Could religious treatment alone stop Connecticut from investigating suspected child medical neglect?

Plain-English summary

In August 1993, Connecticut’s AG interpreted a child-welfare clause saying Christian Science treatment in place of licensed medical care “shall not of itself constitute maltreatment.” The words “of itself” were decisive. The AG said the clause prevented an automatic neglect finding based solely on the treatment choice. It did not create a class of children outside the state’s reporting, investigation and protection system.

The AG said child abuse and neglect findings focused on a child’s condition and whether needed care was being denied, not solely on a parent’s fault or religious motive. A mandated reporter’s duty to report reasonable suspicion and a voluntary reporter’s ability to do so remained. The Department of Children and Youth Services retained its obligation to investigate and take appropriate protective measures when a report warranted it. The AG also distinguished this noncriminal child-welfare interpretation, which his office could provide, from interpretation of penal statutes. He cited constitutional decisions recognizing limits on parental religious practice where a child’s health was endangered; he did not decide a particular family’s medical facts.

Child-protection workers and reporters at the time

The opinion said religious treatment did not close off reporting or investigation. The relevant question remained the child’s condition and the adequacy of care under the child-welfare statutes.

Parents and guardians at the time

The AG read the clause as excluding an automatic finding from Christian Science treatment alone, while leaving the state able to act when necessary medical care was not provided.

Currency note

This opinion was issued in 1993. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

Common questions

Q: Did Christian Science treatment automatically count as child neglect?
A: No. The AG said the statutory clause rejected a finding based on that treatment alone.

Q: Could a teacher or clinician still report suspected neglect involving religious care?
A: Yes. The AG said the clause did not narrow a mandated reporter’s duty to disclose reasonable suspicions.

Q: Could the child-protection agency investigate despite a parent’s religious belief?
A: Yes. The AG said the agency’s investigation and protective duties continued when the child’s medical needs appeared unmet.

Background and statutory framework

Conn. Gen. Stat. § 17a-104 and § 46b-120 contained the religious-treatment language. The AG read it with the child-protection reporting duty in § 17a-101 and the broader neglect definitions. He cited Prince v. Massachusetts for the limits of parental religious liberty when the state protects children’s welfare.

Citations and references

Statutes: Conn. Gen. Stat. § 17a-104; Conn. Gen. Stat. § 46b-120; Conn. Gen. Stat. § 17a-101.

Case: Prince v. Massachusetts, 321 U.S. 158 (1944).

Source

• Landing page: https://portal.ct.gov/AG/Opinions
• Opinion page: https://portal.ct.gov/ag/opinions/1993-formal-opinions/honorable-rose-alma-senatore-department-of-children--youth-services-1993024-formal-opinion-attorney

Original opinion text

Honorable Rose Alma Senatore, Department of Children & Youth Services, 1993-024 Formal Opinion, Attorney General of Connecticut

Attorney General's Opinion

Attorney General, Richard Blumenthal

August 26, 1993

Honorable Rose Alma Senatore

Department of Children & Youth Services

170 Sigourney Street

Hartford, CT 06105

Dear Commissioner Senatore:

I write to respond to your request for an advisory opinion regarding religious exemption provisions included within Connecticut's child abuse and neglect statutes. The critical statutory language is contained in Conn. Gen. Stat. § 17a-104 (with essentially similar language found in Conn. Gen. Stat. § 46b-120) which provides:

"...[t]he treatment of any child by a Christian Science practitioner in lieu of treatment by a licensed practitioner of the healing arts shall not of itself constitute maltreatment."

This statutory language of § 17a-104 relates to Connecticut's law regarding mandatory and voluntary reporting of suspected abuse or neglect. The similar clause found in Sec. 46b-120 relates to the general statutory definitions of abuse and/or neglect. Specifically, you have asked this office to consider the following issues raised by the federal Department of Health and Human Services:

1. Whether the Attorney General's Office is the appropriate agency to provide a legal interpretation of the religious exemptions clause or whether the inquiries should be answered by the Chief State's Attorneys Office;

2. Whether the religious exemption clause relates to the status of the child or, at most, precludes a per se finding of neglect when a child's medical care is denied based on religious beliefs; and

3. Whether Connecticut's children receive equal consideration in matters of reporting, investigation and treatment of suspected and/or actual medical neglect regardless of the religious practices of parents or guardians.

You are advised that the attorney general's office has the jurisdiction to respond to the federal agency's inquiries as framed, that the religious exemption clauses do not operate to prevent mandated and voluntary reporters from disclosing reasonable suspicions of abuse or neglect and do not prohibit the state's child protection agency from investigating and treating such cases, and that, therefore, Connecticut law does not create a "special class" of children who are deprived of protection against medical neglect due to the religious beliefs of parents or guardians.

The religious exemption clauses found within Conn. Gen. Stat. § 17a-104 and § 46b-120, which are the subject of the federal inquiry, are contained within the statutory provisions governing child welfare and protection; these statutes are not part of Connecticut's penal code. Statutory provisions of the penal code form the state's substantive criminal law, and legal interpretation of a penal statute would properly lie within the realm of the chief state's attorney's office. Compare Conn. Gen. Stat. § 51-277(a) (the division of criminal justice is granted jurisdiction over criminal matters) with Conn. Gen. Stat. § 3-125 (attorney general has general supervision of all legal matters of interest to state, except legal matters over which prosecutors have direction.). Since your inquiry and that of the federal agency relates to non-criminal statutes, this office will respond.

The starting point of analysis is the actual language of the religious exemption provisions. The statutes do not provide that treatment of a child by a Christian Science practitioner shall not constitute maltreatment or neglect; the law recites that such treatment shall not of itself constitute maltreatment or neglect. Under the plain meaning doctrine of statutory interpretation, we must read the statute as it is written and construe its words plainly as presented. Conn. Gen. Stat. § 1-1; See Rosnick v. Aetna Casualty & Surety Co., 172 Conn. 416, 422 (1977). We have thoroughly researched the legislative histories of the religious exemption provisions and have concluded that nothing in the histories indicates a legislative intent to allow religious practices or beliefs to limit a mandated reporter's duty to disclose suspected neglect, a voluntary reporter's permissive choice to disclose, or your agency's legal obligation to investigate and treat.

In further interpreting the effect of the language in question, we must consider the religious exemption clauses in context with the more encompassing definitions of maltreatment and neglect. Under state law, "neglect" relates to children who are being denied proper care and attention physically. Conn. Gen. Stat. § 46b-120. "Abused" means, in pertinent part, a child or youth who is in a condition which is the result of maltreatment, including deprivation of necessities. Conn. Gen. Stat. § 46b-120. Under federal law, which the state adheres to in order to receive federal grant dollars, "child abuse and neglect" is defined to include "negligent treatment or maltreatment." 42 U.S.C. §5102. "Negligent treatment or maltreatment" is further defined as the failure to provide adequate food, clothing, shelter or medical care. 45 C.F.R. §1340.2(b). Pertinent to your inquiry, the federal regulations further provide:

"Nothing in this part [negligent treatment or maltreatment] should be construed as requiring or prohibiting a finding of negligent treatment or maltreatment when a parent practicing his/her religious beliefs does not, for that reason alone, provide medical treatment for a child;..." 45 C.F.R. §1340.2(d)(2)(ii).

Under Connecticut statutes, child abuse or neglect findings relate to the condition or status of the child; the culpability of a parent or guardian is not an element of the finding. Thus, reading the religious exemption provisions together with the state and federal statutory definitions of neglect, abuse and maltreatment, we must conclude that a parent or guardian has a duty to provide adequate medical care for a child, that the state has an obligation to intervene if a child is in a condition of abuse or neglect as a result of the denial of necessary medical care and that the type of treatment chosen by a parent or guardian, regardless of its basis in religious practice or belief, shall implicate the mandated reporter law (See Conn. Gen. Stat. § 17a-101), the voluntary reporter law (See Conn. Gen. Stat. § 17a-103), and the court proceedings governing abused and neglected children (See Conn. Gen. Stat. § 46b-120).1 Thus, if the course of treatment selected by a parent is not adequate to meet the medical needs of the child, since the focus of the child protection proceeding is on the resulting condition of the child, the child may be deemed to be neglected and/or abused. As such, any mandated reporter would have an obligation to file a report of suspected abuse or neglect under Conn. Gen. Stat. § 17a-101. A voluntary reporter may disclose reasonable suspicions pursuant to Conn. Gen. Stat. § 17a-103 and would not be barred from reporting because religious practices or beliefs are involved. Upon receipt of any such report, your agency has a legal obligation under state law (See Conn. Gen. Stat. § 17a-101) and federal law (See Juan F. v. O'Neill, No. 89-859 (D. Conn. Jan. 7, 1991) to investigate the report and to take appropriate measures to protect the welfare of the child in accordance with your legal mandates.

Although religious practices generally are protected against state intrusion through the operation of the First Amendment to the United States Constitution, those constitutional rights are not absolute. In Prince v. Massachusetts, 321 U.S. 158 (1944), the United States Supreme Court stated:

"But the family itself is not beyond regulation in the public interest, as against a claim of religious liberty. Reynolds v. United Stat, 98 U.S. 145; Davis v. Beason, 133 U.S. 333. And neither rights of religion nor rights of parenthood are beyond limitation. Acting to guard the general interest in youth's well-being, the state as parens patriae may restrict the parent's control by requiring school attendance, regulating or prohibiting the child's labor and in many other ways. Its authority is not nullified merely because the parent grounds his claim to control the child's course of conduct on religion or conscience. Thus, he cannot claim freedom from compulsory vaccination for the child more than for himself on religious grounds. The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death... Parents may be free to become martyrs themselves. But it does not follow they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves. Id. at 166-167, 170.

In an earlier case, ruling on the interpretation of the concept of the Free Exercise clause, the United States Supreme Court said: "Laws are made for the government of actions, and while they cannot interfere with mere religious belief and opinions, they may with practices." Reynolds v. United States, 98 U.S. 145, 166 (1878).

The law enunciated by the United States Supreme Court has been followed in several jurisdictions. In People Ex Rel. Wallace v. Labrenz, 411 Ill. 618, 104 N.E.2d. 769 (1952), the Illinois Supreme Court upheld the parens patriae power of the state to override a parent's religious practices when the medical condition of the child was at issue. In Maryland, the court there ruled that constitutional guarantees of free religious practice did not extend to the denial to a child of necessary medical care based on an adult's spiritual beliefs. Levitsky v. Levitsky, 190 A.2d. 621 (Maryland 1963). Crucial to many of the courts' interpretations of religious exemption cases is the severity of the risk posed to the child when traditional medical treatment is withheld. If the child were to face death or serious physical infirmities, the courts consistently have disallowed the use of religious exemption clauses to uphold a parent's right to decide. In Custody of a Minor, 379 N.E.2d. 1053, 1056 (Massachusetts 1978), the Massachusetts court held that parental rights do not give parents life and death authority over their children. In Commonwealth of Pennsylvania v. Barnhart, 497 A.2d 616, 624 (Pennsylvania 1985), a criminal case, the court was called upon to consider the effect of the free exercise clause in a case in which a parent was convicted of involuntary manslaughter for treating a cancerous child through spiritual means. In upholding the power of the state to intervene through the criminal process, the Pennsylvania court held that a parent had an obligation to seek medical help for a child where the child's life is in danger and cannot legitimately claim religious freedom if the child should die as a result of treatment withheld. Similarly, in Walker v. Superior Court of Sacramento County, 763 P.2d. 852 (California 1988), also a criminal case of involuntary manslaughter involving a Christian Science parent, the California court held that the religious exemption clause does not apply where a parent's withholding of medical treatment results in death or permanent injury to the child. But see, In re Green, 292 A.2d. 387 (Pennsylvania 1972) (if the child does not face serious medical consequences if treatment is withheld, parental autonomy should prevail).

We are therefore persuaded by the plain language of Connecticut's statute, the absence of any legislative intent to remove certain children from child protection based on a religious exemption clause, and the established United States Supreme Court law as well as decisions from other jurisdictions that the religious exemption clause does not act to limit mandated reporters' obligations to disclose suspected abuse or neglect, voluntary reporters' ability to disclose reasonable suspicions, or your agency's responsibility to investigate and respond to such cases.

Very truly yours,

RICHARD BLUMENTHAL

ATTORNEY GENERAL

Arthur E. Webster

Assistant Attorney General

RB/AEW//eop

Attachment

1 Conn. Gen. Stat. § 17a-101 designates certain individuals as mandated reporters and directs those individuals to report reasonable suspicions of abuse or neglect. Conn. Gen. Stat. § 17a-103 provides that all other individuals who are not mandated reporters may report reasonable suspicions of abuse/neglect; these voluntary reporters are under no legal duty to report.