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She conducted 40 in-depth, ethnographic interviews with family members, health care professionals, and clergy. She studied the law to find out who can be prosecuted in such cases and on what charges. She also studied laws that exempt people from prosecution for homicide and manslaughter if a child dies as the result of withholding medical care due to religious beliefs.

In her book, Linnard-Palmer writes that religious exemptions from child abuse laws were first passed in 1974 by all 50 states because the federal government said it would not allocate federal funds to any state for child protection programs unless the states provided religious exemptions.

The states then gradually changed their exemptions to provide for a greater ability to prosecute for withholding medical care. Today, 48 states can prosecute for manslaughter when a child dies from parental refusal based on religious doctrines. Two states (Ohio and Iowa) have religious exemptions from manslaughter prosecution, while two others (Delaware and West Virginia) allow religious defenses for murder charges. Arkansas allows for religious defense against capital murder.

Linnard-Palmer also sought to understand as much as possible about children’s rights and how they developed, ethical principles and doctrines, parental autonomy, and the rights of parents in guardianship of a child in relation to those of the state. All states have some sort of provision for taking guardianship of a child from the parents, provided the child is critically ill and is being prevented from receiving medical care that would help the child.

California is the only state, however, that allows health care professionals to take temporary guardianship of a child even if the child is not critically ill. In California, the state can take over guardianship of any child experiencing “human suffering,” Linnard-Palmer says.

One reason she wrote the book, she says, is because she wanted other health care professionals to understand their legal duties in cases involving parental refusal of medical care. She says they should have a basic understanding of the laws in their state, understand when to file a child abuse report, and know whom to contact.

She says she hopes health care professionals also will learn how to take care of themselves emotionally in situations like this. It’s impossible to walk away from a case like this without experiencing a wide range of emotions. She continues to wonder about that 4-year-old boy whose mother worried that he would never make it into heaven. She wonders if the boy grew up ostracized by others of his faith because he had received a blood transfusion.

Linnard-Palmer says nurses need to debrief after such incidents and review what happened. She says they should look for ways the situation could have been handled better and encourage written policies or procedures for such situations. She also advises that counseling be available for nurses.

“I think the nurse definitely should share his or her feelings with colleagues immediately and have some sort of debriefing on the unit,” she says. “It can be absolutely overwhelming to be involved in these situations.”

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