I took some time reviewing recent issues of the Southern Medical Journal. I have cited articles from that journal in the past because they have particular interest in articles relevant to spiritual care of patients.
In the July, 2008, issue I found two review articles by Sara H. Sinal, MD; Elaine Cabinum-Foeller, MD; and Rebecca Socolar, MD, MPH. The first is “Religion and Medical Neglect.” (Southern Medical Journal:Volume 101(7)July 2008pp 703-706) The authors note that there is little literature on the subject. They cite particularly an article from 1998 reviewing 172 cases between 1975 and 1995 thought to be related to “religion-motivated medical neglect.” The authors also note how few religious organizations might be implicated. “A total of 23 religious denominations from 34 states were involved, but 5 religious groups accounted for 83% of the fatalities: Faith Assembly (64), First Church of Christ, Scientist (Christian Science) (28), Church of the First Born (23), Faith Tabernacle (16) and End Time Ministries (12).” The article discusses the histories of Faith Assembly and Christian Science, and information regarding child health in those bodies. There is also some discussion of issues related to the medical-religious concerns of Jehovah’s Witnesses.
The article also includes a brief review of the issue of religious exemptions from medical care including vaccinations allowed by some states. They note ambiguity in history and practice:
“The Supreme Court ruled in 1944 that “the right to practice religion freely does not include liberty to expose the community or child to communicable disease or the latter to ill health or death.” However, in 1974 the US Department of Health, Education and Welfare required states receiving federal child abuse prevention and treatment grants to have religious exemption in cases of abuse and neglect. Within 10 years the majority of states had exemptions in the juvenile code, criminal code or both. The federal government removed religious exemption from the federal mandate in 1983, but only a few states have repealed the exemption.”
The second article is titled, “Is Religiosity Associated with Corporal Punishment or Child Abuse?” (Southern Medical Journal. 101(7):707-710, July 2008) The authors note that there is also little information in the literature on this specific topic. However, the available literature notes incidence of corporal punishment is higher among Protestants than among other Christians. They note, however, that religious practice may possibly provide a buffer for those who experience child abuse, both in their own ability to cope and in preventing victims from becoming abusers themselves.
Both articles are worth review. In addition, the Southern Medical Journal has also posted on a separate site the articles published in the journal as a part of their Spirituality and Medicine Interface Project. Articles from the project through 2007 can be accessed at the site. It’s worth the time to review the articles available there.
3 comments:
Interesting. Years ago, I was embroiled, as the director of the blood bank, in getting a court order to get a toddler transfused whose parents were of a sect that refused transfusions.
The other thing I see is in the Amish population here which is no more or less immune to the "dark side" of life than anyone, that things like child abuse, spouse abuse, and neglect go unchecked because the Amish are "so quaint and so religious" that the "English" just don't interfere. They are more likely to "tell the elders" about a situation and "let them handle it in their own way" than hotline them. It's bewildering, that healthcare providers will go against their own instincts when dealing with an ultra-religious community.
Perhaps it seems bewildering, but there is also a strong repetition of the imperative to respect the autonomy of the patient, or the substituted judgement of the patient's appropriate agent. Remember that for most purposes children aren't full moral agents, and so respecting the autonomy of the child becomes respecting the authority of the parent.
Some years ago a student in our central hospital successfully negotiated an apparent impasse between a family and and caregivers regarding care for a Jehovah's Witness patient. It was hard for the staff to appreciate the real import of the decision for the family: that the wrong decision could conceivably save the patient in this live, and condemn the patient in the next. As I have often asked in discussions, "Is it better to mourn a loved one, believing the loved one is in heaven, or to save a loved one, fearing that the efforts to save have condemned the patient to hell?" The fact that it makes no sense to us doesn't change the conviction of the believer.
So, how do we honor the authority of the parent to make substituted judgement for the child if the parent believes he or she faces that sort of decision? We might believe that God is willing to forgive, especially when the factors are out of our control; but the other person may not. How far must we go in respecting autonomy? For, if we are to truly respect autonomy, it includes respecting their right to make decisions with which we radically disagree.
In our transfusion case from several years ago, that was with a Jehovah's Witness family. Prior to the impasse, we had done everything we could short of a transfusion of red cells. Albumen as a volume expander was acceptable because it is a fractionated blood product and heated to where it is no longer "blood."
I remember we had at least three meetings with the ethics committee before we ended up seeking the court order. The order was based on the likelihood of imminent death without it. All in all it was a learning experience but a very tense one.
The issue we are seeing with the Amish is abuse/neglect that goes unreported. My recollection of Missouri law is that there is no religious exemption but observationally, I think this gets underreported by health care providers. It's all very complicated, for the reasons you mention.
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