## Facts

- Tara Cabrera, age six, was hospitalized with fever, limp, and hip pain and was diagnosed with sickle-cell anemia and a recurrent stroke, with imaging showing evidence of an earlier stroke.
- Treating physicians recommended blood transfusion therapy to treat her condition and reduce the risk of further strokes and related neurological injury.
- Medical testimony indicated that without transfusions children in Tara’s situation faced a high probability of recurrent stroke within a short period, with serious risks including paralysis, severe cognitive impairment, and some risk of death.
- Physicians testified that chronic transfusion therapy was the only generally accepted treatment available to reduce sickling and lower the recurrence risk, with substantial effectiveness in comparable patients.
- Tara’s parents, Jehovah’s Witnesses, refused consent to transfusions primarily on religious grounds and also raised concerns about transfusion risks.
- The hospital petitioned the trial court to authorize transfusions and sought appointment of a decisionmaker to consent on Tara’s behalf.
- After a hearing, the trial court adjudicated Tara a dependent child and appointed a guardian ad litem authorized to consent to a one-year course of transfusion therapy.
- The parents and Tara (through counsel) appealed; the appeals were consolidated.

## Issues

1. Whether a minor may be adjudicated dependent when parents refuse medically necessary, standard treatment on religious grounds, thereby withholding necessary medical care.
2. Whether the court, acting under parens patriae authority, may appoint a guardian ad litem to consent to a defined course of transfusion therapy over parental objection.

## Decision

- The Superior Court affirmed the judgment adjudicating Tara dependent and authorizing a guardian ad litem to consent to one year of transfusion therapy.
- The court held that the evidence supported a finding that Tara faced grave, largely preventable harm without transfusions and that parental refusal constituted a failure to provide necessary medical care.
- The court concluded that the Commonwealth’s interest in protecting a child’s life and health outweighed the parents’ religiously based refusal in these circumstances.
- The court found the order appropriately limited in scope and duration and not a broader termination of parental rights.

## Legal Principles

- Parental authority over a child’s medical care is substantial but not absolute; courts may intervene when refusal of care places a child at serious risk of death or severe, permanent injury.
- The Commonwealth may act as parens patriae to protect a minor’s welfare and may authorize medically necessary treatment when parents are unwilling or unable to consent.
- Religious liberty protects belief, but parental conduct based on religious belief may be restricted when it threatens a child’s life or health.
- A dependency adjudication and appointment of a guardian ad litem may be justified when medically necessary treatment is standard, effective, and no comparably accepted alternative is available.
- Orders compelling treatment should be tailored to the child’s medical needs, including reasonable limits on scope and duration.

## Conclusion

The court upheld state intervention to protect a child with sickle-cell anemia from a high risk of catastrophic and avoidable harm, affirming dependency and permitting a guardian ad litem to authorize a limited course of transfusion therapy despite parental religious objections.


In re Cabrera, 552 A.2d 1114 (Pa. Super. Ct. 1989)