On November 6, 2016, two-year-old Ella Foster, the daughter of Grace and Jonathan Foster of Bethel, Pennsylvania, developed a cold. During the next two days, she became listless, her breathing more labored and rapid. On November 8 she died in her father’s arms from bacterial pneumonia. Because it violated their religious beliefs, the Fosters reportedly never took Ella to a doctor when she worsened. Instead, they prayed.

Grace and Jonathan Foster belong to the Faith Tabernacle Church, whose doctrine reportedly instructs members “to believe that the Bible is opposed to all means of healing apart from God’s way.” “You either trust God, or you trust man,” said one church member. The Fosters have six other children, all less than ten years of age. They have since surrendered custody of all six children to the state.

Three months later, on February 1, 2017, John Adams, the Berks County District Attorney, charged the Fosters with involuntary manslaughter and child endangerment. Because Pennsylvania doesn’t have a religious exemption in its criminal code, faith-healing deaths have been successfully prosecuted for decades. In many other states, however, the situation is different. Fifteen states have religious exemptions to felonies, including nine with religious exemptions to homicide, manslaughter and, in the case of Arkansas, capital murder. Twelve states have religious exemptions to misdemeanors.

Religious exemptions to child abuse and neglect, including medical neglect, are a relatively recent phenomenon in American jurisprudence. We’ll start at the beginning.

In the mid-1800s, John Banyard founded the Peculiar People. Located in Essex, England, the Peculiars took their name from 1 Peter 2:9 which calls the Lord’s followers, “a royal priesthood, a holy nation, a peculiar people.” Like all faith healers, the Peculiar People rejected modern medicine, choosing prayer and anointment instead.

In 1868, Lois Wagstaffe, the 14-month-old daughter of Mary Ann and Thomas Wagstaffe, died from pneumonia. The Wagstaffes called on church elders to anoint her with oil. After Lois died, they were charged with manslaughter. The law, however, was on the Wagstaffe’s side. According to British common law, “in the absence of a statute declaring it a positive duty upon a parent to call in a medical practitioner, the omission to do so can scarcely be considered negligence so gross and wanton as to be criminal.” After the Wagstaffes were acquitted, several jurors publicly decried the absence of a law to protect children from medical neglect. Their pleas reached the British Parliament. Six months later, the law was modified. The state now had a legal right to protect children from religiously motivated medical neglect. During the second half of the 19th century, Peculiars were charged, convicted, and imprisoned when their children died from diphtheria, epilepsy, and a variety of other illnesses.

Events in the United States soon mimicked those in England.

In the spring of 1901, Emma Judd and her newborn “were lulled into eternity by the prayers of John Alexander Dowie”—the leader of a faith healing sect in Chicago—after they failed to receive medical care during a complicated childbirth. John Dowie, however, hadn’t broken any laws. The Judd case in America paralleled the Wagstaffe case in England. Soon prosecutors, judges, and child advocates targeted Dowie and his followers, anxious to prevent them from causing more harm.

Public outcry changed the law. From that point forward, faith healers were successfully prosecuted for medically neglecting their children.

In the early 1970s, things changed.

In 1971, presidential hopeful Walter Mondale (D-Minnesota) created the Senate Subcommittee on Children and Youth. In 1972, the Subcommittee published a book titled, “Rights of Children.” This set the stage for Mondale’s seminal piece of legislation: the Child Abuse Protection and Treatment Act (CAPTA).

Although Walter Mondale had frequently butted heads with Richard Nixon, he eventually got the legislation he wanted. “Not even Richard Nixon is in favor of child abuse!” he enthused. Mondale’s bill allocated $86 million to create a center within the Department of Health, Education, and Welfare that would award grants to prevent, identify, and treat child abuse. By the mid-1970s, all 50 states had mandatory child abuse reporting laws. The impact was immediate. In 1963, more than 100,000 abused children were reported to public authorities; by 1982, the number had climbed to 1.3 million. Advocates hailed the new legislation as a watershed event for children’s rights.

Not everyone, however, was celebrating.

In 1967, Dorothy Sheridan, a Christian Scientist, was convicted of involuntary manslaughter for treating her daughter’s pneumonia with prayer instead of antibiotics. Elders in the Christian Science church saw Sheridan’s trial as a wake-up call. If she could be prosecuted for following the tenets of her faith, all of them were at risk. Walter Mondale’s CAPTA was about to shine an unwanted light on their actions. Something had to be done. So church authorities turned to two men they were certain could help. Both were Christian Scientists and both were senior officials in Richard Nixon’s White House.

The church’s lobbying efforts were successful—a qualifying mandate was written into the Code of Federal Regulations: “A parent or guardian legitimately practicing his religious beliefs who thereby does not provide specified medical treatment for a child, for that reason alone shall not be considered a negligent parent or guardian.” States now had to have a religious exemption law to get federal funds from CAPTA; within a few years, 49 states and the District of Columbia had laws with religious exemptions for medical neglect. By 1983, the Department of Health and Human Services, realizing the absurdity of the mandate, eliminated it. But it was too late. Many states still have religious exemptions for medical neglect in their civil and criminal codes.

You’ve probably heard of those two Christian Scientists in the Nixon administration—but for a different reason. One was H.R. “Bob” Haldeman, Nixon’s chief-of-staff; the other was John Ehrlichman, Nixon’s chief advisor for domestic affairs. Although the Watergate scandal consumed much of their time until they resigned in 1973, they still had time to front for their Church’s interests.

On November 12, 1993, Bob Haldeman died of abdominal cancer at his home in Santa Barbara, California; true to his beliefs, he refused all medical treatment. On February 14, 1999, John Ehrlichman died from complications of diabetes in Atlanta, Georgia. Unlike Haldeman, Ehrlichman chose modern medicine to treat his kidney failure. Ironic, given that he had helped to create a loophole that continues to allow parents to legally deny such life-saving treatments for their children.

_________________________________________________________________________________________________

Paul A. Offit, MD is a professor of pediatrics and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. He is the author of Bad Faith: When Religious Belief Undermines Modern Medicine (Basic Books, 2015).