Oregon City, USA - 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 Richard Nixon -- Bob Haldeman and John Erlichman -- and an influential senator, Charles Percy of Illinois, who practised 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 practised 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 been charged with 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.