In Re Willmann
24 Ohio App. 3d 191, 493 N.E.2d 1380 (1986)
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Rule of Law:
The state's interest in protecting the health and welfare of a child under the doctrine of parens patriae can override the parents' fundamental right to make medical decisions for their child, especially when the parents' refusal of necessary medical treatment for a life-threatening condition places the child's life at risk.
Facts:
- David Willmann, a seven-year-old boy, was diagnosed with osteogenic sarcoma, a malignant and aggressive form of bone cancer, in his upper left arm.
- Physicians at Children's Hospital Medical Center (CHMC) determined that David's only chance for survival was a regimen of chemotherapy followed by surgery, which could involve amputation of his arm and part of his shoulder.
- David's parents, Douglas and Lori Willmann, initially consented to chemotherapy in October 1985, and the treatment successfully reduced the tumor's size by 20%.
- In December 1985, when doctors advised that surgery was immediately necessary, the Willmanns refused to provide consent.
- The parents' refusal was based on their religious belief, derived from their interpretation of the Bible, that David had already been divinely healed and therefore no longer needed medical treatment.
- The Willmanns' own consulting expert, Dr. Norman Jaffe, concurred with the CHMC's treatment plan and estimated it gave David a 60% chance of survival.
- Medical experts testified that without the proposed treatment, the tumor would continue to grow, spread, and David would likely die within a year.
- After the parents withdrew consent for all treatment, including further chemotherapy, the tumor began to grow again and invade David's shoulder joint.
Procedural Posture:
- Children's Hospital Medical Center (CHMC) filed a complaint in the Juvenile Division of the Hamilton County Court of Common Pleas.
- The complaint alleged that David Willmann was a dependent child whose condition warranted the state assuming guardianship in his best interests.
- The juvenile court conducted adjudicatory and dispositional hearings.
- The juvenile court found David to be a dependent child as defined by R.C. 2151.04(C).
- The juvenile court issued an order placing David in the temporary custody of CHMC for necessary medical care, including chemotherapy and surgery.
- David's parents, Douglas and Lori Willmann, as appellants, appealed the juvenile court's order to the Court of Appeals of Ohio.
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Issue:
Does the state's interest in preserving the life of a child, under its parens patriae power, justify overriding the parents' constitutionally protected right to refuse necessary life-saving medical treatment for their child based on their religious beliefs?
Opinions:
Majority - Shannon, P.J.
Yes. The state's parens patriae authority to protect a child's life and welfare justifies overriding parental decisions when those decisions deny necessary, life-saving medical care. While parents have fundamental constitutional rights concerning the care and custody of their children and religious freedom, these rights are not absolute. The court found clear and convincing evidence that David was a 'dependent child' because he had a life-threatening illness, the recommended medical treatment was his only chance for survival, and his parents were refusing it. Citing Prince v. Massachusetts, the court reasoned that the right to practice religion freely does not include the liberty to expose a child to ill health or death. It held that while parents may be free to become martyrs themselves, they are not free to make martyrs of their children before they reach an age where they can make that decision for themselves. Therefore, the state's intervention to save David's life was not only justified but necessary.
Concurring - Keefe, J.
Yes. The court correctly determined that the state must intervene to protect David's right to live when his parents refused necessary medical care. However, the concurring opinion expresses concern over the indefinite nature of the juvenile court's order granting temporary custody to the hospital, suggesting a fixed period (e.g., six months) with mandatory review would have been more appropriate. Despite these reservations, the judge concurred with the judgment because the 'temporary' custody status is continually reviewable by the juvenile court at the parents' request, providing them with an ongoing legal avenue to seek termination of the order.
Analysis:
This decision strongly affirms the state's parens patriae power as a significant limitation on parental rights in the context of medical decision-making for children. It establishes that a parent's right to religious freedom does not create a right to deny a child life-saving medical treatment when a clear medical consensus exists regarding the treatment's necessity and potential for success. The case solidifies the principle that the child's right to life is paramount and empowers courts to intervene in cases of medical neglect, even when parents act from sincere religious conviction. This precedent serves as a critical guide for courts balancing the fundamental rights of parents against the state's compelling interest in protecting the lives of children.
