What laws apply in cases in which a child has been harmed due to a parent's decision to rely on faith healing instead of seeking standard medical treatment?

Robert W. Tuttle

These cases are generally heard in state courts because most issues involving family law, including obligations to provide medical care, are regulated by the states rather than the federal government. Indeed, all states have enacted laws to protect children from criminal acts such as abuse and neglect. But before 1974, very few states had explicit statutory exemptions from criminal prosecution for parents who relied on faith healing rather than traditional medicine to treat a child's illness. These statutes became very common, however, in 1974 after the U.S. Department of Health and Human Services enacted an important regulation on the subject. This regulation required that states receiving funds for child abuse prevention programs adopt exemptions for parents who practiced faith healing. Although this federal regulation was rescinded in 1983, by that time the vast majority of states had enacted some kind of exemption from prosecution for parents who practiced this type of spiritual healing, and most of these states still have such exemptions.

These exemptions differ in breadth. Today, a few states, including Arkansas and West Virginia, have laws that grant broad immunity for parents who are prosecuted for criminal neglect or manslaughter as a result of engaging in faith healing rather than standard medical care; in these states, even if a child dies as a result of a parent's decision to rely on prayer rather than medicine, parents are generally protected from prosecution. Most states, however, have much narrower exemptions for faith healing. These narrower laws provide an exemption only in cases in which the child is not seriously harmed. Moreover, even when exemptions protect parents from criminal prosecution, they still allow courts to impose other penalties, such as ordering that the child receive medical care or removing the child from the parents' custody.

In general, in cases in which parents are prosecuted for failing to provide a child with standard medical care, have parents successfully invoked state faith-healing statutes to avoid criminal penalties?

When an exemption clearly and specifically protects the practice of faith healing, parents have been successful in using the exemption to defend against criminal charges, even in cases in which the child has died.

But in states that have an unclear exemption that may or may not apply directly to the conduct in question, parents have been less successful in claiming that their belief in faith healing protects them from criminal charges. Nevertheless, parents still have prevailed in some of these cases because courts generally interpret legal uncertainty in favor of the criminal defendant.

In a 1993 Massachusetts case, for example, the state's high court threw out the conviction of parents who were charged with child neglect when their son died after they used prayer to treat his illness. The court held that even though an exemption for faith healing that was on the books at the time seemed not to apply in the event of a child's death, the couple could not be convicted under the state law. That was the case, the court said, because the exemption was ambiguous enough that it could have led the parents to believe that they were immune from all prosecution for child neglect, even in cases resulting in death. In response to this decision, the Massachusetts legislature eliminated the exemption for faith healing and enacted a rule requiring all parents to seek appropriate medical care for ill and injured children.

Finally, when an exemption clearly does not apply in a case involving faith healing, parents have rarely been able to defend against criminal charges. Sometimes they invoke the protection of religious liberty found in the First Amendment to the U.S. Constitution, but this type of argument usually fails because courts have interpreted the Constitution to provide very little protection for parents in this circumstance. On the other hand, a jury may provide a legal protection of sorts for parents, since jurors have often expressed great sympathy for parents who have lost a child, sometimes regarding the parents' predicament as tragic rather than criminally culpable.

In a recent high-profile case in Oregon, parents were charged with manslaughter and criminal mistreatment in the death of their 15-month-old daughter for refusing to give her necessary medical care. Did these parents rely on a state faith-healing exemption for their defense?

The parents in this case did not make a statutory defense because Oregon's manslaughter and criminal mistreatment laws no longer contain exemptions from criminal prosecution when a child dies as a result of parents relying on faith healing instead of seeking standard medical care. Until 1998, Oregon had one of the nation's broadest exemptions for faith healing, protecting parents from being prosecuted for neglect or manslaughter even when recourse to faith healing resulted in the death of a child. But in 1998, in response to public criticism of faith healing, the legislature narrowed the statute so that it no longer protects parents when their refusal to seek medical care causes serious harm to the child. Because, in the recent case, the child died, the Oregon exemption for faith healing did not apply.

Instead, the Oregon parents argued before a trial court judge that the U.S. and Oregon Constitutions protected them from criminal prosecution, but the judge rejected the parents' constitutional arguments. Because no written decision was released, the judge's reasons for rejecting those arguments were not made explicit. But while we do not know the judge's precise reasons, his conclusion is one that would be almost universally shared by judges and legal scholars.

As to their federal constitutional argument, the parents asserted that the Free Exercise Clause, the provision in the First Amendment to the U.S. Constitution that prohibits government discrimination based on religion, protected them from prosecution. Almost all courts would reject this argument because when people violate laws because of their religious beliefs, the Free Exercise Clause, as interpreted by the U.S. Supreme Court, offers only limited protection. According to the Supreme Court's decision in Employment Division v. Smith (1990), the Free Exercise Clause protects religious beliefs, but it does not insulate religiously motivated actions from a law unless that law singles out religion for disfavored treatment. Therefore, in the Oregon faith-healing case, the Free Exercise Clause did not protect the parents from criminal charges resulting from their failure to seek medical treatment because the state's manslaughter and criminal mistreatment laws require all parents, regardless of their religious beliefs or affiliations, to seek medical treatment for their children.

The parents' argument under the Oregon Constitution was slightly more complicated. They argued that the trial court judge should interpret the state constitution to require a stricter standard than the Free Exercise Clause standard applied by the U.S. Supreme Court in its Smith decision. Under the stricter standard, known as the "compelling interest standard," people would be entitled to exemptions from any law that conflicts with their religious beliefs unless the state could demonstrate the law furthers an important public interest. As I mentioned earlier, the court did not release an official written decision, but a news report of the judge's ruling recounted his declaration that even if the case had been considered under this standard, the parents still would not have been immune from prosecution because the state does have a compelling interest in protecting the health and safety of all children, and this interest trumps even the most sincere religious beliefs of parents. So while parents might have a right under the Oregon Constitution to refuse standard medical care for their children when that refusal does not seriously harm the child, in this case the parents did not have this right because their refusal to seek medical care resulted in their child's death.

After the judge rejected their constitutional arguments, the state's case against the parents went to trial, where a jury ultimately acquitted both parents of manslaughter but convicted the father of a lesser charge of criminal mistreatment.

Could a nonreligious parent successfully argue that faith-healing exemptions violate the Establishment Clause of the First Amendment to the U.S. Constitution because the exemptions favor religious parents over their secular counterparts?

I think it is highly unlikely that a court would invalidate a statutory exemption for faith healing on those grounds. Many federal and state laws exempt people from an obligation to obey certain laws if the conduct in question is based on their religious beliefs. These exemptions generally are known as religious accommodations. (See the Pew Forum's essay A Fluid Boundary: The Free Exercise Clause and the Legislative and Executive Branches.)

The U.S. Supreme Court has held that religious accommodations do not violate the First Amendment's Establishment Clause - which prohibits the government from establishing a religion and from favoring one religion over another, or from favoring religion generally over nonreligious beliefs - if the accommodations are designed to relieve burdens that people experience when statutes or regulations specifically conflict with their religious conduct.

Applying that reasoning, a court would likely hold that exemptions for faith healing do not violate the Establishment Clause because these exemptions relieve parents who believe in faith healing of the distinctive burden imposed on them by laws that require them to seek medical treatment for their children.

Is there a constitutional argument that these exemptions violate the Establishment Clause for a different reason: because they favor certain denominations - those that believe in faith healing - over others?

This question raises much more difficult constitutional issues. Many state statutes limit exemptions for faith healing to members of "recognized" religious traditions. The exemptions often contain this language because the Church of Christ, Scientist (commonly known as the Christian Science church), one of the major religious groups that believes in faith healing, has pushed for the legislation and has developed its own standards for training and licensing practitioners of its spiritual care. An argument can be made that by including only "recognized" religious traditions such as the Church of Christ, Scientist, these exemptions discriminate against parents who sincerely believe in faith healing but who are not members of traditions that have become sufficiently popular or influential to receive state recognition. For example, these exemptions would appear not to protect parents who are members of a newly formed religious group, parents who have sincere religious beliefs about faith healing even though they belong to a denomination that does not practice it, or parents who believe in faith healing but do not belong to a religious tradition at all.

A primary purpose of the Establishment Clause is to prohibit the state from favoring some religious groups over others. So if a court refused to exempt parents on the ground that their faith tradition was not "recognized," it would likely violate the Establishment Clause. But such a court decision is quite unlikely because even when a statute contains discriminatory language, courts can and typically do avoid constitutional problems by interpreting the statute broadly to include all faiths.

This transcript has been edited for clarity, spelling and grammar.