Court Opinion

ID: 9797424
Source: CourtListenerOpinion
Date Created: 2023-08-31 04:20:27.277364+00
Date Added: 2024-06-11T08:54:58.547871
License: Public Domain

ESPINOSA, Judge,
dissenting.
¶ 40 I respectfully disagree with the majority’s result and reasoning because, in my view, it effectively elevates the rights of the irresponsible parent over the needs of an innocent child and justifies it by patching together constitutional doctrines and statutes that have no bearing on the situation at hand. As the majority acknowledges, if somewhat hollowly, even fundamental religious rights are not absolute when it comes to the best interests of a child.
¶ 41 At the outset, I appreciate the majority’s concern that ADES’s custody of Cheyenne is temporary and the ease plan goal is reunification. But Cheyenne could remain in ADES custody for more than a year until permanent custody is resolved, see A.R.S. §§ 8-533(B)(8)(b) and 8-862(A)(2) and (C), and no evidence in the record supports the majority’s conclusion that her immunization is “non-urgent,” ¶32, supra. To the contrary, the evidence is undisputed that permitting Cheyenne to remain “unimmunized poses significant risks to the health and sometimes the life of the child,” even more so here in view of Peterson’s testimony that even routine infections can be life-threatening to an infant of Cheyenne’s age. Thus, although the majority maintains that “nothing prevents the state from arranging to have the child immunized after the parent’s rights have been severed,” n. 6, supra, if that is the ultimate result of the dependency proceedings, such delay is unacceptable in light of the statutory obligations of ADES and the juvenile court to protect this child and the unchallenged medical testimony that her immunizations are medically necessary now. The respondent judge’s decision that immunization is in Cheyenne’s best interest and necessary for her safety is supported by reasonable evidence in the record, was not an abuse of discretion, and is entitled to our deference. See In re Maricopa County Juvenile Action No. JD-6236, 178 Ariz. 449, 451, 874 P.2d 1006, 1008 (App.1994) (appellate court “generally deferential when the juvenile court exercises its substantial discretion to make placement decisions in the best interest of dependent juveniles ... [and] review[s] such orders for abuse of discretion”) (citation omitted).
¶ 42 As a matter of constitutional law and statutory construction, there is little support for the majority’s premise that the state must establish a compelling interest in the specific procedure of immunization because Diana has objected to that procedure on religious grounds. And there is equally scant foundation for the majority’s conclusion that Arizona has “legislatively subordinated” any state interest in immunization, including its interest in immunizing a dependent child in its custody, to a parent’s religious objection. The majority has erred as a result of its misplaced reliance on Yoder; its failure to appreciate the difference between the state’s general interest in child welfare and its particular custodial interests and obligations *141with respect to Cheyenne as a dependent child; and its insistence that statutes reflecting the state’s general public health interest in immunization, which defer to a parent’s religious objection, necessarily modify the state’s more particular obligation under Title 8, A.R.S., to provide medical care for a dependent child. As a result, the majority’s limitation on the juvenile court’s authority is unsound as a matter of both jurisprudence and state public policy.
Constitutional Considerations
¶ 43 The majority relies on Yoder for “guidance” in this context while failing to recognize crucial distinctions between that case and the circumstances presented here. In Yoder, the Supreme Court found the state’s parens patriae9 interest in compulsory secondary education insufficient to overcome the interest of an Amish parent who had shown that such regulation would “gravely endanger, if not destroy, the free exercise of [Amish] religious beliefs.” Yoder, 406 U.S. at 219, 229, 92 S.Ct. at 1535, 1540. The father in Yoder had demonstrated “the adequacy of their alternative mode” of vocational instruction to accomplish the overall interests advanced by the state, id. at 235, 92 S.Ct. at 1543, and had “introduced persuasive evidence ... that accommodating [their] religious objections ... [would] not impair the physical or mental health of [their] child[ren],” id. at 234, 92 S.Ct. at 1542. However, the Court observed, “To be sure, the power of the parent, even when linked to a free exercise claim, may be subject to limitation under Prince [v. Massachusetts, 321 U.S. 158, 64 S.Ct. 438, 88 L.Ed. 645 (1944),] if it appears that parental decisions will jeopardize the health or safety of the child, or have a potential for significant social burdens.” Id. at 233-34, 92 S.Ct. at 1542.
¶ 44 In Prince, the Supreme Court had upheld the state conviction of a Jehovah’s Witness for permitting her niece, a child in her legal custody, to sell publications on the street in violation of state child labor law. 321 U.S. at 159, 64 S.Ct. at 439. The Supreme Court recognized as a cardinal principle “that the custody, care and nurture of the child reside first in the parents,” but added:
[Njeither rights of religion nor rights of parenthood are beyond limitation. Acting to guard the general interest in youth’s well being, the state as parens patriae may restrict the parent’s control by requiring school attendance, regulating or prohibiting the child’s labor, and in many other ways. Its authority is not nullified merely because the parent grounds his claim to control the child’s course of conduct on religion or conscience. Thus, he cannot claim freedom from compulsory vaccination for the child more than for himself on religious grounds. The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death____[T]he state has a wide range of power for limiting parental freedom and authority in things affecting the child’s welfare; and this includes, to some extent, matters of conscience and religious conviction.
Id. at 166-67, 64 S.Ct. at 442 (citations and footnotes omitted). The Court concluded:
Parents may be free to become martyrs themselves. 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 when they can make that choice for themselves.
Id. at 170, 64 S.Ct. at 444.
¶ 45 Yoder’s critical distinction of parental decisions that jeopardize the health or safety of a child, and the specific reference in Prince to a state’s authority to compel immunization despite a parent’s religious objection, present the most obvious and fundamental differences between this case and Yoder. And unlike the parent in Yoder, Diana has provided no evidence that accommodating her religious objection would not impair Cheyenne’s physical health and would constitute an adequate alternative to the state’s interest in providing Cheyenne with *142medically necessary care. Indeed, the undisputed evidence presented to the respondent judge required the contrary conclusion.
¶46 A less obvious but equally critical distinction between this case and Yoder involves the different interests at stake. As the majority concedes, “it is the best interests of the child, not the parent, that are paramount in a dependency proceeding.” ¶ 31, supra. But the Supreme Court in Yoder pointedly did not address the “interest of the child as contrasted with that of the parents” or “the proper resolution of possible competing interests of parents, children, and the state.” 406 U.S. at 230-31, 92 S.Ct. at 1541. In Yoder, the Court was concerned only with the “interest of parents, as contrasted with that of the state.” Id. at 232, 92 S.Ct. at 1541. Specifically, the Court considered the power of the state to impose criminal penalties on Amish parents for refusing on religious grounds to send their children to school. Id. In contrast, this case raises the question of how the competing interests of a child, a parent, and the state are affected by a judicial determination that the parent is unwilling or unable to properly care for the child.
¶ 47 Since Yoder was decided, the Supreme Court has addressed the considerations relevant to a child’s best interests and has made clear that deference to a parent’s decisions about a child’s care is dependent on “the traditional presumption that a fit parent will act in the best interest of his or her child.” Troxel v. Granville, 530 U.S. 57, 70, 120 S.Ct. 2054, 2062, 147 L.Ed.2d 49 (2000) (plurality opinion) (court must afford “at least some special weight” to “fit” parent’s decision regarding grandparental visitation). While generally recognizing the “fundamental right of parents to make decisions concerning the care, custody, and control of their children,” id. at 66, 120 S.Ct. at 2060, the Court explained the importance of the distinction between a “fit” and “unfit” parent when a child’s best interests are at issue:
[T]he Troxels did not allege, and no court has found, that Granville was an unfit parent. That aspect of the case is important, for there is a presumption that fit parents act in the best interests of their chil-dren____Accordingly, so long as a parent adequately cares for his or her children (i.e., is fit), there will normally be no reason for the State to inject itself into the private realm of the family to further question the ability of that parent to make the best decisions concerning the rearing of that parent’s children.
Id. at 68-69, 120 S.Ct. at 2061 (citation omitted). To the extent the majority finds no basis to conclude that the “residual rights of a parent whose child has been adjudged dependent should carry any less weight than those of other parents,” ¶ 27, supra, Troxel clearly provides that authority.
¶48 Here, Cheyenne’s adjudication as a dependent child was a legal determination that she is “[i]n need of proper and effective parental care and control and ... has ... no parent or guardian willing to exercise or capable of exercising such care and control.” § 8-201(13). The state thus has every reason to question Diana’s ability to make the best decisions for Cheyenne’s care and no reason to presume that she would necessarily act in accordance with Cheyenne’s best interests. See Troxel, 530 U.S. at 68-69, 120 S.Ct. at 2061. And the adjudication of dependency resulted in a compelling state interest that justifies the delegation of decisions about Cheyenne’s care to the juvenile court. Maricopa County No. JD-6123, 191 Ariz. at 392, 956 P.2d at 519. This interest is more than sufficient under Yoder. But because Yoder dealt only with parental rights, it provides little guidance here and no authority for limiting the juvenile court’s discretion to make medical decisions for a dependent child.10
*143State’s Interest in Providing Medical Care for a Dependent Child
¶ 49 In my view, the majority also goes astray in characterizing the state’s interest in this case as a general interest “in immunizing children to promote their health and welfare,” ¶ 19, supra, and in asserting that public health regulations pertaining to immunizations required for child-care attendance are “directly applicable to the competing interests here.” ¶ 24, supra. The state’s interest in promoting the health and welfare of children describes the state’s parens patriae interest with respect to all children residing in the state; it is the same interest identified by the Supreme Court in Yoder and Prince and by our supreme court in Cochise County No. 5666-J.
¶ 50 But, pursuant to § 8-531(4), ADES as Cheyenne’s custodian now stands “in loco parentis ” to Cheyenne — that is, “in the place of a parent.” Black’s Law Dictionary 803 (8th ed. 2004) (“Of, relating to, or acting as a temporary guardian or caretaker of a child, taking on all or some of the responsibilities of a parent”); see Bryan v. Bryan, 132 Ariz. 353, 354 n. 1, 645 P.2d 1267, 1268 n. 1 (App.1982) (“In loco parentis is a status embodying two ideas; first, the assumption of a parental status, and second, the discharge of parental duties”); see also Parham v. J. R., 442 U.S. 584, 619, 99 S.Ct. 2493, 2512, 61 L.Ed.2d 101 (1979) (“state agency having custody and control of the child in loco parentis ” has duty to consider child’s best interests and may “speak for the child” with respect to voluntary commitment to mental health facility). ADES’s interests and obligations resulting from its role in loco parentis in this case — distinct from its parens patriae interests and specific to Cheyenne as a dependent child — are governed by provisions of Title 8, and include a statutory duty to provide her with comprehensive medical care. See §§ 8-512, 8-531(4). As our supreme court has explained:
[Cjhildren are not property of their parents whose control may only be interrupted by a finding of fault; on the contrary, ... children ... have special needs and rights ... protected by law[, including] the right to effective and proper parental control and care. If a child is found to be without such parental care and control and without parents willing or capable of exercising such care and control, the child is a dependent child and entitled to have such care and control furnished through the state.
In re Maricopa County Juvenile Action No. J-75482, 111 Ariz. 588, 590-91, 536 P.2d 197, 199-200 (1975).11
¶ 51 Courts in other jurisdictions have recognized, in similar circumstances, that when the state’s custodial interest in providing medical care to a dependent child conflicts with a parent’s religious interest, a court must resolve the conflict based on the best interests of the child. For example, in In re Karwath, 199 N.W.2d 147, 149 (Iowa 1972), the parent of dependent children asserted his residual parental right to challenge, on reli*144gious grounds, tonsillectomies that had been recommended for the children to prevent recurring infections. The Iowa Supreme Court concluded that the state’s “statutory duty to provide ordinary medical care presupposes a right to do so in appropriate circumstances over parental objection even in [the] absence of immediate risk to life or limb.” Id. at 150. Thus, “where the best interests and welfare of children in care and custody of the State reasonably require medical treatment opposed by a parent, residual parental rights cannot be invoked to prevent it.” Id.
¶ 52 In re Stratton, 153 N.C.App. 428, 571 S.E.2d 234 (2002), is also persuasive. That case addressed the identical issue raised here: parents whose children had been adjudicated dependent appealed a court order authorizing the children’s legal custodian to have them immunized. Id. at 235. The parents there maintained that, because their parental rights had not been terminated, they were entitled to assert a statutory exemption from North Carolina’s mandatory immunization laws based on their “ ‘bona fide religious beliefs.’ ” 571 S.E.2d at 236, quoting N.C. Gen.Stat. § 130A-157 (2001). They contended that immunizing their children while in the temporary custody of the state would be a “violation of [their] constitutionally protected religious beliefs” that could not be justified in the absence of “medical emergency or other strong need for immunization.” 571 S.E.2d at 236, 237.
¶ 53 The court in Stratton noted that “[North Carolina] courts do not have a history of routinely ordering the performance of medical procedures on children without parental consent” and acknowledged that “ ‘the custody, care and nurture of the child reside first in the parents.’ ” Id. at 433, 571 S.E.2d 234, quoting Prince, 321 U.S. at 166, 64 S.Ct. at 442. But, the court reasoned,
“A natural parent’s constitutionally protected paramount interest in the companionship, custody, care, and control of his or her child is a counterpart of the parental responsibilities the parent has assumed and is based on a presumption that he or she will act in the best interest of the child. Therefore, the parent may no longer enjoy a paramount status if his or her conduct is inconsistent with this presumption or if he or she fails to shoulder the responsibilities that are attendant to rearing a child____ Unfitness, neglect, and abandonment clearly constitute conduct inconsistent with the protected status parents may enjoy....” Price v. Howard, 346 N.C. 68, 79, 484 S.E.2d 528, 534-35 (1997) (citations omitted). Once unfitness, neglect or other action inconsistent with the parent’s constitutionally protected interest has been found, a court should revert to a basic determination of what action is in the best interests of the child. Id. Here, the trial court found that immunization was in the best interest of the Stratton children.
Stratton, 571 S.E.2d at 237-38. Stratton correctly identifies the proper standard for a juvenile court to apply to conflicts relating to the care of a dependent child: the best interests of the child.
Statutory Construction of A.R.S. § 8-512
¶ 54 The majority recognizes that a state may constitutionally require the immunization of children despite a parent’s religious objection, see ¶ 24, supra, and there can be no serious question about this proposition. See Prince, 321 U.S. at 166-67, 64 S.Ct. at 442-43; see also Brown v. Stone, 378 So.2d 218, 222 (Miss.1979) (citing “ ‘great weight of authority' ” holding that mandatory immunization laws “‘do[] not violate the constitutional rights of anyone, on religious grounds or otherwise’”). But the majority reasons that our legislature, in providing for a religious exemption from immunization requirements for children attending day care, has necessarily determined that Arizona has no compelling state interest in immunizing dependent children that would override a parent’s religious objection. See ¶¶ 23-25, supra.12 See Prince, 321 U.S. at 166-67, 64 S.Ct. at 442-43. This reasoning is infirm because it draws together and conflates com*145pletely unrelated statutes to arrive at a conclusion supported by none.
¶ 55 As an initial observation, the majority relies on a negative inference that the legislature’s choice to provide a religious exemption from immunization for the general population of children is an affirmative expression that it has no compelling interest, and therefore no authority, to have chosen a different course for dependent children. But certainly there are other areas in which the legislature could regulate but declines to, not because the state lacks sufficient interest to justify intervention, but simply as a matter of practical priorities or inclination. As acknowledged by the majority, the religious exemption from immunization permitted by § 36-883 is merely a matter of legislative grace; it should not therefore be elevated to a constitutional shackle on a juvenile court’s determining the medical needs of a dependent child.
¶ 56 Equally problematic is the majority’s implicit requirement that the provisions in Title 8 governing the care of dependent children be read in pari materia with those public health and education statutes, essentially a mixing of apples and oranges. It is well established that “[s]tatutory provisions are to be read in the context of related provisions and of the overall statutory scheme,” and “[s]tatutes relating to the same subject matter should be read in pari materia to determine legislative intent and to maintain harmony.” Goulder v. Ariz. Dep’t of Transp., 177 Ariz. 414, 416, 868 P.2d 997, 999 (App.1993), aff'd, 179 Ariz. 181, 877 P.2d 280 (1994). But that is not the situation here. Although many of the public health, education, and dependency statutes cited in this ease refer to immunizations, they do not share the same statutory scheme. Instead, they “were enacted at different times to protect different interests.” Employers Mut. Cas. Co. v. McKeon, 159 Ariz. 111, 114, 765 P.2d 513, 516 (1988) (statutes regarding uninsured and underinsured insurance coverages not to be read in pari materia with statutes addressing liability coverage).
¶ 57 Because Cheyenne has been adjudicated dependent, the proper point of reference must be those statutes specifically addressing the care of dependent children in the legal custody of ADES and the juvenile court’s authority to make custodial decisions for those children in accordance with statutory guidelines. See In re Pima County Juvenile Action No. J-78632, 147 Ariz. 584, 587, 712 P.2d 431, 434 (1986) (legislature “intended that [ADES] have power to act for the benefit of a dependent child subject to juvenile court review”); see also, e.g., A.R.S. §§ 8-201(13) (definition of “dependent child”); 8-202 (“[j]urisdietion of juvenile court”); 8-512 (“[comprehensive medical and dental care; guidelines”); 8-514.05(c) (foster parent may consent to routine medical procedures); 8-845(B) (“[disposition hearing”; considerations for review of child’s status).
¶ 58 Section 8-512, located in Chapter 5 (“Child Welfare and Placement”) of Title 8 (“Children”), requires ADES to provide comprehensive medical care to a child in its legal custody as prescribed by rules of the Department. Such care expressly includes regular immunizations. First, § 8-512(B) provides for certain immunizations to be included in medical care “as minimums.” Id. In addition, Department rules specify “a complete preplacement medical examination ... [that] shall include as a minimum” specified vaccinations “if not previously provided to the foster child” and also provide for the inclusion of “immunizations” in its “Comprehensive Medical/Dental Program for Foster Children.” Ariz. Admin. Code R6-5-6005(A)(1), (11). The goal of the ADES medical program “is to provide ... full coverage for those medical and dental services which are necessary to the achievement and maintenance of an optimal level of physical and mental health for children in foster care.” Ariz. Admin. Code R6-5-6001. The clear purpose of § 8-512 is to provide for the medical needs of children who become legally dependent upon the state for that care.
¶ 59 In contrast, § 36-883, found in Chapter 7.1 (“Child Care Programs”) of Title 36 (“Public Health and Safety”), authorizes ADHS to promulgate rules “regarding the health, safety and well-being of the children to be cared for in a child care facility,” with the caveat that any infle related to education*146al activities, physical examination, medical treatment or immunization “shall include appropriate exemptions” for children whose parents object on the ground of religious belief. The statute does not pertain to the care of dependent children. Instead, by its terms, the statute speaks to public health concerns about all children enrolled in day care.
¶ 60 Similarly, Article 6 (“School Immunization”) of Chapter 8 (“School Attendance”) in Title 15 (“Education”) does not address the state’s care of dependent children but deals only with general public health concerns. Section 15-872, A.R.S., requires that “a pupil shall not be allowed to attend school without submitting documentary proof’ that he or she has been immunized in accordance with rules promulgated by ADHS in accordance with § 36-672. Section 15-873 permits a parent or guardian to exempt his or her child from these immunization requirements by submitting a signed statement that the parent or guardian has received information about immunizations from ADHS, understands its risks and benefits and the potential risks of nonimmunization, and does not consent to the immunizations due to personal beliefs. § 15-873(A)(1). However, a child who has been exempted from immunization must be excluded from school “during outbreak periods of communicable immunization-preventable diseases as determined by the department of health services or local health department.” § 15 — 873(C); see also Maricopa County Health Dep’t v. Harmon, 156 Ariz. 161, 166-67, 750 P.2d 1364, 1369-70 (App.1987) (neither right to education nor right to free expression of religion violated by county health department order excluding nonimmunized children from school attendance after measles outbreak in community). Other related statutes also attest to the public health nature of the legislature’s interest in immunizing school children. See, e.g., A.R.S. § 36-673 (permitting local health departments to provide no-cost school immunizations and train school nurses to administer them); A.R.S. § 36-697(B)(3) (ADHS “health start program” goals include “increasing] the number of children receiving age appropriate immunizations by two years of age”).
¶ 61 There is no reason to believe the legislature intended these public health statutes pertaining to immunization of children attending child-care facilities and schools to be read together with provisions in Title 8 regarding the care of dependent children, so that an unfit parent could prohibit the child’s immunization on religious grounds. Section 8-512 unambiguously grants ADES authority to immunize children in its legal custody, and any challenged decision by ADES as custodian is subject to the juvenile court’s independent determination of the child’s best interests. See Maricopa County No. J-6236, 178 Ariz. at 451-52, 874 P.2d at 1008-09. No statutory ambiguity calls for further interpretation.
¶ 62 Moreover, there is no conflict between the provisions in § 8-512 authorizing immunization of a dependent child and the public health statutes and regulations cited by the majority. Those provisions recognize the right of a custodian acting in loco parentis, as ADES is here, either to authorize immunizations or request an exemption. See A.R.S. §§ 15-101(15) (“‘[p]arent’ means the natural or adoptive parent of a child or a person who has custody of a child”); 15-101(16) (“ ‘[pier-son who has custody' means a parent or legal guardian of a child, a person to whom custody of the child has been given by order of a court or a person who stands in loco parentis to the child”); 36-673 (informed consent for school immunizations by “person in loco parentis”); Ariz. Admin. Code R9-6-706(F) (“responsible person” may submit statement of exemption from immunization to child-care facility); Ariz. Admin. Code R9-6-701(42) (“ ‘[Responsible person’ has the same meaning as ‘parent’ in R9-5-101”); Ariz. Admin. Code R9-5-101(79) (“[p]arent” includes “[a] natural or adoptive mother or father,” “[a] legal guardian appointed by a court of competent jurisdiction,” or “[a] ‘custodian’ as defined in A.R.S. § 8-201”). Perhaps more to the point in this case, there is no conflict, constitutional or otherwise, in the legislature’s deferring to a fit parent’s decisions as a matter of public health laws but, in the case of a dependent child whose parent has been deemed unfit, deferring instead to the jurisdiction of the juvenile court.
*147¶ 68 In short, there exists no statutory-conflict or ambiguity with respect to the construction of § 8-512. That being so, “application of the in pari materia doctrine to two statutes enacted at different times to deal with different problems, brings more confusion than enlightenment.” McKeon, 159 Ariz. at 114, 765 P.2d at 516. The majority therefore errs in reading § 8-512 as limited by public health statutes that govern fit, custodial parents’ enrollment of their children in a child-care facility or school.
¶ 64 Finally, although the majority repeatedly refers to the “residual rights” language in § 8-531(5)(e) and concludes Diana’s ability to “direct the religious upbringing of her child” — even at the expense of the child’s medical needs — has been “expressly preserved by statute,” ¶ 38, supra, that assertion can only be true if this court rewrites the statute. Nowhere in § 8-531 is religion ever mentioned and, for the reasons outlined above, there is no factual or legal basis for believing the legislature intended such an unstated contradiction to the direct mandate of § 8-512 that dependent children in the state’s custody receive comprehensive medical care, including immunizations. Thus, contrary to the majority’s assertions, the state has not expressly “subordinated its interest in the particular medical procedure [for a dependent child] to the rights of the parent.” ¶39, supra. Furthermore, even if determining a child’s “religious affiliation” is a right that properly remains with the parent of a dependent child, as the state at oral argument acknowledged it “honors” as a matter of practice, Diana has not demonstrated, or even suggested, notwithstanding her religious convictions, that immunizing Cheyenne would prevent or interfere with raising her in the religion of Diana’s choice. Cf. Yoder, 406 U.S. at 218, 92 S.Ct. at 1534 (Amish parent demonstrated compulsory secondary education would “substantially inter-fer[e] with the religious development of the Amish child and his integration into the way of life of the Amish faith community at the crucial adolescent stage of development”).
Conclusion
¶ 65 I believe the majority’s decision displaces the legislature’s clear mandate that a juvenile court provide for a dependent child’s care in accordance with the child’s best interests, see Cochise County No. 5666-J, 133 Ariz. at 161, 650 P.2d at 463, treating the health and safety of a child as a paramount concern, § 8-845(B). Under the majority’s approach, if a parent raises a religious objection to a dependent child’s receiving medical care, the welfare of the child ceases to be the governing standard for the juvenile court.13 Instead, ADES must establish that the health benefits from a particular procedure give rise to a “compelling state interest” before a court may authorize the proposed care — even when Title 8 expressly includes the procedure at issue as part of the comprehensive medical care ADES must provide to dependent children. See § 8-512. This result is not only inconsistent with legislative intent but offends the state’s public policy of protecting and providing for its most helpless citizens — dependent children, whose parents are unable or unwilling to do so.
¶ 66 I respectfully dissent.

. "Parens patriae," Latin for "parent of his or her country,” is defined as "the state in its capacity as provider of protection to those unable to care for themselves.” Black's Law Dictionary 1144 (8th ed.2004).

. The majority’s citation of Employment Division, Department of Human Resources of Oregon v. Smith, 494 U.S. 872, 110 S.Ct. 1595, 108 L.Ed.2d 876 (1990), ¶ 22, supra, does not alter the Supreme Court’s acknowledgment that the Yoder case "in no way determines the proper resolution” of a conflict between a parent, the state, and a child, when a child’s interests are at issue, Yoder, 406 U.S. at 231, 92 S.Ct. at 1541, as they are here. And it is doubtful that Smith — in which the Supreme Court generally rejected the strict scrutiny test for neutral laws of general applicability that incidentally burden religion, 494 U.S. at 878, 883, 110 S.Ct. at 1599-1602— *143has "reaffirmed” a compelling state interest requirement when a parent challenges a decision that affects her religious interests, ¶ 22, supra. See, e.g., Leebaert v. Harrington, 332 F.3d 134, 143-44 (2d Cir.2003) (Smith's "hybrid claims” language dicta; parent's religious objection to mandatory health education subject to rational basis review); Douglas County v. Anaya, 269 Neb. 552, 694 N.W.2d 601, 605-06 (2005) (parent’s objection to metabolic testing of infant did not implicate strict scrutiny under Smith)-, see also Boone v. Boozman, 217 F.Supp.2d 938, 955 n. 38 (E.D.Ark.2002) (noting Smith included compulsory immunization of children as example of state action that should not be subject to compelling interest test; citing Smith, 494 U.S. at 888-89, 110 S.Ct. at 1605-06; Cude v. State, 237 Ark. 927, 377 S.W.2d 816, 818-20 (1964)).

. In my view, proper analysis of Diana’s request for relief requires recognition of this crucial distinction between the state’s limited parens patriae authority to interfere with a fit, custodial parent’s decision and "invade the rights of the parent and the family,” see Cochise County No. 5666-J, 133 Ariz. at 161, 650 P.2d at 463, and its obligation, acting in loco parentis, to provide for the needs of a dependent child whose parents have been found unable to do so. See Pima County No. J-78632, 147 Ariz. at 587, 712 P.2d at 434 (noting ADES’s custodial responsibilities to dependent children). The majority thus errs in concluding that Cochise County No. 5666-J, which pertained to state action against a custodial parent presumed to act in her children’s best interests, involves "similar, if not identical, state and parental interests” as those implicated here, ¶ 22, supra.

. Although the majority cites § 36-883(C) as authority for this legislative determination, ¶ 25, supra, this statute does not actually provide such an exemption but addresses the rule-making authority of ADHS as discussed in ¶ 59, infra.

. Equally troubling, under today’s decision, the ability of an unfit parent to control decisions for his or her dependent child is not necessarily limited to health care. For example, a parent of a seven-year-old dependent child could insist, based on a religious objection to a school’s curriculum or to formal education itself, that their child be home-schooled, or not instructed at all, given the statute that permits a parent to opt out of public education until the child is eight years of age. A.R.S. § 15-802.