The word "neglect" implies that someone has given up caring. But in cases of medical neglect by parents, it can be just the opposite. Recent, highly publicized cases of child medical neglect highlight this paradox. Take Daniel Hauser, the Minnesota boy currently on the run with his mother to avoid court-ordered medical treatment for his cancer. His parents care deeply about his health and well-being, but in a way that conflicts with the best-accepted medical practices for treating Hodgkin's lymphoma (They want to treat him with holistic therapies).
In some cases, parents don't have the ability or resources to give their children the help they need, but also can't bear to give them up, which may be the case with a South Carolina woman, Jerri Althea Gray. Gray and her son, Alexander Draper, fled the state on Thursday, May 21, allegedly to avoid a court hearing to determine if she was being medically negligent in caring for her son. If so, custody of the child would be turned over to the state Department of Social Services. Alexander, 14, weighs 555 pounds, and though authorities have cited his weight as a main concern, they also allude to more pressing medical problems that prompted social services to take action. (The South Carolina DSS issued a statement saying their involvement is always "limited to cases where health-care professionals believe a child is at risk of harm because a parent is neglecting to provide necessary medical care. DSS would not take action based on a child's weight alone.")
That day, both Gray and Draper were discovered at a laundromat in Maryland. Gray was arrested on a S.C. warrant for violating a child custody order and taken to a correctional facility in Baltimore. Her son was examined by paramedics and turned over to the Maryland Department of Social Services while arrangements were being made to get him back to his home state.
With the case of Daniel Hauser, the state was able to make a very clear argument for what they consider neglect: Daniel had cancer that was 90 percent curable with a certain treatment, and his parents were refusing that care. (Whether or not you think it's neglect is a different matter: a Newsvine poll posted on Thursday is split almost down the middle.)
We don't have nearly as much information about Alexander Draper's condition, except that the charges of neglect are in some way related to his extreme obesity. But his mother's arrest has raised questions. What constitutes medical neglect when cases aren't as clear-cut as Daniel Hauser's? It's neglect if a mother isn't giving her sick child proper medication. But what if she's missing doctor's appointments for a chronic condition? Not feeding a child is neglect, but what if a father only feeds his son donuts and soda? There's clear precedent for the state to step in if a parent isn't doing anything to stop cancer that could kill a child in six months. But what if a parent isn't doing anything to stop the onset of type 2 diabetes, a condition that could cause serious lifelong problems and eventual death?
As a matter of necessity, cases of neglect taken on by the DSS in most states are ones that are incredibly dire. "I don't think any social-service agency that's operating at all sensibly will try to look very far in the future if you're talking about things like diet," says Carl E. Schneider, a professor of internal medicine and law at the University of Michigan and a member of the president's commission on bioethics. "They're always under-funded, they always have all these acute cases to worry about, and in terms of allocation of those limited resources, you have to go where those acute problems are."
In fact, the social-service stories that often make the news are ones where agencies didn't intervene in time: where they failed to protect severely abused children. Sadly, the cases only attract public attention when the neglect results in death or serious harm.
But aside from structural problems within the social-service system, Schneider points out the extremely challenging position the state faces when the issue is medical neglect. "[The state] can tell you to take better care of your child, and if you just don't do it, then what? It's hard to sanction parents," he says. "Are you going to fine some parent who is probably poor to start off with? Are you going to put the mother in jail? That won't do the kid any good. After that, you have to start talking about taking the child away, and that is unlikely to be a good thing."
The effects of poverty can't be overlooked when evaluating cases of possible neglect. Doctor's appointments and medicine are expensive. The government provides social services to help parents who don't have the financial or emotional means to care for a child, but understanding, accessing and corralling those services—which can be spread out through different departments and branches of government—can prove challenging for even the most organized parent. And the parents who end up working with social services are often facing circumstances that make being organized nearly impossible. Many don't get paid sick leave, so taking a child to a Medicaid doctor across town can mean losing a day's pay or even a job if the absences are repeated. Often, says Schneider, "these are parents who are leading very, very difficult lives with all kinds of horrifying problems to deal with, and the child is only part of the difficulty of their lives. They have very few resources for helping themselves, much less helping the child."
In situations like these, the state has to make a choice between endangering a minor's physical health by doing nothing, or endangering his emotional health by taking away whatever stability the family provides. Even when parents love their children, the government often has to determine if that love is enough. It's never easy, it's always heartbreaking and—worst of all—the child loses out, one way or another.