Ethics Statements

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Parental Rights Position Statement

CMDA affirms that children at all stages of development are precious human beings bearing the image of God. Children are loved by God, belong to their families, and share in their communities. The family is the normal environment wherein children are to be cherished, protected, and prepared to take on adult responsibilities. Families are prior to the state, which has the obligation to protect children and the family structure. As the family is foundational to a well-functioning society, mothers and fathers both have the responsibility to rear their children. Parental rights are an extension of parental responsibility. Parents' claim to authority over their children, while basic, is not unlimited. The state also has a legitimate, though limited, interest in the welfare of minor children as well as in public health, for which reason laws and policies have been established to balance these interests with parental rights.

CMDA members, as healthcare professionals, have important roles in caring for children and families by providing medical and dental care as well as education regarding health issues. Healthcare professionals caring for children are ethically obligated to honor parents' wishes regarding medical treatment decisions, except in certain situations when there is clear evidence that doing so would risk imminent harm. In duly considering the best interests of the child and family, prevention of harm to children should be the primary guiding principle. This guidance is based on the following parameters:

The Parent-Child Relationship before God

  1. The parent-child relationship is established by God. 
  • Parental responsibilities assigned by the Creator include nurturing, disciplining, teaching the child correct behavior, and imparting a knowledge of and respect for the Creator (Deut 4:9, Deut 6:6-7, Pr 23:15, Pr 29:15, Ps 78:5-6). The rights of parents to make decisions for their minor children are derived from these God-given responsibilities.
  • Parents are responsible for making decisions on behalf of minors, because the young have neither the developmental capacity nor the life experiences to make wise decisions (Pr 22:15, 1Cor 13:11).
  1. All human beings are created in God’s image (Gen 1:27), thus both parent and child have equal value in God’s eyes.
  • A child is a gift from God to parents (Pr 17:6, Ps 127:3-5, Ps 128:3).
  • A child is a person from conception, not a product or extension of a parent, nor the property of the state (Ps 139:13, Jer 1:5).
  • Although having children is a scripturally supported good and a mandate for humanity (Gen 1:28, 9:7), no person may presume to have an unassailable right to become or continue to be a parent on his or her own terms (Gen 16:1-12, 30:1-2).
  1. Parental rights do not extend to actions that do not benefit but cause harm to their children (Jer 7:31, Jer 19:5).

Parental Rights and the State (government at all levels) 

  1. God, who established the family, has also established government to protect the innocent (Rom 13:1,4). Both of these human institutions—the family and the state—are humanly imperfect and degraded by the Fall and thus should be subject to checks and balances.
  • Scripture assigns primary responsibility, including the right to make decisions for minor children, to parents (see references in 1A and 1B above). The United States Supreme Court has generally upheld the right of parents to make decisions for their minor children (Appendix). Parents should have the freedom of conscience to rear their children with the beliefs they hold true.
  • Regrettably, not all parents act in their children's best interests, and when children are at immediate risk of harm, it is sometimes necessary for the state to overrule parental authority or, in cases of great harm or potential death, physically remove children from their parental home. The state may also mandate actions it considers necessary for the general welfare, ignoring parental objections. State action in these cases is legitimate, provided that its authority is not abused (see CMDA statement on Immunization).
  • Although the state has the duty to prevent harm, historically governing authorities have at times been the cause of harm to children. Examples include, but are not limited to:

i. Scripture documents the persecution of believers, even children, because of their faith in God (Ex 1:22, Matt 2:16, Acts 16:16-24).

ii. The first victims of the 20th century Nazi Holocaust were physically and mentally disabled children, who were euthanized in the mistaken belief that their elimination would improve the genetic "hygiene" of the public.

iii. Rogue states have deployed chemical weapons, including nerve agents, against their own people, including children.

iv. Government forces in some countries turn a blind eye to or, in some instances, perpetrate child trafficking, including recruitment of child soldiers, forced labor, and commercial sexual exploitation.

v. Courts have ruled against parents who opposed their minor children’s desire to receive puberty-blocking drugs or undergo sex change surgery or removed from the home children whose parents homeschooled them, on the mistaken logic that “misgendering” children by denying them access to specific medical procedures or providing religious instruction in the home constitutes child abuse.

vi. Governments have subjected families to mandated abortions.

vii. Governments have supported, tacitly or explicitly, or by funding, research that creates and destroys children at the embryonic stage of development.

At such times, healthcare professionals share in the obligation to protect the vulnerable, draw public attention to these harms, and articulate reasons why those responsible should be held accountable.

  1. The state determines the age at which a person is no longer considered a minor and, therefore, has the right to make medical decisions independently of his or her parents. Emancipated minor laws alter this age on a case-by-case basis, setting aside parental authority for those minors considered “emancipated.” These “emancipated minors" may still be in need of adult guidance.

Recommendations

  1. Healthcare professionals caring for children should begin with the assumption that a child's parents (whether biologic, adoptive, or legally appointed guardians) are concerned about the child's welfare and intend to make decisions that are in the best interest of the child.
  2. When parents disagree with medical recommendations and the child's welfare is not at immediate risk, healthcare professionals should continue to provide compassionate care and work with the parents in ongoing mutual dialogue in the prayerful hope that they will come to trust the professional's recommendation.
  3. When parents disagree with medical recommendations and the child's welfare is at immediate risk, healthcare professionals should, when necessary, intervene with assistance from the state on behalf of the child. Parental rights, as understood both scripturally and legally, do not extend to causing harm to a child from abuse or neglect or the refusal of life-saving or health-preserving care (see CMDA statement on Limits to Parental Authority in Medical Decision-Making).
  4. It is appropriate that the minor patient be allowed to participate in medical decision-making to the extent that he or she has the capacity to understand the nature and rationale of treatment. Assent to treatment should always be sought for adolescents and mature minors.
  5. When a minor patient disagrees with his or her parents regarding a medical decision, healthcare professionals should consider the developmental cognitive capacity and values of the patient and strive for consensus toward the medical recommendation. When consensus cannot be reached and the medical team has concerns about the appropriateness of the legally authorized decision-maker's judgment, external review or legal action may be required.
  6. It should not be assumed that laws alone can protect children. Professionals must exercise moral responsibility in order for ethical principles and just laws to have their intended effect. The healthcare professional who has knowledge of harm to a child has a responsibility to alert and cooperate with state agencies to protect the child.
  7. Removal of a child from the parents' care should be undertaken only when there is evidence of serious physical or psychological harm to the child and should not be based solely on the parents' religious beliefs, moral teaching, or educational choices.
  8. Procedures for which there is no legitimate medical indication proven medical benefit include:
  • Female genital mutilation, which causes is known to cause permanent physical and psychological harm.1
  • Gender reassignment hormonal or surgical interventions in children with gender dysphoria (see CMDA statement on Transgender Identification).
  1. When state actions or mandates affecting children usurp parental authority unjustly, are incompatible with medical ethics, or risk harming children, then healthcare professionals have a duty to express concern proportionate to the seriousness of the harm, to educate, and to apply their knowledge and skill to advocate for and protect the children under their care.

Unanimously approved by the House of Representatives
April 26, 2018
Ridgecrest, North Carolina


1 Von Rège I, Campion D. Female genital mutilation: implications for clinical practice. Br J Nurs 2017; 26(18): S22-S27.