Refusal of Medical Treatment and Religious Beliefs

Under the free exercise clause, individuals may refuse medical attention, even that which is necessary to save their lives, as an incident to their religious convictions. As with other religious freedoms, the government may limit this freedom under a strict scrutiny standard, requiring a compelling government interest. In cases where there is no compelling government interest, such as with adults of sound mind, the government should not order unwanted medical procedures. On the other hand, courts have considered the state’s obligation to the health and safety of minor children as a compelling interest. When it is determined that a Compelling State Interest exists, the religious beliefs are not recognized, and the medical treatment is ordered.

Arguments against court-ordered medical procedures rooted in the free exercise clause regularly fail under the states’ right to protect public safety and health. In Reynolds v. United States (1878), the U.S. Supreme Court enunciated the supremacy of public health laws over religious practices. The Court held that although laws ‘‘cannot interfere withmere religious beliefs and opinions, they may with practices.’’

Another argument against court-ordered medical procedures, particularly in the case of minors, is based on fundamental parental rights. The U.S. Supreme Court in Wisconsin v. Yoder (1972) recognized the wide latitude afforded to parents in determining their children’s education. The Court in Prince v. Massachusetts (1944), however, stated that, ‘‘[T]he family itself is not beyond regulation of public interest.’’ The doctrine of parens patriae (recognizing the government’s interest in a child’s welfare) provides a basis for overriding religious objections in courtordered medical procedures. The extent of treatment that may be ordered, however, is subject to the compelling government interest test.

In the most common cases, the life interest of a child is paramount to the religious interest of the child’s parents. While this satisfies the requirement for minor children faced with life-threatening conditions or illnesses, a different test must be used for non–life-threatening diseases. The state power to protect the health and safety of its population, including minors, provides a state interest, but the extent to which that interest meets the compelling interest requirement is not necessarily a settled issue.

Life-threatening conditions are virtually always subject to court intervention. Generally, those interventions are possible only through a finding of neglect on the part of the parents, followed by a court ordered procedure while the child is a ward of the state. Inconsistencies exist, however, when courts determine the extent to which nonemergency medical treatment may be ordered. Courts are often reluctant in such situations to order risky, invasive, and life-threatening treatment. Even as it relates to blood transfusions, which are regularly ordered even when the situation is not life threatening, some courts have refused to order blood transfusions where death was not highly probable.

The current trend among courts, however, is to intervene in situations where treatment is certainly advisable. For example, the Minnesota Supreme Court even upheld an ordered enrollment of a minor in a speech therapy program. The trend of ordering treatment appears to be limited to situations where there is no serious medical disagreement about either the necessity of treatment or the preferred course of therapy. This trend does not apply to complex medical situations and unconventional treatments.

Courts must also balance the religious rights of the minor. In cases where a minor is mature enough to make medical decisions based on his or her religious faith, courts are often willing to allow refusal of treatment when the court would have rejected parental objections. For example, in a case involving a seventeen- year-old Jehovah’s Witness who refused blood transfusions with parental support, the court recognized the distinctiveness of the case because it involved a mature minor, not a younger child. On the whole, however, courts retain more discretion to order medical treatment in cases involving older minors than in cases involving adults.

MICHAEL KOBY

Cases and Statutes Cited

• Prince v. Massachusetts, 321 U.S. 158 (1944)
• Reynolds v. United States, 98 U.S. 145 (1878)
• Wisconsin v. Yoder, 406 U.S. 208 (1972)