Ethics Argument: Cross-Cultural Issues and Diverse Beliefs

In the United States, according to the US Constitution, families are granted the right to religious freedom. When those families that are exercising their religious rights enter the healthcare system, occasionally their beliefs are in direct conflict with the healthcare team’s idea of the best or even routine treatment. While it is acceptable that one can become a martyr as an adult and refuse treatment, it gets a little dicey when dealing with minors. Take, for example, the case of a 3-year-old child who presents with a high fever and a stiff neck.

The health care team convinced it is most likely meningitis, would want to run a spinal tap to confirm and immediately begin antibiotic treatment. If the parents refuse treatment and instead insist on taking the child to the church to heal her through prayer, they run the risk of the child unnecessarily passing away from a serious illness that has a proven and effective routine treatment. This refusal of necessary medical care for religious reasons is medical neglect.

I advocate that:

• Children must be protected uniformly across all levels of government and have equal opportunity for health, regardless of their parent’s beliefs. Further, a religious exemption to child abuse and neglect laws must be repealed to provide more clarity and prevent further harm, suffering, and death.
• Those who do enlist alternative healing routes and deny care that would prevent harm must be held accountable using legal action.
• Medical and spiritual treatment can coincide.

Meningitis

Meningitis is a swelling of the protective membranes that cover the brain and the spinal cord.

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It can be a bacterial or viral infection that generally causes inflammation (Centers for Disease Control and Prevention, 2017). Bacterial and viral meningitis are the most common forms, however, there is also fungal meningitis, amebic, parasitic, and non-infectious meningitis (CDC, 2017). Bacterial meningitis is very deadly and can cause death in as little as a few hours (CDC, 2017). It is estimated that close to 1,000 people contract meningococcal disease in the US each year, and of those who contract it, 10-15 percent die (National Meningitis Association, 2014). Meningitis is most effectively prevented using vaccination, however, protection by vaccination is not 100% effective (CDC, 2017). It is very important if bacterial meningitis is contracted that one starts treatment with antibiotic medication immediately (CDC, 2017). In the earlier case presented, given the 90% survival rate with treatment, the parents neglected their child and should be held accountable for whatever harm came from that decision of informed refusal.

Religious Exemption Repeal

Religious exemptions to child abuse and neglect came about in response to the Child Abuse Prevention and Treatment Act of 1974 (American Academy of Pediatrics, 2013). It stated, “…a parent or guardian legitimately practicing his religious beliefs who thereby does not provide specified medical treatment for a child, for that reason alone shall not be considered a negligent parent or guardian” (American Academy of Pediatrics, 2013). For states to receive federal grant money for child abuse, it was required to enact these religious exemptions (American Academy of Pediatrics, 2013). Luckily, the Health and Human Services Department took a more neutral stance in the 1983 reauthorization of the act, and in 1987 clarified it even more by stating, “reports of medical neglect should be made only if there is harm or substantial risk of harm and religious exemptions should be a matter of state discretion, not federal” (American Academy of Pediatrics, 2013). The problem here is that the substantial risk of harm is subjective and parents often do not have the training to recognize when an illness is moderate and when an illness is severe. While some might argue that these exemptions allow for religious diversity, I believe they convey a message of government endorsement of religion (Dose, 2009). Law-abiding citizens may be misconstrued to believe that the government endorses prayer as an effective medicine and this might even encourage religious parents to delay seeking medical treatment (Dose, 2009). The religious exemption to child abuse and neglect laws must be repealed to provide more clarity and to protect children from further harm and possible death. All states in our country require certain professionals, including social workers, to report reasonable suspicions of abuse, neglect, or exploitation. These religious exemption laws can be confusing for mandated reporters worried about overstepping cultural lines. All children should have equal opportunity to health and access to healthcare regardless of their parent’s beliefs. This is a basic moral principle of justice and children must be protected uniformly across all levels of government (Gehlert & Browne, 2012).

Accountability

Those that do insist on healing their children through alternative routes and deny care that would prevent death, suffering, or harm, must be held accountable using legal action. There should be no exemptions from civil or criminal action that would otherwise be appropriate. The constitutional guarantee of religious freedom does not permit children to be harmed by way of religious practices (Asser & Swan, 1998). Moreover, when a parent neglects or harms a child, religion is not a valid legal defense. The child’s best interests should always be the focus when parents or guardians are making difficult medical decisions (American Academy of Pediatrics, 2013). The children’s lives and future autonomy must be protected. It is not uncommon for the judicial branch to step in with court orders for life-saving treatment despite parents’ religious objections. However, sometimes these orders take too long, and innocent life is lost due to someone’s belief in a higher power.

Collaboration

I do wish to note that there are important factors that must be considered including the likelihood and degree of harm in waiving treatment, and also the benefits and risks associated with the recommended treatment. I believe conventional medical treatment can coincide with religious practices such as prayer. Pediatricians and doctors alike should approach the subject delicately and underscore the importance of treatment and their obligation to report medical neglect. Together with the families, doctors can develop treatment plans that promote health and acknowledge and give strength to the faith the family endorses.

While I may not agree with the extreme religious views, the free exercise of religion in this country does have an important value in society. There is no harm in parents teaching their children their religious beliefs, however, these beliefs must not outweigh other important societal values such as child safety (American Academy of Pediatrics, 2013). I believe that with the repeal of religious exemptions to child abuse and neglect several dangerous problems could be resolved and the parental duty to provide medical care would be unambiguous (Dose, 2009). The number of unvaccinated children attending public school (on the grounds of religious exemption) is on the rise, likewise is the number of vaccine-preventable illnesses. Exposing the community to communicable disease, illness, or death is not in the right to practice religion freely (American Academy of Pediatrics, 2013). With modern science on our side, “we did all we could by the word of God,” is simply not enough.