This past March, the national media reported the story of an 11 year-old Wisconsin girl who died of diabetic ketoacidosis when her parents chose to pray rather than to take her to the emergency room. In the aftermath, despite their religious beliefs and professed love for their late daughter, the parents were charged with reckless homicide. Although extreme cases like this one are uncommon, patients frequently make healthcare decisions based on religious beliefs. And, as in this case, the extent of their legal right to do so sometimes comes into question.

To understand the importance of religious freedom in this country, we need to look no further than the First Amendment to the Constitution. To most of us, the First Amendment is synonymous with "Freedom of Speech." However, in terms of relative importance, it should be noted that religious freedom is actually mentioned first, before "freedom of speech," in the text of the First Amendment.

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.                                                             

United States Constitution, Amendment I 

The freedom to practice the religion of one's choosing must therefore be regarded among the most fundamental rights in our society.

However, even the most sacred rights have limits. For example, although freedom of speech is guaranteed by the First Amendment, it is nonetheless a crime to yell "Fire" in a crowded movie theatre. The legal principle is that individual rights must be curtailed when their exercise places other persons in danger. And, it is from this perspective that we should weigh the intersection of law, medicine and religion.

If the patient is an adult, he has the right to make medical decisions based upon any religious belief that he may choose. As long as he is not placing any other person in danger, a competent adult can refuse any medical care for any reason, even if it means that he will die. And, this refusal must be respected by his physicians.

This means that a Jehovah's Witness can refuse a blood transfusion based on his religious beliefs. It also means that a non-Jehovah's witness can refuse a blood transfusion for non-religious reasons. In fact, any competent adult can refuse a blood transfusion for any reason, religious or otherwise. The choice here belongs to the patient. And, as long as he is not harming anyone but himself, he is free to believe, worship and choose as he sees fit.

But, the rule produces a different result with respect to the medical care of a child. Parents are given substantial discretion in the manner in which they rear children. But, a parent's right to raise a child in accordance with religious beliefs exists only as long as it does not place the child in danger. From a legal perspective, it does not matter whether the person in jeopardy is a stranger or a family member, First Amendment rights cannot be exercised in a way that places other persons in danger.

Most of us are already sensitive to the issue of child endangerment when it arises in cases of "neglect" or "abuse." But, it does not matter how or why a child's welfare is being compromised. Our obligation to a child who is not receiving necessary care is the same regardless of whether his parents love him and believe in God, or love neither him nor God. There is no religious right, nor is there any other type of right, that allows a parent to deprive a child of nourishment, shelter or medical care for illness.

In cases where a child's basic needs are not being met, physicians should notify the appropriate government agency. This process is permitted by HIPAA and required by law in every state. Reporting "loving" and "Godly" parents to a state agency can seem awkward or even "wrong." But, we live in a society which has an expectation that children must have their basic needs met. While physicians are not responsible for setting or enforcing these societal standards, we are required to report situations where they are not being met.