By Genevra Pittman
NEW YORK (Reuters Health) - Pediatricians and child abuse agencies should step in when parents' religious beliefs keep kids from getting necessary medical care, doctors said Monday.
In a policy statement, the American Academy of Pediatrics Committee on Bioethics also said states should repeal any exemptions to child abuse and neglect laws.
Those exemptions mean some states don't always consider parents negligent if they forgo medical treatment for a child because of their religious beliefs.
Finally, the committee said public healthcare funding should not be used for religious or spiritual healing.
That would mean Medicare and Medicaid would no longer cover services at Christian Science sanatoriums, for instance. People with government-funded insurance could still get care at hospitals run by religious groups.
"I think it's important that all children get appropriate medical care, that state policies should be clear about the obligations to provide this care and that state monies directed toward medical care should be used for established and effective therapies," said Dr. Armand Antommaria.
Antommaria directs the Ethics Center at Cincinnati Children's Hospital Medical Center in Ohio and is one of the lead authors of the statement.
He told Reuters Health that cases of parents refusing medical care for their child due to their religious beliefs persist.
People of certain faiths, including many Christian Scientists, advocate prayer before or instead of medical treatments when a person is ill. Jehovah's Witnesses do not accept blood transfusions.
Parents have the right to weigh the risks and benefits of possible treatments and make medical choices for their children, the Committee writes in the journal Pediatrics. But that's no longer the case if their choices rise to the level of medical neglect and abuse.
"The main considerations would be whether the lack of medical treatment would cause death or serious disability," and whether good treatment is available, Antommaria said.
In one recent case, an Ohio court ruled that a hospital could force a 10-year-old Amish girl with leukemia to resume chemotherapy. Her parents had decided to forgo the treatment in favor of "natural medicines." The family had been told the girl had an 85 percent chance of survival with treatment but would die within the year if she did not receive it (see Reuters story of October 7, 2013, here: http://reut.rs/1fesZct).
That part of the committee statement reiterates an earlier policy, Antommaria said. So does the recommendation that states overturn religious exemptions to child abuse laws.
What is new is the call for government-run insurance not to cover unproven spiritual and religious therapies. Those include services provided at sanatoriums and other religious nonmedical health care institutions, as the Committee calls them.
"Part of it is the issue of, if the public funds are going to be used for medical care, they should be used for established effective therapies," Antommaria said. "These other uses aren't appropriate (based on) that criteria."
When it comes to public funding for health services, "The question would be, not so much whether they are science-based or faith-based, but whether they work," Dr. John Lantos said.
He is director of the Children's Mercy Bioethics Center at Children's Mercy Hospital in Kansas City, Missouri, and was not involved in the new recommendations.
"There are some complementary and alternative treatments that work and therefore ought to be covered, I think," Lantos told Reuters Health.
"There are others that have never been shown to work." He said Medicare and Medicaid should not cover any service until it has been rigorously evaluated.
Antommaria said government coverage for religious nonmedical institutions could also be seen as unfair. That's because people may get services there like custodial care that aren't available to Medicare and Medicaid patients at medical facilities.
A spokesperson for The First Church of Christ, Scientist said the organization had no comment on the statement.
SOURCE: bit.ly/cxXOG Pediatrics, online October 28, 2013.