The Death of Madeline Neumann:
Can the law and ethics be reconciled in Wisconsin?
By Robyn Shapiro, JD
Ursula von der Ruhr Professor of Bioethics and Director, Center for the Study of Bioethics
Interesting and controversial ethical and legal issues are raised by the recent death of an 11-year -old girl in Weston, Wisconsin following her parents' decision to pray for healing rather than seek medical help for a treatable form of diabetes. According to newspaper reports, an autopsy revealed that Madeline Neumann died from ketoacidosis, which left her with too little insulin in her body. It is thought that she probably had been ill for a month or so with symptoms such as nausea, vomiting, excessive thirst, loss of appetite and weakness. She attended school first semester, but didn't return for the second semester. Police officers went to the family's home after a California relative called police to check on her, she was taken to the hospital, and pronounced dead. Her parents reportedly attribute the death to not having enough faith; physicians say that intravenous insulin treatment is almost always effective.
In ethics and in law, as a general matter, parents are presumed to be appropriate medical treatment decision-makers for their children and are expected to make decisions that further their children's best interests. In a number of court cases involving challenges to parents' decisions to refuse conventional treatment for their children, courts have ordered the treatment over their objection. For example, in a number of cases involving Jehovah's Witness parents who were refusing simple blood transfusions for their children, courts have ordered the transfusions. Also, in a Tennessee case, the father of a 12-year-old with bone cancer objected to chemotherapy or any other intervention. He was a minister in a faith-healing sect and believed that God would heal his daughter if he chose to. A court order for chemotherapy was entered and upheld on appeal. Similarly, a California court decision involved a child with retinal blastoma who had an eye removed. When the parents, who were Christian Scientists, refused post-operative chemotherapy and radiation, treatments were ordered by a court and the order was upheld on appeal.
The definition of child neglect in Wisconsin Statutes includes failure on the part of a caregiver, for reasons other than poverty, to provide necessary medical care so as to seriously endanger the physical health of the child. Section 48.981(3)(c)(4) of the Statutes, which addresses county departments' evaluation of reports of child neglect, states that " a determination that abuse or neglect has occurred may not be based solely on the fact that the child's parent, guardian or legal custodian in good faith selects and relies on prayer or other religious means for treatment of disease or for remedial care of the child."
How can Section 48.981(3)(c)(4) be reconciled with the general ethical and legal principles requiring parents to safeguard the best interests of their children? How should the word"solely" in this Section be interpreted? Of what importance is the child's age?