|
Religious
Exemptions From Child Abuse Statutes
American Academy of
Pediatrics, Committee on Bioethics
Children sometimes die or become disabled when they
fail to receive medical treatment because of the strongly held religious or
philosophical beliefs or practices of their parents. The numbers of such
incidents of neglect are hard to ascertain reliably, but there are
increasingly frequent reports in the mass media. We believe the reported
cases represent the most extreme examples of a larger problem. According to
newspaper reports, the following are some specific cases that have come to
recent attention: (1) A 4-year-old girl in Sacramento, CA, died of
bacterial meningitis; her only treatment was spiritual healing by a
Christian Science practitioner (Sacramento Bee, April 21, 1984). (2) Two
children died of pneumonia and meningitis in Indiana. Both sets of parents
were prosecuted for withholding medical care from their children. The
parents belonged to the Faith Assembly, a sect that relies exclusively on
faith healing (Medical World News, Oct 4, 1984). (3) A 21h-year-old boy.
died in Boston of bowel obstruction in April 1986 following five days of
treatment by a Christian Science practitioner and nurse (Boston Globe,
April 10, 1986). (4) A 16-month-old Santa Monica, CA, boy died of bacterial
meningitis; his only treatment was prayer by a Christian Science
practitioner. (Los Angeles Times, April 30, 1984). (5) Parents of a
13-month-old boy in Coshocton, OH, who died with bacterial (Streptococcus
pneumoniae) pericarditis were tried and released because of religious
exemption protection. The child had received no medical care because the
parents were members of the Christ Assembly, a group that believes in
healing by prayer (Columbia Citizen-Journal, June 15, 1984). (6) A
23-month-old girl died of bronchopneumonia in Celina, OH, in April 1986. The
parents have claimed that their religious beliefs prevented them from
seeking medical care. Although the parents were prosecuted, charges were
dismissed because of the religious exemption clause[1]
(Akron Beacon Journal, May 6, 1986).
Ethical and Legal Issues
Religion plays an important role in the growth and
development of many children and families. However, when parental practices
have potentially harmful consequences for the child, state intervention may
be warranted.
The boundary between parental freedom in child rearing and the interest-or
even-basic rights-of the child is unclear. The limits to parental. decision
making for children are uncertain, but it is widely accepted that parents
generally will make decisions that do not directly 'threaten the welfare of
their children. Tradition, social forces, and belief systems shape the
limits of acceptable nurturance, of parental imperatives and privileges,
and even of physical force used in the discipline of children. These, of
course, change with time. However, the constitutional guarantees of freedom
of religion do not sanction harming another person in the practice of one's
religion, and they do not allow religion to be a legal defense when one
harms another.
Because the efficacy or necessity of many. medical
practices are arguable, those who claim that much of common medical practice
can be replaced or improved by various forms of nonmedical intervention or
"faith healing" will inevitably find some basis for their claims.. Although
there will always remain areas of legitimate debate, it is the intent of
this Committee to exclude from that debate for the purpose of defining
medical neglect: medical interventions of clear efficacy that can prevent,
ameliorate, or cure serious disease, incapacity, or loss of life and
interventions that will clearly result in prevention of future handicaps or
disability for the child.
Recognition of the prevalence and serious consequences of child abuse and
neglect has led society to develop increasingly comprehensive systems for
its detection and reporting and to the establishment of legislation and
procedures by each of the states. Federal rules, in addition to mandating
that certain procedures for reporting be adopted for each state, also
confirm the inclusion of standard medical treatment in the category of those
rights assured to children and establish the withholding of medical
treatment in some circumstances as a form of child abuse or neglect.
In the United States, the constitutional guarantee of
protection of religious practice from intrusion by. government has been used
by some religious groups to seek exemption from legislative or regulatory
requirements regarding child abuse and neglect.. Certain groups have
succeeded in obtaining exemption from reporting or prosecution for child
abuse and neglect, including medical neglect, in more than three quarters of
the states. There are now statutes in 44 states which contain a provision
stating that a child is not to be deemed abused or neglected merely because
he or she is receiving treatment by spiritual means, through prayer
according to the tenets of a recognized religion. Although these
exemptions take various forms and interpretations in different state
jurisdictions, the overall effect has been to limit the ability of the state
to prosecute parents for abuse or medical neglect of children when such
occurrences may be the result of "religious practice." Severe (even fatal)
physical discipline, failure to seek needed medical care, or refusal of a
proven efficacious treatment of a critically ill child may be protected from
remedy because of the so-called religious exemption clauses now found in the
majority of state codes.
Two important sets of interests are in apparent
opposition─those of children in the benefits of
proven medical and health care and those of parents in making decisions
about their children's wellbeing. Some parents believe that a
constitutionally protected freedom of religion allows them to deny their
children some or all of the benefits of standard medical intervention.
However, this interpretation of the US constitution is in contradiction to
important court rulings to the effect that parents may not martyr their
children based on parental beliefs
[2] and that children cannot be denied essential medical care.
[3],
[4]
Statement
The Committee on Bioethics asserts that (I the
opportunity to grow and develop safe from physical harm with the protection
of our society is a funds. mental right of every child; (2) the basic moral
principles of justice and of protection of children as vulnerable citizens
require that all parents and caretakers must be treated equally by the laws
and regulations that have been enacted by state and federal governments to
protect children; (3) all child abuse, neglect, and medical neglect statutes
should be applied without potential or actual exemption for religious
beliefs; (4) no statute should exist that permits or implies that denial of
medical care necessary to prevent death or serious impairment to children
can be supported on religious grounds; (5) state legislatures and regulatory
agencies with interests in children should be urged to remove religious
exemption clauses from statutes and regulations.
It is not the intent of the Committee to encourage the development of
separate legal systems to respond to parents who abuse or neglect their
children for religious or philosophical reasons. The usual procedures of
detection, reporting, and remediation by established civil or criminal court
processes are. in most
jurisdictions, sufficiently developed and functional. Rather, it is the
Committee's concern that those procedures designed to help children who are
victims of their caretakers and to prevent neglect be applied evenly to all
caretakers. Claims of exemption from responsibility for care-as defined
above-should not be honored on religious or philosophical grounds, and
offending parents or caretakers should not be treated more or less
stringently than those who make no such claim. The Committee does not
intend by this statement to advocate punishment of offending parents as a
solution to the problem of child abuse and neglect, but rather, we are
calling for equal treatment of all abusive parents.
Recommendations
The American Academy of Pediatrics recommends that all pediatricians,
pediatric surgeons, and AAP state chapters vigorously take the lead to (1)
increase public awareness of the hazards to children growing out of
religious exemptions to child abuse and neglect legislation; (2) support
legislation in each state legislature to correct statutes and regulations
that permit harm to children under the shield of religious exemption; (3)
work with other child advocacy organizations and agencies to develop
coordinated and concerted public and professional actions for rescission of
religious exemptions.
The Academy must unequivocally defend the rights of all
children to the protection and benefits of the law and medicine when
physical harm-or life itself-is in the balance.
Committee on Bioethics,
1986-1987
Norman C. Fost, MD, Chairman
William G. Bartholome, MD
William Reed Bell, MD
Alan R. Fleischman, MD
Arthur F. Kohrman, MD
William B. Weil, Jr, MD
Liaison Representative
Kenneth J. Ryan, MD
AAP Section Liaison
Anthony Shaw, MD
References
[1] Ohio Rev
Code 2919.22(A). (This religious exemption clause was held
unconstitutional in State v Miskimens, 22 Ohio Misc.2d 43, 490NE.2d 931
(Ohio Com Pl, 1984). However, because this was a lower court decision,
it only applies in the local jurisdiction of that court and is not
effective throughout the entire state of Ohio]
[2] Prince u
Massachusetts, 321 US 158 (1944)
[3] Jehovah's
Witnesses of Washington King County Hospital, 278 F Supp 488
(Washington, DC 1967), affirmed per curiam 890 US 598 (1968)
[4] Raleigh
Fitkin-Paul Morgan Memorial Hospital v Anderson, 42 NJ 421, 201 A. 2d
537 (1964), certiorari denied 377 US 985 (1964)
This statement has been approved by the Council on Child and Adolescent
Health.
The recommendations in this statement do not indicate an exclusive
course of treatment or procedure to be followed. Variations, taking
into account individual circumstances, may be appropriate.
PEDIATRICS (ISSN 0031 4005). Copyright © 1988 by the American
Academy of Pediatrics.
Reproduced by permission of Pediatrics, Vol. 81, No. 1, January
1988.
|
