“And the prayer of faith shall save the sick, and the Lord shall raise him up,” reads James 5:15.

It is an instruction that Dale and Shannon Hickman, members of the Oregon-based Followers of Christ Church, took too literally when they decided not to take their premature newborn son David to a hospital, despite the fact that he weighed less than 4 pounds and was in “obvious distress,” according to doctors who later reviewed the couple’s home video footage.

The Followers of Christ believe in faith healing and do not seek traditional forms of medical care. That belief did not help David, who died of staphylococcus pneumonia within nine hours of his birth, as the Oregon State Medical Examiner’s office later determined. If the Hickmans had phoned 911 as soon as their son was born, one state doctor estimated that he “would have had a 99 percent chance of survival.” David would be preschool age today.

These are the conclusions of the Oregon State Supreme Court Judge Virginia Linder, who last week upheld the 2011 conviction of the Hickmans on second-degree manslaughter charges. As Courthouse News reports, the Hickmans will be held in separate state penitentiaries until at least January 2018.

Judge Linder’s decision (PDF) is a biting judgment against the Hickmans and a de facto warning for the faith-healing church to which they belong, which has a troubling history of avoidable infant deaths.

When the Hickmans were put on trial for manslaughter, Judge Linder notes, they told the court that they regret nothing about how they handled their premature birth.

“Both of them testified that, looking back on David’s death, they would not have done anything differently,” Linder wrote in her decision.

“We do what the Bible tells us, and we put God first and ask for faith,” Shannon Hickman said at the time. “If we don’t have the faith, then we seek medical treatment because it is not there, you know.”

The Hickmans claimed they did not know that David was unhealthy until minutes before his death, and “did not raise or inject their religious beliefs” into their defense. But the couple did cite their religious beliefs to argue that, given the Oregon Constitution’s protections for freedom of religion, the state would have to prove that they “knowingly” harmed David in order to convict them.

The court disagreed and allowed the state to try the couple for “criminal negligence” instead.

“We granted review to consider whether the state must prove that a criminal defendant acted with ‘knowledge’ that an unlawful result would follow when that defendant’s conduct was motivated by a sincerely held religious belief,” Linder wrote in a summary of her judgment on the appeal case, concluding “that it does not.”

In other words: Adult members of the Followers of Christ Church do not have to believe in medicine but they still have to take their dying children to the hospital. In Oregon, religious freedom has its limits.

But according to a report (PDF) from the National District Attorneys Association (NDAA), what seems like an obvious case of child neglect might not be so clear-cut in many U.S. jurisdictions.

As of February 2015, 39 states and the District of Columbia have “laws providing that parents or caretakers who fail to provide medical assistance to a child because of their religious beliefs are not criminally liable for harm to the child.” In addition, federal law does not require parents to provide medical treatments to children that are against their religious beliefs.

These laws, as Jerry A. Coyne argued in The New Republic this March, allow faith-healing parents like those found in the Followers of Christ sect to skirt prosecution for child neglect.

In fact, Oregon only completely removed its own religious exemptions for such cases in 2011 as a direct response to infant deaths among the Followers of Christ. As The Oregonian reported at the time, Democratic representative Carolyn Tomei said, “Our hope is that we’re sending a certain group of people a message that it’s against the law if their child is in grave danger… to not give them medical care.”

The legislation passed unanimously.

But striking down this exemption came too late for many children born into the small Pentecostal sect, based primarily in Oregon City and Idaho, and other faith-healing communities.

A 1998 Time magazine article reported on an Oregonian investigation, which found that 21 minors in a Followers of Christ graveyard “probably would have lived with medical intervention, often as simple as antibiotics.”

As The Oregonian reports, a 1999 law then removed religious exemptions in some cases, including second-degree manslaughter, but not all of them, due to pushback from Christian Scientists.

Then, in the late 2000s, another string of high-profile cases brought the issue to the attention of state lawmakers. One of these cases came in 2009 when Timothy and Rebecca Wyland did not take their newborn daughter Alayna to a doctor even as a tumorous growth overtook her left eye, threatening to blind her. Shortly after the 2011 law passed, the couple was found guilty of felony criminal mistreatment.

Oregon might now be cracking down on faith-healing defenses but parents in other states can continue to let their children go untreated without suffering criminal consequences.

A 2013 investigation by Portland ABC affiliate KATU found 10 more children buried in a Boise, Idaho, cemetery who may have died because of their faith-healing parents, many of them Followers of Christ. Among the gravestones, KATU reporter Dan Tilkin found children who had died of untreated pneumonia, diabetes, and other ailments.

One 15-year-old girl, Tilkin reported, contracted a case of food poisoning, which eventually caused her esophagus to rupture after the vomiting became severe. She died of cardiac arrest.

But Idaho state law expressly allows faith-healing defenses by stipulating that a parent “who chooses for his child treatment by prayer or spiritual means alone shall not for that reason alone be construed to have violated the duty of care to such child.”

Major medical associations in the U.S. argue that such language should be removed from state laws across the country. The American Medical Association (AMA) supports repealing religious exemptions from state child abuse statutes and contends that medical associations should actively “investigate” known problems with spiritual healing.

In 1998, the American Academy of Pediatrics (AAP) was prompted by cases involving Christian Science healers to weigh in on religious child abuse exemptions. The AAP Committee on Bioethics wrote (PDF) that “the basic moral principles of justice and of protection of children as vulnerable citizens require that all parents and caretakers must be treated equally by the laws and regulations that have been enacted by state and federal governments to protect children.”

And if the Followers of Christ only believe in doing what the Bible says, a certain Psalm comes to mind with added judicial relevance: “Children are a heritage from the Lord, offspring a reward from him… Blessed is the man whose quiver is full of them. They will not be put to shame when they contend with their opponents in court.”