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Community College





















Issues surrounding the
ability of a parent to deny medical care for their child has emerged as a
contentious subject in health law policy. Parents often refer to religious
reasons or personal preferences for alternative medical treatments as validation
to refuse medical treatment for their child. Although the ability of a parent
to consent to potentially life-saving medical treatment for their child is an
established law the ability to refuse life-saving treatment is less defined.
(Kasprak) “The basic legal premise for compelling
treatment in this country rests on a court-made distinction between religious
beliefs and practices. The 1879 U.S. Supreme Court case of Reynolds v.
U.S. (98 US 145) which involved polygamous marriage practices, set a
precedent that, while guaranteeing the free exercise of religious beliefs,
permits the state in certain circumstances to limit religious practices.
Generally, when the state can demonstrate a compelling interest in the
preservation or promotion of health, life, safety, or welfare religious
practices may be curtailed.” (Kasprak)

Failure to provide children with essential
medical care has been increasingly recognized as a form of neglect. (Bioethics
2013) According to the Michigan Department of Health and Human Services neglect
is defined as: Harm or threatened harm to a child’s health or welfare by a
parent, legal guardian, or any other person responsible for the child’s health
or welfare that occurs through either of the following:

Negligent treatment, including
the failure to provide adequate food, clothing, shelter, or medical care.
Placing a child at an
unreasonable risk to the child’s health or welfare by failure of the parent,
legal guardian, or other person responsible for the child’s health or
welfare to intervene to eliminate that risk when that person is able to do
so and has, or should have, knowledge of the risk.(Michigan Department of
Health and Human Services)

 In 1983, the US Department of Health and Human
Services amended its definition of negligent treatment to include failure to
provide adequate medical care. Many factors are important when evaluating for
suspected medical neglect. Some factors include likelihood and magnitude of the
harm of forgoing medical treatment and the benefits, risks, and burdens of the
proposed treatment. (Bioethics 2013) For example, the risk of one unimmunized
child contracting a contagious vaccine-preventable disease may be low if immunization
rates in the community are high and disease prevalence is low. (Bioethics 2013)
Many parents cite religious beliefs as a reason to withhold medical treatment.
Some examples are, “Followers of Christ refuse all medical treatment in favor
of prayer, anointing with oil, and the laying on of hands. Christian Scientists
may use dentists and doctors for “mechanical” problems like setting bones or
childbirth but consider most illnesses to be the result of the individual’s
mental attitude and seek healing through spiritual means, such as prayer.” (Bioethics
2013) Other religions only forbid certain medical interventions such as, Jehovah’s
Witnesses only forbid the use of blood and blood transfusions.

the years court decisions have led to development of laws concerning parents
who refuse medical treatment for their children. Courts
will generally distinguish between children requiring immediate treatment and
those needing only non- emergent care. Courts usually authorize medical care
for the children requiring immediate medical treatment. In passages from its
rulings, the US Supreme Court stated, “The right to practice religion freely
does not include liberty to expose the community or the child to communicable
diseases or the latter to ill health or death” and “Parents may be free to
become martyrs themselves. But it does not follow they are free, in identical
circumstances, to make martyrs of their children before they have reached the
age of full and legal discretion when they can make that choice for themselves.”

When a parent
refuses medical treatment based on conflicting religious beliefs actions can be
taken under child welfare or other laws to have the child removed from the
custody of the parent. This way the person or agency that the court appoints to
act as guardian can authorize the needed medical treatment.

The capacity for the
court to intercede in these cases is rooted in both constitutional and common
law. In the Reynolds case, the Supreme Court distinguished
between religious beliefs and practices. “The court held that the First
Amendment protects religious belief, but the state may impose restrictions on
practice. Thus, a religious practice jeopardizing the health, safety, or
welfare of the person can be limited.” (Kasprak)

There is another basis
for intervention by the courts, “parens patriae” power. Parens Patriae power
means that parents are presumed by law to provide for the necessities of life
required by their child. If a parent fails in this, such as by refusing medical
treatment, the state may intervene to protect the child and ensure that the
child gets the proper medical care.(Kasprak)

 For example, the limits of parent’s right to
refuse life- saving medical treatment based on religious beliefs was tested in
the following two legal cases-one in Oregon and the other in Philadelphia. The
two cases differ in circumstances but not medical outcome. They both deal with
the issue of refusing medical treatment based on religious beliefs.

 In the Oregon case a child died from lack of
medical treatment for a “treatable” disease (diabetes mellitus). The parents
were arrested and charged in criminal court. The girl died in February 2013
from a complication of the diabetes, diabetic ketoacidosis. The parents, Wenona
and Travis Rossiter, were members of the Church of the First Born in
Brownsville, Oregon. The church practiced faith based healing. Both parents
stated that they did not know their daughter was diabetic and therefore were
not responsible. The father was quoted as saying that based on his religious
beliefs he would not have done anything differently. He also stated that if his
daughter had requested to go the hospital he would have tried to talk her out
of it. The church believed that doctors are for people who don’t believe in
God. The mother claimed they believed that their daughter simply had the flu.
The state however, maintained that they should have been aware of their
daughter’s medical condition, and that a reasonable person would have sought
medical care before the condition became serious enough to cause their child’s
death (citation). On the day the child died she was extremely thirsty and
dehydrated. She had been vomiting and urinating all day and couldn’t even stand
up. She had also lost a lot of weight and appeared frail and emaciated. The
parents in this case were convicted of manslaughter.

            In the Philadelphia
case, a couple were convicted of involuntary manslaughter when their 2-year-old
son died of pneumonia. They believed that they could cure their son through prayer
and did not seek medical treatment. They received 10 years of probation. Their
pastor stated that the child died from a lack of spirituality in the parent’s
lives. In April 2013 the couple had another child die. Again, this time, it was
from pneumonia. The parents again asserted that their religion says you should
pray and not seek medical treatment. This time the parents were convicted and
were sentenced to three and a half to seven years in prison.

Many states have “religious
exemptions” to their child abuse and neglect laws. The exemptions come in
response to the Child Abuse Prevention and Treatment Act of 1974. The act
states “Provided, however, that a parent or guardian legitimately practicing
his religious beliefs who thereby does not provide specified medical treatment
for a child, for that reason alone shall not be considered a negligent parent
or guardian.” The states put the religious exemptions in place because it was a
condition for the states to receive federal child abuse grants. In response to
this act the Department of Health and Human Services stated that reports of
medical neglect should only be filed when there is harm or a grave risk of
harm, and religious exemptions should be a matter of state discretion rather
than federal imposition. (Bioethics 2013)

            It is
important to also note that public money can be used to pay for religious and
spiritual healing practices. For example, Medicaid and Medicare cover care
provided at Christian Science sanatoria and other religious nonmedical health
care institutions and exempt these from medical oversight requirements. (Bioethics
2013) Coverage for these non-evidences based treatment practices should be
terminated. Public funds should be used for evidenced based practice
treatments. Furthermore, the fact that these institutions receive public money
seems to legitimize them. Parents are less likely to seek out competent medical
care if they believe they are receiving care from a legitimate source. The
American Academy of Pediatrics recognizes the importance of addressing the
spiritual needs of children as part of a comprehensive care plan, but it
opposes public funding of religious or spiritual healing practices.

American Academy of Pediatrics gives the following recommendations:

pediatric medical subspecialists, and pediatric surgical specialists should
respect families and their religious or spiritual beliefs and collaborate with
them to develop treatment plans to promote their children’s health.

pediatric medical subspecialists, and pediatric surgical specialists should
report suspected cases of medical neglect to state child protective services
agencies, regardless of whether the parents’ decision is based on religious

pediatric medical subspecialists, pediatric surgical specialists, and the AAP
and its chapters should work to repeal religious exemptions to child abuse and
neglect laws and to prevent public payment for religious or spiritual healing





























Philadelphia couple,
who says they seek prayer not doctors, in court after second child dies; no
charges yet. (n.d.). Retrieved January 27, 2018, from


Faith versus Medicine:
When a Parent Refuses a Childs … (n.d.). Retrieved January 27, 2018, from,5067.1


Bioethics, C. O. (2013,
November 01). Conflicts Between Religious or Spiritual Beliefs and Pediatric
Care: Informed Refusal, Exemptions, and Public Funding. Retrieved January 27,
2018, from


Kasprak, J. (n.d.).
Retrieved January 27, 2018, from


& Children’s Services Abuse & Neglect. (n.d.). Retrieved January 27,
2018, from,5885,7-339-73971_7119-21208–,00.html




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