Crank was found guilty of misdemeanor child neglect, along with the man she was living with, Ariel Ben Sherman, who had founded a small prayer group called the Universal Life Church a year earlier in Lenoir City. Their defense, they argued, was right in the Tennessee Code Annotated: Under state law, it wasn’t considered abuse or neglect for parents to seek “treatment by spiritual means through prayer alone” in lieu of medical care for their kids.

The case made it all the way up to the Tennessee Supreme Court. Sherman died while the case was on appeal, but Crank’s conviction was upheld: Because she wasn’t part of a “recognized church or religious denomination,” the Court held, she wasn’t entitled to the faith-healing defense. Her sentence was affirmed: Eleven months and 29 days, to be served on unsupervised probation.

The Court didn’t strike down the law, but one year later, the Tennessee legislature acted. This spring, it quietly repealed the faith-healing exemption in its child-neglect law, becoming one of just a handful of states that don’t provide any religious exemptions to civil or criminal charges of child neglect or abuse.

Religious-freedom fights often focus on issues of speech and prayer, of worship spaces and safe observance. Exemptions to charges of child abuse, however, rarely get that kind of attention. The laws are just there, sitting on the books, waiting for a kid to die before they get repealed.

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Of all the people governments act to protect, children are perhaps the most vulnerable. Despite federal laws that seek to protect kids under 18 from neglect and abuse, there is no one definition across states of what “abuse” actually means, especially when it comes to families who rely on prayer and faith healings in place of medical care. In some places, if a child is injured, or dies, parents can use their state’s religious exemption as a defense against criminal charges.

The federal government started pushing states to pass these laws starting in 1974 under Richard Nixon’s administration. Largely because of lobbying efforts by Christian Scientists, the Department of Health, Education, and Welfare, which later became the Department of Health and Human Services, determined that parents who don’t seek traditional medical care for their kids for religious reasons should not be held negligent. The agency threatened to withhold federal funding from states that didn’t allow similar accommodations. One by one, states codified religious defenses into their child abuse, endangerment, and neglect laws. Even as federal law has changed over the years, most of these laws have stayed on the books, equally distributed across states red and blue.

A few legislatures have changed their laws; like Tennessee, most states only take action after hearing harrowing reports. A few months after the Tennessee Supreme Court ruled in the Crank case, a lobbyist named Chris Ford, who had been hired by the American Academy of Pediatrics and an advocacy group called Children’s Healthcare Is a Legal Duty, or CHILD, approached Senator Richard Briggs about the possibility of sponsoring a repeal bill. The Knoxville surgeon and legislator said yes, although he was wary of potential attacks from religious-freedom advocates and those who oppose “big government.”