VANCOUVER - They were not much bigger than an outstretched hand when they were taken from their parents and given blood transfusions against their parents' will and religious beliefs.
The surviving four B.C. sextuplets have returned home but the fight is not over for their parents and it's not over for Canadian courts.
Two key battles, one in the Supreme Court of Canada and the other in B.C. Supreme Court, could soon give clearer directions on what are often decisions of life and death.
It's an issue that has deeply divided families, the courts and society in general.
Religious parents want to be reassured they can make decisions for their children and not have them taken away, while governments are compelled to protect those same children from risk.
In the B.C. case, the four extremely premature babies were seized and transfused with blood when doctors for the B.C. government convinced the court they wouldn't survive otherwise.
The lawyer for the parents argued in court last week that the government didn't have the right to simply seize the children without the parents questioning the medical necessity of the blood transfusions and the court agreed to hear the case.
Final arguments in the hearing will be heard next month.
Jehovah's Witness say under the authority of the Bible they cannot accept blood transfusions.
It was for the same reason that a 14-year-old girl in Manitoba, known only as A.C., refused a blood transfusion to treat gastrointestinal bleeding due to Crohn's disease.
Manitoba's Director of Child and Family Services went to court and won an order authorizing doctors to given her blood transfusions without the consent of her parents.
The Manitoba Appeal Court judgment, where the girl and her parents lost again, shows the difficulty of these decisions.
"This case highlights the conflict between such societal values as personal autonomy, the sanctity of life and the protection of children,'' it says.
The country's highest court will weigh in on the issue this year.
The Supreme Court of Canada is expected to hear the appeal of the A.C. decision this May.
Even with direction from the high court, Deborah Carlson, a lawyer representing Manitoba's Attorney General in the trial, said each case involving a child's refusal of health care will likely end up in court because the circumstances are never the same.
"What the Supreme Court hearing will do...often times (it) gives guidance to the lower courts,'' Carlson said in an interview.
John Burns, a lawyer for the sextuplet parents, said people often mistake the refusal of blood for refusal of medical care.
"These are not like some parents, perhaps in certain parts of North America, that resort to prayer and faith healing; they want medical treatment,'' he said in an interview.
Burns, who is also Jehovah's Witness, believes fewer of these cases are going through the courts because medical science, such as bloodless treatment, is catching up with their beliefs.
However, Prof. Arthur Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba, said the state usually doesn't intervene in a parent's autonomy unless it's a life-saving situation.
He believes the Supreme Court of Canada could establish a question for the lowers courts to ask that may help settle the issue.
"Is this the decision that a loving, a reasonable parent could make?'' he asked. "And if the answer is 'no loving and reasonable parent would make this decision,' then you intervene.''
Carlson doesn't think the solution is that simple.
"I think that the Jehovah's Witnesses would be very offended by that notion that because you have certain religious values you're not a loving parent,'' she said.
But for parents, these court fights aren't about religion, Burns said.
"They're thinking about treatment. Which is what they should be thinking about,'' he stated. "Religion from that standpoint, you want to accommodate, we live in a diversified religious society, which we respect.''
Burns said the Krever Inquiry into Canada's blood system has shaken up the assumption that blood is always safe and these parents are simply looking for an alternative.
Schafer said no matter what the high court rules these cases will likely continue to funnel through the courts.
"We will because society has an obligation to protect children,'' he said.
While the courts long ago decided that adults can refuse treatment, he said society won't view children in the same way.
"You could follow your wacky views right over the cliff, if it's you and you're a competent adult,'' Schafer said. "But you can't push your kids over the cliff.''
Schafer argues that in the case of the 14-year-old girl who risks being an outcast from her Jehovah's Witness community, the decision to have a blood transfusion would be very difficult.
"Don't underestimate the coercive power of, not just one's immediate family, but all the friends of one's family, all one's relatives, the people they see in Sunday School.
This is a life and death issue,'' Schafer said.
