On the ethics forum at MSNBC and on bioethics.net blogs, Art Caplan, distinguished bioethicist and Director of the Center for Bioethics at U Penn, has posted a commentary on prayer and the medical treatment of children [Children's health can't be left to faith alone]. I urge you to read this comment and want to echo its sentiments here.

In March the news reported the deaths of two children as a result of parental withholding of care. There were, unfortunately, many other cases of parents outright killing their children, but what makes these particular two cases so incomprehensible is that they essentially were allowed to die painful deaths in the name of God.

Or, more specifically, their parents’ belief in God and His healing powers.

Ava Worthington was 15 months old. She died of bronchial pneumonia, a disease easily treated with antibiotics. Her parents essentially watched her die, praying over her as her lungs filled with fluid and she drowned in mucous and puss. Ava most likely experienced days of severe illness with absolutely no relief offered to her by those who are supposed to take care of her.

Madeline Neumann was 11 years old. She died from an easily treatable form of diabetes, suffering for a month with increasingly more severe symptoms while her parents watched and prayed.

In both cases the parents held strong religious convictions that modern medicine is not necessary, that prayer and God’s will are all that matter. That is fine for them, but it is not fine for their children.

Adults have the right to determine their own fate. In theory they have the mental capacity to make their own decisions, knowing the consequences of those decisions. Children do not. That is why it is the responsibility of the adult to take care of them and do what is right for them.

To deny your own children medical care because of your beliefs is ethically and morally wrong. To do what amounts to wilfull torture of a child in no way reflects an offering of faith to God. We have been gifted with reason and with reason we have crafted life-saving medical care. To wilfully ignore that is to reject every notion of what God means to those who believe in him. To throw up your hands when your child dies in front of you and say “oh well, God’s will” is an insult to God. There is no love for God, neighbor or self in purposefully allowing another human being to suffer a painful and preventable death.

If an adult decides out of faith to deny for themselves medical care that might save them, trusting instead to God’s will, that is fine. They have made that committment. They have that right. But children do not have the ability to make the same decisions. They may be able to memorize and recite the Lord’s Prayer, but show me a 15 month old that understands the nature of the Trinity and I will show you a room full of theologians who don’t. The conceptual understanding of what it means to live by faith is gifted and only possible when the brain gets to the point of being able to truly hear the message.

Letting your children die when the ability to save them is at your fingertips is murder. There is no other word for it. And it is wrong. No one should be allowed to die if we can help it, and especially not our children.

“A voice in Ramah was heard, great weeping and mourning; Rachel weeping for the children of her, and she would not be comforted, because they are not.” [Matthew 2:18/Jeremiah 31:15; from the Greek UBS 4th edition, Nestle-Aland 26th edition]

In the science section of the BBC International news website there is a seemingly innocuous little story entitled “Crusaders ‘left genetic legacy’” [BBC news March 27, 2008]. A group of researchers for the Genographic Project are attempting to study human migrations using genetic footprints. In the article the researchers studied the male Y chromosome which changes only slowly over time. Since the changes are slow to occur, they often lead to rather distinct versions of the chromosome appearing — these are called haplogroups. The haplogroups are stable enough to track over successive generations. Most individuals migrate relatively infrequently over the generations such that certain haplogroups become common in a given area. The idea then is if these haplogroups show up somewhere else, some type of migration (forced or voluntary) occurred to bring the haplogroup to a new area.

The reported study looked at 926 men currently living in Lebanon. What the researchers found surprised them. There were clearly two haplogroups present (not very surprising if you consider where Lebanon is located within the Middle East) but the haplogroups seemed to be grouped according to religion. Christian Lebanese men tended to have a haplogroup derived from European areas that had historically sent men on crusade to the Holy Land. Muslim Lebanese men tended to have a haplogroup derived from the Arabian Peninsula, from the groups that sent men to the Holy Land to repel European crusaders. This is, actually, pretty interesting, as the author of the study points out:

“The goal of the study was to put some science to the history of this country - which is very rich,” said Pierre Zalloua, a co-author on the paper, from the Lebanese American University in Beirut.

He added: “To have these great civilisations - with the Islamic expansion and the migration from Europe - coming to Lebanon, leaving not only their genes but also some of their culture and way of life, it can only make us feel richer.”

However, the question I would ask is whether we need to know it? There is already quite enough tension between different groups in the Middle East — pointing out genetic differences (which, ultimately, don’t really mean anything in this case) could potentially only make things worse. Whose to say someone won’t get it into their head to use this genetica information as a sorting mechanism to get rid of those with the “wrong” heritage.

The idea of such migration studies is, in part, to try and show that we all, somewhere along the line, migrated from someplace else, thus attempting to erase notions that we are all different. If everyone migrated from someplace else, how can you really treat people as “other”? We should all just act like one big human family. This is actually a worthy goal, but somehow genetically tagging individuals seems a little dangerous.

Genes don’t make you religious, or specifically Christian or specifically Muslim. Genes don’t really, by themselves, even account for why some people are smart, pretty, big, or whatever. But there are already ethical arguments over what to do about genes that might give you cancer, or heart disease, or diabetes. Can you be excluded from jobs because you might get sick? Can you be denied health coverage because you might be expensive?

Tagging someone as to where they come from only seems to be one more tool for those wishing to exclude, rather than include.

The 3rd District Court of Appeals in Wisconsin upheld a professional misconduct punishment ruling against a pharmacist yesterday and this is good news for all of us [Penalty for Pharmacist's Refusal Upheld, Chicago Tribune; press release, ACLU; and others].

In the case a pharmacist refused to refill a birth control prescription for a young woman after telling her point blank that contraception was wrong. He then refused to help her get her prescription filled at the pharmacy where he worked or at another pharmacy in the area as is required by the Pharmacy Licensing Board [the Board allows for religious objects, but they must be clearly stated to employers and the pharmacist is still obligated to get the prescription filled by someone else]. The young woman eventually did get the prescription, but not until after missing the start date for when she needed to begin taking it.

Upholding punishment in this case is justified. Moreover, pharmacists should all have to undergo ethical training so as to prevent this from occurring in the future. It is well within an individual’s rights to have strong religious convictions, but those convictions are NOT a sanction to put someone else’s health at risk. Which is the bigger sin? Filling a prescription or intentionally causing harm? I would argue the second.

Birth control and the morning after pill are the two most contested prescriptions in the realm of “conscientious objection” on the part of pharmacist. To some degree I would question the committment of any pharmacist who refuses to fill a prescription — if you find it objectionable why did you go into that profession? What’s more is that a pharmacist is not a doctor — he doesn’t know why the pill was prescribed in the first place. In most cases it is probably for birth control, but some women take the pill to regulate their hormones, thus making the pill necessary for the treatment of an underlying condition. And in any case, if abortion is a sin, then wouldn’t it be better to prevent abortion by preventing pregnancy?

My fear with objection to one or two prescriptions is that it sets up the proverbial slippery-slope for other meds. Are these same pharmacists also not filling prescriptions for Viagra — after all, why encourage sex? Will they decide to stop filling prescriptions for gay people — why keep them healthy if they are only going to live in sin, right? What about antibiotics — shouldn’t I just pray for relieve of my infection? Some people would say, surely not — no one would withhold an antibiotic. Think again. Today on CNN you can view a video of a child dying from diabetic complications while the parents sat over the child and prayed. Since when is insulin — a natural hormone we all make — so evil you can’t give it to your child to save their life?

Anyone who goes into a medically related field in theory is supposed to do so because they have the best interests of the patient at the forefront of what they do. Pharmacists have the same obligations of care as any physician. When a pharmacist allows their own religious beliefs to actively interfer with that, then in my opinion they committ a bigger sin, one of purposeful neglect. It is one thing to object to contraception, it is another to make the decision that no one should have it. To deny a legally prescribed medicine to anyone, with no knowledge as to the medical facts of the case, is irresponsible and counter to everything I have ever read in the Bible.

This court decision is a lesson for all of us. Your rights stop where mine begin. No one ever converted at the end of a sword. They aren’t going to do it at a pharmacy counter, either.