The Alaska Supreme Court just reaffirmed a very important legal and ethical principle – declaring that prayer is not a replacement for medicine. While this may seem obvious to many, this is a critical legal decision. It will probably not have the downstream effect that it should, but it does highlight a vital reality.

The case involves Rachel “O”, who has been taking care of her mother, Tiffany “O”. Rachel states that because she graduated from a ministry school she is qualified to treat her mother solely with prayer, including her mother’s epilepsy, and emergency treatment. The essence of the ruling is this:

“If Tiffany required immediate medical attention, the results could be fatal,” the court concluded. “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.”

Generally, when the Constitution or other laws establish that people have certain rights, the state cannot infringe upon those rights, unless the state has a “compelling interest” that is deemed by the courts to be greater than the infringement on individual rights. This is a balancing act, and can sometimes lead to controversial decisions. Eminent domain is an example – we have a right to property and the state cannot seize our property, unless they have a compelling public interest in eminent domain (they need to build a highway through your property). This is meant to balance public interest with individual interest. This became highly controversial because of the Kelo vs New London case, in which the Supreme Court expanded eminent domain to include the state’s interest in maximizing its taxation.

Another example often cited is seat belts or helmet laws – can the state require you to take basic measures to protect yourself? What is the state’s compelling interest? Is protecting its citizens, even from themselves, sufficient? What if you get into an accident and your injuries cause disability which makes you a burden on the state? That is considered a compelling enough state interest to justify the small decrease in liberty represented by having to wear a seat belt while in a car.

The state also has an interest in public health, which is why it can pass laws to mandate or compel vaccination, mask wearing, or take any of the other many public health measures that it does. In every case the courts decide the proportionality between the liberty that is sacrificed and the state’s compelling interest.

So in this case the courts had to decide the proportionality between limiting religious freedom and taking care of those who cannot take care of themselves, which is considered a core responsibility of the state. The limit to religious freedom in this case seems minor. Rachel is perfectly free to pray for her mother in any manner she desires, without limit. Why does her religious freedom require that this prayer occurs instead of medical care? Rachel did argue that the decision amounts to religious discrimination because her care is “based on the tenets of religion instead of how the state wants her cared for.” But the court did not buy that argument.

I could not find in the news coverage exactly what sect Rachel belongs to. Some, like Christian Scientists, no only believe in prayer, they do not believe in medicine, thinking it represents a lack of faith. Rachel may have been operating under her personal beliefs, rather than those of a specific sect.  She said, for example: “psych meds aren’t God!; nor are they life preserving, nor are they healing!” There were multiple instances of Rachel failing to give Tiffany basic medical care, leading the court to conclude:

In this case, while Rachel is Tiffany’s daughter and cared for Tiffany as her guardian for several years, the superior court correctly noted that Rachel’s beliefs and behavior constituted a barrier to Tiffany getting her needs met. The court pointed out that, due to her condition, Tiffany needs a guardian to make “objective decisions” for her. The superior court noted that a history of family tension and Rachel’s “hostility, bordering on paranoia, toward outside entities” resulted in Tiffany “losing valuable services and resources to which she is entitled.”

So this case seems fairly clear – Tiffany’s right to “valuable services” exceeded Rachel’s right to decide how to treat her based upon her personal religious convictions. There is a further principle here as well – religious freedom also includes freedom from religious, including freedom from the religious choices that other people make. In this case Rachel was imposing her personal religious beliefs onto Tiffany, even to the point of endangering Tiffany’s life. We often see these cases when it comes to parents caring for children with only prayer. In those cases there is the added liberty of a parent’s right to care for and raise their own children. I would argue, however, that the state has an even more compelling interest to make sure that children receive at least basic care. But too often the courts side with the rights of parents.

And finally, here are the deeper implications that I think should flow from this decision but probably won’t. The court essentially affirmed that people have the right not only to medicine but to “objective decisions”. This is a critical principle – we need objectivity to determine what is appropriate medicine. To broaden this a bit – in order to have functional objectivity, we need transparency, informed consent, and we need facts. What constitutes objectivity in medicine? Science. We need science to determine the safety and efficacy of any intervention. Without it we essentially have faith healing – relying on personal faith or philosophy instead of the best evidence currently available.

This has direct implications for so-called alternative medicine, much of which is faith-based or at least entirely subjective. Some of it is pseudoscience – it tries to be scientific, but does it badly. But much is unapologetically faith-based (although they may use terms like intuition, culturally-based, traditional, or other euphemisms for faith). By labeling faith healing as “medicine” (even with qualifiers) they are making an end-run around regulations that serve quality control and the establishment of standards within medicine. They short-circuit the separation of church and state, and the distinction, now affirmed by this court, between objective medicine and prayer, or any form of faith healing. This is demonstrably eroding the state’s ability to meet their “compelling interest” to protect people from fraudulent or harmful health care, or substituting magic for health care.

The law, and science, both require internal consistency.