In re Hofbauer
393 N.E.2d 1009, 419 N.Y.S.2d 936, 47 N.Y.2d 648 (1979)
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Rule of Law:
Parents who select a course of medical treatment for their child that is recommended by a licensed physician do not commit child neglect under the Family Court Act, even if the treatment is unconventional and not the most widely accepted medical standard.
Facts:
- In October 1977, seven-year-old Joseph Hofbauer was diagnosed with Hodgkin's disease, a type of cancer that is nearly always fatal if untreated.
- The initial attending physician, Dr. Arthur Cohn, recommended conventional treatment involving radiation and chemotherapy.
- Joseph's parents, the Hofbauers, rejected this recommendation due to concerns about the side effects and instead sought an alternative treatment.
- The Hofbauers took Joseph to a clinic in Jamaica for nutritional or metabolic therapy, which included injections of laetrile.
- Upon returning to New York, the Hofbauers placed Joseph under the care of Dr. Michael Schachter, a licensed New York physician who advocated for and administered the nutritional therapy.
- Dr. Schachter testified that Joseph was responding well to the treatment but did not rule out using conventional methods if Joseph's condition deteriorated.
- Joseph's father also testified that he would consent to conventional treatment for his son if Dr. Schachter advised it.
- Witnesses for both sides acknowledged that conventional treatments like radiation and chemotherapy have potentially dangerous and severe side effects.
Procedural Posture:
- The Saratoga County Commissioner of Social Services filed a neglect petition against Joseph Hofbauer's parents in Saratoga County Family Court.
- After a preliminary hearing, the Family Court temporarily removed Joseph from his parents' custody.
- The parties entered a stipulation returning Joseph to his parents' care under Dr. Schachter, and the proceeding was suspended.
- The Appellate Division directed the Family Court to conduct a fact-finding hearing on the merits of the neglect petition.
- The Family Court held the hearing and dismissed the petition, finding that Joseph was not a neglected child.
- The Saratoga County Commissioner of Social Services (appellant) appealed the dismissal to the Appellate Division of the Supreme Court of New York.
- The Appellate Division unanimously affirmed the Family Court's decision.
- The Appellate Division granted the Commissioner of Social Services leave to appeal to the Court of Appeals of New York, the state's highest court.
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Issue:
Does a parent's choice to provide their child with an unconventional medical treatment recommended by a licensed physician, instead of a conventional treatment, constitute child neglect under section 1012 of the New York Family Court Act?
Opinions:
Majority - Jasen, J.
No. A parent's choice to provide their child with an unconventional medical treatment recommended by a licensed physician does not constitute child neglect in this case. The court's inquiry is not whether the parents made the 'right' or 'wrong' decision, but whether they provided an acceptable course of medical treatment in light of all circumstances. Parents have a fundamental right to raise their children, which includes making decisions about medical care, and great deference must be given to their choices. The court found that the Hofbauers were loving and concerned parents who did not refuse all medical care; rather, they entrusted their child's health to a licensed physician. Parents are entitled to rely on the judgment of a state-licensed physician, as the state itself has recognized that individual as capable of exercising acceptable clinical judgment. Because the parents sought accredited medical assistance and provided a treatment recommended by their physician that was not totally rejected by all responsible medical authority, they did not fail to exercise the minimum degree of care required by the statute.
Analysis:
This decision grants significant deference to parental autonomy in medical decision-making for their children. It establishes that the legal standard for 'neglect' is not met simply because parents choose a controversial or minority-view medical treatment over the conventional standard of care. The ruling protects parents from neglect charges as long as they are acting under the guidance of a licensed physician and have not wholly abandoned medical treatment. This precedent makes it more difficult for the state to intervene in family medical choices, shifting the focus from whether the 'best' treatment is being provided to whether 'adequate' treatment, as supported by a licensed professional, is being administered.
