If Idaho parents are using prayer or 'spiritual means' to treat a sick child instead of seeking medical care, can the state still step in, and what is the threshold?

Plain-English summary

Ken Patterson, who ran the Department of Health and Welfare's Division of Family and Children's Services, asked the AG three related questions about Idaho's religious-exemption provision in the Child Protective Act. The provision lets parents treat a sick child by "spiritual means" (prayer, faith healing) without that choice alone constituting neglect under the Act. Patterson wanted to know what the practical limits were: did the exemption shield parents from state intervention if the child got worse? Did it block reporting and investigation duties for suspected abuse?

The AG's answers, in order: (1) The exemption does not limit administrative or judicial authority to provide medical services to children. It is a defense to a neglect charge based purely on the prayer-versus-medicine choice, not a shield against intervention when the child is harmed. (2) The standard for state intervention is "actual harm" or "threatened harm." Once a child reaches that threshold, the state can act to provide medical care, regardless of the parents' religious beliefs. (3) The exemption does not affect the normal reporting and investigation duties under the Child Protective Act. Mandatory reporters (doctors, teachers, nurses) still have to report suspected abuse, neglect, or abandonment, and DH&W must still investigate.

The structural reading: the exemption is narrow. It addresses the question of whether parents who chose prayer over medicine can be charged with neglect for that choice. It does not address what happens once the child's condition crosses the harm threshold. At that point, the state's protective parens patriae authority kicks in and the parents' religious beliefs do not block intervention.

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

What does "actual or threatened harm" mean in practice?

Courts apply a fact-specific assessment of the child's condition. Actual harm is straightforward: the child is malnourished, septic, in respiratory distress, or showing signs of an untreated medical condition. Threatened harm requires more judgment: the child has a treatable condition that, if not treated soon, will cause serious harm or death. Diabetes without insulin, untreated meningitis, severe dehydration, untreated sepsis, all qualify. The threshold does not require the child to deteriorate to crisis before the state can act.

Who decides whether the threshold is crossed?

In an emergency, hospital staff and physicians have authority to provide emergency care over parental objection where the child's life is in immediate danger. For non-emergency intervention, DH&W files a petition under the Child Protective Act, and a magistrate court holds a hearing. The court can issue an order authorizing medical treatment even over parental objection if the threshold is met. The parents retain due-process protections, including notice and an opportunity to be heard, but the burden of proof is preponderance of the evidence, not beyond a reasonable doubt.

Does this mean parents can never use faith healing in Idaho?

The opinion does not say that. Faith healing as a parental choice is protected by the religious exemption when the child is well or has minor illnesses that resolve on their own. The exemption does not work as a shield once the child is in actual or threatened harm. Parents who continue faith healing past the harm threshold can be charged criminally and lose custody, and the state can authorize medical care directly.

What about the mandatory reporting duty?

Idaho's Child Protective Act has a mandatory-reporter list (physicians, nurses, teachers, social workers, etc.) who must report suspected child abuse, neglect, or abandonment. The 1993 opinion confirms that the religious exemption does not exempt mandatory reporters from this duty. A doctor who suspects a child is being denied needed medical care must report, even if the parents are practicing faith healing. DH&W must investigate the report. Whether DH&W substantiates the report and seeks intervention depends on the harm threshold, not the parents' beliefs.

Has Idaho changed this since 1993?

The opinion's reading of the religious exemption is narrow but the statute itself has been the subject of recurring debate. Several states have repealed or narrowed similar religious-exemption provisions following high-profile cases of children dying after being denied medical care. Idaho's exemption has remained on the books with periodic legislative attention. Anyone relying on this opinion for current practice should verify both the current statutory text and any updated DH&W policies.

Background and statutory framework

The Idaho Child Protective Act (Idaho Code § 16-1601 et seq.) is the state's framework for protecting children from abuse and neglect. The Act includes definitions of "neglect" and "abuse," procedures for reporting and investigation, and authority for DH&W and the courts to intervene to protect children. The "spiritual means" exemption is a narrow exception that says a parent's choice to use prayer instead of medical care does not, by itself, constitute neglect.

The constitutional backdrop is parens patriae: the state's traditional authority to protect children whose parents are not adequately doing so. The U.S. Supreme Court has long recognized that this authority can override parental religious objections when the child is at risk of serious harm or death. Prince v. Massachusetts, 321 U.S. 158 (1944), is the foundational case. State courts applying the parens patriae doctrine have routinely authorized medical treatment over parental religious objections in cases of serious risk.

Citations

• Idaho Child Protective Act (Idaho Code § 16-1601 et seq.)

Source

• Landing page: https://www.ag.idaho.gov/office-resources/opinions/
• Original PDF: https://ag.idaho.gov/content/uploads/2018/04/OP93-09.pdf

Original opinion text

ATTORNEY GENERAL OPINION NO. 93-9
To:

Mr. Ken Patterson, Administrator
Division of Family and Children's Services
Idaho Department of Health and Welfare
450 W. State Street, Third Floor
STATEHOUSE MAIL
Boise, ID 83720

Per Request for Attorney General's Opinion
QUESTIONS PRESENTED
1.

Does Idaho's religious exemption provision, which allows parents to treat their
sick children through "spiritual means," limit administrative or judicial authority
to provide medical services to children?

2.

What is the standard for state intervention for children who are in need of medical
treatment?

3.

Does the religious exemption provision affect the normal reporting and
investigation provisions for suspected child abuse, neglect and abandonment?
CONCLUSION

1.

Idaho's religious exemption provision does not limit administrative or judicial
authority to provide medical services to children.

2.

The standard for state intervention for the medical treatment of children is that
intervention is authorized when children are threatened by, or are in, actual harm.

3.

The religious exemption provision does not affect the normal reporting and
investigation provision for suspected child abuse, neglect and abandonment.
ANALYSIS

Question No. 1:
You have asked whether Idaho's religious exemption provision, which allows
parents to treat their sick children through "spiritual means," limits administrative or
judicial authority to provide medical services to children. Idaho's Child Protective Act

does contain a provision allowing parents to treat their sick child through "spiritual
means." On its face, this appears to conflict with other provisions of the Act which
define "neglect" as the lack of medical care for ill children and require such "neglect"
before the state is authorized to act in protecting the health of children. Our opinion is
that the statutes do not conflict, and the state has authority to act on behalf of ill children.
The Idaho Legislature has authorized state agencies to intervene through the Child
Protective Act in instances where children are in need of medical attention, provided that
the religious preference of the parent is considered.
Idaho Code § 16-1602 defines "neglected" as follows:
(s) "Neglected" means a child:
(1) Who is without proper parental care and control, or subsistence,
education, medical or other care or control necessary for his well-being
because of the conduct or omission of his parents, guardian or other
custodian or their neglect or refusal to provide them; provided, however,
no child whose parent or guardian chooses for such child treatment by
prayers through spiritual means alone in lieu of medical treatment,
shall be deemed for that reason alone to be neglected or lack parental
care necessary for his health and well-being, but further provided this
subsection shall not prevent the court from acting pursuant to section 161616, Idaho Code.
(Emphasis added.)
Furthermore, the Idaho Legislature has granted state courts authority to act as
follows:
(a)
At any time whether or not a child is under the authority of
the court, the court may authorize medical or surgical care for a child when:
(1)
A parent, legal guardian or custodian is not immediately
available and cannot be found after reasonable effort in the circumstances
of the case; or
(2)
A physician informs the court orally or in writing that in his
professional opinion, the life of the child would be greatly endangered
without certain treatment and the parent, guardian or other custodian
refuses or fails to consent.

(b)
If time allows in a situation under subsection (a)(2) of this
section, the court shall cause every effort to be made to grant the parents or
legal guardian or custodian an immediate informal hearing, but this hearing
shall not be allowed to further jeopardize the child's life.
(c)
In making its order under subsection (a) of this section, the
court shall take into consideration any treatment being given the child by
prayer through spiritual means alone, if the child or his parent, guardian
or legal custodian are adherents of a bona fide religious denomination that
relies exclusively on this form of treatment in lieu of medical treatment.
Idaho Code § 16-1616 (emphasis added).
Neither the administrative nor judicial provisions falling within the purview of
these statutes have been challenged in Idaho on general religious freedom grounds.
Other states with similar provisions, however, have addressed this issue. Colorado's
religious exemption references also contain the language "through spiritual means alone."
In analyzing the legislative intent, the Colorado Supreme Court concluded that:
It allows a finding of dependency and neglect for other "reasons," such as
where the child's life is in imminent danger, despite any treatment by
spiritual means. In other words, a child who is treated solely by spiritual
means is not, for that reason alone, dependent or neglected, but if there is
an additional reason, such as where the child is deprived of medical care
necessary to prevent a life-endangering condition, the child may be
adjudicated dependent and neglected under the statutory scheme.
People in Interest of D.L.E., 645 P.2d 271, 274-275 (Colo. 1982). Thus, the Colorado
court holds that a child who is treated "through spiritual means alone" is not deemed for
that reason only to be neglected. Neither is such a child, for that reason alone, shielded
from a finding of neglect if the child is deprived of medical care necessary to prevent a
life-endangering condition.
In Walker v. Superior Court, 763 P.2d 852 (Cal. 1988), the parent of a deceased
child challenged the state's ability to proceed with involuntary manslaughter and felony
child-endangerment charges arising from the death of her four-year-old daughter. Her
daughter was treated through prayer in lieu of medical care and subsequently died as a
result of acute meningitis. The challenge was based upon a "spiritual exemption" clause
found within that state's child protective statutes, which are similar to those of Idaho.

In analyzing the legislative intent of California's child protection laws, the
California Superior Court concluded: "The legislative design appears consistent: prayer
treatment will be accommodated as an acceptable means of attending to the needs of a
child only insofar as serious physical harm or illness is not at risk." Walker, 763 P.2d at
866.
This balancing analysis is consistent with Idaho's Child Protective Act. Just as
Idaho Code § 16-1602 defines child "neglect" to include lack of medical treatment, Idaho
Code § 16-1616 provides the court with the option of providing a child with medical
treatment whether or not the child's parent consents. In other words, nowhere in Idaho
law does the religious exemption provide that a child cannot be medically treated if
prayer is not effective and the child's life is endangered. Idaho's religious exemption
references do not limit either administrative or judicial action when medical treatment for
children is deemed necessary.
This analysis of the Child Protective Act is consistent with Idaho's constitutional
provisions protecting religious freedom. The Declaration of Rights provision of the
Constitution of the State of Idaho provides in article 1, § 4:
Guaranty of religious liberty.--The exercise and enjoyment of
religious faith and worship shall forever be guaranteed; and no person shall
be denied any civil or political right, privilege, or capacity on account of his
religious opinions; but the liberty of conscience hereby secured shall not be
construed to dispense with oaths or affirmations, or excuse acts of
licentiousness or justify polygamous or other pernicious practice,
inconsistent with morality or the peace or safety of the state; nor to permit
any person, organization, or association to directly or indirectly aid or abet,
counsel or advise any person to commit the crime of bigamy or polygamy,
or any other crime. No person shall be required to attend or support any
ministry or place of worship, religious sect or denomination, or pay tithes
against his consent; nor shall any preference be given by law to any
religious denomination or mode of worship.
The drafters of the Idaho Constitution recognized the importance of assuring that
although there should be no limit to an individual's rights to a religious belief, there were
boundaries on an individual's right to religious practices. Polygamy, for example, could
be part of a religion so long as the followers did not participate in this illegal practice.
Constitutional Convention Proceedings, vol. 1, pp. 129-135.
Case law supports this contention. The right to hold a religious belief is
guaranteed and the freedom to practice a religion is constitutionally protected. Bissett v.

State, 111 Idaho 865, 867, 727 P.2d 1293 (1986); Cantwell v. Connecticut, 310 U.S. 296,
60 S. Ct. 900, 84 L. Ed. 1213 (1939). However, the practice of those religious beliefs is
subject to some regulation. United States v. Lee, 455 U.S. 252, 102 S. Ct. 1051, 71 L.
Ed. 2d 127 (1982).
States may clearly regulate "circumstances where the exercise of religious freedom
by parents would expose their children to ill health or death." 52 A.L.R.3d 1120.
The right to practice religion freely does not include liberty to expose the
. . . child 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.
Prince v. Massachusetts, 321 U.S. 158, 166-67, 64 S. Ct. 438, 88 L. Ed. 645, reh'g
denied, 321 U.S. 804, 64 S. Ct. 784, 88 L. Ed. 1090 (1944).
Therefore, a "state may regulate the health, safety, and general welfare of society
in a manner which may infringe upon religion without unconstitutionally invading
liberties protected by the Constitution." State v. Heritage Baptist Temple, Inc., 693 P.2d
1163, 1165 (Kan. 1985).
Neither the express language of Idaho's religious exemption, nor traditional
constitutional principles of religious freedom limit administrative or judicial authority to
provide medical services to children.
Question No. 2:
You next ask what the standard is for state intervention for children who are in
need of medical treatment. Intervention under the Child Protective Act is justified when
a child is threatened by, or in, actual harm.
Idaho Code § 16-1601(2) authorizes the Department of Health and Welfare to
"take such actions as may be necessary and feasible to prevent the . . . neglect . . . of
children." Furthermore, the Department shall maintain: "(a) Protective services on
behalf of children whose opportunities for normal physical, social and emotional growth
and development are endangered for any reason." Idaho Code § 56-204A (emphasis
added).

The Department of Health and Welfare's rules regarding the handling of child
abuse, neglect and abandonment are found in IDAPA 16.06.01300, et seq. All cases of
children threatened with or in actual danger of serious physical harm or illness by reason
of neglect, due to any act or inaction, are therefore subject to the provisions of the Child
Protective Act. These rules are neutral toward religious beliefs. The investigation will
proceed and the determination of neglect will be made based upon the threat of harm to
the child, not upon the religious beliefs of the parents.
Question 3:
Your final question asks whether the religious exemption provision affects the
normal reporting and investigation provision for suspected child abuse, neglect and
abandonment. Clearly, it does not.
In a previous Attorney General's Opinion, Idaho's child abuse reporting statute
was discussed. The opinion of this office has not changed in that Idaho is one of many
states which has mandatory reporting requirements when child abuse, abandonment or
neglect is suspected.
Case law clearly upholds the validity of these statutes in that they are
neither far reaching nor unconstitutional. Jett v. State, 605 So. 2d 926
(Fla. App. 1992); People v. Hedges, 13 Cal. Rprt. 2d 412 (Cal. Super. Ct.
1992); Morris v. Coleman, 194 Mich. App. 606, 488 N.W.2d 464 (Mich.
App. 1992).
Attorney General Opinion No. 93-2.
The premise that parents have a duty to supply their children with food, clothing,
education and medical needs is firmly rooted in history. People v. Pierson, 68 N.E. 243,
245 (N.Y. 1903). This duty is "a basic tenet of our society and law." State v. Williams,
484 P.2d 1167 (Wash. App. 1971); In re Hudson, 126 P.2d 765 (Wash. 1942); Lizotte v.
Lizotte, 551 P.2d 137 (Wash. App. 1976).
Idaho Code § 16-1619 provides:
Reporting of abuse, abandonment or neglect.--(a) Any physician,
resident on a hospital staff, intern, nurse, coroner, school teacher, day care
personnel, social worker, or other person having reason to believe that a
child under the age of eighteen (18) years has been abused, abandoned or
neglected or who observes the child being subjected to conditions or
circumstances which would reasonably result in abuse, abandonment or

neglect shall report or cause to be reported within twenty-four (24) hours
such conditions or circumstances to the proper law enforcement agency or
the department [of Health and Welfare]. The department shall be informed
by law enforcement of any report made directly to it.
The statute clearly requires anyone to report any suspected child neglect, which
includes a child lacking necessary medical care or treatment, to the Department of Health
and Welfare or law enforcement. The reporting party is immune from criminal and civil
liability so long as he or she has reason to believe that a child has been medically
neglected and, acting upon that belief, makes a report of neglect as required in section 161619, Idaho Code. Any person reporting in bad faith or with malice is not immune from
liability.
AUTHORITIES CONSIDERED
1.

Idaho Constitution:
Art. 1, § 4.

2.

Idaho Code:
§ 16-1601(2).
§ 16-1602.
§ 16-1616.
§ 16-1619.
§ 56-204A.

3.

Idaho Cases:
Bissett v. State, 111 Idaho 865, 727 P.2d 1293 (1986).

4.

Federal Cases:
Cantwell v. Connecticut, 310 U.S. 296, 60 S. Ct. 900, 84 L. Ed. 1213 (1939).
Prince v. Massachusetts, 321 U.S. 158, 64 S. Ct. 438, 88 L. Ed. 645, reh'g denied,
321 U.S. 804, 64 S. Ct. 784, 88 L. Ed. 1090 (1944).
United States v. Lee, 455 U.S. 252, 102 S. Ct. 1051, 71 L. Ed. 2d 127 (1982).

5.

Other Cases

In re Hudson, 126 P.2d 765 (Wash. 1942).
Jett v. State, 605 So. 2d 926 (Fla. App. 1992).
Lizotte v. Lizotte, 551 P.2d 137 (Wash. App. 1976).
Morris v. Coleman, 488 N.W.2d 464 (Mich. App. 1992).
People in Interest of D.L.E., 656 P.2d 271 (Colo. 1982).
People v. Hedges, 13 Cal. Rprt. 2d 412 (Cal. Super. Ct. 1992).
People v. Pierson, 68 N.E. 243 (N.Y. 1903).
State v. Heritage Baptist Temple, Inc., 693 P.2d 1163 (Kan. 1985).
State v. Williams, 484 P.2d 1167 (Wash. App. 1971).
Walker v. Superior Court, 763 P.2d 852 (Cal. 1988).
6.

Other Authorities
IDAPA 16.06.01300 et seq.
Attorney General Opinion No. 93-2.
DATED this 6th day of September, 1993.
LARRY ECHOHAWK
Attorney General

Analysis by:
ANN L. COSHO
Deputy Attorney General