary to the immunization requirement of this subchapter or an opposition to the immunization for philosophical reasons.

Maryland Family Day Care Immunization Regulations – COMAR 13A.15.03.02

Maryland Child Care Center Immunization Regulations – COMAR 13A.16.03.04

• Medical Exemption : A licensed physician or a health officer has determined that immunization is medically contraindicated according to accepted medical standards.
• Religious Exemption : The parent objects to the child’s immunization because it conflicts with the parent’s bona fide religious beliefs and practices.

Maryland School Immunization Regulations – COMAR 10.06.04.03

• Medical Exemption : requirements of Regulation .03 of this chapter do not apply to a student who presents a licensed physician’s or health officer’s written statement that the student’s immunization against a disease in Regulation .03 of this chapter is medically contraindicated.

Maryland Immunization Law – MD Educ Code § 7-403

• Religious Belief Exemption : Unless the Secretary declares an emergency or disease epidemic, the Department may not require the immunization of an individual if (1) The individual objects to immunization because it conflicts with the individual’s bona fide religious beliefs and practices; or (2) The individual is a minor and the individual’s parent or guardian objects to immunization because it conflicts with the parent or guardian’s bona fide religious beliefs and practices.

Massachusetts Immunization Law – MA Gen L ch 76 § 15

• Medical Exemption : A child shall be admitted to school upon certification by a physician that he has personally examined such child and that in his opinion the physical condition of the child is such that his health would be endangered by such vaccination or by any of such immunizations.
• Religious Belief Exemption : In the absence of an emergency or epidemic of disease declared by the department of public health, no child whose parent or guardian states in writing that vaccination or immunization conflicts with his sincere religious beliefs shall be required to present said physician’s certificate in order to be admitted to school.

Massachusetts School Immunization Regulations – 105 CMR 220.000

• Medical or Religious Belief Exemption : The requirements in 105 CMR 220.500 (A) and (B) shall not apply: (1) upon presentation of written documentation that the student meets the standards for medical or religious exemption set forth in M.G.L. c. 76, § 15.

Michigan Immunization Law – MI Comp L § 333.9205

Michigan Preschool Immunization Law – MI Comp L § 333.9211

Michigan School Immunization Law – MI Comp L § 333.9208

• Medical Exemption : A child is exempt from the requirements of this part as to a specific immunization for any period of time as to which a physician certifies that a specific immunization is or may be detrimental to the child’s health or is not appropriate.
• Religious or Personal Belief Exemption : A child is exempt from this part if a parent, guardian, or person in loco parentis of the child presents a written statement to the administrator of the child’s school or operator of the group program to the effect that the requirements of this part cannot be met because of religious convictions or other objection to immunization.

Michigan School Immunization Regulations Mich. Admin Code R. 325-176

• Medical Exemption: “Medical exemption” means a written statement from a physician that a vaccination is medically contraindicated for a particular child for a specified period of time.
• Religious or Personal Belief Exemption: “Religious or other exemption” means a written statement which is signed by the parent, guardian, or person in loco parentis of a child, which certifies that immunization is in conflict with religious or other convictions of the signer, and which includes the name and date of birth of the child.

Minnesota School Immunization Law – MN Stat § 121A.15

• Medical Exemption : If a statement, signed by a physician, is submitted to the administrator or other person having general control and supervision of the school or child care facility stating that an immunization is contraindicated for medical reasons or that laboratory confirmation of the presence of adequate immunity exists, the immunization specified in the statement need not be required.
• Personal Belief Exemption : If a notarized statement signed by the minor child’s parent or guardian or by the emancipated person is submitted to the administrator or other person having general control and supervision of the school or child care facility stating that the person has not been immunized as prescribed in subdivision 1 because of the conscientiously held beliefs of the parent or guardian of the minor child or of the emancipated person, the immunizations specified in the statement shall not be required.

Minnesota College Immunization Law – MN Stat § 135A.14

• Medical Exemption : An immunization listed in subdivision 2 is not required if the student submits to the administrator a statement signed by a physician that shows that, for medical reasons, the student did not receive an immunization.
• Personal Belief Exemption : If the student submits a notarized statement that the student has not been immunized as required in subdivision 2 because of the student’s conscientiously held beliefs, the immunizations described in subdivision 2 are not required.

Mississippi Immunization Law – MS Code § 41-23-37

• Medical Exemption : A certificate of exemption from vaccination for medical reasons may be offered on behalf of a child by a duly licensed physician and may be accepted by the local health officer when, in his opinion, such exemption will not cause undue risk to the community.

Missouri Child Care Immunization Law – MO Rev Stat § 210.003

• Medical Exemption : A medical exemption, by which a child shall be exempted from the requirements of this section upon certification by a licensed physician that such immunization would seriously endanger the child’s health or life.
• Personal Belief Exemption : A parent or guardian exemption, by which a child shall be exempted from the requirements of this section if one parent or guardian files a written objection to immunization with the day care administrator.

Missouri School Immunization Law – MO Rev Stat § 167.181

• Medical and Religious Belief Exemption : This section shall not apply to any child if one parent or guardian objects in writing to his school administrator against the immunization of the child, because of religious beliefs or medical contraindications.

Montana School Immunization Law – MT Code § 20-5-403

• Medical Exemption : When a parent, guardian, or adult who has the responsibility for the care and custody of a minor seeking to attend school or the person seeking to attend school, if an adult, files with the governing authority a written statement signed by a physician licensed to practice medicine in any jurisdiction of the United States or Canada stating that the physical condition of the person seeking to attend school or medical circumstances relating to the person indicate that some or all of the required immunizations are not considered safe and indicating the specific nature and probable duration of the medical condition or circumstances that contraindicate immunization, the person is exempt from the requirements of this part to the extent indicated by the physician’s statement. The statement must be maintained as part of the person’s immunization records.
• Religious Exemption : When a parent, guardian, or adult who has the responsibility for the care and custody of a minor seeking to attend school or the person seeking to attend school, if an adult, signs and files with the governing authority, prior to the commencement of attendance each school year, a notarized affidavit on a form prescribed by the department stating that immunization is contrary to the religious tenets and practices of the signer, immunization of the person seeking to attend the school may not be required prior to attendance at the school. The statement must be maintained as part of the person’s immunization records. A person who falsely claims a religious exemption is subject to the penalty for false swearing provided in 45-7-202.

Montana Day Care Immunization Regulations – Mont. Admin. R. 37.95.140

• Medical Exemption : A child seeking to attend a day care facility is not required to have any immunizations which are medically contraindicated. A written and signed statement from a physician that an immunization is medically contraindicated will exempt a person from the applicable immunization requirements of this rule.
• Religious Belief Exemption : A child under five years of age seeking to attend a day care facility is not required to be immunized against Haemophilus influenza type B if the parent or guardian of the child objects thereto in a signed, written statement indicating that the proposed immunization interferes with the free exercise of the religious beliefs of the person signing the statement.

Montana School Immunization Regulation – Mont. Admin. R. 37.114.7

• Medical Exemption : A prospective pupil seeking to attend school is not required to have any immunizations which are medically contraindicated. A written and signed statement from a physician that an immunization is medically contraindicated will exempt a prospective pupil from those immunization requirements as deemed necessary by the physician.
• Religious Belief Exemption : A prospective pupil seeking to attend school is exempt from all or part of the immunization requirements if the parent or guardian of that prospective pupil, an adult responsible for that prospective pupil, or the prospective pupil if an adult or an emancipated minor, objects thereto in a signed, written statement indicating that the proposed immunization interferes with the free exercise of the religious beliefs of the person signing the statement.

Nebraska Child Care Immunization Law – NE Code § 71-1913.01.

• Medical Exemption : certification by a physician, an advanced practice registered nurse practicing under and in accordance with his or her respective certification act, or a physician assistant that immunization is not appropriate for a stated medical reason.
• Personal Belief Exemption : a written statement that the parent or guardian does not wish to have such child so immunized and the reasons therefor.

Nebraska School Immunization Law – NE Code § 79-217

• Medical Exemption : A statement signed by a physician, a physician assistant, or an advanced practice registered nurse practicing under and in accordance with his or her respective certification act, stating that, in the health care provider’s opinion, the immunizations required would be injurious to the health and well-being of the student or any member of the student’s family or household.
• Religious Belief Exemption : An affidavit signed by the student or, if he or she is a minor, by a legally authorized representative of the student, stating that the immunization conflicts with the tenets and practice of a recognized religious denomination of which the student is an adherent or member or that immunization conflicts with the personal and sincerely followed religious beliefs of the student.

Nebraska College Immunization Law – NE Code § 85-902

Nevada School Immunization Law – NV Rev Stat § 392.435

• Medical Exemption : If the medical condition of a child will not permit the child to be immunized to the extent required by NRS 392.435 and a written statement of this fact is signed by a licensed physician and by the parents or guardian of the child, the board of trustees of the school district or governing body of the charter school in which the child has been accepted for enrollment shall exempt the child from all or part of the provisions of NRS 392.435, as the case may be, for enrollment purposes.
• Religious Exemption : A public school shall not refuse to enroll a child as a pupil because the child has not been immunized pursuant to NRS 392.435 if the parents or guardian of the child has submitted to the board of trustees of the school district or the governing body of a charter school in which the child has been accepted for enrollment a written statement indicating that their religious belief prohibits immunization of such child or ward.

Nevada Private School Immunization Law – NV Rev Stat § 394.192

• Medical Exemption : If the medical condition of a child will not permit the child to be immunized to the extent required by NRS 394.192, a written statement of this fact signed by a licensed physician and presented to the governing body by the parents or guardian of such child shall exempt such child from all or part of the provisions of NRS 394.192, as the case may be, for enrollment purposes.
• Religious Belief Exemption : A private school shall not refuse to enroll a child as a pupil because such child has not been immunized pursuant to NRS 394.192 if the parents or guardian of such child have submitted to the governing body a written statement indicating that their religious belief prohibits immunization of such child or ward.

New Hampshire Immunization Law – NH Rev Stat § 141-C:20-a

• Medical Exemption : A child shall be exempt from immunization if a physician licensed under RSA 329, or a physician exempted under RSA 329:21, III, certifies that immunization against a particular disease may be detrimental to the child’s health. The exemption shall exist only for the length of time, in the opinion of the physician, such immunization would be detrimental to the child. An exemption from immunization for one disease shall not affect other required immunizations.
• Religious Belief Exemption : A child shall be exempt from immunization ifa parent or legal guardian objects to immunization because of religious beliefs. The parent or legal guardian shall sign a notarized form stating that the child has not been immunized because of religious beliefs.

New Jersey College Immunization Law – NJ Rev Stat § 18A:61D-1

See also Meningococcal and Hepatitis B vaccine requirements, as well as exemptions from such vaccines.

• Medical Exemption : A student who submits to the institution a written statement that an immunization is medically contraindicated shall submit a valid immunization record of other administered immunizations in accordance with regulations promulgated by the department.
• In-State Student Exemption : An institution may, in accordance with regulations promulgated by the department, exempt from the requirements of section 1 of P.L.1988, c.158 (C.18A:61D-1) any student who attended an elementary or secondary school located in this State.
• Religious Belief Exemption : A student who submits to the institution of higher education a written statement that immunization conflicts with his religious beliefs shall not be required to submit a list of immunizations to the institution as a condition of admission or continued enrollment.

New Jersey High School Hepatitis B Immunization Law

New Jersey School Immunization Law – NJ Rev Stat § 26:1A-9

• Medical Exemption : A child shall not be required to receive a pertussis vaccine as a condition for admission to a public or private school if the child’s health care provider states in writing that the vaccine is medically contraindicated pursuant to subsection b. (1) of section 2 of this act and the reasons for the medical contradictions.
• Religious Belief Exemption : Provisions in the State Sanitary Code in implementation of this act shall provide for exemption for pupils from mandatory immunization if the parent or guardian of the pupil objects thereto in a written statement signed by the parent or guardian upon the ground that the proposed immunization interferes with the free exercise of the pupil’s religious rights.

New Mexico School Immunization Law – NM Stat § 24-5-1

• Medical Exemption : Any minor child through his parent or guardian may file with the health authority charged with the duty of enforcing the immunization laws: (1) a certificate of a duly licensed physician stating that the physical condition of the child is such that immunization would seriously endanger the life or health of the child.
• Religious Belief Exemption : Any minor child through his parent or guardian may file with the health authority charged with the duty of enforcing the immunization laws: (2) affidavits or written affirmation from an officer of a recognized religious denomination that such child’s parents or guardians are bona fide members of a denomination whose religious teaching requires reliance upon prayer or spiritual means alone for healing; or (3) affidavits or written affirmation from his parent or legal guardian that his religious beliefs, held either individually or jointly with others, do not permit the administration of vaccine or other immunizing agent.

New York School Immunization Law – NY Educ L § 914

New York Child Care and School Immunization Law – NY Pub Health L § 2164

• Medical Exemption : If any physician licensed to practice medicine in this state certifies that such immunization may be detrimental to a child’s health, the requirements of this section shall be inapplicable until such immunization is found no longer to be detrimental to the child’s health.
• Religious Belief Exemption : This section shall not apply to children whose parent, parents, or guardian hold genuine and sincere religious beliefs which are contrary to the practices herein required, and no certificate shall be required as a prerequisite to such children being admitted or received into school or attending school.

New York College Immunization Law – NY Pub Health L § 2165

See also New York Meningococcal Meningitis Immunization Law .

• Medical Exemption : If any licensed physician or nurse practitioner certifies that such immunization may be detrimental to the person’s health or is otherwise medically contraindicated, the requirements of this section shall be inapplicable until such immunization is found no longer to be detrimental to such person’s health or is no longer medically contraindicated.
• Religious Belief Exemption : This section shall not apply to a person who holds genuine and sincere religious beliefs which are contrary to the practices herein required, and no certificate shall be required as a prerequisite to such person being admitted or received into or attending an institution.

North Carolina Immunization Law – NC Gen Stat § 130A-152

North Carolina School Immunization Law – NC Gen Stat § 130A-155

• Medical Exemption : The Commission for Public Health shall adopt by rule medical contraindications to immunizations required by G.S. 130A-152. If a physician licensed to practice medicine in this State certifies that a required immunization is or may be detrimental to a person’s health due to the presence of one of the contraindications adopted by the Commission, the person is not required to receive the specified immunization as long as the contraindication persists.
• Religious Exemption : If the bona fide religious beliefs of an adult or the parent, guardian or person in loco parentis of a child are contrary to the immunization requirements contained in this Chapter, the adult or the child shall be exempt from the requirements.

North Dakota School Immunization Law – N.D.C.C. § 27-07-17.1

• Medical or Religious, Philosophical, or Moral Belief Exemption : Any minor child, through the child’s parent or guardian, may submit to the institution authorities either a certificate from a licensed physician stating that the physical condition of the child is such that immunization would endanger the life or health of the child or a certificate signed by the child’s parent or guardian whose religious, philosophical, or moral beliefs are opposed to such immunization. The minor child is then exempt from the provisions of this section.

Ohio School Immunization Law – Ohio Rev Code § 3313.67

• Medical Exemption : A child whose physician certifies in writing that such immunization against any disease is medically contraindicated is not required to be immunized against that disease.
• Religious Belief Exemption : A pupil who presents a written statement of the pupil’s parent or guardian in which the parent or guardian declines to have the pupil immunized for reasons of conscience, including religious convictions, is not required to be immunized.

Ohio College Immunization Law – Ohio Rev Code § 1713.55

Ohio Child Care Immunization Regulations – Ohio Admin. Code 5101:2-12-37.

Oklahoma Child Care Immunization Law – 10 O.S. § 10-411

• Medical Exemption : Any minor child, through his or her parent or guardian, may submit to the health authority charged with the enforcement of the immunization laws, a certificate of a licensed physician stating that the physical condition of the child is such that immunization would endanger the life or health of the child.
• Religious Belief Exemption : Upon receipt of a written statement by the parent or guardian objecting to such immunizations because of religious or other reasons, then such child shall be exempt from the provisions of this act.

Oklahoma School Immunization Law – 70 O.S. § 70-1210.191

• Medical Exemption : Any minor child, through the parent, guardian, or legal custodian of the child, may submit to the health authority charged with the enforcement of the immunization laws of this state: 1. A certificate of a licensed physician as defined in Section 725.2 of Title 59 of the Oklahoma Statutes, stating that the physical condition of the child is such that immunization would endanger the life or health of the child; whereupon the child shall be exempt from the immunization laws of this state.
• Religious Belief Exemption : Any minor child, through the parent, guardian, or legal custodian of the child, may submit to the health authority charged with the enforcement of the immunization laws of this state: 2. A written statement by the parent, guardian or legal custodian of the child objecting to immunization of the child; whereupon the child shall be exempt from the immunization laws of this state.

Oklahoma College Immunization Law – 70 O.S. § 70-3244

• Medical Exemption : A written statement from a licensed physician indicating that a vaccine is medically contraindicated shall exempt a student from the vaccination.
• Religious or Moral Belief Exemption : A student shall be exempt from the vaccination if the student submits a written, signed statement declaring that the administration of the vaccine conflicts with the student’s moral or religious tenets or, if the student is a minor, the student’s parent or guardian provides a written statement that the administration of the vaccine conflicts with the parent’s or guardian’s moral or religious tenets.

Oregon School Immunization Law – OR Rev Stat § 433.267

• Medical Exemption : A document signed by a physician or a representative of the local health department stating that the child should be exempted from receiving specified immunization because of indicated medical diagnosis.
• Religious or Philosophical Belief Exemption : A document, on a form prescribed by the authority by rule and signed by the parent of the child, stating that the parent is declining one or more immunizations on behalf of the child. A document submitted under this paragraph: (A) May include the reason for declining the immunization, including whether the parent is declining the immunization because of a religious or philosophical belief; and (B) Must include either: (i) A signature from a health care practitioner verifying that the health care practitioner has reviewed with the parent information about the risks and benefits of immunization that is consistent with information published by the Centers for Disease Control and Prevention and the contents of the vaccine educational module approved by the authority pursuant to rules adopted under ORS 433.273; or (ii) A certificate verifying that the parent has completed a vaccine educational module approved by the authority pursuant to rules adopted under ORS 433.273.

Oregon College Immunization Law – OR Rev Stat § 433.282

Oregon Community College Immunization Law – OR Rev Stat § 433.283

Oregon School Immunization Regulations – OAR 333-050-0010

• Medical Exemption : “Medical Exemption” means a document signed by a physician or an authorized representative of the local health department stating that the child should be exempted from receiving specified immunizations based on a medical diagnosis resulting from a specific medical contraindication.
• Personal Belief Exemption : “Nonmedical Exemption” means a document, on a form prescribed by the Public Health Division, signed by the parent stating that the parent is declining one or more immunizations on behalf of the child, and including documentation of completion of the vaccine educational module or a signature from a health care practitioner verifying discussion of risks and benefits of immunization.

Pennsylvania School Immunization Law – 1949, Act 14 § 1303

• Medical Exemption : The provisions of this section shall not apply in the case of any child deemed to have a medical contraindication which may contraindicate immunization and so certified by a physician. Such certificates may be accepted in lieu of a certificate of immunization.
• Religious Exemption : The provisions of this section shall not apply in the case of any child whose parent or guardian objects in writing to such immunization on religious grounds.

Pennsylvania Immunization Regulations – 28 Pa. Code § 23.81

• Medical Exemption : Children need not be immunized if a physician or the physician’s designee provides a written statement that immunization may be detrimental to the health of the child. When the physician determines that immunization is no longer detrimental to the health of the child, the child shall be immunized according to this subchapter.
• Religious Exemption : Children need not be immunized if the parent, guardian or emancipated child objects in writing to the immunization on religious grounds or on the basis of a strong moral or ethical conviction similar to a religious belief.

Rhode Island School Immunization Law – RI Gen L § 16-38-2

• Medical Exemption : A certificate from a licensed physician stating that the person is not a fit subject for immunization for medical reasons.
• Religious Belief Exemption : a certificate signed by the pupil, if over eighteen (18) years of age, or by the parent or guardian stating that immunization and/or testing for communicable diseases is contrary to that person’s religious beliefs.

Rhode Island Child Care Immunization Law – RI Gen L § 42-72.1-3

Rhode Island School Immunization Regulations

K-12 Exemptions :

• Medical Exemption : A physician, a physician assistant, a certified registered nurse practitioner, or other licensed practitioner acting within his/her scope of practice signs the Rhode Island Department of Health’s “Medical Immunization Exemption Certificate” provided by the school attesting that the student is exempt from a specific vaccine because of medical reasons, in accordance with ACIP recommendations; or
• Religious Belief Exemption : A parent or guardian completes and signs the Department’s “Religious Immunization Exemption Certificate” provided by the school, attesting that immunization conflicts with the tenets of their religious beliefs.

College Exemptions :

• Medical Exemption : A physician, physician assistant, certified registered nurse practitioner, or other licensed practitioner acting within his/her scope of practice signs the Department’s “Medical Immunization Exemption Certificate” provided by the college/university attesting that the student is exempt from a specific vaccine because of medical reasons, in accordance with ACIP guidelines.
• Religious Belief Exemption : A parent or guardian or student (if eighteen) 18 years of age or older) completes and signs the Department’s “Religious Immunization Exemption Certificate” provided by the college/university, attesting that immunization conflicts with the tenets of their religious beliefs.

South Carolina School Immunization Law – SC Code § 44-29-180

South Carolina Department of Health and Environmental Control Regulation 61-8, as amended, “Vaccination, Screening and Immunization Regarding Contagious Diseases”, and its exemptions apply to this section.

South Carolina School Immunization Regulations – S.C. Code Reg. 61-8.

• Medical Exemption : A Medical Exemption, may be granted when a licensed physician has determined, for medical reasons, that a particular vaccine(s) required by this regulation is not advisable for the child. The exemption is granted when the physician or his/her authorized representative completes and signs the South Carolina Certificate of Immunization containing the Medical Exemption. The physician must indicate whether the exemption is permanent or temporary. If the exemption is temporary, an updated South Carolina Certificate of Immunization showing proof of immunization must be presented to the school or childcare by the end of the exemption period.
• Religious Belief Exemption : A South Carolina Certificate of Religious Exemption may be granted to any student whose parent, guardian, or person in loco parentis signs the appropriate section of the South Carolina Certificate of Religious Exemption stating that one or more immunizations conflicts with their religious beliefs. The Certificate of Religious Exemption form may only be obtained from the local health department.

South Dakota School Immunization Law – SD Codified L § 13-28-7.1

• Medical Exemption : Certification from a licensed physician stating the physical condition of the child would be such that immunization would endanger the child’s life or health.
• Religious Belief Exemption : A written statement signed by one parent or guardian that the child is an adherent to a religious doctrine whose teachings are opposed to such immunization.

South Dakota College Immunization Law – SD Codified L § 13-53-47

• Medical Exemption : As an alternative to the requirement for a physician’s certification, the student may present: (1) Certification from a licensed physician stating the physical condition of the student would be such that immunization would endanger the student’s life or health.
• Religious Belief Exemption : As an alternative to the requirement for a physician’s certification, the student may present: (4) A written statement signed by the student that the student is an adherent to a religious doctrine whose teachings are opposed to such immunizations. If the student is under the age of eighteen, the written statement shall be signed by one parent or guardian.

Tennessee Immunization Law – TN Code Ann. § 37-10-401

• Religious Belief Exemption : In the absence of an epidemic or immediate threat thereof, this section does not apply to any child whose parent or guardian files with proper authorities a signed, written statement that such immunization and other preventative measures conflict with the religious tenets and practices of the parent or guardian affirmed under penalties of perjury.

Tennessee School Immunization Law – TN Code Ann. § 49-6-5001

• Medical Exemption : No child shall be denied admission to any school or school facility if the child has not been immunized due to medical reasons if the child has a written statement from the child’s doctor excusing the child from the immunization.
• Religious Belief Exemption : In the absence of an epidemic or immediate threat of an epidemic, this section shall not apply to any child whose parent or guardian files with school authorities a signed, written statement that the immunization and other preventive measures conflict with the parent’s or guardian’s religious tenets and practices, affirmed under the penalties of perjury.

Tennessee Immunization Regulations – Tenn. Comp. R. & Regs.1200-14-01-.29

• Medical Exemption : Where a physician licensed by the Board of Medical Examiners, the Board of Osteopathic Examiners or a public health nurse employed by a local Health Department determines that a particular vaccine is contraindicated for one of the following reasons: 1. the individual meets the criteria for contraindication set forth in the manufacturer’s vaccine package insert; or 2. the individual meets the criteria for contraindication published by the U.S. Centers for Disease Control or the ACIP; 3. in the best professional judgment of the physician, based upon the individual’s medical condition and history, the risk of harm from the vaccine outweighs the potential benefit.
• Religious Belief Exemption : Where a parent or guardian, or in the case of an adult student, the student, provides to the school a written statement, affirmed under penalties of perjury, that vaccination conflicts with the religious tenets and practices of the parent or guardian, or in the case of an adult student, the student.

Texas Immunization Law – Tex. Health & Safety § 161.004

• Medical Exemption : A child is exempt from an immunization required by this section if the immunization is medically contraindicated based on the opinion of a physician licensed by any state in the United States who has examined the child.
• Religious Belief Exemption : A child is exempt from an immunization required by this section if a parent, managing conservator, or guardian states that the immunization is being declined for reasons of conscience, including a religious belief.

Texas School Immunization Law – Tex. Educ. Code § 38.001

• Medical Exemption : Immunization is not required for a person’s admission to any elementary or secondary school if the person applying for admission: (1) submits to the admitting official: (A) an affidavit or a certificate signed by a physician who is duly registered and licensed to practice medicine in the United States, in which it is stated that, in the physician’s opinion, the immunization required poses a significant risk to the health and well-being of the applicant or any member of the applicant’s family or household; or
• Religious or Personal Belief Exemption : Immunization is not required for a person’s admission to any elementary or secondary school if the person applying for admission: (1) submits to the admitting official: (B) an affidavit signed by the applicant or, if a minor, by the applicant’s parent or guardian stating that the applicant declines immunization for reasons of conscience, including a religious belief.

Texas College Immunization Law – Tex. Educ. Code § 51.933

• Medical Exemption : No form of immunization is required for a person’s admission to an institution of higher education if the person applying for admission submits to the admitting official an affidavit or a certificate signed by a physician who is duly registered and licensed to practice medicine within the United States in which it is stated that, in the physician’s opinion, the immunization required poses a significant risk to the health and well-being of the applicant or any member of the applicant’s family or household.
• Religious Belief Exemption : No form of immunization is required for a person’s admission to an institution of higher education if the person applying for admission submits to the admitting official an affidavit signed by the applicant or, if a minor, by the applicant’s parent or guardian stating that the applicant declines immunization for reasons of conscience, including a religious belief.

Texas Child Care Immunization Law – Tex. Hum. Res. Code § 42.043

• Medical Exemption : No immunization may be required for admission to a facility regulated under this chapter if a person applying for a child’s admission submits one of the following affidavits: (1) an affidavit signed by a licensed physician stating that the immunization poses a significant risk to the health and well-being of the child or a member of the child’s family or household
• Religious Belief Exemption : No immunization may be required for admission to a facility regulated under this chapter if a person applying for a child’s admission submits one of the following affidavits: (2) an affidavit signed by the child’s parent or guardian stating that the applicant declines immunization for reasons of conscience, including a religious belief.

Texas Immunization Regulations – 25 Tex. Admin. Code § 97.61

• Medical Exemption : To claim an exclusion for medical reasons, the child or student must present a statement signed by the child’s physician (M.D. or D.O.), duly registered and licensed to practice medicine in the United States who has examined the child, in which it is stated that, in the physician’s opinion, the vaccine required is medically contraindicated or poses a significant risk to the health and well-being of the child or any member of the child’s household. Unless it is written in the statement that a lifelong condition exists, the exemption statement is valid for only one year from the date signed by the physician.
• Religious Belief Exemption : To claim an exclusion for reasons of conscience, including a religious belief, a signed affidavit must be presented by the child’s parent or legal guardian, stating that the child’s parent or legal guardian declines vaccinations for reasons of conscience, including because of the person’s religious beliefs. The affidavit will be valid for a two-year period. The child, who has not received the required immunizations for reasons of conscience, including religious beliefs, may be excluded from school in times of emergency or epidemic declared by the commissioner of public health.

Utah School Immunization Law – UT Code § 53A-11-301

• Medical Exemption : A student is exempt from receiving the required immunizations if there is presented to the appropriate official of the school one or more of the following: a certificate from a licensed physician stating that due to the physical condition of the student one or more specified immunizations would endanger the student’s life or health.
• Personal Belief Exemption : A student is exempt from receiving the required immunizations if there is presented to the appropriate official of the school one or more of the following: A completed form obtained at the local health department where the student resides, providing: (i) the information required under Subsection 53A-11-302.5 (1); and (ii) a statement that the person has a personal belief opposed to immunizations, which is signed by one of the individuals listed in Subsection 53A-11-302(3)(c) and witnessed by the local health officer or his designee.
• Religious Belief Exemption : A student is exempt from receiving the required immunizations if there is presented to the appropriate official of the school one or more of the following: a statement that the person is a bona fide member of a specified, recognized religious organization whose teachings are contrary to immunizations, signed by one of the following persons: (i) one of the student’s parents; (ii) the student’s guardian; (iii) a legal age brother or sister of a student who has no parent or guardian; or (iv) the student, if of legal age.

Utah School Immunization Regulations – Utah Admin. Code r. 396-100-3

• Exemptions : A parent claiming an exemption to immunization for medical, religious or personal reasons, as allowed by Section 53A-11-302, shall provide to the student’s school or early childhood program the required completed forms. The school or early childhood program shall attach the forms to the student’s USIR.

Vermont School Immunization Law – 18 V.S.A. § 1121

• Medical Exemption : Notwithstanding subsections 1121(a) and (b) of this title, a person may remain in school or in the child care facility without a required immunization: (2) If a health care practitioner, licensed to practice in Vermont and authorized to prescribe vaccines, certifies in writing that a specific immunization is or may be detrimental to the person’s health or is not appropriate, provided that when a particular vaccine is no longer contraindicated, the person shall be required to receive the vaccine.
• Religious or Personal Belief Exemption : Notwithstanding subsections 1121(a) and (b) of this title, a person may remain in school or in the child care facility without a required immunization: (3) If the person or, in the case of a minor, the person’s parent or guardian annually provides a signed statement to the school or child care facility on a form created by the Vermont department of health that the person, parent, or guardian: (A) holds religious beliefs or philosophical convictions opposed to immunization; (B) has reviewed and understands evidence-based educational material provided by the department of health regarding immunizations, including information about the risks of adverse reactions to immunization; (C) understands that failure to complete the required vaccination schedule increases risk to the person and others of contracting or carrying a vaccine-preventable infectious disease; and (D) understands that there are persons with special health needs attending schools and child care facilities who are unable to be vaccinated or who are at heightened risk of contracting a vaccine-preventable communicable disease and for whom such a disease could be life-threatening.

Vermont Immunization Regulations – Vt. Code R. 13 140 021

• Medical Exemption: Persons are exempt from these regulations provided they meet one or more of the following exemptions as defined in 18 V.S.A. § 1122 (a) or, in the case of non-recurring childcare services, in the Department for Children and Families Early Childhood Program Licensing Regulations: (a) If the person or, in the case of a minor, the person’s parent or guardian, presents a Department-supplied form, signed by a health care practitioner authorized to prescribe vaccines, indicating a specific immunization is or may be detrimental to the person’s health or is not appropriate, provided that when a particular vaccine is no longer contraindicated, the person shall be required to receive the vaccine. The form must include the reason for the contraindication and the time period for which the immunization is contraindicated. This form shall be maintained by the child care facility or school as part of the child’s or student’s immunization record.
• Religious Belief Exemption: Persons are exempt from these regulations provided they meet one or more of the following exemptions as defined in 18 V.S.A. § 1122 (a) or, in the case of non-recurring childcare services, in the Department for Children and Families Early Childhood Program Licensing Regulations: (b) If the person or, in the case of a minor, the person’s parent or guardian, annually provides a signed statement to the school or child care facility on a Department-supplied form, indicating that the person, parent, or guardian: (i) holds religious beliefs or philosophical convictions opposed to immunizations; and (ii) has reviewed the evidence-based educational material provided by the department of health regarding immunizations, including: a) the information about the risks of adverse reactions to immunization; b) the information that failure to complete the required vaccination schedule increases risk to the person and others of contracting or carrying a vaccine-preventable infectious disease; and c) the information that there are persons with special health needs attending schools and child care facilities who are unable to be vaccinated or who are at heightened risk of contracting a vaccine-preventable communicable disease and for whom such a disease could be life-threatening.

Virginia School Immunization Law – VA Code § 22.1-271.2

• Medical Exemption : No certificate of immunization shall be required for the admission to school of any student if the school has written certification from a licensed physician, licensed nurse practitioner, or local health department that one or more of the required immunizations may be detrimental to the student’s health, indicating the specific nature and probable duration of the medical condition or circumstance that contraindicates immunization.
• Religious Belief Exemption : No certificate of immunization shall be required for the admission to school of any student if the student or his parent submits an affidavit to the admitting official stating that the administration of immunizing agents conflicts with the student’s religious tenets or practices.

Virginia Home School Immunization Law – VA Code § 22.1-271.4 (2014)

• Medical Exemption : No proof of immunization shall be required of any child upon submission of a written certification from a licensed physician, licensed nurse practitioner, or local health department that one or more of the required immunizations may be detrimental to the child’s health, indicating the specific nature of the medical condition or circumstance that contraindicates immunization.
• Religious Belief Exemption : No proof of immunization shall be required of any child upon submission of an affidavit to the division superintendent stating that the administration of immunizing agents conflicts with the parent’s or guardian’s religious tenets or practices.

Virginia Immunization Law – VA Code § 32.1-46

• Medical Exemption : The provisions of this section shall not apply if the parent or guardian presents a statement from a physician licensed to practice medicine in Virginia, a licensed nurse practitioner, or a local health department that states that the physical condition of the child is such that the administration of one or more of the required immunizing agents would be detrimental to the health of the child
• Religious Belief Exemption : The provisions of this section shall not apply if the parent or guardian of the child objects thereto on the grounds that the administration of immunizing agents conflicts with his religious tenets or practices, unless an emergency or epidemic of disease has been declared by the Board.
• HPV Vaccine Exemption : Because the human papillomavirus is not communicable in a school setting, a parent or guardian, at the parent’s or guardian’s sole discretion, may elect for the parent’s or guardian’s child not to receive the human papillomavirus vaccine, after having reviewed materials describing the link between the human papillomavirus and cervical cancer approved for such use by the Board.

Virginia Child Care Immunization Regulation – 22VAC40-111-90

• Medical Exemption : Pursuant to subsection C of § 22.1-271.2 of the Code of Virginia, documentation of immunizations is not required for any child whose physician or a local health department states on a Department of Health-approved form that one or more of the required immunizations may be detrimental to the child’s health, indicating the specific nature and probable duration of the medical condition or circumstance that contraindicates immunization.
• Religious Belief Exemption : Pursuant to subsection C of § 22.1-271.2 of the Code of Virginia, documentation of immunizations is not required for any child whose parent submits an affidavit to the family day home on the current form approved by the Virginia Department of Health stating that the administration of immunizing agents conflicts with the parent’s or child’s religious tenets or practices.

Virginia School Immunization Regulations – 12VAC5-110-70

• Medical Exemption : No certificate of immunization shall be required of any student for admission to school if the school has written certification on either of the documents specified under “documentary proof” in 12VAC5-110-10 from a physician, registered nurse, or a local health department that one or more of the required immunizations may be detrimental to the student’s health. Such certification of medical exemption shall specify the nature and probable duration of the medical condition or circumstance that contraindicates immunization.
• Religious Belief Exemption : No certificate of immunization shall be required of any student for admission to school if the student or his parent or guardian submits a Certificate of Religious Exemption (Form CRE 1), to the admitting official of the school to which the student is seeking admission. Form CRE 1 is an affidavit stating that the administration of immunizing agents conflicts with the student’s religious tenets or practices.
• HPV Vaccine Exemption : Because the human papillomavirus is not communicable in a school setting, a parent or guardian, at the parent’s or guardian’s sole discretion, may elect for the parent’s or guardian’s child not to receive the HPV vaccine, after having reviewed materials describing the link between the human papillomavirus and cervical cancer approved for such use by the board.

Virginia Immunization Regulation – 12VAC5-90-110

Washington School Immunization Law – WA Rev Code § 28A.210.080

• Medical Exemption : Any child shall be exempt in whole or in part from the immunization measures required by RCW 28A.210.060 through 28A.210.170 upon the presentation of any one or more of the certifications required by this section, on a form prescribed by the department of health: (a) A written certification signed by a health care practitioner that a particular vaccine required by rule of the state board of health is, in his or her judgment, not advisable for the child: PROVIDED, That when it is determined that this particular vaccine is no longer contraindicated, the child will be required to have the vaccine.
• Religious Belief Exemption : Any child shall be exempt in whole or in part from the immunization measures required by RCW 28A.210.060 through 28A.210.170 upon the presentation of any one or more of the certifications required by this section, on a form prescribed by the department of health: (b) A written certification signed by any parent or legal guardian of the child or any adult in loco parentis to the child that the religious beliefs of the signator are contrary to the required immunization measures.
• Personal Belief Exemption : Any child shall be exempt in whole or in part from the immunization measures required by RCW 28A.210.060 through 28A.210.170 upon the presentation of any one or more of the certifications required by this section, on a form prescribed by the department of health: (c) A written certification signed by any parent or legal guardian of the child or any adult in loco parentis to the child that the signator has either a philosophical or personal objection to the immunization of the child.

West Virginia School Immunization Law – WV Code § 16-3-4

West Virginia Private School Immunization Law – WV Code § 18-28-2

West Virginia School Immunization Regulation – W. Va. C.S.R. §64-95-4

• Medical Exemption : The provisions of this rule may not apply if a child has a valid medical contraindication or precaution to a particular vaccine. To obtain a medical exemption the child’s parent or guardian shall present a written request for an exemption from a physician who has treated or examined the child to the local health officer in the county where the child attends school.

Wisconsin School Immunization Law – WI Stat § 252.04

• Health, Religious Belief and Personal Belief Exemptions : The immunization requirement is waived if the student, if an adult, or the student’s parent, guardian, or legal custodian submits a written statement to the school, child care center, or nursery school objecting to the immunization for reasons of health, religion, or personal conviction.

Wisconsin College Immunization Law – WI Stat § 252.09

Wisconsin Immunization Regulations – Wis. Admin. Code DHS § 144.03

• Medical Exemption : Upon certification by a licensed physician that an immunization required under s. 252.04, Stats., is or may be harmful to the health of a student, the requirements for that immunization shall be waived by the department. Written evidence of any required immunization which the student has previously received shall be submitted to the school or day care center with the waiver form.
• Religious or Personal Belief Exemption : Immunization requirements under s. 252.04, Stats., shall be waived by the department upon presentation of a signed statement by the parent of a minor student or by the adult student which declares an objection to immunization on religious or personal conviction grounds. Written evidence of any required immunization which the student has previously received shall be submitted to the school or day care center with the waiver form.

Wyoming School Immunization Law – WY Stat § 21-4-309

Medical or Religious Belief Exemption : Waivers shall be authorized by the state or county health officer upon submission of written evidence of religious objection or medical contraindication to the administration of any vaccine. In the presence of an outbreak of vaccine preventable disease as determined by the state or county health authority, school children for whom a waiver has been issued and who are not immunized against the occurring vaccine preventable disease shall be excluded from school attendance for a period of time determined by the state or county health authority, but not suspended from school as provided in W.S. 21-4-305.

Wyoming Child Care Immunization Law – WY Stat § 14-4-116

Wyoming School Immunization Regulation – Wyo. Code R., Dept. of Health, Mandatory Immunizations, Ch. 1, § 4

• Medical Exemption : A pupil shall not be required to have any immunizations which are medically contraindicated. The State Health Officer or County Health Officer shall grant a medical exemption from the specific immunization requirement in these regulations upon receiving a signed and notarized Wyoming Department of Health Medical Exemption form. This form must be accompanied by written evidence from any physician licensed to practice medicine in any jurisdiction of the United States, that the administration of the specific immunization is medically contraindicated to the pupil. The exemption shall be maintained by the school as part of the immunization record of the pupil.
• Religious Belief Exemption : A pupil shall be exempted from mandatory immunizations based on evidence of a truly held and genuine religious objection. The parent or guardian shall sign a notarized Wyoming Department of Health Religious Exemption form stating that the administration of immunizing agents conflicts with his religious tenets and religious practices. This exemption will be maintained by the school as part of the immunization record of the pupil. Approved Religious Exemptions must be renewed upon entry into the seventh grade.

Photo Credit: National Archives .

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What’s the Law on Vaccine Exemptions? A Religious Liberty Expert Explains

• By Douglas Laycock , [email protected]

Illustration by Ziniu Chen, University Communications

Many U.S. schools, businesses and governments requiring COVID-19 vaccination have offered religious exemptions. But what are they, exactly, and is the government even required to offer the exemptions in the first place?

University of Virginia School of Law professor Douglas Laycock examined the issue in a piece for  The Conversation , re-posted below. Laycock is perhaps the nation’s leading authority on the law of religious liberty and has testified frequently before Congress and has argued many cases in the courts, including the U.S. Supreme Court.

Here’s what he had to say in The Conversation. 

or Americans wary of COVID-19 vaccine mandates, like the sweeping requirements President Joe Biden  announced Sept. 9, 2021 , it seems there are plenty of leaders offering ways to get exemptions – especially religious ones.

No major organized religious group has officially discouraged the vaccine, and many, like the Catholic Church,  have explicitly encouraged them . Yet pastors from New York to California have offered letters to help their parishioners – or sometimes anyone who asks – avoid the shots.

These developments point to deep confusion over how to win a religious exemption. So what are they, and is the government even required to offer the exemptions in the first place?

Many schools, businesses and governments requiring vaccination have offered religious exemptions. Some are loath to challenge people’s claims that getting the shot goes against their beliefs for fear of  being sued , but organizations have come up with  a variety of ways  to assess claimants’ sincerity.

But the legal basis of Americans’ supposed right to a religious exemption to vaccination is less clear than such policies’ popularity would suggest.

As a lawyer and scholar who focuses on religious liberties, I have supported religious exemptions for a baker who  refused to create a cake  for a same-sex wedding, a family-owned business that  refused to provide emergency contraception  to its employees, a Muslim prisoner who was  obligated to grow a beard  and many others.

Even so, I believe that under the general law of religious liberty – including the Constitution and state and federal religious freedom laws – the government has an easy case to refuse religious exemptions from vaccines against infectious disease.

Proving ‘Interest’

There are a variety of ways to present a religious liberty claim, each with a different set of rules.

The most stringent standard is that the government should not require people to violate their conscience without a compelling reason.

The Supreme Court has never been clear about the full range of what counts as “compelling,” but some cases are clear. The government has a compelling interest in preventing significant threats to other people’s health, and especially so in a pandemic. The unvaccinated endanger people who are immunosuppressed or cannot be vaccinated because of their age or any other medical reason. The unvaccinated also endanger people who are vaccinated because no vaccination is 100% effective, as is evident from the number of breakthrough COVID-19 infections in the U.S.

Until last month, no state or federal court had ever granted a religious exemption when the government had to demonstrate compelling interest in requiring a vaccine. Now, a federal judge has granted a  temporary restraining order  to prevent Western Michigan University, a public school, from requiring its student-athletes to be vaccinated. This is a preliminary opinion and seems unlikely to stand up through further proceedings and appeal, since every judge to encounter such an issue in the past has ruled the other way.

The Supreme Court’s current interpretation of the Constitution does not always require a compelling interest.

Under the current law of the Constitution, people have no right to a religious exemption from a rule unless there is also a secular exception or gap in coverage that would undermine the government’s interests just as much. If there isn’t such a secular exception, the government doesn’t have to show any reason at all to refuse religious exemptions.

Usually the only secular exception to vaccine requirements is for “medical contraindications,” meaning that a vaccine would harm the recipient – for example, if someone is allergic to an ingredient in the vaccine.

But these medical exceptions don’t undermine the government’s interest in saving lives, preventing serious illness or preserving hospital capacity. By avoiding medical complications, those exceptions actually serve the government’s interests.

Offering Exemptions

In some states, however, the situation is more complicated. Most states explicitly authorize religious exemptions to vaccination, and sometimes philosophical exemptions as well – regardless of the government’s compelling interests.

Those state laws could not protect anyone from a federal vaccine mandate, and many of them only apply to certain groups – usually schoolchildren. But they could protect people from mandates from their state or local government.

Many private employers  requiring vaccines  offer religious exemptions, too. Title VII of the Civil Rights Act requires businesses to accommodate workers’ religious practice as long as they do not cause “undue hardship” to the employer. But the Supreme Court has interpreted “undue hardship” to mean anything more than a minimal expense, meaning employers don’t need a reason anywhere near as strong as a compelling interest. So employers do not have to allow religious exemptions to their employees.

Still, many employers and governments alike have been reluctant  to challenge  religious exemption claims. When it comes to vaccines against childhood diseases, where the danger did not seem great or immediate, many groups have just taken people’s word for it if they say their religious views prevent vaccination.

Backing Up Beliefs

There is evidence that many claims of religious objections to vaccination are false, particularly given the large anti-vaccine movement in the U.S.

Dorit Rubinstein Reiss, a law professor at the University of California, Hastings, has compiled  anecdotal and survey evidence  that most claims for refusing school vaccination requirements on religious grounds are false. The objectors really do object to vaccination, but their reasons are not religious. Meanwhile,  opposing COVID-19 vaccinations  has become a matter of political identity for many on the political right.

These factors could mean a flood of false religious claims. And whenever that situation arises under the federal law of religious exemptions, the Supreme Court has refused them.

The court rarely talks about this explicitly, but there is a compelling interest in not having a general policy’s effectiveness undermined by thousands or millions of claimed religious objections. That’s part of the reason why the court has refused constitutional protection for religious objections to paying taxes, or serving in the military, or, back in the desegregation era, integrating restaurants.

It is very hard for judges to determine religious sincerity, and mostly they don’t try. But when there are likely to be many exemption claims – both true and false – courts reject them because the difficult task of judging the sincerity of one or a few claimants becomes impossible when there are thousands or millions.

Challenges Ahead?

Still, some claims are probably sincere. One question to ask people claiming religious objections to the COVID-19 vaccines – whether on cross-examination in a courtroom or arguing at a meeting of your local school board – is whether they or their children are vaccinated against other diseases. Even if the answer is “no,” however, that may point to longstanding anti-vaccination views rather than sincere religious objections.

Some Catholics object to COVID-19 vaccinations because decades-old fetal cell lines were used in the vaccine research. If that is their sincere religious belief, it doesn’t matter that  Pope Francis disagrees .

Still, even when religious objections are sincere, the government has a compelling interest in overriding them and insisting that everyone be vaccinated. And that overrides any claim under state or federal constitutions or religious liberty legislation. It is irrelevant to state statutes that explicitly grant vaccine exemptions with no exceptions for compelling government interests. But federal vaccination requirements  override those state laws .

With mandates – and vocal objections – looking poised to grow, the United States could see vaccination requirements more and more put to the test in court this fall. But how far can challenges go? Unless governments mandating vaccines do not defend their rules, or the Supreme Court changes the law, the answer is likely, “Not far.”

Media Contact

Molly Minturn

University of Virginia Library

[email protected] 434-243-3781

Article Information

September 15, 2021

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The Case for Religious Exemptions — Whether Religion Is Special or Not

An exploration and defense of religious accommodation

• Mark L. Rienzi
• See full issue

WHY TOLERATE RELIGION? By Brian Leiter. Princeton, N.J.: Princeton University Press. 2013. Pp. xv, 187. $24.95.

DEFENDING AMERICAN RELIGIOUS NEUTRALITY. By Andrew Koppelman. Cambridge, Mass.: Harvard University Press. 2013. Pp. 243. $55.00.

The United States is a place of enormous religious diversity. How should a liberal and tolerant society respond to such religious diversity, particularly when this diversity means that society will include some people who are unable to comply with certain laws for religious reasons? That question is at the heart of two new books on religious liberty.

For centuries — indeed, even a full century before the adoption of the First Amendment — part of the American response to the nation’s religious diversity has been to grant exemptions from some laws that would force a religious believer to violate her faith. The exemptions approach takes religious diversity seriously by recognizing that people of different faiths have differ-ent rules for what they can and cannot do — for example, religious Quakers cannot fight in the military and religious Muslims cannot transport alcohol. Exemptions reflect the notion that our society is better and richer for this diversity, and that the law should not force people to violate their deeply held beliefs without a very good reason. The opposite path — allowing a variety of religious beliefs , but denying believers the room to act as if those beliefs are actually true — would be a hollow type of religious toleration, and it is a path that American law has largely rejected.

Yet for as long as the Supreme Court has been deciding religious liberty cases, Justices and commentators have been suggesting that religious exemptions also create something of an anomaly: a religious individual’s right to violate a law that others must obey. If this centuries-old practice is an anomaly — and there are good reasons to say it is not — it is a very persistent one, and one of increasing importance as the growth of the modern regulatory state creates ever more op-portunities for friction between legal and religious obligations. In the ongoing controversy over the federal requirement that all new health insurance plans include coverage for contraception, for example, the Obama Administration has granted religious exemptions to protect some religious objectors from having to violate their religion by being forced to “contract, arrange, pay, or refer for” contraceptives, sterilizations, and drugs and devices that can destroy a newly formed embryo. This exemption allows some religious objectors to engage in a behavior — failure to provide insurance coverage for the relevant services — for which other employers will face enormous fines. And where that exemption has been challenged as too narrow — chiefly by religious business owners who claim that their religions forbid them from directing their companies to purchase such products — most courts have sided with the religious business owners.

Two recent books address the practice of granting religious exemptions in very different ways. Professor Brian Leiter’s Why Tolerate Religion?  asks whether there is any “moral reason to single out matters of religious conscience for special legal consideration and solicitude” (p. ix). Leiter argues that while there are compelling reasons to protect liberty of conscience generally (pp. 15–17), he sees no valid reason to give claims of religious conscience any greater protection than exemption claims based on deeply held secular belief (pp. 63–64). And because Leiter views the allowance of secular conscience exemptions as unworkable and a threat to the general welfare (pp. 97–100), he favors eliminating all religious exemptions except those that impose no burdens at all on society or on other individuals (pp. 100–01).

Professor Andrew Koppelman’s Defending American Religious Neutrality  considers religious exemptions as part of a broader analysis of American religious liberty law. Koppelman aims to defend the First Amendment’s balancing of free exercise and establishment concerns against criticisms from two sides: “radical secularists,” who think the law is too generous to religion, and “religious traditionalists,” who think the law is too hostile to religion (p. 1). Koppelman argues that the religious neutrality each side criticizes is actually both “coherent and attractive” and has made the nation “unusually successful in dealing with religious diversity,” even as compared with other liberal democracies (p. 1). The key, according to Koppelman, is understanding the ideal of religious neutrality at the proper level of generality — which has shifted as the nation has grown more religiously diverse, and as the common ground between different religions has narrowed (p. 2).

Within this larger discussion of American religious liberty law, Koppelman argues that the practice of granting religious exemptions is part of the First Amendment’s approach to religion as a “distinctive human good” (p. 11). Unlike Leiter, Koppelman finds valid reasons for the government to single out religion for special treatment (p. 11). In fact, Koppelman argues that the only real controversy over religious exemptions concerns who should grant them (legislatures or judges) rather than whether they should exist (p. 11).

Both Why Tolerate Religion? and Defending American Religious Neutrality offer valuable insights for scholars seeking to understand, challenge, or defend the American system of religious exemptions. At one level, the two books demonstrate the unsurprising fact that one’s appraisal of the value of religion — Leiter’s is fairly negative, Koppelman’s is more positive — will influence one’s opinion of religious exemptions. But the broader lesson of the two books is this: regardless of the value one places on religion itself, there are strong reasons for a liberal and tolerant society to provide religious exemptions to many laws, at least as part of a broader system that generally protects citizens from being forced by the government to violate their most deeply held beliefs. This is because the moral arguments laid out by both authors for generally protecting conscience are far stronger than the mostly practical arguments Leiter offers for eliminating all exemptions.

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“My body is a temple”: Vaccine hesitancy, religious exemptions, and the integrity of Christian witness

Austin Stevenson

• X (formerly Twitter)

As governments and businesses implement COVID-19 vaccine mandates , increasing numbers of people are seeking exemption on religious grounds . As such, mainstream social and political discourse has begun to stray into theological territory, with uninspiring results. One common refrain among those seeking exemption from vaccination is the assertion, “My body is a temple”. Given the near ubiquity of this phrase in the sphere of health and wellness, most people are likely to have forgotten that it comes from the apostle Paul.

In 1 Corinthians, Paul writes, “do you not know that your body is a temple of the Holy Spirit within you, which you have from God, and that you are not your own? For you were bought with a price; therefore glorify God in your body.” (1 Corinthians6:19-20) Here, Paul is repeating a refrain from earlier in this same letter: “Do you not know that you are God’s temple and that God’s Spirit dwells in you?” (3:16)

It has become common for Christians to claim that being forced to take the COVID-19 vaccine is a violation of their religious convictions because their body is a temple, and they are commanded to keep it pure. They make this argument for a variety of reasons. For example, some believe the vaccine has dangerous side-effects ; others think it contains microchips ; and some have suggested that it can alter your DNA or cause infertility . Each of these, it seems, would violate the purity of their bodily temple, making it unsuitable as a vessel for the Holy Spirit.

It is worth stating unambiguously that there is no evidence that any of these things are true of the available COVID vaccines, beyond some extremely rare and typically mild side-effects. Nonetheless, the question I would like to consider is whether a vaccine could, in theory, go against Paul’s exhortation in this passage.

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“A temple of the Holy Spirit”

Let’s begin with Paul’s first letter to the Corinthians itself. Most commentators agree that the purpose of the letter is to urge unity among the Christians in Corinth. In the third chapter, Paul addresses the elephant in the room. The Corinthians have been drawing lines of separation based on who brought them to the faith. Some have been saying “I belong to Apollos” (which is to say, “I’m a member of Apollos’s faction”), while others say “I belong to Paul”. And yet, Paul sees no reason for this to cause strife: “We are God’s servants, working together; you are … God’s building.” Paul and Apollos cooperate in building on the foundation that Christ himself laid. And this leads him to ask: “Do you not know that you are God’s temple and that God’s Spirit dwells in you? If anyone destroys God’s temple, God will destroy that person” (3:16-17).

Paul says that the Corinthian church as a whole is God’s temple, and those who cause division among them are threatening to destroy it. Paul’s warning is not about the pollution of their individual physical bodies, nor any threat from outside. He is warning them about the effect of their own divisive actions on the community. Paul follows this with fitting words for our time: “So let no one boast about human leaders” (3:21).

Three chapters later, Paul returns to the image of the temple, this time with individual Christians in view. Now he is discussing specific sinful habits that are causing division among the Corinthians. In particular, he commands them not to engage the services of prostitutes, and in general to “shun fornication” (6:18). And why should they do this? Because their body is a temple of the Holy Spirit (6:19). Far from suggesting that the Holy Spirit cannot dwell in a body that is physically contaminated by illness, microchips, medicines, or other substances, Paul is urging them to keep themselves free from sin .

Paul is repeating a central theme of the New Testament, which is that the purity laws found in the Torah no longer hold for those who are in Christ, because he has fulfilled them (Matthew 5:17). Christian notions of purity are not about food laws and physical cleanliness, but about the heart. As Jesus explains, “it is not what goes into the mouth that defiles a person, but what comes out of the mouth.” He goes on to explain that “out of the heart come evil thoughts, murder, adultery, sexual immorality, theft, false witness, slander. These are what defile a person.” (Matthew 15:11, 19-20)

Paul has something similar in view in his second letter to the Corinthians: “let us cleanse ourselves from every defilement of body and of spirit, making holiness perfect in the fear of God” (2 Corinthians 7:1). He explains that the sins of sexual immorality and idolatry defile the body and the spirit, and he urges them to free themselves of it (see also 1 Thessalonians 5:19-24).

Grounds for exemption?

It is worth considering the implications of Paul’s words if they did mean what those seeking exemptions from the COVID-19 vaccine take them to mean. If the Holy Spirit cannot dwell in a body that has been contaminated by chemicals or debilitated by injury (let alone in a body injected with a safe and effective vaccine), then countless people who have fallen victim to natural or manmade disasters would be bereft of the presence of God. Similarly, if physical cleanliness was in view, then surely the COVID-19 virus itself would do at least as much to contaminate one’s body. After all, natural illness is one of the main causes of impurity in Leviticus.

Furthermore, it is central to the Christian faith that we may well be called to sacrifice our bodies for the sake of others (see John 15:13; Philippians 2:3-4; 1 John 3:16). We witness this most acutely on the cross. Jesus’s body was made impure by his crucifixion — in fact, that’s a considerable part of the point. It is worth repeating that there is no reason to think that receiving a COVID-19 vaccine involves bodily sacrifice. Regardless, the theological principles here do not support those seeking exemptions. There is no Christian belief that the body must be kept free from physical contamination in order to be a fitting vessel of the Holy Spirit.

In reality, what those seeking exemptions are arguing is that they believe the vaccine will harm them, and therefore they shouldn’t be forced to take it. There is nothing distinctly religious about the fear of bodily harm involved in vaccine hesitancy. In general, non-religious people fear bodily harm just as much. This should lead us to question why religious exemption is being sought here. The answer, it would seem, is that there is a long-standing precedent for exempting religious communities from government mandates, so people have reached for religious exemption as a ready-made solution for their fears.

This should give Christians pause. Freedom of religion plays an important role in our society, but it is always in danger of being abused and misused. As Christians, we have a vested interest in ensuring that it is not. If our non-Christian neighbours come to see us as people who think the rules don’t apply to us, or as people for whom the well-being of the wider community is irrelevant, their tolerance for our beliefs is likely to wane. At the same time, if our theological beliefs are sacred, then we should be unwilling to let people twist them for political or legal purposes. The truth of what Paul wrote should matter more to us than the use to which it can be put in court. A vaccine cannot go against Paul’s exhortation, because it is not what goes into us that defiles us, but the sin that emerges from our hearts.

Paul warns the Corinthians not to deceive themselves, but to have true wisdom (1 Corinthians3:18). James describes such wisdom as “first pure, then peaceable, gentle, willing to yield, full of mercy and good fruits, without a trace of partiality or hypocrisy” (James 3:17). Especially in the United States, the belligerent response on the part of many Christians to the public health efforts of the past two years looks rather different from this vision of wisdom. If we take Paul’s words seriously, our main concern shouldn’t be the physical purity of our own bodies, but the purity of our witness to the world around us. After all, the Christian witness has always been grounded, first and foremost, not in individual political liberty, but in self-sacrifice for the well-being of others.

Austin Stevenson is a PhD Candidate in Theology at the University of Cambridge. He is a supervisor in Theology and Religious Studies in the Cambridge Divinity Faculty , and he teaches courses for Ridley Hall and the Faraday Institute for Science and Religion .

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The Meaning of Religious Exemptions

Governmental recognition of religious liberty is a pressing issue in our current politics

By Franklin I. Gamwell | May 11, 2017

Some critics have challenged the Court’s refusal to ask whether religious exercise has been “substantially burdened.” But that focus is misplaced. As Justices Scalia and O’Connor have said, judges should not determine what is “central” to a given religious belief. Instead, I argue, the relevant question asks what kind of religious activities qualify for exemption.

Approach to an answer requires that “religious” in “religious freedom” has a broad meaning: any conviction about the ultimate basis for evaluating all human activity should be, for political purposes, called religious. Thereby, any comprehensive belief, whether conventionally religious or secularistic, is constitutionally protected. Moreover, such First Amendment protection is essential to our democracy because each adult citizen must be free to advocate any political evaluation she or he finds convincing. If “we the people” are sovereign, each person should be sovereign over her or his belief about the ultimate basis of evaluation. It also follows that popular sovereignty is impossible when differing religious beliefs are assumed immune to public discussion and debate because somehow suprarational and thus “solely a matter of faith.” Our democracy implies government through full and free discussion and debate inclusive of differing comprehensive beliefs.

Whether or not free exercise exemptions should be sanctioned constitutionally or only by statute is controversial. But religious freedom cannot mean granting such exemptions whenever the compelling interest test is inapplicable and some law is contrary to some citizen’s comprehensive belief. Any dissent from a generally applicable law might then be grounds for a claim to exemption. Moreover, something is amiss if such dissent so much as could be the basis for religious free exercise. The claim to exemption does not disagree with a given law’s general applicability. Opposition to a democratically decided statute denies its rightful enactment, but seeking exemption does not contest the law itself.

To be sure, certain religious adherents might assert that a particular law or aspect thereof directly denies one of their religious beliefs—for instance, an ACA requirement that certain employers provide health insurance inclusive of legal contraception. In that case, however, the claim against the state asserts its violation of religious disestablishment, because the law is said to teach something about the ultimate basis of evaluation. A given law is said to target a certain religious belief or kind of religious belief, and the claim for exemption is irrelevant. Moreover, the real issue is not whether some religious adherents assert this; in fact, any law can be said to deny a religious belief. The proper question is whether a particular law does in fact explicitly say something about comprehensive evaluation. And the proper test is then whether the law restricts a full and free political discourse by teaching something about how citizens should evaluate political decisions. The ACA teaches no such restriction; each member of “we the people” is entirely free to evaluate and oppose the law, and a claim against its general applicability has no merit.

Hence, free exercise claims make sense only if the candidate activities are limited in a way independent of political dissent. What’s distinctive to religious practices is the kind of cultivation they require. As comprehensive, religious belief must evoke in adherents an innermost commitment and must develop competence in applying ultimate evaluative terms to diverse situations of human life—and many religious communities include activities of symbolic expression and associated teaching designed for this cultivation. Because they assume the given comprehensive belief, these activities are rightly prescribed only for adherents of it. Politically, then, such practices facilitate participation in the public discourse, where the comprehensive evaluation is advocated.

Here, then, is a proposal: only cultivating activities in preparation for (among other things) public discourse can be candidates for free exercise exemptions. Claims for an exemption are improper unless the activity in question is prescribed only for adherents of a given comprehensive belief. In contrast, dissent from a generally applicable law has no claim to exemption because failure to prevail in the full and free discourse is not grounds for release from the law’s requirements. Free exercise exemptions are meant to enhance how the public determines generally applicable laws, not as compensation when the public finds one’s political view wanting.

Given a relevant constitutional provision or statute specifying religious exemptions, use of peyote in worship ceremonies or the drinking of wine in certain eucharistic celebrations or a certain personal appearance in the military or in prison are, to cite some examples, possibly exempt from generally applicable laws prohibiting such activities— if in each case the activity is prescribed only for those who cultivate the comprehensive belief they already confess. Perhaps this mediation is mostly found in conventionally religious communities, but so-called “religious” liberty should also provide exemption for the cultivation of secularistic beliefs.

What is not a candidate for exemption, however, is activity that opposes a generally applicable law itself; no person can be exempted from democratically determined laws she or he takes to be wrong. And because activities prescribed only for adherents should be distinguished from political advocacy by claimants themselves, there is no harm in allowing them to determine when the former have been sufficiently burdened. Given this account, neither Hobby Lobby v. Burell nor Zubik v. Burell includes a claim fit for a free exercise exemption.

Photo Credit: Nicholas Eckhart /Flickr via Compfight ( cc )

Franklin I. Gamwell

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Hundreds of URI students have requested religious vaccine exemptions by checking a box

While Rhode Island’s colleges tout high vaccination rates against COVID-19, religious exemptions are not always difficult to obtain. 

At the University of Rhode Island, requesting one is as simple as checking a box.

A copy of the one-page form, which the school sent to The Providence Journal, asks students seeking exemptions to provide personal information including their name, address and health-care provider in the first section. The second section then asks the student to check off which vaccine they do not wish to take, the COVID-19 immunization being the sole option.

The student is then prompted to initial the form next to several statements acknowledging health risks and the possibility of being excluded from school if an outbreak occurs. 

Unlike at other schools — including the Community College of Rhode Island and Providence College — URI students are not required to write a personal statement detailing their objections to the vaccine or the tenets of their faith. 

So far, the university has totaled about 1,080 exemptions, most of them on religious grounds.

More: Colleges require vaccination, but hundreds of students get exemptions

University Health Services Director Ellen Reynolds, who also serves as assistant vice president of student health and wellness, said that as long as the form is filled out properly, in most cases, the exemptions are granted. 

Part of the reason the form does not require a personal statement, Reynolds explained, is a lack of guidance from the Rhode Island Department of Health. As it stands, URI is modeling its document off of a 2019 template provided by the state for religious-exemption requests. However, those apply to more traditional illnesses such as the flu, hepatitis and measles.

Reynolds said that because the state has not mandated COVID-19 vaccines for college students, “they weren’t able to provide us with a form.”

“I think the discussion was that we wanted to remain consistent with what we do with our other mandated vaccine requests for religious or medical exemptions,” Reynolds said. “So as a state entity and a state school, we felt that we would keep consistent with what we’ve done with other diseases.”

There is nothing that prohibits schools — whether they’re state or private institutions — from adding to and adjusting that form. For example, CCRI’s form asks for a “detailed statement describing how vaccination would be contrary to your religious beliefs, practices or observances,” while Providence College asks for an essay that is then evaluated by a priest.

CCRI has so far granted 373 medical or religious exemptions — nearly 5% of those attending in-person classes — while Providence College has granted less than 120 — less than 3% of its student body. URI's exemptions amount to 7% of those registered for in-person learning.

The Journal has requested Rhode Island College’s exemption rate along with copies of the application forms and is awaiting a response.

More: Rhode Island College postpones start of classes to allow more students to get vaccinated

More: Across RI, college students enter new year, new normal

As it stands, medical exemptions are difficult to obtain, being granted for a limited number of conditions including anaphylaxis, Reynolds said. In the case of URI’s religious exemptions, which are not nearly as tricky to secure, Reynolds acknowledged that some students could be using the request form simply because they do not want to be vaccinated.

“I think because the State of Rhode Island does not traditionally require any type of clergy or religious attestation to the form, that’s always the possibility,” she said.

URI emphasized that in addition to its exemption forms, students must complete a second form acknowledging multiple points including their responsibility to abide by safety guidelines — including testing and mask wearing — and the possibility that they may need to evacuate campus if COVID-19 cases are discovered.

Most of this two-page form involves checking boxes except for a section in which students must specify how they would leave campus, where they would stay and how they would travel there without public transit.

According to Reynolds, as long as it’s reasonable and “it’s not 'I’m going to go to Florida and I’m going to get there by pony',” then the plan is approved.

The Department of Health confirmed to The Journal that it did not provide colleges with templates specific to COVID-19. Thus schools were left to make their own decisions about how involved those forms would ultimately be.

"We sent general immunization exemption form templates to the colleges and universities," said spokesman Joseph Wendelken. "Each school has their own COVID-19 vaccination policy, so they will have their own COVID-19 vaccination exemption form."

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Lived Religion in Religious Vaccine Exemptions

• PMID: 38662066
• DOI: 10.1353/pbm.2024.a919713

This essay explores a more inclusive and equitable interpretation of "religion" within the context of religious vaccine exemptions. The existing literature critiques the prevalent interpretation of the meaning of religion in religious exemption cases, but frequently overlooks the importance of incorporating the concept of "lived religion." This essay introduces the concept of lived religion from religious studies, elucidates why this lived religion approach is crucial for redefining "religion," and illustrates its application in the domain of religious vaccine exemptions. The author contends that broadening the meaning of religion by employing the concept of lived religion would promote a more inclusive and equitable implementation of religious vaccine exemptions.

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Catholic Charities appeals Wisconsin ruling blocking its religious tax exemption

August 13, 2024 Catholic News Agency News Briefs 0 Print

Washington, D.C. Newsroom, Aug 13, 2024 / 19:18 pm (CNA).

Catholic Charities of the Diocese of Superior, Wisconsin, has appealed to the U.S. Supreme Court to reverse a decision to remove its religious organization designation and bar it from receiving a religious tax exemption.

The agency, which operates under the purview of the Diocese of Superior and has programs for the disabled, elderly, and impoverished, argued caring for those in need is part of its religious mission.

“Catholic Charities Bureau carries out our diocese’s essential ministry of caring for the most vulnerable members of our society,” Bishop James Powers of Superior said in a  statement  released on the day of Catholic Charities’ appeal to the Supreme Court.

“We pray the court will recognize that this work of improving the human condition is rooted in Christ’s call to care for those in need,” Powers added.

Catholic Charities of the Diocese of Superior is appealing a  March ruling  by the Wisconsin Supreme Court that said the organization isn’t entitled to receive a religious exemption and must pay into the state unemployment system. The  4-3 ruling  said that because Catholic Charities of the Diocese of Superior’s activities are not “primarily” religious the group does not qualify as a religious organization.

The Wisconsin Supreme Court also said that to successfully challenge the state’s primarily religious standard, Catholic Charities would have to prove it was unconstitutional “beyond a reasonable doubt.”

On Aug. 9 Catholic Charities of the Diocese of Superior appealed the March ruling to the U.S. Supreme Court. The group is being represented by Becket, a firm that specializes in religious liberty cases and has been involved with several high-profile Supreme Court cases.

In its  appeal  to the U.S. Supreme Court, Catholic Charities called the Wisconsin court’s ruling “absurd” and argued that it curtails its First Amendment rights by “penalizing Catholic Charities for engaging in critical parts of its ministry” including “serving those in need without proselytizing.”

“The state denied Catholic Charities an exemption precisely because its religious beliefs and exercise differed from what the Wisconsin Supreme Court thought were ‘typical’ religious activities,” Catholic Charities wrote in its appeal. “That wrongly disfavors those religious traditions that ask believers to care for the poor without strings attached.”

The appeal states that a ruling by the Supreme Court would resolve religious liberty questions impacting churches and faiths beyond just Wisconsin.

The questions Catholic Charities, represented by Becket, are posing to the Supreme Court are: 1) whether a state violates the First Amendment by denying tax breaks to one religious group while denying them to another; and 2) whether a state can impose a beyond a reasonable doubt standard for constitutional challenges.

According to the appeal, the Wisconsin Supreme Court’s decision “deepens a split among lower courts over whether federal constitutional violations must be proven ‘beyond a reasonable doubt.’”

The appeal argues that this case is the “ideal vehicle” to resolve the split and to “set this important area of law onto a firmer — and constitutionally sounder — footing.”

“It shouldn’t take a theologian to understand that serving the poor is a religious duty for Catholics,” Eric Rassbach, vice president of Becket, said in a statement. “But the Wisconsin Supreme Court embraced the absurd conclusion that Catholic Charities has no religious purpose. We’re asking the Supreme Court to step in and fix that mistake.”

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• Israel’s ultra-Orthodox still won’t fight, invoking scripture

An age-old argument is making Binyamin Netanhayu face an enduring dilemma

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T he armed forces bent over backwards on August 4th to welcome a new wave of recruits. Induction centres in Jerusalem and Tel Hashomer near Tel Aviv were adapted to soothe the religious sensitivities of prospective draftees. No female soldiers were in sight, so as not to offend the young men who had grown up in an environment strictly segregated by sex.

But to little avail. Out of the first group of 900 members of the ultra-Orthodox community summoned to pre-enlistment interviews and medical check-ups, only 48 turned up. The rest obeyed their rabbis: stay away and stick to your studies.

Israel is at war on several fronts but a sizeable chunk of its population—the ultra-Orthodox, or Haredim, make up 14% of all Israelis—refuse to take part in the war. They claim a sacred role to continue studying the Torah and Talmud under any circumstances. Besides, army life would corrupt these cloistered young men, they say. Rabbi Yitzhak Yosef, a former chief rabbi of Israel, has called for the students to emigrate if forced to enlist. Some of them arrived at the induction centres and shouted: “We will die before joining up.”

This creates a headache for Binyamin Netanyahu, Israel’s prime minister. He is loth to accept a ceasefire in Gaza, forcing the army to rely heavily on a limited pool of tired conscripts and reservists. Some 63,000 young Haredi men are reckoned to be eligible for conscription, but should he enforce the draft he would lose the support of the ultra-Orthodox parties, a key element of his ruling coalition.

Mr Netanyahu has been dragging his feet over the issue, though the Supreme Court has ruled the historic exemption of Haredi students to be unequal and thus illegal. The coalition has been trying to propose a vague set of enlistment quotas in the hope of satisfying the court, or at least buying the government time. Meanwhile, the independent-minded attorney-general has enraged Mr Netanyahu’s far-right ministers by cancelling state benefits for those who refuse to join up.

The row over the draft reflects not only the rift between the ultra-Orthodox and the rest of Israeli society. It has also reignited the struggle between a legal system determined to enforce the Supreme Court’s rulings and Mr Netanyahu’s government, which had been bent on curbing the court’s independence before war broke out in Gaza on October 7th.

The dispute has also deepened the enmity between Mr Netanyahu and Yoav Gallant, his defence minister. Mr Gallant, anxious to bolster the armed forces’ ranks, has refused to co-operate with Mr Netanyahu in his attempts to reach a backroom deal with his coalition partners. This has intensified divisions over the management of the war, most recently regarding the conditions for a ceasefire in Gaza. Speculation is rife that Mr Netanyahu is planning to fire him. On August 12th Mr Gallant said talk of “total victory”, a favourite slogan of Mr Netanyahu, was “nonsense”. The prime minister accused his defence minister of “adopting an anti-Israel narrative”.

To be sure, the rivalries between Mr Netanyahu and every defence minister to have served under him in his long political career predate the war in Gaza. So do Israel’s divisions over the powers of state, synagogue and Supreme Court.

But with the war now dragging on into its 11th month and the government seemingly incapable of agreeing on a strategy to end it, Israel’s façade of unity is crumbling. The government’s failure to enforce the law on an influential community is yet another symptom of Israel’s current political dysfunctionality, even as its troops are fighting for their lives. ■

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