Preserving the appropriate relationship between the state and children is hard. No one likes to see parents make foolish decisions which threaten or harm their children. But that doesn’t justify granting the state the authority to mandate medical treatment/testing or allow it to usurp parental rights. Foolishness or ignorance does not justify state intervention. State intervention is only justified if parents act with intent to harm their children.

Regarding opponents of infant vaccines, or the antivaxxers as Sean called them, I don’t know enough to argue the science. Anecdotally, one of my close relatives suffered such a severe reaction to a vaccine that she was hospitalized for a time. She manifested the symptoms of a severe case of the disease for which she was vaccinated. So I know that vaccines aren’t all safe, but that isn’t enough to complete the risk analysis.

But so far as I know, parents are free to decline vaccines on behalf of their children. Parents are not free to decline the PKU test/newborn screening. That is the more serious problem, and that is the reason for the rhetoric. When the state forces parents to subject their children to testing or treatment, the relationship between the individual and the state is corrupted, and individual autonomy is violated in favor of the majority’s will.

The tests certainly don’t have the same public health externalities that vaccines do, so you can’t support these tests with market failure reasoning. Obviously infants should be vaccinated, where vaccines are safe and effective, if not for the infant’s sake, then for the benefit of all other individuals in society.

I’m certainly not qualified to discuss ethics with you, but even without the externality argument, I’m still not sure this decision is something to get worked up about. If you weigh the potential damage from requiring the test – mental distress to parents from not letting them choose which important medical tests to administer – against the potential problems with the child’s brain development, I’m not sure how the result comes out. Certainly phenylketonuria is uncommon enough it isn’t a slam dunk for either group. I know you won’t like the balancing idea, but I don’t know how else to reconcile important, but potentially conflicting, rights of parents and infants.

Either way, I’d oppose the hospital keeping the blood sample for other purposes, and I’d insist the hospital provide information about the test to parents beforehand. If I was the policy maker given this choice, I’d need some statistics before I could be confident siding with either group – making the test required or optional. Characterizing avoidance as “neglect” which permits the state to seize children (though I doubt seizure on these grounds is common or incontestable) also seems unduly harsh, perhaps a fine slightly in excess of the cost of the test would be more appropriate.

As a side note, I’m not sure characterizing the effectiveness of medical tests is an issue of “opinion.” If the test is effective and safe, the harms are clear and significant, and the treatment is effective and basically side-effect free, I don’t know if there is much room for opinion. For example, antivaxxers aren’t expressing an opinion any more than the flat earth society. If the science is clear, which it may or may not be here, I don’t think you can shield bad information and illogical beliefs under the label of an “opinion.”

Thanks for the post!