RELIGIOUS EXEMPTIONS TO MEDICAL TREATMENT OF CHILDREN
IN STATE CIVIL & CRIMINAL CODES
CHILD’s Legal Initiatives
Educational & Advocacy Activities
Religious Exemptions From Health Care For Children
A. Exemptions from preventive and diagnostic measures
- 44 states have religious exemptions from immunizations. The six states that require all schoolchildren to be immunized without exception for religious belief are California, Connecticut, Maine, Mississippi, New York, and West Virginia.
- Most states have religious exemptions from metabolic testing of newborns. Such tests detect disorders that will cause mental retardation and other handicaps unless they are treated promptly.
- Several states including Colorado, Delaware, Florida, Idaho, Iowa, Maine, Michigan, Minnesota, Nevada, Pennsylvania, and Tennessee have religious exemptions from prophylactic eye drops for newborns. The eye drops prevent blindness of infants who have been infected with venereal diseases carried by their mothers.
- Such states as Delaware, Illinois, Iowa, Kansas, Maine, Massachusetts, New Jersey, and Rhode Island have religious exemptions from screening children for lead poisoning.
- California has a religious exemption from tuberculosis testing of public school teachers. Ohio has a religious exemption from testing and treatment for tuberculosis. It lets parents use “a recognized method of religious healing” instead of medical care for a child sick with tuberculosis.
- California, Colorado, Michigan, Minnesota, Ohio and some other states offer religious exemptions from physical examinations of school children.
- Connecticut, New Jersey, Oregon, West Virginia, and some other have religious exemptions from hearing tests for newborns.
- Iowa, Maryland, Missouri, North Carolina, North Dakota and some others have religious exemptions from pulse oximetry, a non-invasive test to detect critical congenital heart defects of newborns.
- Delaware, Wyoming, and other states have laws with religious exemptions for both children and adults from medical examination, testing, treatment, and vaccination during public health emergencies.
- Oregon and Pennsylvania have religious exemptions from bicycle helmets.
- Oregon has a religious exemption from Vitamin K that is given to newborns to prevent spontaneous hemorrhage.
- California, Colorado, Massachusetts, Michigan, Minnesota, Ohio, and some others have statutes excusing students with religious objections from studying about disease in school.
B. Exemptions from providing medical care for sick children
- Thirty-eight states and the District of Columbia have religious exemptions in their civil codes on child abuse or neglect, or failure to report, largely because of a federal government policy from 1974 to 1983 requiring states to pass such exemptions in order to get federal funding for child protection work. The states are Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Virginia, Washington, Wisconsin, and Wyoming.
- Fifteen states have religious defenses to felony crimes against children: Arkansas, Idaho, Indiana, Iowa, Louisiana, Minnesota, Mississippi, New Jersey, Ohio, Oklahoma, Utah, Virginia, Washington, West Virginia, and Wisconsin
- Twelve states have religious defenses to misdemeanors: Alabama, Alaska, California, Colorado, Delaware, Georgia, Kansas, Maine, Missouri, New Hampshire, New York, and South Dakota.
- Florida has a religious exemption only in the civil code, but the Florida Supreme Court nevertheless held that it caused confusion about criminal liability and required overturning a felony conviction of Christian Scientists for letting their daughter die of untreated diabetes. Hermanson v. State, 604 So.2d 775 (Fla. 1992)
States with a religious defense to the most serious crimes against children include:
- Idaho, Iowa, and Ohio with religious defenses to manslaughter
- Washington and West Virginia with religious defenses to murder of a child
- Arkansas with a religious defense to capital murder
The scope of the religious exemptions pertaining to sick and injured children varies widely. Some protect only a right to pray or a right to rely exclusively on prayer when the illness is trivial while others confer a legal right for parents to withhold even lifesaving medical care from children. Some are in chapters on the duty to report child abuse and neglect, thus apparently exempting mandated reporters from reporting cases of faith-based medical neglect to state child protection services. Many state laws contain ambiguities that have been interpreted variously by courts. Some church officials have advised members that the exemption laws were passed because legislators understood prayer to be as effective as medicine.
C. Federal policy
In response to Christian Science church lobbying, the federal government began requiring states to enact religious exemptions from child abuse and neglect charges in 1974. CHILD founders Rita and Douglas Swan lobbied for several years against this regulation. The federal government rescinded it in 1983.
In 1996, however, Congress enacted a law stating that the federal Child Abuse Prevention and Treatment Act (CAPTA) did not include “a Federal requirement that a parent or guardian provide a child any medical service or treatment against the religious beliefs of the parent or guardian.” 42 USC 5106i Furthermore, Sen. Dan Coats, R-Indiana, and Congressman Bill Goodling, R-Pennsylvania, claimed during floor discussion that parents have a First Amendment right to withhold medical care from children.
CHILD Inc. believes the present law discriminates against a class of children and endangers them. CAPTA mandates that states in the grant program have laws requiring parents to provide needed medical care for their children, but simultaneously allows those states to give parents in faith-healing sects the right to withhold all medical treatment from children.
In January, 1997, within a month after the religious exemption was added to CAPTA, the Christian Science church got HB1104 introduced in Maryland that exempted believers in spiritual healing from all civil and criminal charges regardless of the harm to the child, using language taken verbatim from the new federal law. HB1104 was defeated. Also in 1997, Oregon enacted a religious defense to first- and second-degree manslaughter. In 1998, Washington enacted the following defense to criminal mistreatment: “It is the intent of the legislature that a person who, in good faith, is furnished Christian Science treatment by a duly accredited Christian Science practitioner in lieu of medical care is not considered deprived of medically necessary health care or abandoned.” RCW 9A.42.005. Washington has made prayer “medically necessary health care” for all diseases of helpless children.
In 2003 CAPTA was reauthorized with no change to the religious exemptions although several organizations called upon Congress to remove the exemption, including the United Methodist Church, National Association of Medical Examiners, Justice for Children, and the National Child Abuse Coalition, which consists of about thirty national organizations working to prevent child abuse.
Data on Injuries to Children Because of Religion-based Medical Neglect
Two studies indicate that Christian Science adults have higher mortality rates than the general population. See William Simpson, “Comparative longevity in a college cohort of Christian Scientists,” Journal of the American Medical Association (JAMA) 262 (Sept. 22-29, 1989): 1657-8, and William Simpson, “Comparative mortality in two college groups, 1945-83,” Mortality and Morbidity Weekly Report 40(August 23,1991):579-82.
Pediatrician Seth Asser and CHILD president Rita Swan have published a study of 172 deaths of children when medical care was withheld on religious grounds. They found that 140 of the children would have had at least a 90% likelihood of survival with medical care. See Seth Asser and Rita Swan, “Child fatalities from religion motivated medical neglect” Pediatrics 101(April 1998):625-9.
Deaths of Christian Science children between 1974 and 1994 from the following causes are in CHILD’s files: 5 of meningitis, 3 of pneumonia, 2 of appendicitis, 5 of diabetes, 2 of diphtheria, 1 of measles, 8 of cancer, 1 of septicemia, 1 of a kidney infection, 1 of a bowel obstruction, and 1 of heart disease.
Between 1973 and 1990, 65 Faith Assembly children are known to have died of treatable illnesses without medical care. In 1983 the Centers for Disease Control and the Indiana Board of Health conducted a study of Faith Assembly members, who shun all medical care including obstetrics. Pregnant women in Faith Assembly were 86 times more likely to die than other expectant mothers in Indiana. The mortality rate for Faith Assembly infants up to 28 days old was 270% higher. See Andrew Kaunitz, Craig Spence, et al., “Perinatal and maternal mortality in a religious group avoiding obstetrical care,” American Journal of Obstetrics and Gynecology 150 (Dec. 1, 1984):826-31.
The Oregonian reported that 78 children died between 1955 and 1998 in the Followers of Christ Church in Oregon City, a church opposed to medical care. Twelve children died in an Idaho affiliate of the Followers of Christ. See Mark Larabee and Peter Sleeth, “Faith healing raises questions of the law’s duty-belief or life?,” The Oregonian (June 7, 1998):1.
Sects claiming a religious exemption from immunizations have had outbreaks of polio, measles, whooping cough, and diphtheria. In 1991 there were 492 measles cases in Philadelphia among children associated with Faith Tabernacle and First Century Gospel Church, which refuse immunizations. Six children died.Christian Science schools in the St. Louis area have had four major measles outbreaks between 1985 and 1994. The first included three deaths of young people. The 1994 outbreak had 247 cases. It spread to children in public schools and cost St. Louis County more than $100,000 to manage. It is the largest measles outbreak in the U.S. since 1992.The Netherlands had an outbreak of 2000 measles cases, including three deaths of young people, that began at a Dutch Orthodox Reformed Church school in 1999-2000. The church has religious beliefs against vaccination.Two recent studies indicate that religious and philosophical exemptions to immunizations increase cases of disease. Daniel Feikin et al. in “Individual and community risks of measles and pertussis associated with personal exemptions to immunization,” JAMA 284 (December 27, 2000):3145-50, studied all reported confirmed measles cases among Colorado children aged 3 to 18 years during 1987-1998 and all reported confirmed and probable pertussis cases among the same population for 1996-98. The authors found that exemptors were 22 times more likely to acquire measles and 6 times more likely to acquire pertussis than vaccinated children. Furthermore, the authors found that at least 11% of vaccinated children who contracted measles acquired the infection through contact with an exemptor. Daniel Salmon, et al., “Health consequences of religious and philosophical exemptions from immunization laws: individual and societal risk of measles,” JAMA 282 (July 7, 1999):47-53, found children with religious or philosophical exemptions from immunizations were 35 times more likely to contract measles than vaccinated children.
CHILD’s Public Policy Achievements.
Since 1990, Arizona, Colorado, Delaware, Hawaii, Maryland, Massachusetts, Minnesota, North Carolina, Rhode Island, Oregon, South Dakota, and Tennessee have repealed some or all religious exemptions from a duty to provide medical care for a sick child. CHILD gave extensive support to repeal bills in several of those states and has blocked the Christian Science church from getting more religious exemptions enacted in some states.Presentations by CHILD members to the American Academy of Pediatrics, American Medical Association, National Child Abuse Coalition, National Committee for the Prevention of Child Abuse (now Prevent Child Abuse America), U.S. Advisory Board on Child Abuse and Neglect, National District Attorneys Association, United Methodist Church, and the National Association of Medical Examiners contributed to those organizations’ adoption of policy statements against religious exemptions.
CHILD’s Legal Initiatives – Lawsuits
Children’s Healthcare Is a Legal Duty, Bostrom, and Petersen v. DeParle and Shalala, 212 F.3d 1084 (Eighth Circuit 2000), cert. denied 121 S.Ct. 1483 (2001).
In August, 1997, CHILD Inc. and two of its Minnesota members filed suit asking the U.S. District Court of Minnesota to rule unconstitutional the new statute mandating payment for “religious non-medical health care.” The statute classifies religious non-medical health care institutions as hospitals and skilled nursing facilities for the purposes of receiving Medicare and Medicaid funds, but exempts them from the standards that medical hospitals and skilled nursing facilities have to meet.
It allows the religious non-medical health care institutions to have sect-based admission criteria, to require all the patients to pay for prayers by church-accredited spiritual healers, and to receive Medicare funds for custodial care. It also requires these institutions to have “religious beliefs” against medical examination, diagnosis, and treatment, and prohibits the government from requiring medical diagnoses of their patients.
On July 24, 1998, the district court granted summary judgement for the defendants. Judge Ann Montgomery wrote that her ruling was “premised on the notion that nonmedical nursing services, including such things as feeding, cleaning, clothing, and other aspects of physical maintenance can be ‘unbundled’ from medical nursing services. She held that “religious nonmedical health care” is “a subset” of normal medical care.
CHILD appealed the ruling to the Eighth Circuit, U.S. Court of Appeals. The American Academy of Pediatrics, American Medical Association, American Nurses Association, Iowa Medical Society, Minnesota Civil Liberties Union, Americans for Religious Liberty, American Humanist Association, and the Council for Secular Humanism filed amicus briefs in support of CHILD.
The Christian Legal Society, National Council of Churches of Christ, National Association of Evangelicals, General Council of Finance and Administration of the United Methodist Church, Presbyterian Church (U.S.A.), Christian Medical and Dental Society, and Senator Edward Kennedy, D-Massachusetts, filed amicus briefs in support of the federal government and the Christian Science church.
On May 1, 2000, in a 2-1 ruling, the appeals court upheld summary judgement for the government. Both the majority’s opinion and a strong dissent are at www.ca8.uscourts.gov/opndir/00/05/983521P.pdf.
CHILD petitioned the U.S. Supreme Court for review. Its position was supported in amicus briefs filed by the American Academy of Pediatrics, American Medical Association, American Nurses Association, Iowa Medical Society, B’nai B’rith Anti-Defamation League, Americans for Religious Liberty, American Humanist Association, and the Council for Secular Humanism. The Supreme Court denied review April 2, 2001.
CHILD was represented by Robert Bruno of Burnsville, Minnesota, in all three of its suits. Marci Hamilton was the counsel of record for the cert. petition in CHILD v. deParle.
Children’s Healthcare Is a Legal Duty, Bostrom, and Petersen v. Vladeck and Shalala, 938 F. Supp. 1466 (D. Minn. 1996)
CHILD v. Vladeck was filed January 19, 1996, in the U. S. District Court of Minnesota as a taxpayers’ suit against the federal government for using Medicare and Medicaid funds to pay for Christian Science nursing. The Christian Science church later entered the case as a defendant-intervenor.
On August 7, 1996, the Court struck down the laws and regulations mandating such payments, declaring them unconstitutional, invalid, and unenforceable.
When Medicare and Medicaid programs were set up in 1965, Congress authorized reimbursements to care facilities accredited by the Christian Science church. The facilities, called “sanatoria” by the government, are staffed by “nurses” who have no state licensure, medical training, or even first aid training. They do not work under supervision of any state-licensed personnel. All sanatoria nurses and administrators must be members of the Christian Science church. All patients must retain Christian Science healers for spiritual “treatments.”
CHILD argued that it was unconstitutional for the government to delegate to a church the power to determine which institutions should receive public money and for the government to pay for “pervasively sectarian” activities.
CHILD’s main concern, however, is that the Medicare/Medicaid reimbursements for Christian Science care facilities encourage endangerment of children. Christian Science nurses cannot take a pulse or use a fever thermometer. They have no training in recognizing contagious diseases. They will not do even simple, non-medical procedures to relieve discomfort, such as applying heat or giving backrubs.
They have been retained to attend sick children and have sat taking notes as the children suffered and died, but they have not called for medical care nor recommended that the parents obtain it. The notes of these nurses indicate that they observed children having “heavy convulsions,” vomiting repeatedly, and urinating uncontrollably. They have seen the children moaning in pain and too weak to get out of bed. They have seen their eyes roll upward and fix in a glassy stare. One Christian Science nurse force-fed a toddler as he was dying of a bowel obstruction.
On January 23, 1997, Attorney-General Janet Reno advised Congress that her office could no longer defend the statutes and regulations mandating public money for Christian Science nursing. In June, however, Senator Orrin Hatch, R-Utah, introduced an amendment mandating payment for “religious non-medical health care” that was added to the budget bill with no discussion and signed into law in August. The amendment repealed the statutes and regulations declared unconstitutional in CHILD’s suit, thus mooting the court’s ruling, and established payments for Christian Science nursing under new statutory language.
Children’s Healthcare Is a Legal Duty, Inc. and Brown v. Deters, 92 F.3d 1412 (Sixth Circuit 1996), cert. denied 117 S.Ct. 1082 (1997)
CHILD and Brown v. Deters was filed in August, 1994, in the U.S. District Court for the Southern District of Ohio, Western Division. The suit challenged the constitutionality of Ohio’s religious defense to felony child endangerment and manslaughter at ORC 2919.22a. Brown’s children are being raised in Ohio by their mother, whose religion objects to medical treatment of illness. CHILD and Brown charged that the Ohio statute deprives a class of children of equal protection of the laws in violation of the fourteenth amendment to the Constitution. CHILD asked the court to rule the religious defense unconstitutional, that is, to grant declaratory relief from the statute.
CHILD v. Deters raised the question of whether a religious exemption from a parental duty of care is a legitimate act of legislative discretion. Beginning in 1903 American courts have consistently ruled that the first amendment does not confer a right to withhold medical care from children. (See People v. Pierson, 68 N.E. 243 (N.Y. 1903); Prince v. Massachusetts, 321 U.S. 158 (1944).) Nevertheless, state legislatures have enacted exemption laws allowing parents to withhold medical care from children on religious grounds.
The circuit courts of Coshocton and Mercer Counties, Ohio, ruled ORC 2919.22a unconstitutional, but the rulings were not appealed. (See State v. Miskimens, 490 N.E.2d 931 (Ohio 1984), and State v. Miller, Mercer County Circuit Court, 1987). Other state courts have ruled religious exemptions unconstitutional either on first or fourteenth amendment grounds (e.g. Brown v. Stone, 378 So.2d 218, 221 (Miss. 1979)), but federal courts have not yet ruled on the question.
The federal district court granted CHILD standing to have a trial on the merits of the statute, but the Sixth Circuit U.S. Court of Appeals ruled that the Ohio Attorney-General has eleventh amendment immunity until she enforces or threatens to enforce the statute to the detriment of the Brown children.
CHILD petitioned the U.S. Supreme Court for review. An amicus brief in support of the petition was filed by the National Task Force on Children’s Constitutional Rights, National Committee for the Rights of the Child, National Association of Counsel for Children, American Academy of Pediatrics, Council on Child Abuse of Southern Ohio, People Against Child Abuse, Hear My Voice, Dr. David Chadwick, and Dr. Donald Duquette. The Supreme Court denied review in February, 1997.
CHILD’s Legal Initiatives – Amicus Curiae Briefs
State v. Crank, 486 S.W.3d 15 (Tenn. 2015)
Jessica Crank, 15, died of Ewing’s sarcoma in September, 2002, in or near Lenoir City, Tennessee. Her mother, Jacqueline Crank, belonged to New Life Tabernacle whose minister Ariel Ben Sherman preached against medical care. Crank and Sherman relied exclusively on ritual and prayer for several months and avoided medical care. They pled guilty to misdemeanor child neglect in 2012. Sherman died a few months later, but Crank appealed arguing that a religious exception to child abuse, neglect and endangerment charges is unconstitutional on Establishment Clause, due process, and vagueness grounds.
CHILD filed an amicus brief urging the Tennessee Supreme Court to rule the religious exceptions unconstitutional as violating the Fourteenth Amendment equal protection rights of children. The brief was co-signed by the Tennessee Chapter of the American Academy of Pediatrics, Tennessee Medical Association, Prevent Child Abuse Tennessee, First Star, Center for Children’s Justice, Prevent Child Abuse Pennsylvania, Pennsylvania Chapter of the American Academy of Pediatrics, Victor Vieth, and Donald Duquette. The brief was signed by Catherine Swan, an attorney in Steamboat Springs, Colorado.
The Tennessee Supreme Court upheld Crank’s conviction in February, 2015, held that the religious exemption was not unconstitutionally vague, and declined to rule on whether it violated the Establishment and Free Exercise Clauses.
State v. Crank, 2013 WL 5371627 (Tenn. Crim. App. Sept. 26, 2013)
See facts above. CHILD filed an amicus brief urging the Tennessee Court of Criminal Appeals to rule the religious exception unconstitutional as violating the Fourteenth Amendment equal protection rights of children. The brief was co-signed by the Tennessee Chapter of the American Academy of Pediatrics, Tennessee Medical Association, Prevent Child Abuse Tennessee, First Star, National Child Protection Training Center, Institute for Science in Medicine, and Donald Duquette, the director of the University of Michigan Child Advocacy Law Clinic.
The Court of Criminal Appeals upheld Crank’s conviction and declined to rule on constitutional issues.
Sebelius v. Hobby Lobby Stores, Inc., 134 S. Ct. 678 (2013)
CHILD cosigned an amicus brief in a U.S. Supreme Court case on whether a private company has a religious right to exemption from the Affordable Care Act. Hobby Lobby argued that the Religious Freedom Restoration Act (RFRA) gives it a right to offer only health insurance that does not cover contraceptives or abortions although the Affordable Care Act requires it to offer more comprehensive coverage.
The amicus brief argued that RFRA is unconstitutional as applied to federal law. CHILD opposes RFRA because it privileges religious practice above the best interests of children. In addition, CHILD believes that access to contraceptives is a public good and that it is certainly in the best interests of all children for their mothers to have access to contraceptives and for girls to have access to emergency contraceptives, particularly when they are victims of rape.
The brief was prepared by the Freedom From Religion Foundation. The U.S. Supreme Court ruled in favor of Hobby Lobby Stores in Burwell v. Hobby Lobby, 723 F.3d (2014).
Wollschlaeger v. Farmer, case #11-cv-22026-MGC, U.S. District Court Southern Dist. of Florida (2011)
In 2011 CHILD signed an amicus brief prepared by the American Civil Liberties Union of Florida in support of physicians who challenged a Florida law prohibiting physicians from discussing gun ownership and gun safety with their patients, entering information about guns in patients’ medical records, “unnecessarily harassing” patients about their guns during medical exams, and discriminating against patients solely on the basis of their gun ownership.
The physicians argued that the law violated their First Amendment free speech rights and was unconstitutionally vague and overbroad.
While largely focused on physicians’ free speech and due process rights the amicus brief also argued on behalf of a child’s rights to receive information about his health and safety.
The court granted the plaintiffs’ request for summary judgment on June 29, 2012.
Workman v. Mingo County Board of Education, 419 Fed.Appx. 348, 2011 WL 1042330 (C.A.4(SC))
West Virginia parent Jennifer Workman appealed the ruling below to the U.S. Court of Appeals for the Fourth Circuit, charging that the school system violated her free exercise, equal protection, and due process rights.
CHILD filed an amicus brief in support of the school board arguing that parents have no constitutional right to endanger their children’s health, that the child has a constitutional right to equal protection of her interest in remaining free of vaccine-preventable disease, and that the state needs only a rational basis for a neutral law of general applicability.
The brief was prepared by James Dwyer of the William and Mary Law School and co-signed by the West Virginia Chapter of the American Academy of Pediatrics, Center for Rural Health Development, West Virginia Association of Local Health Departments, and Immunization Action Coalition.
In 2011 the Fourth Circuit U.S. Court of Appeals upheld the state’s right to require immunizations without exception for religious belief. It did not address a child’s equal protection rights or the standard of review.
Workman v. Mingo County Board of Education, 667 F. Supp.2d 679 (WV 2009)
West Virginia is one of two states in the nation that does not allow personal-belief exemptions from immunizations. West Virginia parent Jennifer Workman has religious beliefs against immunizations. When her unimmunized daughter was excluded from school, Workman filed suit in federal court against the school board claiming that she had a First Amendment right to refuse immunizations for her daughter.
CHILD filed an amicus brief in support of the school board arguing that parents have no constitutional right to endanger their children’s health and that the child has a constitutional right to equal protection of her interest in remaining free of vaccine-preventable disease.
The brief was prepared by James Dwyer of the William and Mary Law School and co-signed by the West Virginia Chapter of the American Academy of Pediatrics, Center for Rural Health Development, West Virginia Association of Local Health Departments, and Voices for Vaccines.
In 2009 the U.S. District Court Southern District of West Virginia upheld the state’s right to require immunizations without exception for religious belief.
Douglas County v. Anaya, 694 N.W.2d 601 (Neb. 2005), cert. denied S.Ct (2005)
In 2005 CHILD filed an amicus brief in support of Nebraska’s right to require metabolic screening of all newborns regardless of the parents’ religious objections. The defendants had religious beliefs against any withdrawal of blood and argued that the state could not interfere with their religious practice unless their child was sick.
The Nebraska Supreme Court unanimously upheld the metabolic screening law in the nation’s first reported ruling that the state had the right to require a health screening over parents’ religious objections. The U.S. Supreme Court declined to review the ruling.
The brief was written by Professor James Dwyer of Marshall Wythe School of Law, College of William and Mary, Williamsburg, Virginia. It was cosigned by the National Association of Counsel for Children and the Nebraska Chapter, American Academy of Pediatrics.
Commonwealth v. Nixon, 761 A.2d 1151 (Pa. 2000), cert. denied S.Ct (2001)
In 2000, CHILD filed an amicus brief arguing that parents’ convictions for manslaughter and felony child endangerment should be upheld. The parents let their 16-year-old daughter die of untreated diabetes because of their religious beliefs against medical care. They argued at trial and on appeal that their daughter made a mature person’s choice to practice her religion and did not want medical care.
The Pennsylvania Supreme Court upheld the parents’ conviction, rejecting the arguments that Pennsylvania had a “mature minor doctrine” that excused parents from providing care to a minor and that the girl’s constitutional privacy rights gave her a right to refuse lifesaving medical care.
The brief was written by Professor James Dwyer of Marshall Wythe School of Law, College of William and Mary, Williamsburg, Virginia. The National Association of Counsel for Children, National Exchange Club Foundation, and American Humane Association, Children’s Division, cosigned the brief.
City of Boerne v. Flores, 521 U.S. 507 (Tex. 1997)
Joined by the American Professional Society on the Abuse of Children, CHILD filed an amicus brief in the U.S. Supreme Court arguing that the Religious Freedom Restoration Act limits the state’s ability to protect children and is unconstitutional.
The Supreme Court ruled the act unconstitutional in June, 1997, on grounds that Congress had exceeded its authority to override state and local law.
The brief was written by Robert Bruno of Burnsville, Minnesota.
People v. Shalala, case #93-15700 and -15936, U. S. Court of Appeals, Ninth Circuit (1993)
In 1993, CHILD filed an amicus brief urging the court to review the constitutionality of California’s statutory religious exemption to child neglect and nonsupport charges and to rule them unconstitutional on first and fourteenth amendment grounds. The California Medical Association also filed an amicus brief calling for a ruling on the discrimination posed by the exemption. Later the case became moot when the federal government withdrew its appeal.
CHILD’s brief was prepared by Michael Botts of Nevada, Iowa, and Peter Healy of Kansas City, Missouri.
Educational & Advocacy Activities – Publications
“Faith-Based Medical Neglect: for Providers and Policymakers” Journal of Child & Adolescent Trauma, October 9, 2020
“Pulse oximetry should be required without a religious exemption.” American Journal of Bioethics, 16:1, 26-28, DOI: 10.1080/15265161.2015.1115151
“Religious attitudes to death: Religious exception defense.” In: Payne-James J. and Byard R.W. (eds.) Encyclopedia of Forensic and Legal Medicine, 2nd edition, v. 4, pp. 109-114. Oxford: Elsevier.
“Child abuse under the guise of religion,” New York Times online forum entitled “Room for Debate,” 10 March 2015.
“The Long Haul,” American Academy of Pediatrics Senior Bulletin, Summer 2014.
“Congress should require health insurance for children,” Louisville Courier-Journal, 25 April 2014.
“Protect children and faith with religion-neutral laws,” NewsWorks, 25 June 2013.
“House amendment nullifies impact of childhood vaccine bill,” Tacoma News-Tribune, 8 Apr. 2011.
“Prayer-fee mandates removed from federal health care bills,” ICSA Today 1 (2010):18-21
(ICSA is the International Cultic Studies Association).
“Religion and Child Neglect” in Child Abuse and Neglect: Diagnosis, Treatment and Evidence,
Carole Jenny, editor (Philadelphia: Elsevier/Saunders, 2010).
The Last Strawberry (Dublin: Hag’s Head Press, 2010).
“Matthew, you cannot be sick,” Dublin Review 37 (winter 2009-10)43-69.
“Does one bizarre health care policy merit another?,” Cedar Rapids Gazette, 19 Oct. 2009.
“Medical Neglect Related to Religion and Culture,” Encyclopedia of Domestic Violence, NY:
“Religious Attitudes Toward Corporal Punishment,” Encyclopedia of Domestic Violence, NY:
“When faith fails children—religion-based medical neglect: pervasive, deadly. . . and legal?”
The Humanist (November/December 2000):11-16.
“Oregon’s great leap forward,” Seattle Post-Intelligencer, 27 Aug. 1999.
“On statutes depriving a class of children of rights to medical care: can this discrimination be litigated?,”
Quinnipiac Health Law Journal v. II, issue 1 (1998):73-95.
“Child fatalities from religion motivated medical neglect” Pediatrics 101(April 1998):625-9
(Seth Asser is senior author).
“Letting children die for the faith,” Free Inquiry 19 (winter 1998).
“The children we abandon: medical neglect on religious grounds,”
American Atheist (autumn 1998):22-26).
“Perspectives: Religion-based medical neglect and corporal punishment must not be tolerated,”
The APSAC Advisor 11(spring 1998):2-3.
“Children, medicine, religion, and the law,” Advances in Pediatrics 44 (1997): 491-543.
“Discrimination de jure: religious exemptions for medical neglect.”
The APSAC Advisor 7 (winter 1994): 35-8.
“Public policy: religious exemptions.” Brown University Child and Adolescent Behavior Letter
January 1993: 2-3.
The Law’s Response when Religious Beliefs against Medical Care Impact on Children.
Sioux City: CHILD Inc., 1990.
“First Amendment does not give the right to injure children.” The Los Angeles Times 14 July 1990: F16.
“Fragile life: religious beliefs that kill children.” Kentucky Hospitals (winter 1989): 8-12.
“Barriers to medical care of children: how you can help.” The Exchangite (Jan.-Feb. 1989): 6-7.
“Review of The Health and Wealth Gospel by Bruce Barron.” Cultic Studies Journal 5.1 (1988): 136-9.
“Spiritual healing claims wither on the vine of investigation.” New York City Tribune 28 January 1988: 8.
“The law should protect all children.” Journal of Christian Nursing (spring 1987): 40.
“Christian Science, faith healing, and the law.” Free Inquiry (spring 1984): 4-9.
“Faith healing, Christian Science, and the medical care of children.”
New England Journal of Medicine 309 (29 December 1983): 1639-41.
“Laws protect parents who let children die.” USA Today 17 August 1983: 8A.
“Faith healing sects and children’s rights to medical care.” Proceedings of the Fifth National Conference on
Child Abuse and Neglect. Milwaukee: Region V Child Abuse and Neglect Resource Center, 1982.
“Christian Science: Threat to Children?” A. D. (July-Aug. 1980): 25-6.
Educational & Advocacy Activities – Public Presentations
Freedom from Religion Foundation Conference, Madison WI, 10 Oct. 2015
Pediatric House Staff Almuni Association Conference, Gainesville FL, 8 Nov. 2014
First Coast Child Protection Team talk, Jacksonville FL, 7 Nov. 2014
Northwest Peers meeting, Olympia WA, 15 Jan. 2014
St. Martin’s University campus talk, Lacey WA, 15 Jan. 2014
Child-friendly Faith Project conference, Austin TX, “Religion, culture, and criminal law,” 8 November 2013
Lurie Children’s Hospital of Chicago Child Maltreatment Symposium, “Medical Neglect Related to Religion and Culture,” 26 September 2013
American Academy of Pediatrics Chapter Advocacy Summit, Schaumberg IL, “Persistence Counts,” 16 March 2012
Center for Inquiry/Council for Secular Humanism Conference, Orlando FL, “Oregon Reforms the Child Abuse Shield Law,” 2 March 2012
Northwest Freethought Conference, Portland, Oregon, 26 March 2011
Salem Humanists, Salem, Oregon, 22 February 2011
Oregon State University Hundere Lecture in Religion and Culture, 28 January 2010
Iowa Society for Consumer Healthcare Advocacy, Iowa City, 20 October 2006
Morningside College ACAS lecture, “When Religion Endangers Children,” Sioux City, 26 February 2003
Florida’s First Coast Conference on Child Maltreatment, Jacksonville, 19 April 2001
Northern New England Conference on Child Maltreatment, Portland, 18 September 2000
National Association of Counsel for Children, Portland, 10 October 1999
American Family Foundation, Chicago, 14 November 1998
American Atheists, Washington DC, 13 June 1998
San Diego Conference on Responding to Child Maltreatment, 28 January 1998, on “Religion-based Medical Neglect: Update on the Status of Children We Abandon”
Minnesota Civil Liberties Union, Minneapolis, 19 August 1997
Council on Child Abuse for Southern Ohio, Cincinnati, 10 June 1997
Mayo Clinic Family Practice Residents Seminar, Rochester MN, 6 June 1997
Training conducted for Iowa child abuse investigators in Iowa City, Des Moines, and Newton 30 March 1995, 10 May 1995, 19 June 1995, 2 November 1995, and 9 May 1996
National Child Abuse Coalition, Washington D.C., 13 December 1994 on “The Religious Exemption Issue in the 1995 CAPTA Hearings”
Freedom from Religion Foundation conference, Madison, 1 October 1994 on “Medical Neglect of Children on Religious Grounds”
Third Central Midwest Conference on Child Abuse, Moline IL, 1 April 1993 on
National Association of Counsel for Children conference, Philadelphia, 19 October 1992, on “Religiously-based Medical Neglect: Legal Child Abuse?,” a plenary lecture and “Cultural Barriers to Medical Care of Children,” a workshop
St. Luke’s Child Protection Center conference, Cedar Rapids IA, 1 October 1992, on “Medical Neglect of Children on Religious Grounds”
St. Luke’s Regional Medical Center, Sioux City IA, 22 September 1992, pediatric inservice on “Cultural Barriers to Medical Care of Children”
Marian Health Center and Siouxland Council on Child Abuse and Neglect conference, Sioux City IA, 29 April 1992, on “Cultural Barriers to Medical Care of Children”
Iowa School Nurses Organization spring conference, Des Moines IA, 11 April 1992, on “Equal Rights for Children under the Law”
Iowa Chapter of National Committee for Prevention of Child Abuse spring conference, Des Moines IA, 10 April 1992, on “Medical Neglect in the Context of Religious Beliefs”
United States Advisory Board on Child Abuse and Neglect hearings, Los Angeles, 3 April 1992, on “Public Policy on Religiously-based Medical Neglect”
San Diego Conference on Responding to Child Maltreatment 1992, San Diego, 24 January 1992, on “Medical Neglect in the Context of Religious Beliefs,” a general session lecture
University of California at San Diego Medical Center, San Diego, 21 January 1992, pediatric grand rounds on “Medical Neglect and Religious Exemptions”
27th Annual Postgraduate Symposium on Medicine and Religion, Kansas University Medical Center, Kansas City KS, 16 October 1991, on “The Christian Science Parent in a Health Care Crisis”
Interagency Council on Child Abuse and Neglect, Los Angeles, 11 July 1991, presentation on deaths of Christian Science children
Minneapolis Children’s Medical Center, Minneapolis, 25 June 1991, grand rounds presentation for hospital staff on “Ethical Issues: Withholding Medical Care on Religious Grounds”
Regional Conference on Medical Neglect of Children, Council Bluffs IA, 30 November 1990, on “Medical Neglect: Public Policy and Public Scrutiny”
Cult Awareness Network Conference, Teaneck NJ, 27 October 1989, on “Child Abuse and Medical Neglect”
Symposium in Pediatric Medical Ethics, Arnold Palmer Children’s Hospital, Orlando, 8 November 1988, on “Children’s Rights to Medical Care”
Cult Awareness Network Conference, Washington DC, 19 March 1988, on “Public Policy on Sectarian Medical Neglect”
Seventh National Conference on Child Abuse and Neglect, Chicago, November 1985, on “Religious Exemptions from Parental Duties of Care”
Committee for the Scientific Investigation of Claims of the Paranormal, Buffalo, 28 October 1983, on “Paranormal Health Cures”
Fifth National Conference on Child Abuse and Neglect, Milwaukee, April 1981, three-hour workshop on “Faith Healing Sects and Children’s Rights to Medical Care”
Educational & Advocacy Activities – Testimony before Legislatures
Video of WA House Judiciary Hearing on religious exemption repeal bill HB1290 (begins at 58:00 mark) January, 2017
Washington Senate Human Services & Corrections Committee, February 2014
Oregon Senate Judiciary Committee, April 2011
Oregon House Judiciary Committee, February 2011
Wisconsin House Children and Families Committee, March 2010
Nebraska Unicameral Health and Human Services Committee, January 2007, February 2006, and January 2000
Iowa House Education Subcommittee, January 2006
Maine Joint Standing Committee on Health and Human Services, May 2005
Nebraska Unicameral Education Committee, February 2005
Rhode Island House Health, Education, and Welfare Committee, February 2004
Missouri House Judiciary Committee, April 2003
Colorado Senate Health, Environment, Children, and Families Committee, March 2001
Maryland House Judiciary Committee, March 2001
Colorado House Criminal Justice Committee, February 2001
Oregon House Criminal Law Committee, March 1999
South Dakota House and Senate Health and Human Services Committees, February 1998
Michigan House Judiciary Committee, February 1997
U. S. Senate Labor and Human Resources staff briefing, June 1995
Minnesota House Judiciary Committee, March 1994
Minnesota House Judiciary Committee, December 1991
Minnesota Senate Judiciary Committee, March 1991
South Dakota House State Affairs Committee, January 1990
California Assembly Committee on Public Safety, October 1989
Ohio House Children and Youth Committee, March 1989
Ohio House Children and Youth Subcommittee, March 1985
North Dakota House, January 1979
Educational & Advocacy Activities – Television, Radio & Podcasts
Community Television of Knoxville, Freethought Forum, interview with Rita Swan, 24 May 2016
KJRH news, Tulsa OK, 23 May 2012
KOTV news, Tulsa OK, 22 May 2012
TruTv, In Session, 18 May 2010
CNBC Diabetes Life, 16 August 2009
PBS Religion and Ethics, 17 May 2009
Arts and Entertainment Investigative Reports, Prayer and Healing: Power or Placebo?, 17 December 2001
Court TV Crier Today, 31 July 2000
Fox National Evening News, 21 June 1999
NBC 30, Hartford CT, April 1999
Leeza, November 1998
NBC Today, 23 October 1998, 6 July 1990, and 20 September 1983
KATU Evening News, Portland, April 1998
WKBT LaCrosse, Hurting or Healing, February 1994
The Shirley Show, Canadian television, 1 February 1994
WPVI A. M. Philadelphia, 19 February 1991
Evening Magazine, August 1990
Inside Report, 16 July 1990
This Evening, July 1989
KOMO Seattle, Town Meeting, 20 November 1988
KPNX Phoenix, God is my Doctor, 13-16 November 1988
KUSA Denver, In God’s Hands, 4 October 1988
British Independent Television, Good Morning Britain, June 1988
ABC Nightline, 17 June 1988
KING Seattle, Good Company, 1 June 1988
ABC 20/20, 6 May 1988
NBC Nightly News, 26 April 1988 and 5 July 1990
WJW Cleveland, When Faith is Fatal, week of 13 November 1987
WTVN Columbus, Midday program, 28 January 1987
WTVN Columbus, Discover Columbus, 17 March 1985
WTOL Toledo, All Things New, 27 January 1985
CBS Crossroads, 27 June 1984
KPIX San Francisco, People are Talking, 23 May 1984 and 11 September 1989
KATU Portland OR, Town Hall, 9 May 1984
KDKA Pittsburgh, Pittsburgh 2Day, May 1980, 17 January 1984, and 8 January 1987
Break Away, 24 February 1984
KTIV Sioux City, 29 December 1983, et al.
KCAU Sioux City, six interviews since August 1983
KYW Philadelphia, People are Talking, May 1980 and 1 November 1983
WBZ Boston, People are Talking, 17 October 1983
PBS Latenight, May 1982
Detroit, Kelly and Company, May 1982
Baltimore, People are Talking, May 1980
Detroit, Good Morning, Detroit, December 1979
Donahue, November 1979 and 17 May 1988
Deism Podcast, Interview with Rita Swan begins at 5-minute mark, 5/2016.
The Thinking Atheist, Medical Neglect in the Name of God, part one, with Rita Swan, podcast of 1/26/2016.
(Part 2 with CHILD Board Member Dr. Paul Offit, podcast of 2/2/2016)
Freethought Radio, Madison, WI, Protecting the Children, an interview with Rita Swan which begins at the 22-minute mark of podcast of 6/29/2015.
WEKU Lexington, KY, Eastern Standard, 5 May 2015
WBUR Boston, MA, Here & Now 1 April 2014
Many radio interviews at local stations in Atlanta, Washington DC, Chicago, Detroit, St. Louis, Tampa, Rochester, Tucson, Phoenix, Seattle, Los Angeles, Miami, Providence, San Antonio, San Francisco, Natl. Public Radio et al.
Educational & Advocacy Activities – Founders’ Honors & Awards
Lifetime Achievement Award to Rita Swan by the Freedom from Religion Foundation, 10 October 2015
Oregon Governor’s Proclamation, 18 September 2013
President’s Certificate for Outstanding Service given by the American Academy of Pediatrics to Rita Swan, 16 March 2012
Outstanding social justice work award given by the Iowa Chapter of the Methodist Federation for Social Action, 6 June 2010
Honoris causa award given by Omicron Delta Kappa chapter at Morningside College, 27 April 2003
Outstanding legal advocacy award given by National Association of Counsel for Children, 1 October 2001
Iowa volunteerism award given by Governor Tom Vilsack, 24 September 2001
Child advocacy service award given by Oregon Pediatric Society, 17 June 2000
Award for child advocacy given by Oregon Peace Officers Association Child Abuse and Sex Crimes Investigators, 2 November 1999
Distinguished alumna award from Emporia State University, 21 October 1994
Giraffe Hero Commendation, given to people who stick their necks out for the common good, Langley, Washington, 12 January 1993
Human rights service award given by Sioux City Human Rights Commission, 2 May 1991
Child advocacy service award given by South Dakota Chapter of the American Academy of Pediatrics, 14 September 1990
Listing in Who’s Who in the Midwest, Who’s Who of Emerging Leaders in America, World Who’s Who of Women, Baron’s Who’s Who of the World, and other directories