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PEDIATRICS Vol. 99 No. 2 February 1997, pp. 279-281
AMERICAN ACADEMY OF PEDIATRICS:
Religious Objections to Medical Care
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ABSTRACT |
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Parents sometimes deny their children the benefits of medical care because of religious beliefs. In some jurisdictions, exemptions to child abuse and neglect laws restrict government action to protect children or seek legal redress when the alleged abuse or neglect has occurred in the name of religion. The American Academy of Pediatrics (AAP) believes that all children deserve effective medical treatment that is likely to prevent substantial harm or suffering or death. In addition, the AAP advocates that all legal interventions apply equally whenever children are endangered or harmed, without exemptions based on parental religious beliefs. To these ends, the AAP calls for the repeal of religious exemption laws and supports additional efforts to educate the public about the medical needs of children.
The American Academy of Pediatrics (AAP) recognizes that religion
plays a major role in the lives of many children and adults in the
United States and is aware that some in the United States believe
prayer and other spiritual practices can substitute for medical
treatment of ill or injured children. Through legislative activity at
the federal and state levels, some religious groups have sought, and in
many cases attained, government recognition in the form of approved
payment for this "nonmedical therapy" and exemption from child
abuse and neglect laws when children do not receive needed medical
care. The AAP opposes such payments and exemptions as harmful to
children and advocates that children, regardless of parental religious
beliefs, deserve effective medical treatment when such treatment is
likely to prevent substantial harm or suffering or death.
The US Constitution requires that government not interfere with
religious practices or endorse particular religions. However, these
constitutional principles do not stand alone and may, at times,
conflict with the independent government interest in protecting children.1 Government obligation arises from that interest when parental religious practices subject minor children to possible loss of life or to substantial risk of harm.2,3
Constitutional guarantees of freedom of religion do not permit children
to be harmed through religious practices, nor do they allow religion to
be a valid legal defense when an individual harms or neglects a
child.4
Acute Illness or Injury
The AAP asserts that every child should have the opportunity to
grow and develop free from preventable illness or injury.5 Children also have the right to appropriate medical evaluation when it
is likely that a serious illness, injury, or other medical condition
endangers their lives or threatens substantial harm or suffering. Under
such circumstances, parents and other guardians have a responsibility
to seek medical treatment, regardless of their religious beliefs and
preferences. Unfortunately, certain groups have obtained exemptions
from legal sanctions and state child abuse and neglect reporting laws
based on the child's "treatment" by spiritual means, such as
prayer.6 The overall effect has been to limit the
government's ability to protect children from abuse or neglect.
The AAP is concerned about religious doctrines that urge parents to
avoid seeking medical help when their children are seriously ill. Each
year, some parents' religious views lead them to eschew appropriate
medical care for their children, resulting in substantial harm or
suffering or death due to treatable conditions such as meningitis,
bowel obstruction, diabetes mellitus, or pneumonia (Boston
Globe. August 12, 1993:1; Pittsburgh Post-Gazette.
March 16, 1991:B1).4,7 The AAP considers failure to seek
medical care in such cases to be child neglect, regardless of the
motivation. The basic moral principle of justice requires that children
be protected uniformly by laws and regulations at the local, state, and
federal levels. Parents and others who deny a child necessary medical
care on religious grounds should not be exempt from civil or criminal
action that otherwise would be appropriate. State legislatures and
regulatory agencies should remove religious exemption clauses from
statutes and regulations to ensure that all parents understand that
they should seek appropriate medical care for their children.
Preventive Care
Some religious tenets hold that members should not seek or receive
medical care for any condition, including pregnancy. These beliefs can
result in increased perinatal and maternal mortality.8 Some
religious groups deny children the benefits of routine preventive care.
For example, some parents, acting in accord with state laws, refuse to
have their children immunized because of religious beliefs. The AAP
does not support the stringent application of medical neglect laws when
children do not receive recommended immunizations. Although the risk to
unimmunized individuals is relatively low, serious adverse reactions to
vaccination are rare and the AAP strongly endorses universal
immunization. Recent outbreaks of vaccine-preventable infectious
diseases, with consequent serious complications and deaths, have been
linked to groups that refused immunization for religious
reasons.9-12
The AAP therefore supports the use of appropriate public health
measures, such as mandatory mass vaccinations in epidemic situations,
when necessary to protect communities and their unimmunized members. In
addition, the AAP is concerned that children unimmunized for any reason
may expose young children, not yet old enough to be protected, to
infections such as pertussis or invasive Haemophilus influenzae disease. The risk is especially high in child care facilities. In such situations, all parents of children in the facility
should be informed of the hazards.
Mature Minors
The weight given to parental religious beliefs in decisions
affecting their children's well-being declines with the child's increasing age and development. That is, as minors mature, their interest in and capacity for participating in health care decisions affecting themselves increases, as does their ability to make decisions
regarding their parents' religious views. The law and AAP policy
recognize the doctrine of the "mature minor."13 This concept acknowledges that many children, usually beginning in adolescence, can contribute to or make medical decisions, including those about life-sustaining treatment. Thus, in selected cases, disputes may be avoided when a minor has the capacity to make an
independent decision in light of religious values and recommended medical therapy.
Need for Care and Respect
The AAP wishes to underscore its recognition of the important role
of religion in the personal, spiritual, and social lives of many
individuals and cautions physicians and other health care professionals
to avoid unnecessary polarization when conflict over religious
practices arises. Pediatricians should seek to make collaborative
decisions with families whenever possible and should take great care
when considering seeking authority to override parental preferences.
Nevertheless, physicians who believe that parental religious
convictions interfere with appropriate medical care that is likely to
prevent substantial harm or suffering or death should request court
authorization to override parental authority or, under circumstances
involving an imminent threat to a child's life, intervene over
parental objections. When caring for children whose prognoses are grave
even with treatment, physicians should use restraint in pursuing a
court order to initiate or continue treatment when parents object to
it. In such situations, physicians should work with the parents and
children to ensure provision of appropriate palliative care.
Threatening or seeking state intervention should be the last resort,
undertaken only when treatment is likely to prevent substantial harm or
suffering or death. Even under these circumstances, physicians should
respect parental religious beliefs and the role of parents in rearing their children. Of course, a physician may withdraw from these cases,
after securing acceptable alternative medical care, when continuing in
the doctor-patient-family relationship would violate the physician's
own moral precepts.
The AAP emphasizes that all children who need medical care that is
likely to prevent substantial harm or suffering or death should receive
that treatment. The AAP opposes religious doctrines that advocate
opposition to medical attention for sick children. Adherence to such
views precludes appropriate assessment and intervention to protect the
children. The AAP believes that laws should not encourage or tolerate
parental action that prevents implementing appropriate medical
treatment, nor should laws exempt parents from criminal or civil
liability in the name of religion.
The AAP calls for all those entrusted with the care of children
to:
THE PROBLEM
RECOMMENDATIONS
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Abstract
Recommendation
References
COMMITTEE ON BIOETHICS, 1995 TO 1996
Joel E. Frader, MD, Chairperson
Lucy S. Crain, MD
Kathryn L. Moseley, MD
Robert M. Nelson, MD
Ian H. Porter, MD
Felipe E. Vizcarrondo, MD
LIAISON REPRESENTATIVES
Watson Bowes, MD
American College of Obstetricians & Gynecologists
Alessandra Kazura, MD
American Academy of Child & Adolescent
Psychiatry
Ernest F. Krug III, MD
American Board of Pediatrics
SECTION LIAISON
Donna A. Caniano, MD
Section on Surgery
LEGAL CONSULTANT
Nancy M. P. King, JD
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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ABBREVIATIONS |
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AAP, American Academy of Pediatrics.
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REFERENCES |
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Recommendation
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- Planned Parenthood of Central Missouri v Danforth, 428 US 52, 74(1976)
- Prince v Commonwealth of Massachusetts, 321 US 158, 170(1944)
- Jehovah's Witnesses v King County Hospital Unit No. 1, 278 F Supp 488 (WD Wash 1967), affirmed per curiam 390 US 598(1968)
- Walker v Superior Court, 763 P2d 852, 860 (Calif 1988), cert denied, 491 US 905(1989)
- UN Convention on the Rights of the Child. New York, NY: United Nations; 1989
- Skolnick A. Religious exemptions to child neglect laws still being passed despite convictions of parents. JAMA. 1990;264:1226, 1229, 1233
- State of Minnesota v McKown, 475 NW2d 63 (Minn 1991), cert denied, 112 S Ct 882(1992)
- Kaunitz AM, Spence C, Danielson TS, Rochat RW, Grimes DA Perinatal and maternal mortality in a religious group avoiding obstetric care. Am J Obstet Gynecol. 1984; 150:826-831 [Medline]
- Rodgers DV, Gindler JS, Atkinson WL, Markowitz LE High attack rates and case fatality during a measles outbreak in groups with religious exemption to vaccination. Pediatr Infect Dis J. 1993; 12:288-292 [Medline]
- Etkind P, Lett SM, Macdonald PD, Silva E, Peppe J Pertussis outbreaks in groups claiming religious exemptions to vaccinations. AJDC. 1992; 146:173-176
- Novotny T, Jennings CE, Doran M, Measles outbreaks in religious groups exempt from immunization laws. Public Health Rep. 1988; 103:49-54 [Medline]
-
Centers for Disease Control
Outbreak of measles among Christian Science students
Missouri and Illinois, 1994.
MMWR.
1994;
43:463-465 [Medline] -
Committee on Bioethics, American Academy of Pediatrics
Informed consent, parental permission, and assent in pediatric practice.
Pediatrics.
1995;
95:314-317
[Abstract/Free Full Text]
Pediatrics (ISSN 0031 4005). Copyright ©1997 by the American Academy of Pediatrics
Statements of reaffirmation:
- AAP Publications Retired or Reaffirmed, October 2006
- American Academy of Pediatrics
Pediatrics 2007 119: 405.[Extract] [Full Text] [PDF]
-
Policy Statement—AAP Publications Retired and Reaffirmed
Pediatrics 2009 124: 845.[Extract] [Full Text] [PDF]
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