Most of the world’s religions share a version of the Golden Rule, conveyed in the book of Leviticus as, “Love your fellow as yourself.”

The notion of treating one’s neighbor as you’d wish to be treated was important to the theology of Mary Baker Eddy, who founded The Church of Christ, Scientist in 1879. But a central feature of Eddy’s theology – the belief that healing prayer renders medical care unnecessary – can be in conflict with the Golden Rule when it comes to infectious diseases such as pandemic flu.

That conflict played out at least five times between 1978 and 1994 in the St. Louis area, when measles outbreaks spread at two large Christian Science schools, killing three Christian Scientists and in some cases, moving beyond campus borders, sickening hundreds.

At the end of October, President Barack Obama declared the outbreak of the H1N1 virus a national emergency. Also called swine flu, the virus has sickened an estimated 22 million people and killed 4,000 nationally, according to the Centers for Disease Control and Prevention.

Though the CDC said on Friday that a fall wave of swine flu infections had peaked, doctors say the combination of travel and family visits over the holidays could increase cases of the virus. And as a potential pandemic looms, some bioethicists say members of religious groups who choose to forgo vaccines put their neighbors’ health at risk and threaten the common good.

“Viruses and other contagious diseases don’t care about our personal beliefs, ” said Nancy Berlinger, deputy director of the Hastings Center, a New York-based bioethics research institute.

Meanwhile, others point out that constitutional protections for religious worship easily outweigh any pressure on members of religious groups to capitulate to voluntary H1N1 vaccinations if they prefer prayer to medicine.

And although the church advocates healing through prayer, no church doctrine forbids Christian Scientists from turning to medicine if they wish.

Concepts in conflict

At the core of the issue are two ideas that help define Western civilization – in public health and religious freedom – that are sometimes at odds.

The first is a strategy epidemiologists call “herd immunity, ” which allows the masses to protect the weak. The second is the free exercise clause of the First Amendment.

The concept of herd immunity says that when most of the population is inoculated against a disease, the chain of infection breaks down. Those who can’t be vaccinated – infants, for instance, or those with conflicting medical conditions – are protected.

Those who can’t be vaccinated, or who choose not to be, are called “free riders” by epidemiologists because they gain the benefit of herd immunity – even though they don’t participate. Because immunization is never 100 percent effective, when free riders get sick, it puts even those who have been vaccinated at risk.

That’s what happened in the 1980s and 1990s at two Christian Science schools in the St. Louis area.

In 1985, three Christian Scientists affiliated with Principia College in Elsah died, and 712 students were quarantined on campus, when an outbreak of measles sickened more than 100 people.

In 1989, another measles outbreak at Principia sickened nearly 100 people, including some off campus, not affiliated with the school.

In 1994, another outbreak spread to the Principia, which serves students pre-K through senior high in St. Louis County. Nearly 200 people contracted measles that year, including a doctor from Barnes-Jewish Hospital and an infant, both of whom were infected by Principia students off campus. Hundreds of Principia students and their parents ultimately decided to be vaccinated during the outbreaks, but many opted against vaccination.

Compulsory vaccination for diseases such as measles or mumps has ensured herd immunity, but religious exemptions, allowed in most states, disrupt its effectiveness and allow for outbreaks. The government has not made H1N1 vaccinations mandatory.

Still, the Hastings Center’s Berlinger cited a 1944 U.S. Supreme Court decision that said the “right to practice religion freely does not include the liberty to expose the community or the child to communicable disease or the latter to ill health or death.”

While the law protects Americans’ right to practice religion as they want to, Berlinger said, “it also places limits on the practice of religion when it starts to intrude into public health or the health of (a) child.”

She said another ethical concern was that when a population refuses to be vaccinated, public health resources have to be diverted to that population if an outbreak occurs.

“We’re all members of the public, no matter what our personal beliefs are, ” Berlinger said, “and there’s a point at which those beliefs start affecting someone else.”

But Rebecca Dresser, a professor of law and medical ethics at Washington University, said the fact that most states allow religious exemptions for mandatory vaccinations showed that “the public health benefits of the vaccine are outweighed by the desire to show respect for religious beliefs.”

Dresser said it would be “offensive” to impose the H1N1 vaccine on particular communities based on religious belief. “There’s always a desire to keep this stuff voluntary, ” she said.

Immunity through prayer?

Christian Science leaders stress that there is no church dogma that forces followers to refuse vaccinations or medical treatment. Those who choose to rely solely on prayer for their health care, they say, do so with their eyes open.

That focus on prayer traces its roots to 1866, when Eddy “discovered” what she later called “the science of Christianity” when she was restored to health while reading a New Testament account of Jesus healing the sick.

Eddy founded the church in 1879, and today, there are about 1,800 Christian Science churches in nearly 60 countries. About 1,000 of those are in the United States, 100 in Missouri and Illinois.

Eddy wrote that people who believe in infectious and contagious diseases mentally prepare themselves to catch those diseases “whenever there appear the circumstances which he believes produce it.”

Eddy believed that matter is “unreal and temporal, ” and that only Spirit, or God, is real and true. Because man is made in God’s image, man is spiritual, not material, Eddy said. Disease is an evil product of the world, but it is material, and therefore does not exist in the spiritual world.

“A calm, Christian state of mind is a better preventive of contagion than a drug, or than any other possible sanative method, ” Eddy wrote.

A church spokesman said that although most Christian Scientists choose to rely on prayer exclusively to stay healthy and get better when they are sick, the church does not mandate that choice.

“Health care decisions are personal decisions, and no church elders, leaders or officials weigh in on that, ” said Phil Davis, a church spokesman. “This is a church that honors individuality and individual decision making.”

Cooperating with health officials

Because Americans ages 6 through 24 are in close contact with one another in day-care facilities, school classrooms and college dormitories, they are a priority group for H1N1 vaccinations. The school-age crowd is also more susceptible to catching H1N1 and developing serious complications because they haven’t built up as much natural immunity from exposure to previous flu pandemics, according to the CDC.

Today, there are about 550 students at the Principia and 525 at Principia College. Officials consider the campuses two parts of one school, and it’s the largest Christian Science-based educational institution in the country. The school employs 550 faculty and staff members.

Officials from both the Illinois Department of Health and the department of health in Jersey County, where Principia College is situated, called school officials “good partners” and “very cooperative.”

Philip Riley, a Principia administrator who supervises the school’s student care facilities, said the school was not offering the swine flu vaccine on campus, but said anyone who wanted to receive it was free to do so wherever it was offered. He said the school sent an e-mail about H1N1 to students, staff and faculty in September.

“On the prayerful side we said, ‘Let’s pray about this for ourselves and community, ’” Riley said. “On the practical side, we said, ‘If someone is feeling poorly, you should stay home from school or work. Don’t come back until a day after you’re feeling back to normal.’”

Church officials point out that Eddy was a stickler for the law, and that when a law mandates vaccination, Christian Scientists abide by it. But because the H1N1 vaccine is not compulsory, church spokesman Davis said there had never been a need to compromise between Eddy’s belief in the Golden Rule and healing prayer.

“If the teaching and practice of Christian Science were dogmatic or there was a prohibition against vaccination, there would be a compromise, ” Davis said. “But if Christian Science, in fact, heals, then there is no compromise. Instead, it’s part of the solution to infectious disease.”