It is unclear whether there exists a genuine “secular” authority which can function outside of religion, rather than as a particular variety of religion. I contend that while such an authority can exist with the legitimacy to arbitrate between competing religious traditions, this legitimacy quickly erodes within the context of the clinic. A popular thread within scholarship around religion holds that “secularity” is an instance of, rather than an alternative to, “religion” on the grounds that secularity—like all religions—is a moral-metaphysical worldview with an associated history of shared practices enduring over time. This thesis is defended in some form by Peter Harrison, John Milbank, Jeff Bishop, and others. I contend that this view fails to properly reflect the legitimating role of pluralism in cases where the secular tradition is not imposed onto a diverse community by an independent authority. The question I explore is whether the right-making features of the secular-religious distinction can endure in clinical settings. I conclude that while such features can endure in the clinic, genuine pluralism depends on ongoing negotiation between worldviews while the clinic often depends on autocratic dicta. Specifically, I contend that in a democratic pluralistic society, a tradition of acknowledging a common (though not necessarily universal) set of values and practices can reify such practices as the appropriate default commitments of that society for the purpose of legal and social conduct. While the secular is reified in this way, religious traditions are entitled to exemptions from it—a privilege uniquely held by those traditions. Conversely, the secular retains a privileged status of being able to adjudicate conflicts between religions. This exchange of privileges between the secular and the religious is legitimated by key features of a sufficiently free and diverse society, which is often presupposed by a pluralistic democracy. The clinic, by contrast, has several hallmarks of authoritarianism. Consequently, the conditions which legitimate secularity in public life are likely to vanish in the clinic - meaning the override of a religious preference by a clinician is liable to become merely an imposition of one religious worldview (i.e., the secular) over another, unjustly. In such cases the secular de re is lost and all that remains is the secular de dicto. The secular de dicto has no more legitimacy to arbitrate between religious traditions than any other religious tradition, yet often will continue to do so. When this occurs, harm is done, including spiritual violence against patients. I draw out the way the imposition of the de dicto secular can contribute to moral distress in cases of conscientious objection and patient noncompliance. By clarifying the conditions under which the secular and the religious are genuinely distinct, and by identifying the features of the clinic which undermine this distinction, I offer insights into how to best recognize when we are justified in overriding a sought religious exemption and when we are not.

Presented in 2026 at the Conference on Medicine and Religion