Refusal of Medical Treatment on Religious Grounds

You asked if state law addresses a parent or guardian's refusal to allow a minor to get a blood transfusion on religious grounds.

There is no specific state statute addressing the refusal on religious grounds, by a parent or guardian, to allow a blood transfusion for a minor. There are a number of provisions of state law that allow parents or minors to refuse certain medical treatment or health screenings for religious purposes. A person 17 or older can donate blood without parental consent under state law.

A recent Connecticut Supreme Court decision found that the administration by a hospital of blood transfusions over the objection of a patient who had just delivered a baby violated her common law right of bodily self-determination. The court found that the hospital's interest in protecting its patient did not extend to the patient's baby, whose health was not in danger.

Many cases in which courts have been asked to order medical treatment have involved patients who refused to give consent based upon religious beliefs. Some of the most common involve those whose religious beliefs forbid transfusions or any blood products or by-products. When faced with patients in need of surgery requiring blood, doctors have turned to the courts to try and overcome a patient's refusal to consent to a transfusion. How the courts decide such cases depends on factors such as whether the patient is an adult or minor, competent or incapacitated, or the chief provider for minor dependents (see Fay Rozovsky, Consent to Treatment: A Practical Guide, p.440).

In many of these cases, doctors or hospitals have gone to court seeking the appointment of a legal representative for the purpose of obtaining consent to a transfusion. In other cases, the plaintiffs have sought a court order compelling the transfusion.

The basic legal premise for compelling treatment in this country rests on a court-made distinction between religious beliefs and practices. The 1879 U.S. Supreme Court case of Reynolds v. U.S. (98 US 145) which involved polygamous marriage practices, set a precedent that, while guaranteeing the free exercise of religious beliefs, permits the state in certain circumstances to limit religious practices. Generally, when the state can demonstrate a compelling interest in the preservation or promotion of health, life, safety, or welfare religious practices may be curtailed (Rozovsky, pp. 440-441).

Over the years, court decisions and legislative enactments have developed laws concerning parents who refuse medical treatment for their children. Different approaches have developed for life-saving treatments versus elective measures. Several states have passed laws recognizing the right of patients, including minors to decline treatment that conflicts with their religious beliefs and practices (a review of Connecticut's law follows below).

Courts usually draw a distinction between children requiring immediate attention and those needing remedial or elective care. Generally, courts have authorized medical care for children who require immediate life-saving treatment.

When parents decline to permit treatment on the ground that it conflicts with their religious beliefs, actions can be instituted under applicable child welfare or other laws to have the child removed (at least temporarily) from the parents' custody. The agency or person in whom custody is vested can then consent to necessary medical care. Connecticut's comparable law on this can be found at CGS §§ 45a-603 to 622 (see attached).

Court intervention in such cases is based on both constitutional and common law. In the Reynolds case, the Supreme Court distinguished between religious beliefs and practices. The court held that the First Amendment protects religious belief, but the state may impose restrictions on practice. Thus, a religious practice jeopardizing the health, safety, or welfare of the person can be limited (see Rozovsky, p.338).

The other basis for court intervention is the state's “parens patriae” power—parents are presumed at law to provide for the necessities of life required by their children. If a parent fails in this, such as by refusing to provide the child with necessary medical care, the state may step in to protect the child and get the necessary care (Rozovsky, p. 338).

In the case of Stamford Hospital v. Vega, (236 Conn. 646 (1996), the plaintiff hospital sought an injunction to authorize the administration of a blood transfusion to the defendant patient who had refused to give consent. The defendant (a Jehovah's Witness) bled heavily following the birth of a healthy baby. The attending physician and other hospital physicians believed it was essential that she receive blood transfusions for survival.

The trial court, relying on the state's interests in preserving life and protecting innocent third parties such as the baby, granted the injunction. The hospital had claimed that the baby would have been abandoned had the defendant died and that the defendant's life would be saved by the transfusions.

The defendant appealed the decision to the Appellate Court which dismissed the appeal as moot. She then appealed to the Connecticut Supreme Court. The Supreme Court reversed and remanded the case to the Appellate Court with directions to reverse the trial court's decision and remand the case to the trial court with a judgment for the defendant.

The issuance of an injunction authorizing the hospital to administer a blood transfusion to the defendant violated her common law right of bodily self-determination; the hospital's interest in protecting its patients did not extend to the defendant's baby, whose health was not in danger, and, as compelling as the hospital's interest in preserving life and upholding the ethical integrity of the medical profession might be, those interests were not sufficient to take priority over the defendant's common law right to bodily integrity as long as she was sufficiently informed of the consequences of her decision, was competent to make such a decision, and freely chose to refuse the blood transfusion.

State law allows any person 17 years of age or older to, without written parental consent, donate blood and to consent to withdrawal of blood from his body in conjunction with any voluntary blood donation program (CGS § 19a-285a).

State law requires a pregnant woman to submit to a blood test for syphilis twice during her pregnancy—within 30 days of her first examination and during the final trimester. But the law specifies that these testing requirements do not apply if in conflict with the woman's religion (CGS. § 19a-90(a), (b)).

Public Act 97-8 (June 18 Special Session) requires that, by July 1, l999), any health care institution providing childbirth services include universal newborn hearing screening as part of its standard of care and have a compliance mechanism in place. The requirement does not apply to any infant whose parents object that the screening conflicts with their religious practices.

State law requires hospitals and other health care institutions to administer a number of tests to newborns in their first 28 days of life. This includes tests for phenylketonuria (PKU), hypothyroidism, galactosemia, sickle cell anemia, and other diseases. But such tests are not performed on newborns whose parents object based on conflict with their religious tenets and practices (§ 19a-55).

By law, a board of education may require children to be vaccinated before attending a public school, unless the child presents (1) a letter from a physician, approved by the local health director, certifying that such vaccination would not be prudent on account of the physical condition of the child or (2) a statement from a parent or guardian of the child that such immunization would be contrary to the religious beliefs of such child (§ 10-204, 204(a)).

Each board of education must provide vision, audiometric, and postural screenings at various times throughout a student's career. But no pupil must undergo a physical or medical examination or treatment, or be compelled to receive medical instruction if the pupil or his parents object on religious grounds (§ 10-214).

Each board of education must require each enrolled child to have a health assessment before public school enrollment. This includes a (1) physical exam; (2) updating of immunizations; (3) vision, hearing, speech, and dental screenings; and (4) other information a physician feels is necessary and appropriate (§ 10-206(b)).

Finally, each board of education must require pupils enrolled in public schools to also have health assessments in either grade 6 or 7, and in either grade 10 or 11 (§ 10-206(c)).

But again, no pupil has to undergo any of these medical examinations or treatments in conjunction with the health assessments if the parent, guardian or pupil objects on religious grounds (§ 10-208).


February 3, 1999		99-R-0180
REFUSAL OF MEDICAL TREATMENT ON RELIGIOUS GROUNDS

By: John Kasprak, Senior Attorney