Futile treatments or futile lives?

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I was interviewed by Tom Woods on his great podcast.  We talked about the Alfie Evans case and discussed in depth the question of “best interests” of the child, and the appalling reasoning by which the UK medical authorities and the court decided that he was better off dead.  I think you’ll find the episode worth listening to.

In reading about the case I discovered that the UK judge presiding over the case was greatly offended by a comment made by Dr. Nikolaus Haas, the German physician who—along with the doctors from the Vatican’s Bambino Gesu Hospital—had offered to transport the baby out of the UK and provide the care that the parents requested, namely, placement of a tracheostomy and feeding tube so he could be cared for at home.

In his report to the court, Dr. Haas said the following, which the judge found “inflammatory and inappropriate:”

Because of our history in Germany, we’ve learned that there are some things you just don’t do with severely handicapped children. A society must be prepared to look after these severely handicapped children and not decide that life support has to be withdrawn against the will of the parents if there is uncertainty of the feelings of the child, as in this case.

That was an obvious reference to the dark, eugenics period of German history under the Nazi regime.

Bizarrely, in response to Haas’ “tendentious views,” the judge cited a letter from Pope Francis, dated November 2017, and addressed to the Pontifical Academy for Life, in which the pontiff restated the Catholic doctrine regarding the means of conserving life.   Francis wrote:

Greater wisdom is called for today, because of the temptation to insist on treatments that have powerful effects on the body, yet at times do not serve the integral good of the person.  Some sixty years ago, Pope Pius XII, in a memorable address to anaesthesiologists and intensive care specialists, stated that there is no obligation to have recourse in all circumstances to every possible remedy and that, in some specific cases, it is permissible to refrain from their use…Consequently, it is morally licit to decide not to adopt therapeutic measures, or to discontinue them, when their use does not meet that ethical and humanistic standard that would later be called “due proportion in the use of remedies.”…The specific element of this criterion is that it considers “the result that can be expected, taking into account the state of the sick person and his or her physical and moral resources” (ibid.). It thus makes possible a decision that is morally qualified as withdrawal of “overzealous treatment. Such a decision responsibly acknowledges the limitations of our mortality, once it becomes clear that opposition to it is futile. “Here one does not will to cause death; one’s inability to impede it is merely accepted” (Catechism of the Catholic Church, No. 2278).

The doctrine of regarding the liceity of allowing death to proceed was elaborated over the centuries by Catholic moral theologians.  The best historical treatment of the topic is the book Ordinary and Extraordinary Means of Conserving Life by the Abp. Daniel Cronin, who made it the topic of his doctoral dissertation in the 1950s.

Accordingly, one is not obligated to sustain life at all costs but, depending on the particular circumstances, “taking into account the state of the sick person and his or her physical and moral resources” one may choose to forego “overzealous treatment,” as the pontiff puts it.

This suggests that the UK court did not intend the death of Alfie, but simply thought that the treatment was  “extraordinary.”

But that cannot be.  First of all, everyone agreed that the baby was in a coma and likely had no sensation and therefore did not suffer physically, which is one way by which the “physical and moral resources” can be exhausted.

Secondly, the baby was growing, was able to fight infections, and was overall surviving, at least for the time being.  There was therefore no indication that the treatment sought by the family would not serve the “integral good of the person.”  There is nothing overzealous about placing a feeding tube and a tracheostomy to help feed and ventilate a patient.

Thirdly, and most importantly, Francis went on later in that letter to state specifically say that:

The patient, first and foremost, has the right, obviously in dialogue with medical professionals, to evaluate a  proposed treatment and to judge its actual proportionality in his or her concrete case, and necessarily refusing it if such proportionality is judged lacking.

In other words, it is not for third parties to decide whether a treatment is too burdensome or “disproportionate” but the decision belongs properly to the patient or, in the case of a child in a coma, to the parents.  Only the person, or his or her surrogate, can decide on what is ultimately a personal matter.

So, there is no question that the decision to withdraw life support for Alfie could not be made on the basis of the argument of “disproportionate means,” and that is made patently obvious by the fact the Pope has specifically supported the parents’ decision in March and April of this year, weeks after the judge issued his ruling.

It is clear that the “best interests” that the UK doctors and courts sought were the death of the child, and that is made explicit, in my mind, in the last opinion of the judge, date April 11, 2018 where he plainly stated:

I came to the conclusion, that Alfie’s brain had been so corroded by neuro-degenerative disease that his life was futile (emphasis mine).

If a life is deemed futile, no care can ever seem justifiable.

[Related post: Cato’s Michael Cannon is terminally confused about Alfie Evans]

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