Adult Daughter Who Relies on “Faith-Based Medicine” Loses Guardianship Over Intellectually Disabled Mother

From yesterday’s unanimous Alaska Supreme Court decision in In re Tiffany O., written by Chief Justice Joel Bolger:

A daughter was appointed as guardian for her mother, a woman in her 60s who suffers from epilepsy [and is intellectually disabled]. The daughter relied on faith-based medicine to care for her mother, electing to, in one instance, pray over her mother after she became nonresponsive instead of calling emergency services. The superior court ultimately removed the daughter as guardian, finding that her behavior and “intractable belief system” caused her to deprive her mother of appropriate services and care.

We conclude that the superior court did not abuse its discretion when it removed the daughter as her mother’s guardian. We also conclude that removing the daughter as guardian did not violate the Alaska Constitution’s free exercise clause because the State possessed a compelling interest in preventing harm to the mother….

The Alaska Supreme Court has, since 1979, interpreted the Alaska Constitution as presumptively requiring religious exemptions from generally applicable laws; but the court held that this presumption is rebutted here:

Alaska’s free exercise clause was first interpreted in Frank v. State (Alaska 1979). In Frank we determined that, to invoke a religious exemption from a facially neutral state law, three requirements must be met: (1) a religion must be involved, (2) the conduct in question must be religiously based, and (3) the claimant must be sincere in his or her religious belief. “Once these three requirements are met, ‘[r]eligiously impelled actions can be forbidden only “where they pose some substantial threat to public safety, peace or order,” or where there are competing governmental interests “of the highest order … [that] [are] not otherwise served.”‘”

Rachel meets the first Frank requirement because her beliefs regarding medical care are strongly informed by her religion. She meets the second requirement because her treatment decisions are based on her religious training and beliefs. And in the absence of any evidence to the contrary, we assume that Rachel’s religious beliefs are sincere.

With these three requirements met, the second part of the test under Frank requires that a facially neutral statute that interferes with religious-based conduct be justified by a compelling state interest. In other words, the question becomes whether the government’s interest in protecting Tiffany outweighs Rachel’s interest in following her religious beliefs.

The guardianship statutes reflect the government’s strong interest in protecting the health and safety of a vulnerable ward. A guardian has the duty to “assure the care, comfort, and maintenance of the ward” and to “assure that the ward receives the services necessary to meet the essential requirements for the ward’s physical health and safety.” A guardian may be dismissed if “there is an imminent danger that the physical health or safety of the ward will be seriously impaired.” These statutory interests are similar to the government’s interests in protecting the life, health, and safety of other vulnerable groups, interests that we have previously found to be compelling.

“[A]fter a court determines that the claimed exemption implicates a compelling government interest,” the appropriate question “is ‘whether that interest … will suffer if an exemption is granted to accommodate the religious practice.'” Here there is evidence that, should this exemption be granted, Tiffany’s health and safety would be at risk. If Rachel cares for her mother following the tenets of her religious beliefs, then she will abandon the duties described by the guardianship statutes, including the duty “to meet the essential requirements for [Tiffany’s] physical health [and] safety.” By depriving her mother of personal care services and emergency services in favor of prayer, Rachel not only fails to satisfy the essential requirements under the statute, but also puts Tiffany’s health and safety at risk.

Granting this exemption would be directly counter to the State’s interest in protecting its most vulnerable citizens from harm. Rachel stated that if her mother were to have a heart attack or stroke, she would first pray for her rather than call emergency services. The threat to Tiffany’s health, should she be returned to Rachel’s care, is not speculative. While serving as guardian, Rachel did not ensure that Tiffany received her epilepsy medication as prescribed, putting Tiffany at significant risk.

Should Rachel be reinstated as guardian, Tiffany’s health and safety will be seriously compromised. If Tiffany required immediate medical attention, the results could be fatal. For this reason, while religious liberty is a fundamental right under the Alaska Constitution, the State’s actions in this case are justified by a compelling interest.