Vaccination and custody issues – child’s best interest

On March 22, 2016 a court of appeals in Michigan joined several other states in finding that a parent who lost custody cannot refuse to immunize her children.  The court upheld an order to immunize the children even though if fit, the parent could have  used a religious exemption her state offered. As in other jurisdictions, the court’s ruling on vaccination and custody was based on the child’s best interests, though the Michigan court emphasized that vaccinating was both for the benefit of the child and the community.

The Michigan court emphasized the extensive powers courts have to make decisions for children in their care. Fit parents have extensive leeway to make medical decisions for their children; but if found unfit, that broad power belongs to the court.

The court also interpreted the law to narrow the effect of other provisions that would have allowed the parent to oppose immunization. This was not the only possible interpretation, and the route the court chose shows its support of the decision to vaccinate and protect children and community. 

The facts of the case

 

Parents of four children were found unfit parents. The reasons “included periods of homelessness and unstable housing, failure to provide financial support and food for the children, improper supervision of the children, and respondent’s mental health and substance abuse issues, including suicidal ideation prompting respondent’s hospitalization.”

The children were placed in foster care and the parents started a program with the goal to have the family reunited. The social worker working with the children requested that they be immunized, and the parents opposed on religious grounds. The trial court held a hearing and listened to the parents and to the children’s pediatrician who supported immunizing them for their own sake and for protecting the community from disease.

The court concluded that the parents, having been declared unfit, lost the power to oppose immunization. “Because it concluded that the giving of vaccines would benefit the children and society, the trial court entered an order for the children to receive the physician-recommended immunizations.”

The parents appealed on both constitutional and statutory grounds. The Court of Appeals rejected both challenges.

The decision in context

 

We have seen other jurisdictions – Maine, Oregon, North Carolina and Georgia rule that the state has the authority to vaccinate children taken out of their home and put in its care over parental opposition, even if the parent could otherwise use an exemption to school immunization requirements. This is because vaccinating is clearly in a child’s interest. Even the one outlier – an Arizona court of appeals acting over a strong dissent  – only went the other way on the grounds that the harm was not imminent enough, not on the grounds that immunizations were against the child’s best interests.

The Michigan court arrived at the same result, and it’s worth going over its arguments briefly to explain, again, the legal situation in these cases.

The constitutional argument

 

The court addressed in detail the rights of parents over their children, summarizing the fact that our jurisprudence acknowledges that the Fourteenth Amendment’s due process clause protects those as part of its protection of liberty. The court reminded us that parental control is not absolute because “’a state has a legitimate interest in protecting the moral, emotional, mental, and physical welfare of the minor.’ In re Sanders.”

However, it stated that in the case of a fit parent, there is a presumption that the parent is acting in the best interest of the child. In contrast, for an unfit parent, “the state may interfere with a parent’s right to direct the care, custody, and control of a child.”

I think the language in the ruling in relation to fit parents – something not before the court, and hence not part of the binding part of the decision – was too expansive. The precedents the court itself relied on, especially Prince v. Massachusetts, remind us that even when dealing with fit parents the state may intervene to protect a child’s health and welfare. While this does not affect this particular decision – since the focus was on unfit parents, the discussion of the rights of fit parents is just provided as contrast, with the boundaries of parental authority not at issue – it can give the wrong impression. I wish the court has qualified it more.

But that was not the focus of the decision. Instead, the decision determined that unfit parents cannot constitutionally prevent the state from acting for the child’s welfare.

The statutory argument 

 

The court pointed out that the provisions governing disposition of minors under the state’s custody – embodied in MCL 712A.18(1)(f) in the juvenile code – are very broad and provide courts extensive authority. The parent tried to argue that the exemptions in two other statutes limit the state’s authority to require immunization over the parents’ objections:

  1. The clause in the public health code that provides for exempting children from school immunization requriements;
  2. MCL 722.127 of The Child Care Organizations Act, which allows parents to exempt from immunization children in institutions, including foster homes.

The court rejected both arguments, interpreting the court’s authority under the juvenile code as extremely broad, and stating that’s what was used here. Since the juvenile code does not have an exemption provision, the exemptions elsewhere do not limit the court’s authority.

This argument seems very strong for the school immunization requirements, since immunizing foster children can be independent from the school context. But it’s less strong for the Child Care Organizations Act, which on its face seems to cover foster placement. To counter that the court drew on an established cannon of interpretation which states that a specific provision of law trumps over a general one. Since the Juvenile Code’s provision is more specific, it governs here. The court was also – appropriately – influenced by the policy argument supporting immunizing a child to protect child and community.

The court also rejected an argument that a case finding no distinction between fit and unfit parents for custody purposes, concluding it’s irrelevant here.

In short, the court interpreted the trial’s court authority to order immunization for the child broadly, rejecting several potential legal counter arguments and reaffirming the value of vaccinating. The court concluded:

[infobox icon=”quote-left”]After her adjudication as an unfit parent, respondent lost, at least temporarily, the right to make immunization decisions for her children. That responsibility now rests with the trial court, and the trial court did not exceed its authority by ordering immunization of the children over respondent’s objections given that the facts proven and ascertained demonstrate that immunization is appropriate for the welfare of the children and society.[/infobox]

Vaccination and custody

 

Vaccines protect children and society. Ordering vaccinating of children taken from their parents’ custody over the opposition of such parents is appropriate, given those benefits, and Michigan joined other jurisdictions in so finding.

Full case – Michigan Custody Vaccine decision

Dorit Rubinstein Reiss
This article is by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law (San Francisco, CA), is a frequent contributor to this and many other blogs, providing in-depth, and intellectually stimulating, articles about vaccines, medical issues, social policy and the law. 

Professor Reiss writes extensively in law journals about the social and legal policies of vaccination. Additionally, Reiss is also member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.