OREGON CITY, Ore. (AP) - When Dr. Seth Asser saw row after row of flat headstones marking children's graves in a small cemetery not far from the end of the historic Oregon Trail, he knew many of these early deaths should not have happened.
The children's parents relied on faith healing, instead of doctors.
The pediatrician published a landmark study concluding many of the deaths could have been prevented if the children had received medical care.
"What struck me was the fact that it was obvious from the expressions on the headstones that the children were loved," Asser said. "So it was especially troublesome they were not afforded the care that most parents would give their children."
His study 10 years ago brought attention to the issue, and yet today three criminal cases - two in Oregon and one in Wisconsin - have revived concerns about exemptions that most states grant to parents who rely on faith healing instead of doctors to treat sick children.
Faith healing has deep roots in American history, and yet it may seem surprising that in the 21st century, children still die because parents choose not to seek medical help from physicians.
State laws across the nation exempt members of religious groups from prosecution if they choose faith healing over science. Asser and a colleague, Rita Swan, have been trying to get states to repeal such laws, arguing that safety should always come first, no matter what the parents believe.
"We can't legislate good parenting, but at least we shouldn't have laws allowing bad parenting," said Swan, who now heads the advocacy group Children's Healthcare.
But Swan and Asser have been lonely voices, partly because tragedies are rare and partly because legislators are loath to challenge parental rights, especially when they are intertwined with the constitutional right to freedom of religion.
"There hasn't been a groundswell of organized advocacy to get the laws changed," said Shawn Francis Peters, a University of Wisconsin professor and author of a book on faith healing. "I do think there's broad public sentiment to do it, but that doesn't get things through the meat grinder of legislation."
According to the U.S. Department of Health and Human Services, at least 30 states have specific exemption laws on the books.
What does federal law say? According to HHS, nothing in the amendments to the original 1974 Child Abuse Prevention and Treatment Act, can "be construed as establishing a federal requirement that a parent or legal guardian provide any medical service or treatment that is against the religious beliefs of the parent or legal guardian."
Five states have repealed exemption laws, Swan said: Hawaii, Maryland, Massachusetts, Nebraska and North Carolina.
Some states have revised their laws, including Oregon in 1999. After a stormy debate in the Oregon Legislature, then-Gov. John Kitzhaber - a doctor - signed a compromise bill into law that eliminated the Oregon spiritual healing exemption in some manslaughter and criminal mistreatment cases.
Many of the exemption laws were enacted in the 1970s, promoted by two top advisers to former President Nixon - Bob Haldeman and John Erlichman - and an influential senator, Charles Percy of Illinois, who practiced Christian Science.
The religion, founded by Mary Baker Eddy just after the Civil War, embraces a form of faith healing its adherents say is unique and different from the way it is practiced by some fundamentalists.
The Church of Christ, Scientist, emphasizes that it does not prevent any members from seeking medical care, and it is quick to distance itself from other religious groups that demand prayer be the only method for healing.
"One of the mistakes people make is lumping all these groups together," said Stephen Lyons, a Boston attorney who has defended Christian Scientists.
Church leaders also deny their lobbying efforts with state lawmakers across the country have kept the laws on the books, even though Peters and a fellow author on faith healing, Boston College historian Alan Rogers, say the effort is intense and largely successful.
"It's remarkable," Rogers said. "Without exception, it has been the push of the Christian Science church."
Two pending criminal cases expected to test Oregon's revised law are against parents belonging to the Followers of Christ Church, the same religious sect that owns the cemetery visited by Asser in 2001.
Jeffrey Dean Beagley, 50, and his 46-year-old wife, Marci Rae Beagley, have pleaded not guilty to charges of criminally negligent homicide for failing to provide adequate medical care, in violation of their duties as parents.
Their 16-year-old son, Neil, died in June from complications of a urinary-tract blockage that triggered heart failure. Doctors said a simple procedure could have saved his life.
In the other Oregon case, Carl Brent Worthington and his wife, Raylene, have pleaded not guilty to charges of manslaughter and criminal mistreatment in the death of their 15-month-old daughter, Ava, who died at home from bacterial pneumonia and a blood infection, conditions the state medical examiner said were treatable.
The Beagleys and the Worthingtons have refused to talk to reporters, and their attorneys have declined to comment, along with prosecutors.
In a third case, in Wisconsin, Leilani and Dale Neumann face reckless homicide charges in the death of their 11-year-old daughter due to complications from diabetes.
Leilani Neumann has said the family believes in the Bible and that healing comes from God, but she said they do not belong to an organized religion or faith and have nothing against doctors.
The Followers of Christ figured prominently in a state legislative battle over the Oregon exemption that began in 1998 with the discovery of the children's graves, and the death of an 11-year-old member of the sect from complications caused by diabetes.
The political battle ended with revision of the law, but not its repeal.
"I was there" - for repeal, said Oregon Senate President Peter Courtney. And, he notes, so were churches, child health care advocates, law enforcement and plenty of parents.
What stopped the Legislature from an outright repeal of the law was an effort to protect religious freedom and parental rights and at the same time protect children.
"We tried and tried and tried to figure out a way to speak to, to be sensitive to, and balance all those influences," Courtney said. "Did we do it? I don't know."
"These are extremely sensitive cases nationally," said Josh Marquis, an Oregon district attorney who has been part of the debate over how to balance those conflicting rights. "It's where faith meets the law."
In a 1998 study published in the medical journal Pediatrics, Asser and Swan, herself a former Christian Scientist, documented 172 faith-related child deaths in the United States between 1975 and 1995. They found that 140 of the children died from conditions for which survival rates with medical care exceeded 90 percent.
Asser notes that no government agencies systematically collect data, and reliance on faith healing is not a category listed on a death certificate.
Before federal medical privacy laws were tightened, he was able to talk to medical examiners about cases, but that has become more difficult.
Asser has tracked a handful of cases that have gotten media attention in the past decade, including deaths in Philadelphia, Massachusetts and California. But he still learns about many of the deaths only through concerned friends or family members who contact him or Swan.
And death is not the only troubling outcome when children avoid doctors because of their parents' religious beliefs.
Beth Young, a professor at the University of Central Florida, says her hip dysplasia, which could have been easily corrected when she was an infant, went unnoticed and untreated by her Christian Scientist parents. Young finally went to a doctor in her 20s to find out why it was such a struggle to walk and climb stairs.
She learned her hip joints were deteriorating - but that it was too late for a surgical fix.
"It's not going to get any better," Young said in an interview. "I think about that every day. If my parents knew how simple the treatment was, I don't think they would have ignored it. So I do feel cheated."
She added: "I can remember times when I would pray and pray and pray, and I would think that maybe I'm healed now, and then I would go check, and I'd go walk in front of a mirror or something, and then I would discover, no I'm not."
Lyons, the Boston lawyer, has drawn national attention for defending parents in faith healing cases.
He successfully represented David and Ginger Twitchell, Christian Science parents in Boston who were acquitted of manslaughter charges in the 1986 death of their 2-year-old son from a congenital defect that caused the bowel to twist and become obstructed.
The landmark case caused enough concern to persuade Massachusetts lawmakers to abolish the religious exemption, said Jetta Bernier, executive director of Massachusetts Citizens for Children.
But even when such exemptions are abolished or revised, prosecutions can be difficult so long as parents show they are sincere in their religious beliefs, legal experts say.
"The status quo is very difficult to upset," said Jesse Choper, the Earl Warren Professor of Public Law at the University of California, Berkeley.