Mexico fought a civil war, known as The War of Reform, between 1857 and 1861, over a question that still haunts modern democracies: Who should hold the ultimate power — democratically elected representatives accountable to the people or religious institutions claiming moral authority over public life?
The War of Reform pitted those wanting to modernise Mexico through secularisation, against conservatives hell-bent on preserving the Roman Catholic Church’s entrenched privileges.
The church’s resistance was material; it sought to preserve legal immunities for clergy; its vast landholdings and financial power; control over education and therefore public thought; authority over civil registries of births, marriages and deaths; dominance of public religious expression; and entrenched tax exemptions and revenue privileges.
At stake was controlled law, land, public institutions and the people’s daily lives and deaths.
When the war ended in 1861, the reformists had somehow prevailed despite the church’s seemingly unassailable power, wealth and privilege. The church has made one serious strategic blunder: underestimating democratic people power.
After Mexico won independence, Benito Juárez’ reforms nationalised church property (excluding houses of worship), entrenched civil marriage, established secular education and, most significantly, enforced the separation of church and state.
The message was clear: public authority must not be subordinated to ecclesiastical power. But the church retained one clear advantage: it learned the lessons of the Reform Wars when many secular states did not.
Today, debates framed as “religious freedom” in Australia, such as around same-sex marriage, abortion rights and protecting paedophiles by the sanctity of the confessional, often concern not private belief, but institutional power exercised against what the church sees as “unworthy” individuals — often women — within publicly-regulated systems.
When religious institutions seek exemptions from allowing lawful end-of-life healthcare within taxpayer-funded aged care facilities, the issue is similarly about authority: does public money and public law yield to private doctrine, or if democratic secular governance ultimately prevails.
Limits of secular protection
Section 116 of the Constitution states that the Commonwealth shall not establish any religion, impose religious observance, prohibit the free exercise of religion, or require religious tests for public office.
It is frequently cited as evidence that Australia is a secular country.
But the High Court interpretation has been narrow. The court confirmed in the 1943 case of Adelaide Co of Jehovah’s Witnesses Inc v Commonwealth that religious freedom is not absolute and may yield to civil authority. In the 1981 case, Attorney-General (Vic); Ex rel Black v Commonwealth, it held that state funding of religious schools did not constitute the government establishing a religion.
As a result, Australia is constitutionally secular in form, yet structurally deferential to religious interests in practice.
There are few better examples than the systemic government outsourcing of health and aged care to private religious institutions. They receive billions of dollars in taxpayer funding to operate hospitals, schools and residential aged-care facilities.
In aged care, in particular, faith-based providers hold a significant share of available beds, especially in regional areas, where alternatives are limited to non-existent.
At the same time, voluntary assisted dying (VAD) is now lawful in every state and in the ACT.
These laws were passed after years of public campaigning leading to parliamentary debate and inquiry. They reflect sustained majority support that terminally-ill people should have the option of lawful medical assistance to relieve unbearable suffering.
Yet, some faith-based aged-care providers flatly refuse to permit VAD assessments or administration within their facilities. Others seek recognition of “conscientious objection” at an institutional level — widely confirmed as unconstitutional.
When a publicly-funded institution claims conscientious objection, it is not to protect an individual’s personal belief; it is the enforcement of institutional doctrine within a taxpayer-funded service onto an individual seeking to access legal health care.
Democratic mandate vs religious lobby
The religious lobby has responded by trying to protect its interests. Governments frequently emphasise “respect for faith traditions” when designing VAD implementation frameworks, seeking to avoid backlash from organised religious lobby groups, particularly inside parliament.
Yet the democratic mandate from their constituents is clear. Support for VAD consistently extends across religious and non-religious people alike. Parliament has debated and passed these laws in multiple jurisdictions. The principle of equity of access is foundational to a universal democratic health system.
The imbalance lies not in numbers, but in organisation. A small but wealthy network of conservative religious lobbyists exert disproportionate influence. Governments, wary of manufactured cultural conflicts through cashed-up media campaigns, too often default to accommodating this lobby.
But the intense public pushback against last year’s Carter bill in NSW, which sought to allow religious residential aged-care managements to deny residents access to legal, publicly funded end-of-life care made the people’s view clear.
Public money must come with public obligations. When services are funded by taxpayers and regulated by the state, access should be governed by civil law — not by religious lobby groups with monopoly market shares.
Defend secularism
The War of Reform demonstrated that the separation of church and state requires political courage and constitutional clarity about where democratic authority really lies.
Section 116 does not prevent governments from privileging religious institutions through funding and regulatory exemptions. That gap has allowed institutional doctrine to shape access to essential services in ways that would be unacceptable if imposed by any other private entity.
Voluntary assisted dying sharply exposes that contradiction.
When a democratically-enacted law is curtailed within publicly-funded facilities because of religious doctrine, the boundary between church and state is not simply blurred, it is at risk of evaporating entirely.
A secular democracy should not fear those with a religious belief and neither do individual religious rights pose a threat. But it should not allow organised institutional religious power to dilute lawful rights endorsed by the majority.
If publicly-funded institutions are to serve a diverse population, they must operate on civic principles that apply equally to all.
If separation of church and state is to mean anything, it must mean this: No institution receiving public funds can be allowed to substitute religious doctrine for democratically enacted law — including VAD.
[Suzanne James is an advocate for voluntary assisted dying.]