. While AAP recognizes the importance of religion to people's lives, it also warns physicians and other health care professionals should put the health and welfare of children over religious considerations (Committee on Bioethics 1997). It encourages pediatricians to respect parents' decision but not when their religious convictions interfere with medical care necessary to prevent harm, suffering or death. When this happens, pediatricians should seek the authorization of the court to override parental authority. If the threat to a child's life is imminent, the health care practitioner should intervene over parental objections. Securing court authorization should, however, be the last course of action. The health care practitioner should cooperate with the family in applying appropriate palliative care. Even when the securing of court authorization is the last option, physicians should continue to respect the parents' religious beliefs as well as their role in rearing their children (Committee on Bioethics)..

In essence, the AAP rejects and opposes religious doctrines that refuse health care for sick children (Committee on Bioethics 1997). The Academy believes the laws should not encourage or tolerate parents who deny their sick children appropriate medical care. It also believes that laws should not exempt parents from criminal or civil liability and prosecution for religious reasons (Committee on Bioethics).

The Constitution accords parents the right and privilege of raising their children in the assumption that they naturally possess their children's best interests. This right extends to the training and indoctrination of children but not to medical choices, which involve life or death consequences (Bender 2004). The State may intervene and override parental authority in emergency situations, even it must infringe upon parents' religious convictions to refuse treatment. For example, Jehovah's Witness beliefs prohibit blood transfusions and the use of blood products, even at the risk of death. On the other hand, Christians rely almost entirely on prayers to heal people and, as a result, do not seek proper medical intervention or treatment. The Courts authorize blood transfusions, appendectomies and other medical interventions to save the health or lives of children, whatever the convictions or wishes of their parents. The State thus acts in the best interest of the affected children, whom it protects as future "productive citizens." Its exercise of parental authority allows these children the best chances of surviving into adulthood. In the 1944 ruling of Prince v Massachusetts, the Court said that parents could opt to become martyrs but not free to "make martyrs of their children (Bender)."

Some urgent medical interventions have been deferred by the Courts back to parents, however (Bender 2004). In the Newmark v Williams of 1991 case, the doctor of a cancer-stricken three-year-old offered a 40% success by chemotherapy. The parents rejected and preferred healing by a Christian practitioner. The Court ruled in favor of the parents, reasoning that they knew and loved the child more. While there was doubt as to the effectiveness of the preferred course of action, the Court's interest was in protecting the future of the child. It did not think that forced intervention would guarantee to promote or preserve the future of the child-citizen (Bender).

Many elective surgical and medical procedures not related to the improvement of a child's physical health are in contention (Bender 2004).. These procedures include infant circumcision and human growth hormone treatments. They put children in vulnerable conditions. Circumcision can cause pain, infection, constriction due to scar tissue and interference with bonding with one's mother. Human growth hormone treatments, on the other hand, may reduce self-esteem, affect parent-child-relationship and create dependency on the hormone on account of an imaginary "handicap (Bender)."

The best interests standards are meant to maximize benefits and minimize harm for minors who are unable to make appropriate medical decisions (Kopelman 2008). It is first used in determining the best treatment option for a sick child. Parents and clinicians weigh all the sides and balance harm with benefit. Then they decide on the most suitable treatment plan, based on these considerations (Kopelman).

This standard is also used in divorce proceedings in court when settling custody disputes (Kopelman 2008). When the parents cannot agree, the judge balances the complexities of both sides and then rules according to the child's best interests. Policy-makers also apply this standard in evaluating health systems priorities....

The U.S. already spends approximately 14% of its gross national product on health care. Despite this, the death rate for children in the U.S. continues to be the highest among the rich countries in the world. New laws intended to improve the health of children have not dented U.S. infant mortality rates, which rank the U.S. As the 18th highest in the industrialized world. Furthermore, health problems among children in the U.S. emanate from the failure to provide appropriate health care for them. Health care provisions are most needed for allergies, asthma, dental conditions, hearing loss, vision defects and chronic disorders. and, lastly, the best interests standard applies in determining research policies for children. Some parents allow minor children to participate in studies, which could benefit them, directly or indirectly (Kopelman).
Immunization has been one of the successful public health interventions in preventing diseased condition, mortality and health care costs (Salmon 2002). It is an effective strategy in the U.S. To control preventable disease through vaccines. All laws requiring vaccination or immunization are State or local laws. No federal laws require it. Massachusetts was the first to pass an immunization law in 1809, followed by 20 other States for particular diseases as a requisite for school entrance in 1963. In 1970, 20 States observed this law. A landmark study by Robbins, et al. In 1960 showed that these States had lower incidence of measles. By 1980, all 50 States enforced school immunization laws. Eventually, many laws were amended to cover the entire school population. State laws make sure that all or nearly all children over 5 years are fully vaccinated. It demonstrates public and public health commitment to vaccination. These allow immunization with additional resources. Centers for Disease Control and Prevention established a system for immunization, regardless of political interest, media coverage, budget allocations and presence or absence of outbreaks. The Supreme Court upheld its constitutionality. Many States today also require licensed day care centers to enforce vaccination (Salmon).

However, some perceive these laws as coercive on the part of the State (Salmon 2002). In response, 48 States permit religious exemptions and 19 allow philosophical or personal exemptions. A study conducted by Rota, et al. found differences in the ways the States implement non-medical exemptions. The main objective is to acquiesce to the desire of the small minority who objects to immunization for religious reasons. The risks incurred by those who secured exemptions for religious reasons were a 35% greater susceptibility to measles. This was according to a population-based cohort study on measles from 1982 to 1992. This finding was validated by another population-based, retrospective cohort study by Feikin, et al. On reported cases of measles and pertussis in Colorado between 1987 and 1998. Feikin and his team found that exemptors were 22 times or 95% more susceptible to measles and 5.9 times or 95% to pertussis (Salmon).

By constitutional law, States compel vaccination in the interest of public health (Salmon 2002). The Supreme Court has not ruled on the constitutionality of religious beliefs, which ground themselves in the First Amendment and liberty rights. More studies appear needed to discover the reasons for exemptions and parents' refusal of vaccination (Salmon).

Method

This study used the descriptive-normative method of research in recording, describing, interpreting, analyzing and comparing information gathered from authoritative and timely sources.

Bibliography

Bender, Denise G. Do Fourteenth Amendment Considerations Outweigh a Potential State

Interest in Mandating Cochlear Implantation for Deaf Children. Journal of Deaf

Studies and Deaf Education: University of Oklahoma Health Sciences Center, 2004

Committee on Bioethics. Religious Objections to Medical Care. Volume 9 number 2

281 Pediatrics: the American Academy of Pediatrics, 1997

Kopelman, Loreta M. Using the Best Interests Standard to Make Decisions for Children.

The Bioethics Center Newsletter: University Health Systems of Eastern Canada, 2008

Pasquerella, Lynn. Protecting Faith vs. Protecting Futures. The PRC Report Online:

University of Rhode Island, 2000. Retrieved on March 15, 2008 at http://www.uri.edu/artsci/psc/pscreport/spring00/paski.html

Salmon, Daniel a. Mandatory Immunization Laws and the Role of Medical Religions and Exemptions. Institute of Vaccine Safety: Johns Hopkins Bloomberg School of Public Health