Cultic Studies Journal, Volume 17, 2000, Page 4
Child Fatalities From Religion-Motivated Medical Neglect
Seth M. Asser
University of California, San Diego
School of Medicine
Rita Swan
Children's Healthcare is a Legal Duty (CHILD)
Abstract
Objective. To evaluate deaths of children from families in which faith healing
was practiced in lieu of medical care and to determine if such deaths were
preventable.
Design. Cases of child fatality in faith-healing sects were reviewed.
Probability of survival for each was then estimated based on expected
survival rates for children with similar disorders who receive medical care.
Participants. One hundred seventy-two children who died between 1975 and
1995 and were identified by referral or record search. Criteria for inclusion
were evidence that parents withheld medical care because of reliance on
religious rituals and documentation sufficient to determine the cause of
death.
Results. One hundred forty fatalities were from conditions for which survival
rates with medical care would have exceeded 90%. Eighteen more had
expected survival rates of 50%. All but three of the remainder would likely
have had some benefit from clinical help.
Conclusions. When faith healing is used to the exclusion of medical
treatment, the number of preventable child fatalities and the associated
suffering are substantial and warrant public concern. Existing laws may be
inadequate to protect children from this form of medical neglect. Pediatrics
1998 101 625-629 child abuse, child neglect, child fatality, Christian
Science, faith healing, medical neglect, prayer, religion and medicine.
Despite the great advances of scientifically based medicine, some individuals and groups
continue to look primarily outside of modern medicine for remedial care.1 Applied to minor
or self-limited problems, many non-medical practices are probably benign, but may lead to
avoidable morbidity and mortality with more serious ailments.
Claims that prayer or religious beliefs have psychological or other benefits that contribute to
illness recuperation are scientifically testable and perhaps supported by some evidence.2, 3
Although some churches have published testimonials claiming that organic and functional
diseases are healed by soliciting divine power, this has not been confirmed by scientifically
valid measures.4 Death rates in graduates of a Christian Science college, a group whose
central tenets deny the reality of disease and promote avoidance of medical services,5 have
been reported to be higher than graduates of a secular institution.6
Although legal precedents have established the right of an adult to refuse life-sustaining
treatment, they do not allow parents or guardians to deny children necessary medical care.
The US Supreme Court stated this principle eloquently: ―The right to practice religion freely
does not include the liberty to expose the community or child to communicable disease, or
the latter to ill health or death. ...Parents may be free to become martyrs themselves.

Cultic Studies Journal, Volume 17, 2000, Page 5
But it does not follow they are free, in identical circumstances, to make martyrs of their
children before they have reached the age of full and legal discretion. ...‖7
Despite this ruling, in late 1974 the US Department of Health, Education, and Welfare
required states receiving federal child abuse prevention and treatment grants to have
religious exemptions to child abuse and neglect charges.8 With federal money at stake,
states rapidly enacted exemptions in the juvenile code, criminal code, or both.9, 10
A few cases of children who died because of religion-motivated medical neglect have
received national press coverage, but most get little or none. Reports in the medical
literature are also rare. The American Academy of Pediatrics‘ first policy statement against
religion-based medical neglect in 1988 cited press accounts rather than case reports.11
Outbreaks of vaccine-preventable disease among groups with religious objections to
immunization are reported frequently.12-14 However, medical citations of fatalities are
rare.14,15 One study of perinatal events reported an Indiana sect that had a threefold
increase in infant mortality and an 80-fold increase in maternal mortality compared with the
general population.16 The study reported here describes deaths that have occurred after the
federal government required religious exemptions to child abuse and neglect laws.
Methods
We compiled a list of child fatalities in the United States that occurred during the period
from 1975 through 1995. Initial cases were from the files of children‘s Healthcare Is a Legal
Duty (CHILD), Inc, a nonprofit organization that gathers information on religion-based child
abuse and neglect. These cases were collected from newspaper articles, trial records,
personal communications, and public documents. With institutional review board approval,
police records, coroners‘ files, and other confidential materials were examined for additional
information. During this supplemental search, four additional candidates were identified.
Cases were included if the available information, including clinically descriptive histories
and/or post mortem medical data, was sufficient to determine the cause of death with
reasonable medical certainty, the standard for presentation of a medical opinion in most
courts. This was assessed by one author (S.M.A.), a pediatrician who has qualified in court
to examine records and present expert opinion in child fatality cases.
Cases were excluded if documentation of the cause of death was inadequate or if the history
did not indicate that failure to seek medical care was primarily based on a reliance on faith
healing. Examples of the latter include children of some Amish communities where the
barriers to care are more cultural than theological and children of Jehovah‘s Witnesses who
were denied only blood products and were not expected to be healed by divine intervention.
After considering the underlying conditions and diagnoses that directly contributed to death,
children were assigned a likely outcome when commonly available remedial or preventive
medically supervised care (Table 1). Because medical advances altered expected mortality
rates during the study period, comparisons were based on clinical experience and published
statistics of the appropriate era. For chronic conditions (e.g., tumors, diabetes) survival
was compared with long-term survival rates published in journals or textbooks from the
relevant field. For acute problems, such as infections and perinatal complications, the
logical comparison was expected mortality during the acute process.
In most cases, the diagnosis permitted an assignment to an expected outcome based on a
published statistic. For example, the mortality rate for treated cases of Rocky Mountain
Spotted Fever in 1983 was less than 2%, less than one-third the rate for untreated cases.17
Thus, a death during 1984 was considered to have an excellent probable outcome with
medical treatment.