Alfie Evans and the Crossroads of History

Once again, a little child is at the center of the battle between light and darkness. From First Things:

Certain studies can be cited in support of what the physician desires, and studies pointing in a different direction can be ignored. Directive, emotive, and exaggerated language can be used to manipulate, especially when the likely outcomes of various options are under discussion. Numbers can be used in a similar way: Should a consult focus on the two-thirds of patients who have poor outcomes—or on the one-third who have good ones?

These forms of manipulation are a persistent concern in clinical ethics, and they present themselves in dramatic fashion when medical teams discuss disability. Sometimes the desire of a physician to achieve the outcome he wants is so strong that he will engage in deceptive practices called “slow coding” or “show coding.” The physician agrees with the parents that everything possible will be done for their child (“full code”)—but in reality the physician and medical team will not engage in aggressive treatment. This practice is defended by some ethicists today, and is often justified by the physician’s personal judgment that the life of a particular child is not worth saving.

Most often it is done on the down-low. Physicians are good at avoiding public scrutiny of their actions generally, and in these kinds of cases in particular. Decisions to refuse to treat a child because of a disability are distorted by euphemistic references to “mercifully” removing or foregoing “burdensome” or “extraordinary” treatments.

To be clear: The distinctions between life-sustaining treatment that is morally required and that which may be foregone—pioneered by the Catholic moral theology in the late Middle Ages and early Modern period—are essential in these cases. Personally, I take a wide view of what kinds of things might make life-sustaining treatments extraordinary, even arguing that Catholic social teaching requires expense to be one of the factors considered. 

But the principle of never aiming at the death of an innocent person—whether by action or omission—must remain absolutely exceptionless. This is what the dignity of the person requires, especially if one wishes to protect vulnerable populations who are at risk of being marginalized by those who find them inconvenient. And given the checkered history of Western medicine when it comes to the value of the disabled, we must take care to be certain that this principle is enforced in the clinic. Enter the current row over Alfie Evans. At first glance, it may seem that this case has much in common with last year’s debate over Charlie Gard. And indeed, there are important similarities. (Read more.)

From The Catholic Herald:

 These two cases (and there may well be many other we do not know about) provide some context to help us understand why Alfie Evans has been granted Italian citizenship and offered a hospital place in Rome. Essentially, Pope Francis asked the Italian government to act, and they did, just as they had acceded to previous papal requests.

So what can we conclude? First of all, that the Papacy has an eye to, as well as a deep commitment to, human rights, which, as we should all know, transcend national boundaries. So too does the Italian government, whether it be one of the right (as Berlusconi) or the left (like Renzi’s). This leads to a difficult and distressing question. If the Pope and the Italian government (and others too) see the Alfie Evans case in this way – that is a case of human rights – why can’t our own government and courts see it in the same way? The parents are only asking to take their child abroad for treatment; it is devastating that they are not allowed to do so. The intransigence of the British courts and a large swathe of British opinion on this matter makes Britain look as intolerant, in certain lights, as Sudan and Afghanistan. (Read more.)
 

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