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Independent Scientology and Nation of Islam news
Faith-Based Medical Neglect: for Providers and Policymakers. The case of Scientology.
Faith-Based Medical Neglect: for Providers and Policymakers
Rita Swan
Journal of Child & Adolescent Trauma volume 13, pages343–353(2020).
Faith-Based Medical Neglect: for Providers and Policymakers
https://link.springer.com/content/pdf/10.1007/s40653-020-00323-z.pdf
* * * * * BEGIN ABSTRACT * * * * *
Abstract
A substantial minority of Americans have religious beliefs against one or more medical treatments. Some groups promote exclusive reliance on prayer and ritual for healing nearly all diseases. Jehovah’s Witnesses oppose blood transfusions. Hundreds of thousands of schoolchildren have religious or conscientious exemptions from immunizations. Such exemptions have led to personal medical risk, decreases in herd immunity, and outbreaks of preventable disease. Though First Amendment protections for religious freedom do not include a right to neglect a child, many states have enacted laws allowing religious objectors to withhold preventive, screening, and, in some states, therapeutic medical care from children. Religious exemptions from child health and safety laws should be repealed so that children have equal rights to medical care.
Religion and science are arguably two of the most powerful drivers in human existence. Many consider them different types of truth and both valid while others try to combine them or reject one for the other. Faith-based rejection of medical care has cost the lives of many children and poses challenges to providers.
Asser and Swan (1998) reviewed deaths of 172 U.S. children after medical care was withheld on religious grounds from 1975 to 1995. Many of the children died of readily treatable infectious diseases and diabetes. The authors found that 80% of the children would have had at least a 90% likelihood of survival with timely medical care.
Many types of child abuse and maltreatment have been justified by some on religious grounds—for example, severe corporal punishment, exorcism, forced labor, forced marriage, dangerous diets, conversion therapy, and sexual abuse. Yet only faith-based medical neglect is protected in statute. Preventive and screening measures from which many state laws provide religious exemptions include immunizations, metabolic testing, blood lead-level tests, newborn hearing tests, prophylactic eye drops, vitamin K injections or drops, vision examinations, dental examinations, and school instruction about disease (Children’s Healthcare Is a Legal Duty, hereafter cited in text as CHILD (2020a), Religious exemptions from health care). Oregon and Pennsylvania have religious exemptions from bicycle helmets for children (Pennsylvania Consolidated Statutes §75–3510(b)(3); Oregon Revised Statutes 814.487).
This article discusses public policy and case law on faith-based medical neglect, beliefs against medical care in several denominations, and advice for providers who encounter religious objectors.
Scope of Statutory Exemptions
Religious exemptions about medical care of sick and injured children vary widely in meaning. Some are likely innocuous while others allow preventable deaths. Several states have a religious exemption in their reporting laws or in statutory definitions of child abuse and neglect (e.g. Calif. Penal Code §11,165.2(b) and Rev. Code of Washington 26.44.020(18)). Such placement sends a message to the would-be reporter that withholding medical care on religious grounds is not child neglect and therefore should not be reported to state child protection services.
Thirty states have religious defenses in their criminal codes. Nine have religious defenses to negligent homicide, manslaughter, or capital murder. West Virginia’s statute defining the crime of murder of a child does “not apply to any parent.. . who fails or refuses.. . to supply a child.. . with necessary medical care” on religious grounds” (WV Code 61.8D-2(d)). Arkansas has a religious defense to capital murder for those who cause deaths of children “under circumstances manifesting extreme indifference to human life” (Ark. Code 5–10-101(a)(9)(B)). There could be identical facts on what two Arkansas parents did to a child and one parent could be sentenced to death while the other would not be charged with murder – based upon their different religious beliefs. Virginia has a religious defense allowing Christian Scientists to deprive a child of medical care after they have physically assaulted and injured the child (Va. Code 18–2-314).
None of these exemption laws is required by the U.S. Constitution’s protections for religious freedom. Rulings upholding the state’s right to require medical care of sick children regardless of parents’ religious beliefs go back to 1903 (People v. Pierson 1903). In 1944, the U.S. Supreme Court held that the First Amendment does not include a right to neglect a child’s health or safety (Prince v. Massachusetts 1944). Many convictions of religious objectors have been upheld on appeal (e.g. Oregon v. Hickman 2015).
In Douglas County v. Anaya (2005), the Nebraska Supreme Court upheld the state’s right to require metabolic screening without a religious exemption. In Workman v. Mingo County Schools (2009), relying on many longstanding precedents in case law, a federal appeals court upheld the state’s right to require immunizations without a religious exemption.
At the time of this article, no U.S. court has held that parents have a constitutional right to religious practices that abuse or neglect children. States clearly have authority under the Constitution to require parents to provide medical care regardless of their religious beliefs. What remains unsettled, however, is whether legislatures may give parents a statutory right to withhold necessary medical care on religious grounds. At this time, there has been no Supreme Court decision in this regard. A law that allows some parents to deprive their children of medical care while requiring other parents to provide it would seem to violate the rights of children to the equal protection of the laws guaranteed in the fourteenth amendment of the Constitution.
While courts have upheld the state’s right to require parents to provide medical care, the federal courts have never ruled on whether children have equal protection rights to medical care (and therefore all parents must be required to provide it). Since parents must give permission for a child to sue and the religious exemptions are a privilege for the same parents whose children are endangered by the exemptions, it is extremely difficult to get courts to rule on this issue.
If the United States ratified the U.N. Convention on the Rights of the Child, children would arguably have rights to medical care, but the U.S. remains the only country in the world not to ratify the convention. Lobbying in state legislatures appears to be the only way to remove religious exemptions. The American Medical Association (1986), American Academy of Pediatrics (2013), National District Attorneys Association (2015), National Association of Medical Examiners (personal communication March 4, 2001), Prevent Child Abuse America (2007), and CHILD (2015) are among the organizations calling for repeal of these religious exemptions. Many religious exemptions are arguably in violation of the Establishment Clause in extending only to adherents of a “well-recognized religion” or “a bona fide” religion. Several courts have ruled that the government cannot give privileges to some sects and not others (Davis v. State 1982; McCarthy v. Boozman 2002; Dalli v. Board of Education 1971 et al.).
Idaho, a Special Case
The most compelling need for statutory change is in Idaho. The state not only has religious exemptions to manslaughter, non-support, criminal injury, and neglect (Ida. Code 18–1501(4), 18–401(2), 16–1602(25)(a)) but also has several congregations of denominations that oppose medical care and rely exclusively on prayer and ritual when their children are sick or injured. Idaho began keeping records on stillbirths in 2002 (Ida. Bureau of Vital Records 2015). In Peaceful Valley Cemetery, a cemetery used and controlled by the anti-medical sect Followers of Christ, 33% (63) of the 189 graves of those dying from 2002 through 2017 are minor children or stillbirths (CHILD, 2020b, Child abuse in Idaho). Statewide only 3% of Idaho deaths were minor children or stillbirths during those years (Idaho Bureau of Vital Records, 2015 and 2018). Therefore, the proportion of Peaceful Valley graves for minor children and stillbirths is more than 10 times the proportion of deaths among minor children and stillbirths statewide.
If one knew the causes of death for all the children buried in Peaceful Valley, the data would probably look even more elevated for them. Statewide, accidents are the leading cause of death among Idaho children older than one year, but accidents probably account for only a small fraction of the child deaths in Peaceful Valley.
Idaho public officials have generally been indifferent. The legislature unanimously passed the religious defenses to non-support, criminal injury of dependents, and manslaughter within four days after they were introduced. A coroner for Canyon County, Idaho where many of the deaths have occurred said in 2011 that she did not even do autopsies on Followers of Christ children because state law requires autopsies only when a crime is suspected and she and law enforcement agree that Idaho allows parents to withhold lifesaving medical treatment from children on religious grounds (Tilkin 2011). In one case, Idaho law enforcement did not report an untreated child trauma victim to state child protective services because of the parents’ religious beliefs (Nance 2010).
National and state media coverage of preventable deaths of Idaho children has not motivated the legislature to change the law. A bill (HB458) was introduced in 2014 to limit the religious defense but the House speaker would not allow a committee to hold a hearing on it. Representative Christy Perry, R-Nampa, whose district has had many deaths of Followers’ children, said state law should allow their parents to withhold lifesaving medical care because the Followers believe eternity is more important than earthly life (Gettys 2015). Perry dismissed concerns about the children saying they were
mostly coming from out of state (Gettys 2015).
Some of the cases for which coroners’ reports are available describe symptoms that must have brought great suffering and terror. Here is a coroner’s report on the death of an adolescent girl in 2012:
I was told that approximately 3 days earlier that the deceased and 5 other family members had suddenly started having severe nausea, vomiting and diarrhea. I was told that it was felt that they were suffering from some sort of food poisoning. Within 24 to 36 hours all but the deceased started to feel better. The deceased continued to suffer from the above described symptoms and became weaker over the next several hours until she was unable to attempt to eat or drink. She gradually became more lethargic and slipped into unconsciousness. She remained in this state for 4 to 5 hours and went into cardiac arrest. (Canyon County, Idaho Coroner 2012)
On the autopsy, gastrointestinal hemorrhage and a ruptured esophagus were found.
After a long struggle with chronic osteomyelitis in her pelvic bone, another adolescent girl gradually drowned as her lungs filled with fluid from pneumonia (Payette County, Idaho Coroner 2011). In 2013 a four-day old baby died with a bowel obstruction. His belly was hard and distended; his scrotum sac was swollen to four times normal size. (Canyon County, Idaho Coroner 2013). In Peaceful Valley there are graves of 27 children with the last name of Eells and 33 children with the last name of Shippy. After losing four children, one Followers mother said she had struggled with grief and anger but then became glad they were with God (Duara 2017). Many parents must have seen many children die in their extended families and yet refused to change their beliefs against medical care.
A lobbyist for the Christian Science church testified that the religious exemptions were put in Idaho’s criminal code at her church’s urging. Like laws in several other states, they use Christian Science code words, such as calling prayer “treatment” (e.g. Ida. Code §18–1501(4)). Many religious exemptions reward extremism in covering only those who rely on “spiritual means alone” to heal the child (e.g. Ida. Code §18–1501(4)). If the parent combines spiritual remedies with Gatorade or cool baths or finally calls 911, then s/he is not relying on spiritual means alone and can be prosecuted for neglect of the child.
The religious defenses to homicide apply only to deaths of children and, in some states, of dependent adults. One wonders whether any legislators would agree to a law that allowed others to recklessly cause their deaths. Yet, Idaho is not the only state in which such laws have been passed with no debate or discussion.
Washington State
In 1997 Washington enacted a religious defense to criminal mistreatment and second-degree murder stating that Christian Science “treatment” (i.e. prayer) is “medically necessary health care” for children and dependent adults sick with any disease whatsoever (Rev. Code of Wash. 9A.42.005). This law was not considered by committees, given public hearings or debated on the floor. Instead, it was inserted by a six-person conference committee tasked with reconciling House and Senate bills though it was not in either (Wash. Legislative Archives, personal communication, March, 2011). Child advocates had no way of knowing the provision was being considered.
Religious Groups Opposing Standard Child Medical Care
[SNIP]
Church of Scientology
The Church of Scientology opposes some forms of medical care but claims a biochemical basis for its beliefs, which are mixed with the science fiction written by its founder L. Ron Hubbard (Hubbard 1950). Scientology stridently attacks psychiatry (Citizens Commission on Human Rights 2020). The church claims to heal all mental health problems with its dianetics, performed in expensive sessions with “auditors,” galvanometers, and accusations before a group (Reactive mind, traumatic memories, 2015).
Scientologists believe babies should have a “silent birth” and not be exposed to any discomfort or language for at least the first week of life. Scientologists refuse to have metabolic testing, immunizations, or any other uncomfortable procedures for babies until they are at least a week old (Spiering v. Heineman 2006). Their dietary beliefs have endangered babies. Hubbard discourages breast feeding because there are few “Guernsey-type mothers” today and recommends infants be fed “barley water” instead. Hubbard calls his formula for barley water “the nearest approach to human milk that can be assembled easily” (Hubbard 1988, p. 138).
* * * * * END ABSTRACT * * * * *
Faith-Based Medical Neglect: for Providers and Policymakers
Rita Swan
Journal of Child & Adolescent Trauma volume 13, pages343–353(2020).
Faith-Based Medical Neglect: for Providers and Policymakers
https://link.springer.com/content/pdf/10.1007/s40653-020-00323-z.pdf
* * * * * BEGIN ABSTRACT * * * * *
Abstract
A substantial minority of Americans have religious beliefs against one or more medical treatments. Some groups promote exclusive reliance on prayer and ritual for healing nearly all diseases. Jehovah’s Witnesses oppose blood transfusions. Hundreds of thousands of schoolchildren have religious or conscientious exemptions from immunizations. Such exemptions have led to personal medical risk, decreases in herd immunity, and outbreaks of preventable disease. Though First Amendment protections for religious freedom do not include a right to neglect a child, many states have enacted laws allowing religious objectors to withhold preventive, screening, and, in some states, therapeutic medical care from children. Religious exemptions from child health and safety laws should be repealed so that children have equal rights to medical care.
Religion and science are arguably two of the most powerful drivers in human existence. Many consider them different types of truth and both valid while others try to combine them or reject one for the other. Faith-based rejection of medical care has cost the lives of many children and poses challenges to providers.
Asser and Swan (1998) reviewed deaths of 172 U.S. children after medical care was withheld on religious grounds from 1975 to 1995. Many of the children died of readily treatable infectious diseases and diabetes. The authors found that 80% of the children would have had at least a 90% likelihood of survival with timely medical care.
Many types of child abuse and maltreatment have been justified by some on religious grounds—for example, severe corporal punishment, exorcism, forced labor, forced marriage, dangerous diets, conversion therapy, and sexual abuse. Yet only faith-based medical neglect is protected in statute. Preventive and screening measures from which many state laws provide religious exemptions include immunizations, metabolic testing, blood lead-level tests, newborn hearing tests, prophylactic eye drops, vitamin K injections or drops, vision examinations, dental examinations, and school instruction about disease (Children’s Healthcare Is a Legal Duty, hereafter cited in text as CHILD (2020a), Religious exemptions from health care). Oregon and Pennsylvania have religious exemptions from bicycle helmets for children (Pennsylvania Consolidated Statutes §75–3510(b)(3); Oregon Revised Statutes 814.487).
This article discusses public policy and case law on faith-based medical neglect, beliefs against medical care in several denominations, and advice for providers who encounter religious objectors.
Scope of Statutory Exemptions
Religious exemptions about medical care of sick and injured children vary widely in meaning. Some are likely innocuous while others allow preventable deaths. Several states have a religious exemption in their reporting laws or in statutory definitions of child abuse and neglect (e.g. Calif. Penal Code §11,165.2(b) and Rev. Code of Washington 26.44.020(18)). Such placement sends a message to the would-be reporter that withholding medical care on religious grounds is not child neglect and therefore should not be reported to state child protection services.
Thirty states have religious defenses in their criminal codes. Nine have religious defenses to negligent homicide, manslaughter, or capital murder. West Virginia’s statute defining the crime of murder of a child does “not apply to any parent.. . who fails or refuses.. . to supply a child.. . with necessary medical care” on religious grounds” (WV Code 61.8D-2(d)). Arkansas has a religious defense to capital murder for those who cause deaths of children “under circumstances manifesting extreme indifference to human life” (Ark. Code 5–10-101(a)(9)(B)). There could be identical facts on what two Arkansas parents did to a child and one parent could be sentenced to death while the other would not be charged with murder – based upon their different religious beliefs. Virginia has a religious defense allowing Christian Scientists to deprive a child of medical care after they have physically assaulted and injured the child (Va. Code 18–2-314).
None of these exemption laws is required by the U.S. Constitution’s protections for religious freedom. Rulings upholding the state’s right to require medical care of sick children regardless of parents’ religious beliefs go back to 1903 (People v. Pierson 1903). In 1944, the U.S. Supreme Court held that the First Amendment does not include a right to neglect a child’s health or safety (Prince v. Massachusetts 1944). Many convictions of religious objectors have been upheld on appeal (e.g. Oregon v. Hickman 2015).
In Douglas County v. Anaya (2005), the Nebraska Supreme Court upheld the state’s right to require metabolic screening without a religious exemption. In Workman v. Mingo County Schools (2009), relying on many longstanding precedents in case law, a federal appeals court upheld the state’s right to require immunizations without a religious exemption.
At the time of this article, no U.S. court has held that parents have a constitutional right to religious practices that abuse or neglect children. States clearly have authority under the Constitution to require parents to provide medical care regardless of their religious beliefs. What remains unsettled, however, is whether legislatures may give parents a statutory right to withhold necessary medical care on religious grounds. At this time, there has been no Supreme Court decision in this regard. A law that allows some parents to deprive their children of medical care while requiring other parents to provide it would seem to violate the rights of children to the equal protection of the laws guaranteed in the fourteenth amendment of the Constitution.
While courts have upheld the state’s right to require parents to provide medical care, the federal courts have never ruled on whether children have equal protection rights to medical care (and therefore all parents must be required to provide it). Since parents must give permission for a child to sue and the religious exemptions are a privilege for the same parents whose children are endangered by the exemptions, it is extremely difficult to get courts to rule on this issue.
If the United States ratified the U.N. Convention on the Rights of the Child, children would arguably have rights to medical care, but the U.S. remains the only country in the world not to ratify the convention. Lobbying in state legislatures appears to be the only way to remove religious exemptions. The American Medical Association (1986), American Academy of Pediatrics (2013), National District Attorneys Association (2015), National Association of Medical Examiners (personal communication March 4, 2001), Prevent Child Abuse America (2007), and CHILD (2015) are among the organizations calling for repeal of these religious exemptions. Many religious exemptions are arguably in violation of the Establishment Clause in extending only to adherents of a “well-recognized religion” or “a bona fide” religion. Several courts have ruled that the government cannot give privileges to some sects and not others (Davis v. State 1982; McCarthy v. Boozman 2002; Dalli v. Board of Education 1971 et al.).
Idaho, a Special Case
The most compelling need for statutory change is in Idaho. The state not only has religious exemptions to manslaughter, non-support, criminal injury, and neglect (Ida. Code 18–1501(4), 18–401(2), 16–1602(25)(a)) but also has several congregations of denominations that oppose medical care and rely exclusively on prayer and ritual when their children are sick or injured. Idaho began keeping records on stillbirths in 2002 (Ida. Bureau of Vital Records 2015). In Peaceful Valley Cemetery, a cemetery used and controlled by the anti-medical sect Followers of Christ, 33% (63) of the 189 graves of those dying from 2002 through 2017 are minor children or stillbirths (CHILD, 2020b, Child abuse in Idaho). Statewide only 3% of Idaho deaths were minor children or stillbirths during those years (Idaho Bureau of Vital Records, 2015 and 2018). Therefore, the proportion of Peaceful Valley graves for minor children and stillbirths is more than 10 times the proportion of deaths among minor children and stillbirths statewide.
If one knew the causes of death for all the children buried in Peaceful Valley, the data would probably look even more elevated for them. Statewide, accidents are the leading cause of death among Idaho children older than one year, but accidents probably account for only a small fraction of the child deaths in Peaceful Valley.
Idaho public officials have generally been indifferent. The legislature unanimously passed the religious defenses to non-support, criminal injury of dependents, and manslaughter within four days after they were introduced. A coroner for Canyon County, Idaho where many of the deaths have occurred said in 2011 that she did not even do autopsies on Followers of Christ children because state law requires autopsies only when a crime is suspected and she and law enforcement agree that Idaho allows parents to withhold lifesaving medical treatment from children on religious grounds (Tilkin 2011). In one case, Idaho law enforcement did not report an untreated child trauma victim to state child protective services because of the parents’ religious beliefs (Nance 2010).
National and state media coverage of preventable deaths of Idaho children has not motivated the legislature to change the law. A bill (HB458) was introduced in 2014 to limit the religious defense but the House speaker would not allow a committee to hold a hearing on it. Representative Christy Perry, R-Nampa, whose district has had many deaths of Followers’ children, said state law should allow their parents to withhold lifesaving medical care because the Followers believe eternity is more important than earthly life (Gettys 2015). Perry dismissed concerns about the children saying they were
mostly coming from out of state (Gettys 2015).
Some of the cases for which coroners’ reports are available describe symptoms that must have brought great suffering and terror. Here is a coroner’s report on the death of an adolescent girl in 2012:
I was told that approximately 3 days earlier that the deceased and 5 other family members had suddenly started having severe nausea, vomiting and diarrhea. I was told that it was felt that they were suffering from some sort of food poisoning. Within 24 to 36 hours all but the deceased started to feel better. The deceased continued to suffer from the above described symptoms and became weaker over the next several hours until she was unable to attempt to eat or drink. She gradually became more lethargic and slipped into unconsciousness. She remained in this state for 4 to 5 hours and went into cardiac arrest. (Canyon County, Idaho Coroner 2012)
On the autopsy, gastrointestinal hemorrhage and a ruptured esophagus were found.
After a long struggle with chronic osteomyelitis in her pelvic bone, another adolescent girl gradually drowned as her lungs filled with fluid from pneumonia (Payette County, Idaho Coroner 2011). In 2013 a four-day old baby died with a bowel obstruction. His belly was hard and distended; his scrotum sac was swollen to four times normal size. (Canyon County, Idaho Coroner 2013). In Peaceful Valley there are graves of 27 children with the last name of Eells and 33 children with the last name of Shippy. After losing four children, one Followers mother said she had struggled with grief and anger but then became glad they were with God (Duara 2017). Many parents must have seen many children die in their extended families and yet refused to change their beliefs against medical care.
A lobbyist for the Christian Science church testified that the religious exemptions were put in Idaho’s criminal code at her church’s urging. Like laws in several other states, they use Christian Science code words, such as calling prayer “treatment” (e.g. Ida. Code §18–1501(4)). Many religious exemptions reward extremism in covering only those who rely on “spiritual means alone” to heal the child (e.g. Ida. Code §18–1501(4)). If the parent combines spiritual remedies with Gatorade or cool baths or finally calls 911, then s/he is not relying on spiritual means alone and can be prosecuted for neglect of the child.
The religious defenses to homicide apply only to deaths of children and, in some states, of dependent adults. One wonders whether any legislators would agree to a law that allowed others to recklessly cause their deaths. Yet, Idaho is not the only state in which such laws have been passed with no debate or discussion.
Washington State
In 1997 Washington enacted a religious defense to criminal mistreatment and second-degree murder stating that Christian Science “treatment” (i.e. prayer) is “medically necessary health care” for children and dependent adults sick with any disease whatsoever (Rev. Code of Wash. 9A.42.005). This law was not considered by committees, given public hearings or debated on the floor. Instead, it was inserted by a six-person conference committee tasked with reconciling House and Senate bills though it was not in either (Wash. Legislative Archives, personal communication, March, 2011). Child advocates had no way of knowing the provision was being considered.
Religious Groups Opposing Standard Child Medical Care
[SNIP]
Church of Scientology
The Church of Scientology opposes some forms of medical care but claims a biochemical basis for its beliefs, which are mixed with the science fiction written by its founder L. Ron Hubbard (Hubbard 1950). Scientology stridently attacks psychiatry (Citizens Commission on Human Rights 2020). The church claims to heal all mental health problems with its dianetics, performed in expensive sessions with “auditors,” galvanometers, and accusations before a group (Reactive mind, traumatic memories, 2015).
Scientologists believe babies should have a “silent birth” and not be exposed to any discomfort or language for at least the first week of life. Scientologists refuse to have metabolic testing, immunizations, or any other uncomfortable procedures for babies until they are at least a week old (Spiering v. Heineman 2006). Their dietary beliefs have endangered babies. Hubbard discourages breast feeding because there are few “Guernsey-type mothers” today and recommends infants be fed “barley water” instead. Hubbard calls his formula for barley water “the nearest approach to human milk that can be assembled easily” (Hubbard 1988, p. 138).
* * * * * END ABSTRACT * * * * *
