THE story of Pamela Hamilton is a sad one - for her, for her parents, her church, and the state. The 12-year-old girl died under mandated medical care. She and her family opposed extensive chemotherapy treatments for a diagnosed tumor in her leg. Their grounds were religious. As members of the Church of God of the Union Assembly in La Follette, Tenn., the Hamiltons believed in spiritual healing and refused medication on religious grounds.
Tennessee's Department of Human Services took Pamela into custody when her parents wouldn't provide medical treatment for her. She was given chemotherapy, which many doctors regard as controversial treatment.
In ordering her custody, the state reasoned that Pamela was too young to make up her own mind about whether to rely on medicine or prayer. She should have the opportunity to form her own religious beliefs when she becomes an adult, the district attorney argued.
When Pamela died, the physicians said the treatments were not started early enough to save her life - although no medical guarantees had been given for her recovery.
This case raises two fundamental freedom questions:
1. May the state - over the objection of parents - make decisions about what is in the best interests of a child?
2. May constitutional guarantees of free exercise of religion be set aside under certain circumstances?
United States courts are now struggling with these issues. What they do may greatly change public policy.
The issue of parental rights versus state jurisdiction is central to Cruzon v. Missouri Dept. of Health, a case now being decided by the US Supreme Court. Although it involves a young woman who is in a vegetative state as a result of an automobile accident, and there is no apparent religious issue, the jurists must decide whether the parents' desire to remove feeding tubes should take precedence over the state of Missouri's claim of a fundamental responsibility to keep the patient functioning through mechanical apparatus. Ross Nankivell, visiting assistant professor at Northern Illinois University's college of law, says the main issue here is not the ``right to die'' but the ``right to refuse treatment.''
Findings in the Cruzon case could influence the results of other cases that more directly address the right to practice what you preach, say some church leaders.
The Mark Rippberger family rely on prayer for healing. Their five children are healthy youngsters. But Natalie, an infant, died after an illness, later diagnosed to be meningitis.
The Rippbergers had prayed fervently for Natalie on the grounds that their religion, Christian Science, had effectively healed them in the past. The state prosecuted them on manslaughter and felony child-abuse charges and a California jury brought in a conviction on the abuse charge while finding the couple not guilty of manslaughter.
An attempt by the prosecutor to give the state legal jurisdiction over the other children in the family was denied by the judge. But the parents have been fined, sentenced to public-service work, and ordered to report any future illnesses of their children to authorities and learn about childhood diseases through a manual designed for home use. An appeal is in the works.
Religious free exercise has been a difficult issue for US courts. There is consensus that constitutional prohibitions in the First Amendment against government ``establishment'' of religion are usually absolute, but that religious ``free exercise'' may be limited.
The high-water mark for the right to practice-what-you-preach came with a Supreme Court ruling in 1972. The jurists ruled in Wisconsin v. Yoder that the Amish religious sect is exempt from state compulsory-education laws that require children to attend school beyond the eighth grade. The Amish, who abide by a simple rural lifestyle, say that education beyond this point teaches worldly values that are at odds with their creed.
Then Chief Justice of the United States Warren Burger, writing for a 7 to 2 majority of the Supreme Court, stressed that the Amish had a long history - about 300 years - of resisting modern influences. He added that the state had not demonstrated a ``compelling governmental interest'' in requiring Amish children to go to high school over their parents' objections.
In partial dissent, then Associate Justice William Douglas stressed that the children be consulted about their own visions of the future before they were ``forever barred from entry into the new and amazing world of diversity that we have today.''
The words of the Chief Justice, however, still ring in the ears of those seeking the protection of the free-exercise clause: ``A way of life that is odd or even erratic but interferes with no rights or interests of others is not to be condemned because it is different.''
Jesse Choper, dean of the University of California at Berkeley law school, has said that the Amish ruling represents the crest of religious liberty in the courts.
William Ball, who successfully argued the case for the Amish, agrees, but he points out that in recent years the High Court has altered the government's burden of proof from ``compelling state interest'' to simple ``public interest.'' A recent case, involving use of land for a state highway that American Indians considered sacred, illustrates this point. The Supreme Court, in ruling for the state, used the less-stringent standard of public interest.
Where the free-exercise issue is prayer in connection with treatment of a sick child, constitutional scholars and others are divided.
Some take the position that the First Amendment protects only religious beliefs, not its practices. Few, however, downplay the importance of free exercise itself.
James Reichley, a Brookings Institution scholar who specializes in church and state policy, says that ``free exercise carries a lot of constitutional weight. There must be real reasons to limit it.''
Dr. Reichley adds that ``it [free exercise] expresses the Founders' belief that religion is not simply a recognized right but, like [freedom of] speech and press, is essential to free government.''
Pastor Richard John Neuhaus argues that ``religion is universal - the state is not universal.'' He says that ``free exercise of religion is intimately connected with all rights of conscience.''
Some religious scholars say there is a lack of tolerance today for unpopular religious beliefs, or those outside the mainstream. Bettina-Gayle Almeleh of the American Jewish Committee, a group that endorses religious freedom and separation of church and state, insists that ``tolerance isn't enough.''
``In the United States, we do a very bad job of explaining religious diversity,'' she says.
Robert Maddox, executive director of Americans United for Separation of Church and State, quotes Thomas Jefferson who said ``we are a people of religious freedom, not tolerance.''
The Rev. Mr. Maddox says that there is a need for ``a raising of consciousness'' among prosecutors in current religious cases. And he urges nonmainstream groups to do a better job of ``communicating themselves'' as part of the religious community.
``Maybe then these cases will be handled with a scalpel rather than a bush-ax,'' he says.
Robert Bork, a longtime federal judge and recently an unsuccessful nominee for a seat on the US Supreme Court, says that ``prosecuting people criminally'' for believing in and practicing a particular religious faith ``is a wild overreaction.''
Yet as Reichley points out, ``it may be too much to expect the state totally to accommodate pure Christianity.'' He concludes that it isn't ``easy to carry out the fullness of one's belief.'' Nonetheless, he stresses the importance of seeking ``as much freedom as possible for the sake of a free society.''