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While AAP recognizes the importance of religion to people's lives, it also warns physicians and other health care professionals should put the health and welfare of children over religious considerations (Committee on Bioethics 1997). It encourages pediatricians to respect parents' decision but not when their religious convictions interfere with medical care necessary to prevent harm, suffering or death. When this happens, pediatricians should seek the authorization of the court to override parental authority. If the threat to a child's life is imminent, the health care practitioner should intervene over parental objections. Securing court authorization should, however, be the last course of action. The health care practitioner should cooperate with the family in applying appropriate palliative care. Even when the securing of court authorization is the last option, physicians should continue to respect the parents' religious beliefs as well as their role in rearing their children (Committee on Bioethics)..
In essence, the AAP rejects and opposes religious doctrines that refuse health care for sick children (Committee on Bioethics 1997). The Academy believes the laws should not encourage or tolerate parents who deny their sick children appropriate medical care. It also believes that laws should not exempt parents from criminal or civil liability and prosecution for religious reasons (Committee on Bioethics).
The Constitution accords parents the right and privilege of raising their children in the assumption that they naturally possess their children's best interests. This right extends to the training and indoctrination of children but not to medical choices, which involve life or death consequences (Bender 2004). The State may intervene and override parental authority in emergency situations, even it must infringe upon parents' religious convictions to refuse treatment. For example, Jehovah's Witness beliefs prohibit blood transfusions and the use of blood products, even at the risk of death. On the other hand, Christians rely almost entirely on prayers to heal people and, as a result, do not seek proper medical intervention or treatment. The Courts authorize blood transfusions, appendectomies and other medical interventions to save the health or lives of children, whatever the convictions or wishes of their parents. The State thus acts in the best interest of the affected children, whom it protects as future "productive citizens." Its exercise of parental authority allows these children the best chances of surviving into adulthood. In the 1944 ruling of Prince v Massachusetts, the Court said that parents could opt to become martyrs but not free to "make martyrs of their children (Bender)."
Some urgent medical interventions have been deferred by the Courts back to parents, however (Bender 2004). In the Newmark v Williams of 1991 case, the doctor of a cancer-stricken three-year-old offered a 40% success by chemotherapy. The parents rejected and preferred healing by a Christian practitioner. The Court ruled in favor of the parents, reasoning that they knew and loved the child more. While there was doubt as to the effectiveness of the preferred course of action, the Court's interest was in protecting the future of the child. It did not think that forced intervention would guarantee to promote or preserve the future of the child-citizen (Bender).
Many elective surgical and medical procedures not related to the improvement of a child's physical health are in contention (Bender 2004).. These procedures include infant circumcision and human growth hormone treatments. They put children in vulnerable conditions. Circumcision can cause pain, infection, constriction due to scar tissue and interference with bonding with one's mother. Human growth hormone treatments, on the other hand, may reduce self-esteem, affect parent-child-relationship and create dependency on the hormone on account of an imaginary "handicap (Bender)."
The best interests standards are meant to maximize benefits and minimize harm for minors who are unable to make appropriate medical decisions (Kopelman 2008). It is first used in determining the best treatment option for a sick child. Parents and clinicians weigh all the sides and balance harm with benefit. Then they decide on the most suitable treatment plan, based on these considerations (Kopelman).
This standard is also used in divorce proceedings in court when settling custody disputes (Kopelman 2008). When the parents cannot agree, the judge balances the complexities of both sides and then rules according to the child's best interests. Policy-makers also apply this standard in evaluating health systems priorities....
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