September 1983 V/1


Twelve-year-old Parnela Hamilton broke her leg last July. When treating her broken leg, her physician discovered a cancerous tumor which was diagnosed as Ewing"s sarcoma. Larry Hamilton, Pamela a father and pastor at the Church of God of the Union Assembly in La Follette, Tennessee, and her mother, Deborah, refused treatment of Pamela's cancer because taking medicine is against their religion. "Only God can heal my daughter," declared her father; "She has the faith to recover; it will be God's will if she does not." Having been notified of Pamela's condition, the Tennessee Department of Social Service petitioned the courts for custody of Pamela on the grounds that her life was endangered because of the religious beliefs of her parents. By the time the courts of Tennessee granted the transfer of custody, two months had elapsed. The attending physician stated that she had only a 50/50 chance of survival due to the "red hot and angry tumor which now has spread through her thigh and up to the hip joint." Even though her life was endangered, Pamela agreed with her parent's decision and declared, "I do not want radiation and chemotherapy because I do not want my hair to fall out or to be sick,"

Ethical Considerations

When considering the relationship between parents and children from the Judeo-Christian ethical perspective, two interrelated assumptions are paramount. First, the family unit must be fostered and protected because it is the fundamental element upon which society and culture depend for strength and continuity. Second, parents should have care and custody of their children because experience shows that parents love their children and strive to help them become virtuous human beings. Like most ethical assumptions, this latter one yields to contrary evidence. Hence, if parents are abusing their children and endangering their lives, then society intervenes and removes the children from the parents' custody, at least for a time. The right of intervention on behalf of children illustrates another ethical assumption; namely, that parents do not "own" their children. Rather, parents are stewards, caretakers, of their children, enablers who help their children grow in knowledge and virtue. Above all, life and death decisions concerning children are not to be made for the benefit of the parents.

Both ethical reasoning and legal precedent give priority to the expression of a person's religious faith, Because religious faith is the most personal, important, and profound act of conscience, its expression should not be limited unless it is manifestly injurious to other people. Hence, as long as parents respect the well-being of their children, they have the ethical and legal right to rear and educate their children in the religion of the parents' choice. The right to choose a religion for children, as well as many other rights, gradually wanes as children mature and are able to make competent decisions for themselves. Here, of course, we encounter the crux of the matter: When are children able to make competent decisions for themselves? When do children become young adults? The laws of every country try to solve this question by stating that, for legal purposes, young people become adults at age 16, 18, or 21, depending upon the right in question. (Strangely, in most states of our country, young people may marry at an earlier age than they may buy alcoholic beverages.) The laws, however, express only a general norm; it may often happen that a young person is mature enough to make important decisions for himself or herself well before the legal age of maturity. In recognition of this fact, ethicists now suggest that capable children be asked to give their "assent" to surgery or other serious medical treatments, even though the proxy consent of their parents or guardian will suffice for ethical and legal clearance for medical treatment.


Cases resembling that of Pamela Hamilton are not unusual. The courts frequently appoint guardians for children whose parents being Jehovah Witnesses believe that the bible prohibits blood transfusions even in the danger of death. The ethical basis for court action is the assumption that the life of the child should not be endangered due to the religious beliefs of the parents. Even if the child agrees with the parents' belief, the ethical and legal thinking in most of these cases is that the child cannot make a competent decision and because life is such an important gift, he or she would choose life if a competent and free decision were possible.

But Pamela's case situation is different from the usual transfer of custody case for religious reasons. First of all, she agrees with her parents' decision that she should not receive medicine for treatment of cancer. On the face of it, the parent's statement that "God will cure" is rather unreasonable. Though religious people attribute omnipotence to God and in that sense believe that God does cure, they usually do not deny that human beings have a cooperative role to fulfill in effecting a cure, That human beings will one day die is assured, but they have a right and a duty to use positive means such as medicine and surgery to prolong their lives as long as living enables them to pursue the goal of life. But even though the belief of Pamela and her parents seems unreasonable, it is a religious belief and should be honored unless it manifestly harms other people.

This brings us to the second issue which makes Pamela's case somewhat different; She may die within a year even if chemotherapy and radiation are utilized. Making final ethical or medical judgments upon facts recounted in news stories is not only dangerous, it is impossible. Yet three physicians with whom I discussed this case mused that because of the advanced state of the sarcoma, Pamela's chances for survival for two years "are not encouraging."

In most states, if Pamela were over 18 and stated that because of her religious beliefs she did not wish to receive medical treatment for her tumor, people might try to persuade her to change her mind but, in the last analysis, they would be legally and ethically bound to respect her decision. The question that bothers is: Even though she is only 12 years old, did the court make an effort to determine her maturity? No doubt Pamela's faith is strong, but is it due to her parents' influence or to her own free convictions? And did the court consider the gravity of her condition before making its decision? Given the choice, most people will choose life over death and legal precedent must be based upon what happens most of the time. But legal precedent alone does not guarantee an ethical solution, In order to have an ethical solution, legal precedent must be interpreted in light of the pertinent facts of the case and the ethical assumptions upon which the precedent is based. Pamela"s case reminds us that religious and family rights are very important and that the courts must consider particular facts and assumptions as well as precedent in order to form ethical decisions.

Kevin O'Rourke, OP

© Kevin O'Rourke, O.P.