What does it mean to be a public Catholic institution in Canada? How does this Catholic identity evolve with the secularisation and diversification of society, and with the rising awareness of the complicated legacy of Catholicism and colonisation in Canada? This article explores those questions drawing on document analysis and interviews with staff working in Catholic health care. Taking a legal pluralist approach, it documents how Catholic health-care institutions navigate between transnational canon laws and ethics, and human rights law. Catholic health care is situated in a web of national and transnational legal regimes. We argue that this navigation takes different forms to adapt to societal changes, such as the authorization of Medical Assistance in Dying (MAiD). This article speaks directly to how Christianity continues to play a subtle, but still constant presence in Canadian Catholic hospitals, and debunks tropes that construct relationships between state and religion as one of clear separation.