COMMENTARY

Parental Authority Should Be Overridden for a Sick Child

Arthur L. Caplan, PhD

Disclosures

November 01, 2017

Hi. I am Art Caplan, and I am at the division of medical ethics at the New York University (NYU) School of Medicine.

An increasing phenomenon in American society, and Canada too, is parents who, for religious reasons, don't want to take their child to the doctor. Now, we have had this issue for many, many, many decades. It goes back to Christian Science, which has always had a leery attitude about healthcare.

We have certainly seen some Jehovah's Witnesses who go to get healthcare, but they are not accepting of blood transfusion, and then there are a host of other people who either belong to an increasing number of more fundamentalist sects, or they may pursue natural healing, some types of more homeopathic approaches, not scientific, but they find themselves in groups or choose to follow those modes of responding to illness and disease.

Recently, a Michigan couple was charged with involuntary manslaughter. Their baby was delivered by a midwife, who didn't see any problems at the delivery, but the midwife came back the next day and saw that the baby was severely jaundiced. She urged the parents to take the baby to the doctor or a hospital. The parents did not. I think the mother said, "God doesn't make mistakes," and they began to pray over their infant.

They were only discovered later by the police, when the child was dead. When the police finally showed up at the couple's home, they found a bunch of people praying over the poor, little infant. Something had been solvable here. We have jaundice that is usually a symptom of problems that can be remediated, and sadly this child died.

What is the ability of the state to override parental authority, and what is your obligation to do something if you think parents are pursuing a course of action that is not in their child's best interest? Well, people can intervene under the following circumstances: If there is a life-threatening condition, you certainly can report a family that is not taking action on that life-threatening condition to social services at the city or state level, and you should.

Courts will override parents if they think there is an efficacious intervention, such as insulin for diabetes or antibiotics for meningitis, where the child can benefit. It is harder to get experimental novel treatments ordered by courts; they will give more discretion to parents in those situations.

It is also the case that if the parents are basically trying to pray, sometimes medicine can work with them. You pray, we will do the medical treatments; maybe they will accept working together. I have seen that happen in some instances.

You have an obligation if you learn or hear from a midwife or anybody who has been involved in childcare—a babysitter, whoever—that a child is sick, and they are concerned, that should be reported to child welfare. Again, the county, the city, or the state—any of those will do. You could report it to the police. Once reported, you are out of the game. You do not have to worry too much because they will take it up and try to investigate and make sure that the child is being protected.

I know very well that many of these services are busy and overwhelmed, but they make time, and they do try to look out, particularly for children who might not be getting the necessary medical care that they need.

You cannot prevent every instance of parents not showing up within the medical systems. Sometimes they are just outside of the safety net. Sometimes they can stay off the grid, and you do not find out, tragically, until it is too late.

I favor prosecuting those cases because it sends a message that it will not be tolerated, even though I do not think that these parents need to go to jail. I think that they need to be sentenced to community volunteerism. There is no point in punishing them; they have lost their child, they are grieving, but having prosecutions occur does send the message that the community will not put up with prayer as an alternative to established medical care.

At the end of the day, child welfare and the child's best interest can override parental discretion and parental choice, and in some instances, it has to.

I am Art Caplan at the division of medical ethics at the NYU School of Medicine. Thanks for watching.

Talking Points: Parental Authority Should Be Overridden for a Sick Child

Issues to consider:

  • Failure to provide children with essential medical care has been increasingly recognized as a form of neglect. In 1983, the US Department of Health and Human Services amended its definition of negligent treatment to include failure to provide adequate medical care.[1]

  • Many healthcare professionals are concerned that although parents have broad authority, they have less discretion in making medical decisions for their children than for themselves.

  • Some healthcare professionals contend that although the free exercise of religion, including parents teaching their children their religious beliefs, is an important societal value, it must be balanced against other important societal values such as protecting children from serious harm.

  • The courts have consistently ordered life-saving medical treatment over parental religious objections. In passages frequently quoted in subsequent rulings, the US Supreme Court famously stated, "The right to practice religion freely does not include liberty to expose the community or the child to communicable disease 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."[1]

  • Several US studies found that adults from different racial/ethnic and socioeconomic groups generally agree on what constitutes child neglect.[2]

  • Although society generally believes that parents or guardians are best situated to understand their child's unique needs, including healthcare needs, and should participate in caring and thoughtful medical decision-making, this parental responsibility is not an absolute right. For instance, some healthcare professionals believe that it is critical to design childhood immunization exemption policies so that they clearly serve the best interests of both the individual child and the community.[3]

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