A girl falls ill, desperately so. In an effort to restore her flagging health, her parents turn to the Bible rather than medical science; she never sees a doctor. Prayer, however, fails to heal the youngster, and she dies. Authorities then puzzle over whether the parents, in denying her the medical treatment that almost certainly would have saved her life, have committed neglect, abuse, or manslaughter—or perhaps even no criminal offense at all.
Over the past few months, this complex and tragic scenario has been playing out in two separate high-profile cases. In Oregon on March 2, a 16-month old girl named Ava Worthington died from bacterial pneumonia and a blood infection—ailments that her parents, citing the tenets of their religious faith, had chosen to treat with prayer rather medicine. Her parents, Carl and Raylene Worthington, currently face manslaughter and criminal mistreatment charges for their alleged roles in the child’s death. Meanwhile, an 11-year old Wisconsin girl named Kara Neumann died from diabetic ketoacidosis on Easter Sunday. Treatments of insulin almost certainly would have controlled the ailment, but Kara’s parents – their beliefs about physical healing shaped in part by the teachings of a Florida-based online ministry—chose to treat her with prayer in lieu of medical science. In late April, authorities charged the couple with second-degree reckless homicide, a felony punishable by up to twenty-five years in prison.
It is difficult to determine precisely how many Ava Worthingtons and Kara Neumanns there are in the United States every year. A landmark study published in the journal Pediatrics uncovered more than 150 reported fatalities over a 10-year period—a tally that one of the study’s authors later said represented only “the tip of the iceberg” of a surprisingly pervasive problem. Assessing whether forms of religion-related child abuse pose a greater risk to children than more widely publicized threats, such as ritual satanic abuse, a wide-ranging study funded by the National Center on Child Abuse and Neglect concluded that “there are more children actually being abused in the name of God than in the name of Satan.” Since the late nineteenth century, hundreds of such instances of abuse have resulted in tangled criminal litigation. The parents charged in these cases—many of them Christian Scientists or members of small Christian churches that ground their doctrines in narrowly literal interpretations of the Bible—often have argued that the First Amendment safeguards their decision to adhere to their faiths’ religious traditions and treat their ailing children solely by spiritual means. Prosecutors, meanwhile, have balked at the notion that constitutional protections for religious liberty provide an absolute bar to state regulation of religious conduct, particularly when that behavior puts the safety of children at risk.
Their task often has been complicated, however, by murky state manslaughter and abuse statutes that appear to provide exemptions for religious healing practices. Wisconsin’s child abuse statute, for instance, seems to shield from criminal liability those parents who engage in “treatment through prayer.” More than thirty other states offer similar kinds of apparent legal protections for devout parents who reject medicine and turn to prayer when their children are ailing.
A number of groups have lobbied for the repeal of such religious exemptions, chief among them the advocacy organization Children’s Healthcare Is a Legal Duty (CHILD). Its head, Rita Swan, has argued that these stipulations, while safeguarding the religious liberty of parents, endanger the health of children and violate several different interrelated constitutional standards.
Groups ranging from the United Methodist Church to the National District Attorneys Association also have called for the repeal of religious exemptions to child-abuse and neglect laws. Several prominent medical organizations—among them the American Medical Association and the Bioethics Committee of the American Academy of Pediatrics—have echoed those calls. In 1988, the latter body issued a statement declaring that “all child abuse, neglect, and medical neglect statutes should be applied without potential or actual exemption for [the] religious beliefs” of parents. Deeply committed to “the basic moral principles of justice and of protection of children as vulnerable citizens,” the members of the bioethics committee called upon state legislatures to remove religious exemption clauses and thereby ensure “equal treatment for all abusive parents.”
In response to a series of deaths involving children from the Worthington’s church, the Followers of Christ, Oregon repealed its religious-healing exemption in 1999, which would seem to make the prosecution of the Ava’s parents a straightforward affair. Nonetheless, they appear ready to mount a vigorous defense. They most likely will fall back on the claim that their religious practices are shielded from regulation by the First Amendment and analogous provisions in Oregon’s constitution. If comparable cases in other states can serve as any guide, this claim is unlikely to give them much legal traction: in cases stretching back to the late 19th century, a variety of courts have held that an individual’s right to religious liberty is not absolute, and that it can be outweighed by the state’s interest in protecting others or maintaining public order. In cases involving children and faith healing, courts generally have found that the state’s interest in protecting the welfare of children is paramount.
The Wisconsin case is likely to be somewhat more complicated because an apparent exemption for faith healing practices remains in place in that state’s child abuse and neglect laws. Although Dale and Leilani Neumann were not charged under it, they are likely to claim that its presence in the criminal code raises a question of “due process of law” (a right guaranteed by the Fifth and 14th Amendments of the U.S. Constitution. The couple might argue that, in effect, Wisconsin’s laws are too confusing for the average layperson to understand because one part of the criminal code (the child abuse statute) appears to explicitly protect spiritual healing practices while another (the second-degree reckless homicide law, under which they were charged) does not. Which measure were they supposed to follow? And in which circumstances?
Unlike the religious liberty argument, this claim has proven effective in several other states, including Minnesota. In 1990, prosecutors there tried a similar end-run around a religious-healing exemption, and three different courts (the trial court, the state court of appeals, and the state supreme court) ruled against them. The courts held that that the laws “provided ‘inexplicably contradictory’ definitions of prohibited behavior so as to violate due process requirements,” as one of the judicial opinions issued in the case put it. Because it’s from another state, the precedent in that case (State v. McKown) isn’t directly applicable in Wisconsin, but it almost certainly will be referenced by the Neumanns as courts here try to untangle the legal issues in their case. So too will be a similar case from Florida known as State v. Hermanson.
But this due process argument is by no means an air-tight defense for the Neumanns. Courts in other jurisdictions, most notably California, have rejected it. The rulings in these cases have found that there is no real conflict between the potentially applicable statutes, and that an average person would not be confused by them.
Arguing that they were “Christians first, citizens afterward,” a prominent Christian spiritual healer once urged his followers to disregard secular laws that might compel them to forsake their religious beliefs regarding healing. Such is the dilemma that confronts parents like the Worthingtons and Neumanns, who have chosen to treat their sick or injured children with prayer instead of medicine. Not only must they safeguard the health of their sons and daughters; they also must try to reconcile their devotion to God with their duties as citizens in a society that boasts a long and sometimes checkered history of regulating uncommon religious conduct.
Defining these obligations through the enforcement of secular laws—especially ones that are constitutionally fuzzy—can be a complicated business. Moreover, there is no guarantee that it will deter devout and stubborn parents from engaging in religious practices that endanger the health of their children. But the alternative—simply ignoring the suffering of the youngest and most vulnerable members of our nation’s churches—seems unconscionable.