American Journal of Law & Medicine

Spiritual healing, sick kids and the law: inequities in the American healthcare system.

I. INTRODUCTION

Main Street in Sarasota, Florida. A high-tech medical arts building rises from the east end, the county's historic three-story courthouse is two blocks to the west and sandwiched in between is the First Church of Christ, Scientist. A verse inscribed on the wall behind the pulpit of the church reads: "Divine Love Always Has Met and Always Will Meet Every Human Need." This is the church where William and Christine Hermanson worshipped. It is just a few steps away from the courthouse where they were convicted of child abuse and third-degree murder for failing to provide, conventional medical care for their seven-year-old daughter.

This Article is about the intersection of "divine love" and "the best interests of the child." It is about a pluralistic society where the dominant culture reveres medical science, but where a religious minority shuns and perhaps fears that same medical science. It is also about the struggle among different religious interests to define the legal rights of the citizenry. Of utmost importance, it is about the rights of children who are caught in the midst of this struggle. Specifically, this Article focuses on provisions that exist in a majority of the states that exempt parents, who rely on prayer in lieu of medical care, from the parental obligations mandated for all other parents by child abuse and neglect statutes.

This Article begins with an analysis of the theological principles and practices of religious groups that rely on prayer. In Part III, the Article reviews published empirical studies both on mortality rates for members of these groups and on infection rates for vaccine-preventable diseases both for members of these groups and for the public at large. Then, in Part IV, it examines the history and current status of spiritual exemption statutes. Part V provides an analysis of constitutional issues based on the Free Exercise and Establishment of Religion Clauses of the First Amendment. Part VI provides an analysis of constitutional issues based on the Due Process and Equal Protection clauses of the Fourteenth Amendment.

In Part VII, it reviews the specifics of cases decided by state supreme courts. The Article concludes with recommendations to substantially modify the exemptions because they do not protect the best interests of the child, and instead cause a pattern of discrimination against these children as a class, therefore creating inequities in the healthcare system. Specifically, this Article advocates that spiritual exemptions from vaccinations be eliminated and that exemptions from providing medical care be eliminated when the child's condition is a serious threat to his or her health or life. As this Article goes to press, prosecutors in Tennessee are filing criminal charges against a mother who fatally withheld medical treatment for cancer from her teenager, opting instead to rely solely on the power of prayer. (1)

II. THE RELIGIOUS MINORITY: GROUPS THAT OPPOSE CONVENTIONAL MEDICINE

The Christian tradition depicts life on earth as a journey from God back to God. While denominational theologies differ, the overriding principle is that Christians are the children of GOd and will be rewarded with eternal salvation by living according to the teachings of God's word as found in the Bible. For practicing Christians, prayer is an essential part of life's sojourn on earth, and prayers are offered for a multitude of things including relief from sickness. Scientists are beginning to study the impact both of prayer for oneself and prayer for others, and the National Institutes of Health are now funding research on the medical effects of prayer through the Frontier Medicine Initiative. (2)

While prayer is integral to the Christian tradition, the overwhelming majority of churches and their members recognize the value of conventional medical care. Priests and ministers are daily visitors at hospitals, nursing homes and hospices. There are, however, two notable exceptions to this tradition: the Christian Science Church and a small number of fundamentalist churches, often referred to as fundamentalist sects. While the Christian Science Church has a well-defined theology that has been the subject of many research papers, the fundamentalist sects are more difficult to study because they are insular and have often isolated themselves from the public's view and certainly from the probing eyes of social scientists. Some of the major sects include Church of the First Born, End Time Ministries, Faith Assembly and Faith Tabernacle. (3)

A. THE CHRISTIAN SCIENTIST CHURCH

Mary Baker Eddy founded the Church of Christ, Scientist in 1879. Healing through prayer is at the center of Christian Science theology. Eddy experienced chronic illness during her young adult years. Her search for a cure ended in 1866 when she was suddenly healed from injuries received in a severe fall. She believed the healing was the result of reading the New Testament, and she came to believe that spiritual healing was a natural part of Christian life. (4)

DesAutels, a scholar bridging two worlds as a life-long Christian Scientist and a medical ethicist, argues that:

 
   the choice of both Christian Scientists and non-Christian 
   Scientists is not one of simply deciding between alternative 
   approaches to curing disease, but is one of deciding between 
   alternative world views.... [Christian Scientists] choose to 
   live a religious way of life with spiritual growth as the goal 
   and with physical healings as one additional benefit from the 
   gaining of an increased understanding of spiritual reality. (5) 

While Christian Scientists do not deny the physical symptoms of disease, they believe these symptoms are not caused by viruses or bacteria, but by not being spiritually whole with God. The Church's publication on healing for children, Freedom and Responsibility, states:

 
   disease and physical suffering are in no sense caused or 
   permitted by God, and that since they are profoundly alien to His 
   creative purpose, it is wrong to resign oneself to them and right 
   to challenge them. To the Christian Scientist this conviction is 
   rooted in both the Old and New Testaments. In its fullest 
   implications, such a conviction furnishes the basis on which 
   illness, seen as an aspect of human alienation from God, can be 
   actively confronted and overcome. (6) 

Since, in the Christian Science world view, the symptoms of disease are caused by a lack of spiritual wholeness, the most effective method for "curing" those symptoms is to grow closer to God through prayer and moral regeneration. According to Eddy, "Jesus ... proved by his deeds that Christian Science destroys sickness, sin, and death." (7)

Some Christian Scientists retain the services of Christian Science practitioners who are professional "prayers" and who charge fees for their services. Usually these practitioners pray from their own homes or offices, rather than coming to the bedside of their patients. Christian Science nurses do come to the bedside to assist in the care of those who are ill, but they have no medical training and provide no medical treatment. Christian Science sanitoria (nursing homes) also care for those who are ill, but, again, without any medical treatment.

Christian Scientists are quick to point out that while Christian Science healing methods sometimes fail, the healing methods of medical doctors do as well, and parents of children who die in hospitals are not prosecuted. Moreover, they point to the explosion in medical malpractice lawsuits and the published accounts of fatalities caused in hospital settings through medical error. (8) They are supported in their worldview by testimonials of their healings both at Wednesday evening services and in various Church publications.

Part of the Christian Science view in the United States is that Christian Science healing methods cannot be combined with medicine because the methods interfere with one another. (9) According to Christian Science Church historian Robert Peel, however, members (in the United States) are allowed to choose either conventional medicine or spiritual healing, and are not pressured to accept the latter. (10) Rita Swan, a former Christian Scientist whose infant son died of meningitis and who subsequently founded Children's Healthcare Is a Legal Duty (CHILD), disputes Peel's view that members may choose without pressure. She and her husband were pressured not to seek conventional medical care when their son became ill. (11) She also notes that prior to her son's illness, she opted for surgery after years of attempting to cure an ovarian cyst through Christian Science methods. When she admitted to local church officials that she had been treated with conventional medicine, she was placed on probation and forced to resign from church offices. (12) In Great Britain and Canada, however, Christian Science methods are used simultaneously with conventional medicine because in both countries the law requires that all children receive conventional medical care. (13)

B. FUNDAMENTALIST SECTS

Fundamentalist sects are more difficult to analyze because there are so many, and they adhere to different theological principles. Some interpret biblical passages to mean that only God can heal. (14) They point to Mark 16:17-18, which reads in part, "they shall lay hands on the sick and they shall recover," (15) and to James 5:13-15, which reads:

 
   is any sick among you? Let him call for the elders of the 
   church; and let them pray over him, anointing him with oil in 
   the name of the Lord: And the prayer of faith shall save the 
   sick, and the Lord shall raise him up; and if he have committed 
   sins, they shall be forgiven him. (16) 

According to Ronald Flowers, these sects believe that God will heal the truly faithful and if a follower rejects medicine and trusts in God, he has demonstrated the kind of faith required for God to heal. If healing does not come, it is because either the follower did not have sufficient faith or God had another plan for him. The Reverend Hobart Freeman, founding minister of the Faith Assembly in Indiana, typifies this view.

 
   You'll see that [God] clearly tells you that you've got to 
   burn all your bridges so that you have no choice but to fight 
   the devil on your own and overcome him. Burn your bridges so 
   that you know there's no bridge between your sickness and the 
   doctor's office.... I'll tell you friends, it's not as painful 
   as you might think, not as terrifying as you might think, when 
   you trust God alone. (17) 

III. EMPIRICAL EVIDENCE

A. RETROSPECTIVE MORTALITY STUDIES

From the medical scientist's perspective, the effectiveness of a treatment is measured by empirically based morbidity and mortality studies. The effectiveness of Christian Science and faith healing methods cannot be compared to medical therapies because members of these churches do not participate in scientific studies. However, studies based on mortality rates and on retrospective evaluation of causes of death indicate that spiritual healing is less effective than medicine. Records of the King County coroner's office in Seattle, Washington indicate that for a twenty-one-year period beginning in 1935, death rates for Christian Scientists for most causes of death were substantially higher than for non-Christian Scientists. Christian Science deaths from diabetes and malignancy were twice the national average. (18)

William F. Simpson published a study in the Journal of the American Medical Association comparing mortality rates for graduates of Principia College, a Christian Science college, with those of the University of Kansas for the period from 1934 to 1983, and found mortality rates to be higher among the Principia graduates. For example, seventy-one percent of males who graduated from the University of Kansas between 1934 and 1938 were still alive at the time of the study, compared to only sixty-four percent of males who graduated from Principia College. (19) Simpson published similar findings in Morbidity and Mortality Weekly Report (MMWR), a publication of the Centers for Disease Control. This study compared mortality rates at Principia with those at Loma Linda University, a Seventh-Day Adventist college, and found the mortality rate at Principia was forty per 1000 compared to twenty-two per 1000 at Loma Linda. (20) A study of Faith Assembly members in Indiana between 1975 and 1982 showed perinatal morality rates to be nearly three times higher than rates for the rest of Indiana, and maternal mortality rates to be ninety-two times higher. The authors point out that the maternal mortality rates were comparable to rates in developing nations where obstetrical care was unavailable, and that Bangladesh had a significantly lower maternal mortality rate than Faith Assembly members. (21)

A retrospective study of 172 child fatalities among faith healing sects for the years 1975 through 1995 evaluated the probability of survival if conventional medical care had been provided. Researchers found that survival rates for 140 of these cases would have exceeded ninety percent, and an additional eighteen cases would have had survival rates in excess of fifty percent. Fifty-nine of these children were newborns, and all but one would have had a good to excellent expected outcome with medical care. The mothers in these cases generally declined conventional prenatal care and delivered with no assistance at all or with the attendance of an unlicensed "midwife." (22) Subsequent to the publication of this study in Pediatrics, the journal of the American Academy of Pediatrics, an Oregon newspaper reported the deaths of seventy-eight children between 1955 and 1998 in a religious sect called the Followers of Christ. These deaths were not included in the Pediatrics study. CHILD's newsletter reported that doctors stated that at least twenty-one of these children probably would have lived had they been provided medical care. (23)

B. ANECDOTAL REPORTS

Specific events raise questions about the success of healing through prayer. In 1972, there was an outbreak of polio at a Christian Science boarding school in Connecticut. Eleven children were paralyzed before an outsider notified state health officials. (24) In 1985, there was an outbreak of measles at Principia College, the Christian Science college mentioned above. Most of the 700 students there had not been vaccinated; about 120 students became ill, and three died. This is more than twenty times higher than the death rate from measles in the general population. (25) CHILD reports that five children in a Missouri Christian Science school died over a nine-year period of illnesses highly manageable by conventional medicine. These mortality rates are substantially higher than the rates for children of similar socioeconomic backgrounds whose parents use conventional medical care. (26) In 1994, there was an outbreak of measles in St. Louis that spread from one Christian Science youth to 247 people--nearly all of them children--and many of them non-Christian Scientists. The reported cost to St. Louis County was in excess of $100,000. (27)

C. IMMUNIZATION STUDIES

In 2002, all states required that students be immunized for certain diseases prior to attending school, except for students for whom a vaccination is medically contraindicated. …

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