Newmark v. Williams
1991 Del. LEXIS 104, 21 A.L.R. 5th 857, 588 A.2d 1108 (1991)
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Rule of Law:
The state's interest in preserving a child's life, under the doctrine of parens patriae, does not overcome a parent's right to refuse medical treatment when the proposed treatment is highly invasive, has severe side effects, and offers a low probability of success.
Facts:
- Three-year-old Colin Newmark developed an aggressive, advanced form of cancer known as Burkitt's Lymphoma.
- His parents, Morris and Kara Newmark, are members of the Christian Science church, which believes in spiritual healing through prayer rather than conventional medical treatment.
- Out of fear of criminal liability, the Newmarks took Colin to the duPont Institute, where doctors surgically removed a large intestinal tumor; the parents consented to this as a 'mechanical' procedure.
- After the surgery, doctors diagnosed the advanced cancer and recommended an 'extremely intensive' regimen of chemotherapy.
- Dr. Rita Meek, a pediatric oncologist, testified that the chemotherapy offered at best a 40% chance of 'survival,' which she defined as living two years without a recurrence of cancer.
- Dr. Meek also testified the treatment was highly toxic, would have severe side effects including kidney failure and high risk of infection, would bring the child 'near death' with each cycle, and could itself be fatal.
- The Newmarks refused to consent to the chemotherapy, choosing instead to rely on spiritual treatment and prayer in accordance with their religious faith.
Procedural Posture:
- The Delaware Division of Child Protective Services (DCPS) petitioned the Family Court for temporary custody of Colin Newmark to authorize chemotherapy.
- The Family Court, a trial court, granted DCPS's petition, finding the Newmarks' refusal to consent to chemotherapy constituted child neglect.
- The trial court issued a stay of its order to permit the Newmarks (appellants) to file an immediate appeal to the Delaware Supreme Court, the state's highest court, against DCPS (appellee).
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Issue:
Does a parent's refusal to consent to a highly invasive and risky medical treatment with less than a 40% chance of success for their terminally ill child, based on sincere religious beliefs, constitute child neglect under Delaware law justifying state intervention?
Opinions:
Majority - Moore, Justice.
No, a parent's refusal to consent to such a risky and invasive treatment with a low chance of success does not constitute child neglect. The court must conduct a balancing test weighing the interests of the parents, the child, and the state. While the state has a significant interest in preserving life under the parens patriae doctrine, that interest is not absolute and diminishes as the intrusiveness of the proposed medical treatment increases and the prognosis for success dims. Here, the proposed chemotherapy was exceptionally toxic, painful, and life-threatening in its own right, with less than a 40% chance of success. Given these egregious facts, the parents' fundamental right to make decisions for their child, coupled with the child's interest in dignity and freedom from such an invasive regimen, outweighs the state's interest. Therefore, the Newmarks' decision did not amount to neglect.
Analysis:
This decision establishes a significant limitation on the state's parens patriae power in medical treatment cases involving minors. It moves beyond a simple 'life vs. religion' framework to a more nuanced analysis that considers the specific nature, risks, and success probability of the proposed treatment. The case sets a precedent that parental autonomy is given greater weight when a medical procedure is highly invasive, toxic, and offers a low chance of a cure. It distinguishes such situations from cases where parents refuse simple, safe, and highly effective treatments (like blood transfusions), thereby creating a spectrum for judicial review of parental medical decisions.
