Medical Neglect Of Children On Religious Grounds by Dr. Rita Swan (November 1994)

This speech was presented on October 1, 1994 at the seventeenth annual convention of the Freedom From Religion foundation convention held in Madison, Wisconsin. Dr. Swan left the Christian Science Church and became its critic following the death of her own baby son from meningitis, which initially went untreated under the authority of the church.

CHILD Inc. was founded to combat the problem of child abuse and neglect on religious grounds. Every form of child abuse has been justified by somebody on religious grounds: forced labor, forced marriage, kidnapping, physical abuse, sexual abuse, starvation, and medical neglect.

Religiously-based medical neglect presents a special case in that a large body of religious exemption laws make it legal. These exemptions are almost entirely due to the Christian Science church. They are of two main types: exemptions to preventive and diagnostic measures and exemptions that apparently allow parents to withhold medical care when the child is sick.

Forty-eight states have religious exemptions from immunizations. Children claiming a religious exemption from immunization have much higher rates of vaccine-preventable diseases and also spread diseases into the general community. The Christian Science church argues that their unvaccinated children are no threat to the rest of the population, which does get vaccinated. But that is too simplistic. Unvaccinated carriers can transmit deadly diseases to infants too young to be vaccinated and to medically fragile children. We have a growing number of immunosuppressed children in our schools and daycares today–children with AIDS, children with cancer, who need to be protected from any contact with unvaccinated carriers. Furthermore, the measles vaccine has a 5% failure rate. It is therefore possible for a properly vaccinated child to catch measles from an unvaccinated child.

The Center for Disease Control recently reported that 45% of the nation’s 730 measles cases during the first six months of this year were among Christian Science children and groups in Western states who claim inoculation compromises their political freedom.

Most state laws have another type of religious exemption–those from child abuse, neglect, and criminal charges. They are largely due to a federal policy by which the federal government actually forced states to pass religious exemptions to child abuse and neglect charges between 1974 to 1983.

Arriving at the same time as a rebirth of interest in charismatic faith healing, the religious exemptions have contributed to many deaths of children. We have 165 cases in our files of children dying after medical care was withheld on religious grounds since January 1975.

After widespread coverage of some of these deaths and many protests from us, the federal government stopped requiring states to pass the religious exemption laws in 1983. Unfortunately, by that point in time, virtually every state had them.

Today, after more than a decade of backbreaking work in state legislatures, we have only four states with no religious exemptions either in the child abuse and neglect laws or the criminal laws. Those four are South Dakota, Hawaii, Maryland, and Massachusetts.

I should emphasize that the actual reach of religious exemption laws varies widely. It is not accurate to say that 46 states allow parents to withhold medical care on religious grounds. Since 1982 criminal charges have been filed in 42 cases of religiously-based medical neglect. Convictions have been won in the majority of these cases despite the religious exemption laws though there have also been several acquittals and appellate overturns because of the exemptions.

Only twenty of the 46 states have a religious exemption in the criminal code, and only about seven of the twenty have a religious exemption to a felony charge. Prosecutors have been able to win convictions by charging from other chapters of their codes that do not have religious exemptions, finessing their meaning, etc.

But this is far from an ideal solution. We believe the state has a moral obligation to make its standards clear to parents before their child dies. The religious exemption laws seem to tell parents that they have a religious right to withhold medical care.

And many prosecutors do not want to undertake the extra work that these cases entail. We know, for example, of twenty Christian Science children who died between 1981 and 1992, but only seven of the deaths were prosecuted.

In the past seven years the U. S. Dept. of Health and Human Services (HHS) has taken some timid steps to undo the damage they did by requiring religious exemptions between 1974 and 1983. HHS now says that the laws cannot contain either an explicit or implicit religious exemption from reporting a sick child to the child welfare agency, from investigation by the agency, or from a court’s ordering of medical care for the child, but that the state laws can have a religious exemption from adjudicating parents as negligent.

We still believe that there should be no religious exemption at all. A child’s life should not be totally dependent on a report being made to Protective Services. Parents have custody of children and should therefore have a duty to care for them.

But HHS’s timid changes were nevertheless an improvement in protection for children associated with faith-healing sects. HHS withheld federal child abuse grants from a handful of states to force these improvements and warned other states that they might lose their child abuse grants.

The states have understandably been confused by the various shifts in HHS policy and the lack of rationale for them. The Christian Science church has exacerbated the confusion. In June of this year the U.S. House added a rider to the HHS appropriations bill that prevents HHS from implementing any policies that restrict “non-medical health care of children.”

Next year Congress will have to reauthorize the federal Child Abuse Prevention and Treatment Act. We’ve been told that both the House and Senate will hold hearings on the religious exemption issue. Congress will have to either allow HHS to carry out the timid improvements it wants to make, prohibit HHS from making any changes in state laws, or direct HHS to require states to repeal these laws.

Of course, we want HHS to clean up the mess they created and require repeal. But it will be extremely difficult to persuade legislators to that position. Already the issue is characterized by many as a states’ rights issue. Nobody cared about states’ rights when the federal government forced the states to pass these laws, but now the question for many is whether the federal government should force the states to do something that ostensibly tramples on religious freedom.

The hearings will be held by Senator Thomas Dodd’s Subcommittee on Children and by Congressman Major Owens’ Subcommittee on Select Education and Civil Rights. Dodd has not been sympathetic to our position. He told pediatricians that the Christian Scientists are fine respectable people who “do not want to deprive their children of health care.” We find this disconnect often. Even though the Christian Scientists are asking for the right to deprive children of medical care, politicians can’t believe that these affluent, conservative, well-educated people are really asking for that.

Another issue is the national health care plans. Essentially, Christian Science wants to be both a religion and a health care. It uses terminology from medical care. Christian Science calls its faith healers “practitioners,” who take patients, give treatments, and send bills for them. The treatments are an argumentative form of prayer. The only formal training of these practitioners is a two week course in theology. Then they can apply for church accreditation, qualified to treat all diseases of children and adults.

The church has other agents called nurses, who have no training at all. They do provide a rudimentary level of physical care: they give baths and fix meals. But they are also cheerleaders for the church. They read and sing from church literature and encourage the patients to believe that Christian Science methods are healing them. And there is much that the theology prevents them from doing: the nurses cannot recognize contagious diseases, take a pulse, or use a fever thermometer. Using hot packs, ice packs, or backrubs to relieve discomfort is against the theology. Medical nurses must work under the supervision of doctors, but Christian Science nurses are not supervised by any state-licensed providers.

The recognition that the Christian Science church has won for its eccentric, unlicensed health care is astonishing. Over forty major insurance companies reimburse for the bills sent by Christian Science practitioners and nurses. The IRS allows such bills to be deducted as medical care expenses. Medicare and Medicaid pay for the nurses out of public money. Christian Science practitioners are authorized to certify sick leave and disability claims for both private and public employees. Even though they have no training in diagnosis and believe that disease is healed by claiming it is unreal, when there’s money involved, the disease becomes real enough to claim the money.

This year the church lobbied to get its “health care services” reimbursed in the national health care plans. To our surprise, the ACLU’s Washington office told one of our allies that such reimbursements are constitutional, even if the government subsidizes the insurance–so long as they are permissive rather than mandatory and the government does not tie them to accreditation standards of a church.

Just before health care died in Congress, we heard that the mainstream Senate bill had been changed to conform to the ACLU’s requirements. The new wording was that “nothing in this act shall be construed to prohibit an insurance company from reimbursing for CS pracs, nurses, and nursing homes” and it did not say who could call themselves a Christian Science practitioner or nurse.

This issue will be back next year and we would be grateful for your help with it. Maybe what we’re going to have to do is bill all our friends for Christian Science treatments.

Finally, I’d like to tell you about a lawsuit we’ve filed in federal court and have high hopes for. We feel profoundly that religious exemptions from child health care requirements are unconstitutional. They give a privilege to one type of religion and they deprive one group of children of the equal protection of the laws. Usually, there is a way to bring suit when a person’s civil rights are violated. But parents have to give permission for a child to bring a suit, and the religious exemption laws are for the protection of parents.

For years we have wrestled with the problem of how to gain standing to represent the children endangered by the religious exemptions. This year we found a father divorced from a Christian Scientist who was willing to join us in this litigation, suing on behalf of himself and his minor children in the care of his ex-wife.

It is the first case in which a federal court has been asked to rule a religious exemption unconstitutional for its discrimination against children.

Now I’d like to close with slides of a few of the victims of Christian Science.

Child advocacy pioneer Rita Swan, with her husband, founded Children’s Healthcare Is a Legal Duty (CHILD, Inc.) in 1983. She has been a children’s advocate for medical health care since 1978, working at the federal level to remove religious immunity from the Code of Federal Regulations. In 1983, the U.S. Dept. of Health and Human Services removed its religious immunity proviso from federal mandate. Since then she has lobbied at the state level for repeal of religious exemptions. CHILD testimony was instrumental in persuading the American Academy of Pediatrics to work against religious exemptions for child healthcare requirements.

She graduated with a B.A. in English from Emporia State University in 1963, receiving a Masters in English from the University of Wisconsin in 1965 and a Ph.D. in English from Vanderbilt University in 1975. She is listed in Who’s Who in the Midwest, has appeared on Donahue, PBS Latenight, NBC’s Today, NBC Nightly News, ABC 20/20 and Good Morning Britain. She has made many presentations before symposia, academic and social, on the dangers of religious medical exemption laws for children, and has testified before several state legislatures. The Swans’ child protection work has been discussed in People, the AMA, Time, Redbook and many other publications. Rita is president of CHILD, Inc., Box 2604, Sioux City IA 51106. She can provide details on the upcoming Congressional hearings at (712) 948-3500.

Freedom From Religion Foundation