Religious Exemptions to Child Neglect: A Case for Repeal

Abigail Records
CAP Red Group
April 24, 2016

Religious Exemptions to Child Neglect: A Case for Repeal

Children depend on their parents to keep them safe. This expectation of safety extends to
the provision of medical care, especially when such care is necessary to prevent imminent death
or severe disability. Federal law requires that parents and guardians provide their children with
access to medical care, but most states allow parents to deny care if it conflicts with their
religious beliefs. Because children must rely on parents or guardians to make informed decisions
about medical care, denial of medical care to a child presents a risk of harm to the child, and
laws related to medical exemptions for religious reasons are outdated, state legislatures must
repeal laws allowing religious exemptions to critical medical treatment for children.
Children rely on their parents or guardians to take care of their basic needs, including
food, shelter, and healthcare. A child generally has little capacity to seek out these resources and
a limited understanding of the elements necessary to maintain good health. Basic needs include
critical medical care, and denial of such care to a child presents a risk of harm. Parents who deny
medical treatment for their children should be held liable.
In 1974, Congress passed the Child Abuse Prevention and Treatment Act, which provides
Federal funding to states in support of prevention, assessment, investigation, prosecution, and
treatment of child abuse and neglect (Child Welfare Information Gateway 1). Congress deferred
to the Department of Health, Education and Welfare (HEW; now Health and Human Services) to
determine religious exemption policies under the Act. HEW mandated that, as a prerequisite for
receiving Federal funds, states adopt religious exemptions to child neglect (National Center for
Prosecution of Child Abuse 1). These exemptions provide legal protection for parents who deny
their children critical medical attention, if such care violates their religious beliefs. In 1983, the

Department of Health and Human Services struck down the religious exemption requirement, but
few states have repealed their exemption laws. Only six statesHawaii, Massachusetts,
Maryland, Nebraska, North Carolina, and Oregonhave eliminated exemptions to civil and
criminal abuse and neglect charges (Asser; Kost). There is no federal requirement that parents or
legal guardians provide their children with medical treatment that is against their religious beliefs
(National Center for Prosecution of Child Abuse 1).
Over the years since the establishment of religious exemptions to child neglect, various
attempts have been made to reshape relevant laws. Some of these legal challenges have seen
success. In March 2011, the Oregon House of Representatives unanimously passed a bill that
removed legal protection for parents choosing faith healing over medical treatment for their
children (Kost). This legislation came in response to the Followers of Christ, an Oregon City
church with a long history of medically treatable child deaths. When the Oregon bill passed,
Democratic representative Carolyn Tomei said, Our hope is that were sending a certain group
of people a message that its against the law if their child is in grave danger to not give them
medical care (Kost). In March of 2016, the Tennessee Senate unanimously approved a bill to
repeal the spiritual treatment exemption to the states child abuse and neglect statute (Locker).
The legislation followed the highly publicized death of Jessica Crank, a 15-year-old with a rare
form of cancer whose parents ignored medical advice and pursued treatment through prayer.
Not every attempt to address medical child neglect on religious grounds has been
successful. In February of 2016, a bill was introduced to the Idaho Senate Health and Welfare
Committee to amend state law to require medical care for children in cases of imminent death or
severe disability (Rasmusson). As it had done in the past, the Legislature chose not to debate the
measure (Prentice). Thirty-seven states offer some level of exemption for parents who withhold

medical treatment from their children on religious grounds. Idaho is one of nine states that allow
religious exemptions for negligent homicide, manslaughter or capital murder (Rasmusson).
Religious exemptions to medical treatment for children may lead to preventable death. A
1998 study in Pediatrics analyzed 172 cases of child mortality due to faith-based medical neglect
and found that 140 of the deceased had conditions that were curable with a probability of greater
than 90 percent (Asser). Deaths associated with childbirth complications are relatively high
amongst communities practicing faith-based healing. In the Followers of Christs Peaceful Valley
Cemetery in Idaho, approximately one-third of the graves belong to minor children, with 35
percent of the graves dating from 2002 to 2013 belonging to stillborn babiesmore than ten
times the number of stillbirths nationwide during those years (Rasmusson). It is plausible that the
unusually high number of stillbirths amongst Followers of Christ members is correlated with
their refusal to seek medical care for their unborn children.
Citizens in states with religious exemptions for medical neglect must demand that state
legislatures repeal laws allowing religious exemptions to critical medical treatment for children.
Six states have eliminated exemptions to civil and criminal abuse and neglect charges, setting an
example for others to follow. Legislators must be made aware of the ramifications of these
clauses and implored to make appropriate changes. The medical community supports repeal of
religious exemptions and may serve as a strong ally in advocacy efforts with state and federal
legislatures. Citing the avoidable suffering and deaths of numerous children each year due to
treatable conditions such as meningitis, bowel obstruction and pneumonia, the American
Academy of Pediatrics Committee on Bioethics called for all those entrusted with the care of
children to adhere to specific recommendations, including support of a repeal of religious
exemption laws (Committee on Bioethics, 280). The Committee, which included ten medical

doctors, asserted that parents who deny their children medical care in the name of religion should
be subject to child abuse and neglect laws.
Statistical data on preventable illness associated with religious beliefs is not routinely
collected, and most cases go unreported unless they attract the attention of outsiders. Anecdotal
evidence suggests that religion-based medical neglect is an ongoing problem, though, with the
Jessica Crank case as a recent example (Locker). If religious exemptions to child neglect remain
in place, it is likely that more children will needlessly suffer from treatable medical conditions.
In the worst cases, these exemptions may lead to additional preventable deaths. Moreover,
repercussions of parental decisions to opt out of medical treatment for their children may extend
to other children in the community. For example, many parents cite religious exemptions to
avoid required vaccinations for their children. A study published in JAMA Pediatrics, reported
that substandard vaccination compliance led to the 2015 measles outbreak at the Disneyland
Resort in Anaheim, California (Majumder et al.). Ninety percent of the 51 people who fell ill as a
result of the outbreak had not received the measles vaccine. Two of the children who became ill
were too young to be vaccinated, relying on herd immunity to stay safe (Kaplan). In this case,
herd immunity was compromised by the numerous unvaccinated patrons of the resort. While the
parents in Anaheim may or may not have objected to vaccination on religious grounds, the
Disneyland case highlights the potential damage that such exemptions may cause.
Children are not mature enough to make informed decisions about medical treatments
and must rely on parents or guardians to keep them safe. When parents fail to keep their children
safe, they should be held legally responsible. This includes failure to provide medical treatment
for preventable serious illnesses. Denial of medical care to a child presents a risk of harm to the
child and should be punishable under child neglect laws, regardless of whether the medical

treatment conflicts with parents religious beliefs. State legislatures must repeal laws allowing
religious exemptions to critical medical treatment for children.

List of Works Cited

Asser, Seth M., and Rita Swan. Child Fatalities From Religion-Motivated Medical Neglect.
Pediatrics 101.4 (1998) : 625-629. Print.
Child Welfare Information Gateway. About CAPTA: A Legislative History. U.S. Department
of Health and Human Services, Childrens Bureau. July 2011. Web. 18 March 2106.
Committee on Bioethics, American Academy of Pediatrics. Religious Objections to Medical
Care. Pediatrics 2 (1999) : 279-281. Print.
Kaplan, Karen. Vaccine Refusal Helped Fuel Disneyland Measles Outbreak, Study Says. Los
Angeles Times. Los Angeles Times Media Group, 16 March 2015. Web. 18 March 2016.
Kost, Ryan. Oregon House Unanimously Votes to End Faith Healing Exception. The
Oregonian. Oregonian Media Group, 10 March 2011. Web. 18 March 2016.
Locker, Richard. Bill Would Repeal Spiritual Treatment Exemption to Tenn. Child Neglect
Law. Knoxville New Sentinel. Knoxville News Sentinel, 13 March 2016. Web. 18 March
2016.
Majumder, Maimuna S., Cohn, Emily L., Mekaru, Sumiko R., Huston, Jane E., and John S.
Brownstein. Substandard Vaccination Compliance and the 2015 Measles Oubtreak. JAMA
Pediatrics 169.5 (2015) : 494-495. Print.
National Center for Prosecution of Child Abuse. Religious Exemptions to Child Neglect.
National District Attorneys Association. NDAA, 11 February 2015. Web. 15 February 2016.
Prentice, George. Rep. Gannons Faith-Healing Bill Wont Get Hearing in Idaho House.
Boise Weekly. Bar Bar Inc., 27 February 2014. Web. 18 March 2016.
Rasmusson, Cameron. Idahos Faith Healing Dilemma. Boise Weekly. Bar Bar Inc., 16 March
2016. Web. 18 March 2016.

Annotated Bibliography
Asser, Seth M., and Rita Swan. Child Fatalities From Religion-Motivated Medical Neglect.
Pediatrics 101.4 (1998) : 625-629. Print.
This study evaluates the deaths of children from families in which faith healing was practiced
in lieu of medical care. The authors determine that the number of preventable fatalities
associated with faith healing are substantial and warrant public concern.
Child Welfare Information Gateway. About CAPTA: A Legislative History. U.S. Department
of Health and Human Services, Childrens Bureau. July 2011. Web. 18 March 2106.
This factsheet outlines the key federal legislation addressing child abuse and neglectthe
Child Abuse Prevention and Treatment Actwhich was originally enacted on January 31,
1974.
Committee on Bioethics, American Academy of Pediatrics. Religious Objections to Medical
Care. Pediatrics 2 (1999) : 279-281. Print.
Citing the avoidable suffering and deaths of numerous children each year due to treatable
conditions such as meningitis, bowel obstruction and pneumonia, the American Academy of
Pediatrics Committee on Bioethics calls for all those entrusted with the care of children to
adhere to specific recommendations, including support of a repeal of religious exemption
laws. The Committee, which includes ten medical doctors, asserts that parents who deny their
children medical care in the name of religion should be subject to child abuse and neglect
laws.
Kaplan, Karen. Vaccine Refusal Helped Fuel Disneyland Measles Outbreak, Study Says. Los
Angeles Times. Los Angeles Times Media Group, 16 March 2015. Web. 18 March 2016.
This online newspaper article reports on the publication of an analysis in JAMA Pediatrics,
which characterized the 2015 outbreak of measles at Disneyland Resort in Anaheim,
California. The article points out that 96% to 99% vaccination rates are required for herd
immunity. The vaccination rate among people exposed to the measles during the outbreak
was as low as 50%.
Kost, Ryan. Oregon House Unanimously Votes to End Faith Healing Exception. The
Oregonian. Oregonian Media Group, 10 March 2011. Web. 18 March 2016.
This online newspaper article reports on the Oregon Houses approval of a bill removing
legal protections for parents who choose faith healing over medical intervention for their
children.
Locker, Richard. Bill Would Repeal Spiritual Treatment Exemption to Tenn. Child Neglect

Law. Knoxville New Sentinel. Knoxville News Sentinel, 13 March 2016. Web. 18 March
2016.
This online newspaper article reports that the Tennessee Senate approved a bill to repeal the
"spiritual treatment" exemption to the state's child abuse and neglect statute. The article
recounts the story of Jessica Crank, a 15 year-old suffering from rare cancer who treated
with prayer, in lieu of medical treatment, by her mother and her mothers spiritual advisor.
Majumder, Maimuna S., Cohn, Emily L., Mekaru, Sumiko R., Huston, Jane E., and John S.
Brownstein. Substandard Vaccination Compliance and the 2015 Measles Oubtreak. JAMA
Pediatrics 169.5 (2015) : 494-495. Print.
Epidemiological modeling is used in this study of the 2015 measles outbreak at the
Disneyland Resort in Anaheim, California. The authors conclude that MMR vaccination rates
in many of the affected communities fail to sustain herd immunity thereby putting the greater
population at risk.
National Center for Prosecution of Child Abuse. Religious Exemptions to Child Neglect.
National District Attorneys Association. NDAA, 11 February 2015. Web. 15 February 2016.
This document is a comprehensive compilation of Religious Exemption statutes from all U.S.
jurisdictions including states, territories, and the federal government, as of February 2015. In
39 states, the District of Columbia and Guam, parents or caretakers who fail to provide
medical assistance to a child because of their religious beliefs are not criminally liable for
harm to the child. There is also no Federal requirement that a parent or legal guardian provide
a child any medical treatment that is against the religious beliefs of the parent or legal
guardian.
Prentice, George. Rep. Gannons Faith-Healing Bill Wont Get Hearing in Idaho House.
Boise Weekly. Bar Bar Inc., 27 February 2014. Web. 18 March 2016.
This online newspaper article reports on the especially grim situation for children in Idaho
whose parents shun medical treatment. The report includes personal stories of former
Followers of Christ and Christian Science church members.
Rasmusson, Cameron. Idahos Faith Healing Dilemma. Boise Weekly. Bar Bar Inc., 16 March
2016. Web. 18 March 2016.
This brief online newspaper article reports that the Idaho Legislature opted not to debate a
Faith Healing bill.