The Ninth Circuit Court of Appeals has upheld a lower court's decision dismissing a lawsuit filed by Brittany K. MacDonald, a registered nurse, against Oregon Health and Science University (OHSU). MacDonald challenged the university's COVID-19 vaccination policy after her request for a religious exemption was denied. This ruling, issued on October 2, 2026, affects healthcare workers and raises questions about the balance between public health mandates and individual religious rights.
MacDonald worked at OHSU's Doernbecher Children’s Hospital and had been employed there since 2012. In September 2021, she submitted a request for a religious exemption from OHSU's vaccination requirement, citing her Christian beliefs against abortion and the use of fetal cell lines in vaccine development. After her request was denied, she was terminated for not complying with the vaccination mandate. MacDonald subsequently filed a lawsuit claiming violations of her First Amendment rights and Title VII of the Civil Rights Act, which prohibits employment discrimination based on religion.
The case reached the Ninth Circuit after a district court dismissed MacDonald's Free Exercise claim against individual defendants in the case, citing qualified immunity. The court ruled that the right to refuse a state-mandated vaccine based on religious beliefs was not clearly established at the time of her exemption denial. The ruling also addressed her Title VII claim, concluding that accommodating her request would impose undue hardship on OHSU.
The court's opinion was authored by Judge Kiyo A. Matsumoto, with Judge Michael Daly Hawkins and Judge Eric C. Tung also participating. The panel affirmed the district court's dismissal of MacDonald's claims, stating, "The right to refuse a state-mandated vaccine by a healthcare worker who works in-person with vulnerable populations due to allegedly religious concerns about fetal cells and bodily integrity or sanctity was not clearly established at the time." This ruling underscores the challenges faced by individuals seeking religious exemptions in the context of public health policies.
MacDonald's lawsuit highlighted a broader debate over the intersection of public health mandates and religious freedoms. The COVID-19 pandemic prompted many institutions, including OHSU, to implement strict vaccination policies to protect vulnerable populations. The court found that OHSU demonstrated it could not accommodate MacDonald without incurring undue hardship, citing significant health and safety risks to patients and employees.
The court noted that MacDonald failed to present sufficient evidence to support her claims of religious hostility by OHSU's administration. It emphasized that the university's policies were designed to ensure the safety of its patients and staff during a public health crisis. The court stated, "OHSU could not have accommodated MacDonald without undue hardship," reinforcing the idea that public health considerations can outweigh individual religious claims in certain circumstances.
Judge Tung dissented, arguing that the defendants' actions violated established law prohibiting the targeting of religious beliefs. He contended that the policy effectively dismissed MacDonald's religious objections to the vaccine based on fetal cell concerns, which he viewed as discriminatory. Tung's dissent raises important questions about the treatment of religious beliefs in the context of public health mandates.
This ruling has significant implications for healthcare workers and others seeking religious exemptions from vaccination requirements. It reinforces the legal protections afforded to institutions implementing public health measures during emergencies while also highlighting the complexities of balancing individual rights against collective safety.
Looking ahead, MacDonald may consider appealing the decision to the U.S. Supreme Court, although it remains uncertain whether the high court will take up the case. The outcome could set a precedent for future cases involving religious exemptions and public health mandates, particularly as similar challenges continue to arise in various sectors.