Vaccines, Religious Freedom, and Parental Rights

Last week, Massachusetts’s highest court unanimously ruled that the commonwealth’s Department of Children and Families violated the Massachusetts Constitution when it vaccinated a child temporarily in its custody despite the religious objections of her parents. It was a significant religious freedom ruling at a time when declining public trust in vaccines is likely to make such conflicts more common.

The case also reflects a different approach to disputes over the free exercise of religion than what’s reflected in existing U.S. Supreme Court precedent. And it may be a sign of what’s to come in federal jurisprudence, as the U.S. Supreme Court has signaled that it could revisit its landmark free exercise ruling Employment Division v. Smith.

The Massachusetts case, Care and Protection of Eve, involved a baby (given the pseudonym Eve) who was temporarily removed from her parents’ custody due to concerns about domestic violence. The parents, who are Rastafarians, stated that they avoid Western medicine, including vaccines, as a matter of their religious practice. 

The department and Eve (via a representative) sought to vaccinate Eve according to the standard immunization schedule recommended by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. A juvenile court judge ruled that Eve’s best interest outweighed the parents’ religious beliefs opposing vaccines, relying on affidavits from two doctors that a failure to vaccinate “exposes infants and children to an unacceptable level of risk for life-threatening preventable illnesses that can cause severe disease or death.”

The Massachusetts high court rejected this reasoning, ruling that the judge’s order had violated the rights of Eve’s parents. The court pointed to the parents’ “sacred private interests” to raise their children and freely practice their religion, rooted in the right to religious free exercise and substantive due process under both the state and federal constitutions. A temporary loss of custody, the court explained, does not eliminate the parents’ constitutional rights over their child’s religious upbringing.

The court’s analysis ultimately turned on the Massachusetts Constitution, which, it noted, provides more expansive free exercise protections than the U.S. Constitution under the 1990 Smith decision. Smith held that if a law is neutral and generally applicable, it doesn’t need to be justified by a compelling state interest even when it burdens religious practice. By contrast, under the Massachusetts Constitution, any law that burdens the exercise of religion must survive strict scrutiny: It must advance compelling state interests and be narrowly tailored in pursuit of those interests.

The Massachusetts court emphasized that it applies this test in “a concrete, pragmatic, and fact-specific way.” While recognizing that there was a compelling government interest in the “health benefits associated with, and risks minimized by, vaccination,” the court concluded that providing an exemption to Eve’s parents wouldn’t “substantially hinder the fulfillment of the goal.” The court pointed to the fact that Massachusetts allows for religious exemptions from mandatory school vaccinations, and that the department has been inconsistent in requiring the vaccination of children in its care (including Eve’s own siblings). It also noted that because Eve is a baby, this case did not involve a child expressing interests contrary to those of her parents. (The court did not address how it would rule in such a case.) 

With vaccines becoming increasingly politicized, these kinds of conflicts are likely to emerge more regularly. In fact, Massachusetts’s is one of several state high courts to recently consider disputes over vaccinations and parental rights. In March, the North Carolina Supreme Court addressed a case in which a 14-year-old boy sued for damages after he was administered the Covid-19 vaccine against his and his parents’ wishes. The court ruled that the state constitution protects the “right to bodily integrity” and the right to control a child’s upbringing. The court further determined that these state constitutional claims were not preempted by a federal law, the Federal Public Readiness and Emergency Preparedness (PREP) Act, which provides broad immunity to health workers during public health emergencies. The Vermont Supreme Court, meanwhile, ruled in a case presenting similar claims that the PREP Act did preempt state law. 

The Massachusetts case is also notable for offering an example of what a different understanding of free exercise under the U.S. Constitution might look like in practice — at a time when several justices on the U.S. Supreme Court have expressed openness to revisiting Smith. 

Massachusetts isn’t the only state high court to chart a different path than Smith. Last year, the Virginia Supreme Court also departed from federal precedent and embraced even more stringent protections than Massachusetts, ruling that Virginia must accommodate religious beliefs unless they “break out into overt acts against peace and good order.” Applying this standard, the Virginia high court allowed a lawsuit to go forward by a teacher who had lost his job for refusing on religious grounds to use a student’s preferred pronouns in the classroom. The dissent criticized the majority for creating “a sweeping super scrutiny standard with the potential to shield any person’s objection to practically any policy or law.”

Jerry Dickinson, dean of University of Pittsburgh School of Law, has written about “judicial federalization” — instances wherein the U.S. Supreme Court has looked to state courts’ interpretation of state constitutions as a source for interpreting the meaning of the U.S. Constitution. If (and most likely when) Smith is revisited, these state examples may well play an influential role.

Alicia Bannon is the director of the Judiciary Program at the Brennan Center for Justice and editor in chief for State Court Report. 

Suggested Citation: Alicia Bannon, Vaccines, Religious Freedom, and Parental Rights, Sᴛᴀᴛᴇ Cᴏᴜʀᴛ Rᴇᴘᴏʀᴛ (May 23, 2025), https://statecourtreport.org/our-work/analysis-opinion/vaccines-religious-freedom-and-parental-rights