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October 26, 2011

Life-Threatening Childhood Obesity and Legal Intervention

Author Affiliations

Author Affiliation: Massachusetts Trial Court, Worcester (carol.erskine@jud.state.ma.us).

JAMA. 2011;306(16):1762-1764. doi:10.1001/jama.2011.1520

To The Editor: The Commentary by Ms Murtagh and Dr Ludwig1 raised the specter of state intervention for dangerously obese children as a method of resolving the related health issues in this population. Although such a suggestion evokes a strong dialogue about the scope and limits of governmental interference in the sanctity of family life, states have always stepped in when the life, health, or safety of a child is at risk in the home. It must be remembered, however, that state intervention is allowable only under clearly defined legal parameters because governmental intrusion into family life, as the authors acknowledged, implicates highly protected Constitutional rights. While those rights are not absolute, the US Supreme Court in Santosky v Kramer2 made clear that “The fundamental liberty interest of natural parents in the care, custody, and management of their child does not evaporate simply because they have not been model parents. . . . ” As such, judicial scrutiny with appropriate due process protections is mandatory when states seek to remove a child from parental custody. The standard of proof is high in child welfare cases, as it should be. Even where temporary custody is requested, the stakes are enormous because transfer of a child from the family home into substitute care, as the Commentary pointed out, has myriad consequences.

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