Christian Science Healing of Minor Children: Spiritual Exemption Statutes, First Amendment Rights, and Fair Notice

In August 1993, the Supreme Judicial Court of Massachusetts overturned the manslaughter convictions of David and Ginger Twitchell in the death of their two-year-old son, Robyn.(1) This became the latest in a series of prosecutions and appealed verdicts involving Christian Science parents who relied solely on spiritual healing and whose children died of illnesses generally recognized as highly treatable with conventional medicine.(2) These trials have raised a host of legal and ethical questions that are not easily resolved. Most have directly confronted questions relating to first amendment guarantees of freedom of religion and fourteenth amendment guarantees of due process, specifically fair notice of potential criminal conduct. Equal protection also lurks as a constitutional issue, and broader issues of parental control of children, potential conflict of rights between a parent and child, and government intrusion into the privacy of the family also are integral to the debate. At the heart of the debate is a dispute regarding the meaning and implementation of the first amendment, which simultaneously provides that the government "shall make no law respecting an establishment of religion" and no law "prohibiting the free exercise thereof."(3) This nation was founded by immigrants seeking relief from religious persecution, and the Constitution is clear in its intent to prohibit such persecution. The Church of Christ, Scientist, was founded on the theological principle of healing the body through devout prayer in lieu of conventional medical care. As will be discussed below, most states have clauses in their child medical neglect statutes that allow exemptions for spiritual healing in lieu of conventional medical care.(4) This raises the question of whether such exemptions violate the first amendment's prohibition on laws respecting the establishment of religion. An equally important issue is whether the exemptions shield parents from prosecution under involuntary manslaughter statutes. Has the fair notice requirement of due process been violated because of the seeming contradiction between the spiritual healing exemptions, which appear to recognize prayer as a form of healing, and the requirement of gross negligence that is necessary to support a manslaughter conviction? Specifically, may Christian Science parents who eschew conventional medical care for their children and rely instead on prayer be prosecuted for manslaughter if a child dies? This seeming paradox is addressed in every case to reach the state supreme court level. While the first amendment and due process issues have dominated the legal arena thus far, questions of equal protection also merit discussion. In some states he exemptions apply only to members of organized religious groups that rely on spiritual healing. In these states protection is not afforded to parents who may have a personal belief in spiritual healing but do not belong to organized religions that, as part of their theology, advocate reliance on spiritual healing.(5) In these states, for example, Christian Scientists could claim protection of religious freedom when they refuse medical care for a child, but theoretically Catholics and Methodists could not because reliance on spiritual healing is not part of their theologies. Even in states whose spiritual exemption clauses do not specifically reference organized religions, a claim of violation of equal protection could be made because the law provides to one class of citizens what it denies to others. That is, the law allows parents who rely on spiritual healing to avoid conventional medical care for their children but mandates it for other parents. For example, in 1984 Congress enacted the so-called "Baby Doe" amendments to the Child Abuse Prevention and Treatment Act, the same statute that provided the basis for the regulations containing the spiritual exemption clauses.(6) These amendments require treatment for newborns under certain circumstances. …