Medical treatment trumps religious beliefs, courts say

But Ohio case involving Amish exposes gray area

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When the religious beliefs of parents conflict with the medical needs of the child, medical care trumps religion.

In Pennsylvania, and most other states, the law allows health and government officials to get court approval to provide medical care to save a child's life over the parents' religious objections.

But in Akron, Ohio, where Amish parents removed their 10-year-old daughter from the hospital to avoid further chemotherapy, the issue enters a legal gray area.

"I think this is a more heartrending question," said Wes Oliver, associate professor of law and director of the Criminal Justice Program at the Duquesne Law School. "Do you require parents to take extraordinary measures to give a child a percentage chance of survival, or do you leave that decision for the parents?"

In the Amish case, the parents took their daughter to the hospital in May for chemotherapy before removing her from treatment in June.

The girl is diagnosed with lymphoblastic lymphoma, an aggressive form of non-Hodgkins lymphoma that medical officials say is curable. The Leukemia Research Foundation says there's a first-year survival rate of 81 percent for non-Hodgkins lymphoma, with a five-year survival rate of 67 percent and 10-year survival rate of 56 percent.

"What's interesting in this case is, the one reason people don't go through chemotherapy involves the cost-benefit analysis. If the rationale is that the child undergo chemotherapy with no significant chance of a cure, then this is not a religious objection. If it were a religious objection, the parents would never have sought treatment for the child in the first place," he said.

Withholding medical care for religious reasons has caused the death of more than 60 children nationwide since the 1970s, the Massachusetts Citizens for Children reports, including one 1981 Pittsburgh case, two 1991 cases in Altoona and 13 cases in the Philadelphia area.

In April, a second child of Philadelphia parents who believe in faith healing died from pneumonia after they refused to seek medical help. They now face murder charges.

The Massachusetts website lists no cases involving the Amish. The issue more commonly involves members of Jehovah's Witnesses, Christian Science, the Faith Tabernacle, the Church of the First Born, the Faith Assembly and the End Time Ministries.

When medical or government officials become aware of seriously ill children whose parents are withholding medical care, the law allows them to intercede to prevent the child's death. Parents are entitled to their religious beliefs until they endanger their children.

"Religion always loses that battle," Mr. Oliver said. "It is easy for us as a society to draw the line because most people don't share those religious views of being torn between religious views and saving lives."

Parents typically face involuntary manslaughter charges when the lack of medical care leads to a child's death.

But the Akron case is murkier. The Amish parents argued that chemotherapy was hurting, not helping their daughter, who was suffering great discomfort from the treatment.

In July, Medina County Probate and Juvenile Judge John Lohn ruled against transferring guardianship because "there is not a scintilla of evidence showing the parents are unfit." But an injunction issued two weeks ago ordered treatments to resume immediately until the legal issue was resolved. However, the family visited the hospital but once since then.

Akron Children's Hospital appealed a judge's decision in seeking to assign an attorney to provide limited guardianship to make medical decisions for the Amish girl. In testimony, the hospital said the girl will die without chemotherapy, while The Associated Press quoted Robert McGregor, the hospital's chief medical officer, as saying it's the hospital's moral and legal duty to provide medical care for the child.

News reports say the family is treating the girl with herbs and vitamins.

"I don't think this is a conflict of religion and medicine," Mr. Oliver said. "This seems to be the parent's judgment of quality of life and chances of survival."

In 1981, Kris Ann Lewis, 13, of Pittsburgh died after her mother, a Christian Scientist, refused to allow the girl to be treated for bone cancer, relying instead on religious healers. Her mother never faced charges due to the state religious exemption law, the Massachusetts organization states.

In the late 1980s and early 1990s, 10 children statewide whose parents were members of Faith Tabernacle, and one whose parents were members of the First Century Gospel Church, died without medical care. Some but not all of the parents faced involuntary manslaughter charges.

Those deaths included Justin Barnhart, 2, of the Beaver Valley and Melinda Sue Friedenberger, 18 weeks old, and Clayton Nixon, 8, both of Altoona.

Bruce Noel, intake manager for Allegheny County Children, Youth and Families, said cases requiring CYF action most often involve children of Jehovah Witnesses who do not believe in blood transfusions. The state Child Protective Services law allows CYF to investigate allegations of medical neglect. If religion is involved, CYF can ask the court to grant it authority under the Juvenile Act to seek medical treatment for the child. Mr. Noel said Juvenile Court judges routinely agree to save the child's life.

Mary Carrasco, director of the Child's Place at Mercy in the Pittsburgh Mercy Health System, said it's rare when parents withhold care for children based on religious beliefs. But the Akron case, she said, raises difficult questions for the courts.

A 10-year-old is old enough to express opinions. The child also could face serious side effects from chemotherapy with no guarantee of success. The child told the court that chemo hurt internal organs and would make her infertile.

"These are all things that play into the decision," Dr. Carrasco said. "It's not cut and dried. All I can say is that I'm glad I'm not involved in that case."

nation - health

David Templeton: dtempleton@post-gazette.com or 412-263-1578.


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