"They should hang them."

Thus one man-on-the-street bluntly summed up his feelings to a Boston newspaper reporter shortly after the trial of David and Ginger Twitchell ended last July. The Twitchells, Christian Scientists, were convicted of manslaughter for turning to prayer instead of medical treatment when their small son Robyn became ill in 1986.

The child's death occasioned one of the most highly publicized trials relating to religious practice in recent history.

Despite the guilty verdict, the issues raised in the Twitchell trial remain both unsettled and, for many, unsettling. In a striking post-trial development, several of the jurors in the case publicly questioned the fairness of the legal process that led to their own decision to convict -- in particular the withholding of information from the jury on a longstanding Massachusetts law permitting reliance on spiritual healing.

In a similar case in the Midwest, an appellate court recently upheld the dismissal of charges against a Christian Scientist couple on the ground that a similar state law did explicitly permit this practice and did not define it as a crime.

On the other hand, legislatures in a number of states are now considering bills that would prohibit or severely restrict reliance on spiritual healing in the care of children. Supported by organizations as diverse as American Atheists and the American Academy of Pediatrics, these bills have also been pressed in recent years by federal officials wielding the power of the health and human services purse. Even for many who aren't the "hanging" kind, the question is not whether to restrict such healing but how much to restrict it.

For Christian Scientists themselves, the issue is deeply emotional but not necessarily the "clash of absolutes" that comes across in the courtroom. Many members of the denomination over the years have been healed or seen their children healed of life-threatening conditions through this method of treatment. Objectively, they question whether legislation imposing medical care more systematically on their children would result in better overall health or more lives saved.

Yet the tragedy of a child's death is no less searing for Christian Scientists than it is for others. As parents, they feel acutely the central ethical issue in these cases -- the possibility that a death might have been prevented -- and their own responsibility to exercise wisdom in providing a preferred religious form of care.

They surely face questions similar to those other parents might ask themselves when a loved child dies under medical care: Did we do enough? What if we had sought treatment earlier? What if we had gone to a different physician?

From the earliest major legislation on children's welfare enacted by Congress, the Sheppard-Towner Act of 1921, federal law sought to keep with parents the primary responsibility for making decisions on their children's care. The intention to support, not supplant, the family was carefully spelled out. The reasoning clearly wasn't that parents would always make the right decisions but that children would be better off on the whole with decisions as much as possible in the hands of those who love them most.

State laws throughout this century have reflected that perspective. Contrary to a persistent myth, the provisions permitting spiritual healing did not originate with federal regulations promulgated by the Department of Health, Education and Welfare in 1974. Those regulations simply maintained the legal status quo under which Christian Scientists had been raising and caring for their children for many decades without evident disadvantage.

Whether the authority of medical care in the 1990s justifies some change in that status quo is obviously the question. The last four decades have seen glowing reports of medical advances and, paradoxically, growing criticism of medical dogmas and performance. The court actions against Christian Scientist parents have shared news space with in-hospital tragedies and continuing pronouncements on the current "crisis" in the medical care system.

Those court actions have generated a great deal of mutual recrimination but less moral clarity in sorting out conflicting conscientious concerns.

The concerns on both sides need to be recognized. Only then can the line be rightly drawn between what the state can legitimately ask of parents who dissent from the dominant medical culture and more dubious demands for medical conformity that one Massachusetts legislator termed "chauvinistic."

The role of government also needs more careful thought. Is it simply the enforcer of medical orthodoxy? Or is its proper role that of a more neutral mediator between law-abiding citizens including minorities of differing perspectives? At least until the last several decades, government tended to assume the latter role. One by-product of the massive bureaucratization of health care since the 1960s has been a profound yet largely undebated shift in this role.

Finally, the issue demands some coming to grips with the reality of spiritual healing itself. Mark Twain, one of the severest critics of Christian Science in an earlier era, nevertheless recognized the challenge presented by the experience of Christian Scientists to all who take seriously "the power, through loving mercifulness and compassion, to heal."

As he went on: "These things are true, or they are not. If they were true seventeen and eighteen and nineteen centuries ago it would be difficult to satisfactorily explain why or how or by what argument that power should be non-existent in Christians now."

If these things are true -- and whatever the explanation for these healings, they have happened, and continue to happen, on a significant scale and in many cases medically confirmed -- the issues on which the Twitchell and similar cases turn are not morally one-sided. Nor are they narrowly denominational. They involve the relation of spiritual ideals to living and practice.

For the children's and the parents' sake, the discussion needs to be freed from the acrimony that so often surrounds differences between religious and secular views of man.

The writer is manager of the Committees on Publication for The First Church of Christ, Scientist, in Boston.