When religious beliefs and medical needs collide

Judges have a difficult job. Author Ian McEwan has a long piece where he looks at cases in the UK where the law intersected with religious beliefs. He focuses on the decisions by one appeals court judge Sir Alan Ward who seems to be a remarkably humane and thoughtful judge and how he handled two cases where he had to go against the beliefs of families and the religious institutions they belonged to.

One case involved a pair of conjoined twins.

Untreated, both would die. Separated, the weaker must perish, for it had a failing heart, virtually no brain and “no lungs to cry with”. Only its healthier sibling kept it alive by way of their shared circulatory system. And slowly, the weak baby was sapping the strength of the strong. The hospital wanted to operate to save the viable child, but surgery would involve deliberately killing its twin by severing an aorta. The parents objected for religious reasons: God gave life; only God could take it away. Public interest was intense.

On the face of it, a simple moral premise: one rescued and flourishing child is better than two dead. But how was the law to sanction murder, and set aside the insistence of the parents, endorsed by the then Roman Catholic Archbishop of Westminster, that both children should be left to die?

Just as religion and religious passion and disputes have pervaded domestic and international politics to an extent we could not have predicted 20 years ago, so they have vigorously entered, or re-entered, the private realm, and therefore the family courts. In the case of the conjoined twins, Ward ruled against the parents and for the hospital. But it was, as the nice legal term has it, “an anxious question”. The operation went ahead, the weaker baby died (or, as the then Archbishop of Westminster might have put it, was judicially murdered), while its sibling underwent extensive reconstructive surgery and flourished.

For us without religious shackles, this case seems agonizing but fairly straightforward, agonizing because it involves taking an action that would result in one child dying, something that most people, religious or not, will find troubling and hard to do.

The other case seems more straightforward and involved a child of Jehovah’s Witnesses who had leukemia where the hospital staff were convinced that he needed a blood transfusion to survive but that was prohibited by that religion. Their website explains the reasons.

This is a religious issue rather than a medical one. Both the Old and New Testaments clearly command us to abstain from blood. (Genesis 9:4; Leviticus 17:10; Deuteronomy 12:23; Acts 15:28, 29) Also, God views blood as representing life. (Leviticus 17:14) So we avoid taking blood not only in obedience to God but also out of respect for him as the Giver of life.

All those passages are prohibitions against eating blood or food that contains blood and Jehovah’s Witnesses in 1945 introduced a new doctrine that extended that prohibition to the introduction of any blood products into one’s system even via transfusions. While they have promoted the use of bloodless surgery as an alternative, I am not sure whether it can be used in all circumstances.

While an adult has the right to refuse medical treatment, a child does not have that right even if the child and the parents agree on it. The state is deemed to have an overriding interest in the health of a child. The matter came before judge Ward as a matter of life or death and in the middle of the hearing, he took the extraordinary step of suspending the proceedings and going to visit the boy in hospital.

He suspended proceedings, crossed London in a taxi, met the loving, anxious parents, then sat at the boy’s hospital bedside for an hour. Among many other things, they talked about football, which was the lad’s passion. Later that evening, the judge returned to the Courts of Justice to give his decision. He “set aside” his ward’s and the parents’ articulately expressed refusal of a blood transfusion and ruled for the hospital. The child’s welfare was his paramount consideration.

Months later, Ward took the boy (now in good health) and his father to a football match, which they watched from the directors’ box. The young man was able to meet his football heroes. The gleam of joy in his eyes, his excitement at being alive, was a sight the judge would never forget. The court’s decision was vindicated.

But this story does not have a happy ending.

A few years later the young Witness was readmitted to hospital and needed another blood transfusion. By then, he was old enough to make an independent decision. He refused treatment and died for his beliefs.

I sometimes wonder about the aftermath of such cases. As long as the parents of the dead child remain steadfast believers, they may be able to live with the death as god’s will or even an act of martyrdom. But what if a parent later becomes a nonbeliever? How could they possibly live with the fact that their dogma-based decision led to their child’s death?

I would be curious to see whether there have been any studies of people whose children have died as a result of their decision to withhold treatment and whether they lost their faith subsequently. My guess is that their child’s death will make them even more steadfast believers and refuse to contemplate nonbelief because the consequences would be too hard to deal with.


  1. says

    Untreated, both would die. Separated, the weaker must perish, for it had a failing heart, virtually no brain and “no lungs to cry with”.

    Too many people are obsessed with obeying the Hippocratic Oath literally. Doctors need the freedom and encouragement to do the least harm when “do no harm” isn’t the answer or isn’t an option. Ending the life of the weaker conjoined twin to save the other may not be what people want to do, but it’s not unethical. Killing the stronger one by refusing the surgery would be the unethical act.

    As for religion and medical treatment for kids, the child’s life comes before “religious freedom”. Until children are old legally enough to make medical decision for themselves, society has (or should have) an obligation to act in the best interests of a child, even if it means violating religion’s beliefs.

    If a religion said, “Do not feed a disobedient child,” we’d take children out of the home if the parents refused to feed one and the child were starving to death. And yet we don’t remove children whose parents refuse to give them medical care, some of which is just as likely to kill kids. When the news item below came out, the rightwing corporate media fell over themselves in avoiding any mention of the woman’s religion:


    Mother cited religious reasons for refusing to admit sick infant to hospital

    A Florida mother was arrested after refusing to seek medical treatment for her sick and dehydrated newborn, telling police she preferred to “pursue a religion based treatment” for her child.

    Sarah Anne Markham was arrested Tuesday on a charge of child neglect. According to police, a pediatrician told Markham that her baby needed to be admitted to Florida Hospital South for treatment because the child was dehydrated and was losing weight.

    However, according to a Casselberry Police Department report, Sarah Anne Markham cited a desire to “pursue a religion based treatment” for her child as her reason for refusing to take her infant daughter to the hospital.

  2. Uncle Ebeneezer says

    Mano, I’m guessing you’ve probably seen this already, but just in case…here’s a good piece on the child deaths in Oregon and Idaho from Followers of Christ members who used faith healers or denied their children medical treatment. Pretty disturbing that these parents, iirc, are exempt from prosecution in most cases.


  3. says

    Evil. This is one of the most evil things religion does. Bad enough that they’re shoving the idiotic beliefs into growing minds in the first place, but this is just outright abuse, that gets WAY too much respect.

    Not that I feel strongly or anything.

  4. Charles Sullivan says

    Interestingly, in the conjoined twins case Lord Justice Robert Walker claimed that the operation would simply separate the weaker twin, Mary, from her sister, Jodie, and then “she would die, not because she was intentionally killed, but because her own body cannot sustain her life.”

    I find this argument to be disingenuous. Of course Mary was killed, intentionally. I do think that performing the operation was the right choice, but that doesn’t change the fact that Mary was deliberately killed in order to save Jodie.

    Perhaps the law prevented the Justice from condoning the intentional killing of an innocent, and thus he had no choice but to argue this way if the operation was to go forward.

  5. Numenaster says

    the weaker baby died (or, as the then Archbishop of Westminster might have put it, was judicially murdered)

    Judicially murdered or religiously murdered, the weaker baby was doomed regardless. I prefer the outcome which leaves its twin still alive, and cannot understands parents who would choose otherwise.

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