Sixteen-year-old Justina Pelletier returned to her parents’ home on Wednesday, ending an unhappy custody dispute that focused a harsh national spotlight on the Massachusetts Department of Children and Families. To the web-driven “Free Justina” movement, the state’s decision to take Pelletier away from her family last year, after a hospital raised concerns that she may have been abused, was a textbook case of an overweening government trampling a family’s rights. That version of events cast aside all nuances, placing the state firmly in the role of villain. But on the most basic level, DCF acted correctly when it responded to a credible allegation of child abuse. Pelletier’s case doesn’t call for limiting DCF’s powers; rather, it shows the need for the agency to develop better ways to evaluate exceptionally tricky cases like this one.
The term child abuse calls to mind beatings or molestation, but nothing like that was ever alleged against the Pelletiers. Rather, doctors at Boston Children's Hospital reported to DCF their suspicions that the Pelletiers were subjecting their daughter to unnecessary medical treatments, a form of "medical child abuse," when they demanded she receive treatment for a mitochondrial disease and rejected Children's Hospital's diagnoses that traced her ailments to psychiatric problems. Though rare, parents overmedicating their children can have fatal consequences. In an exceptional circumstance, the state must be able to step in.
The problem, however, is that not every accusation is true, and DCF lacked a good way to evaluate the complaint from Children's. In the Pelletier case, the family's resistance to Children's was not unfounded or unreasonable; another doctor, at Tufts Medical Center, had earlier backed the mitochondrial disease diagnosis. DCF employees are social workers, not doctors or scientists. To judge such claims, the state instead relied on free advice from local hospitals — often Children's.
In the future, the state needs an independent system in place to sort out claims of medical child abuse. And state policy must also reflect the limitations of the medical profession: As the disagreement between Tufts and Children's showed, even well-trained, well-intentioned doctors can reach different conclusions in an especially tough case. Even after an independent review by the state, total certainty may not be possible for every child. When it's impossible to say who is right, the state shouldn't necessarily assume it's the parents who are wrong.