The case and death of Alfie Evans raises issues that must be addressed

At the very least, we want to be able to entrust our care and that of our loved ones to people who are not on the fence about whether life is a basic and irreducible good.

Alfie Evans is pictured in this photo posted by Daniel Evans to the Facebook group, Alfies Army Official, April 23. (CNS photo/Daniel Evans, Alfies Army Office Facebook group); right: Tom Evans, father of Alfie Evans, holds a rosary outside of St. Peter's Square at the Vatican April 18. (CNS photo/Paul Haring)

Any genuinely comprehensive review of the case of Alfie Evans would require many months and significant resources, not to mention the willingness of his parents, attorneys, doctors, and judges to sit for extended interviews. Our desire to know is powerful, as is our desire to blame. The cold comfort of finger-pointing is often more attractive and alluring — even seductive — than any alternative, especially when we have been given to feel that something terrible has happened. We want a villain to be responsible for the evil that visits the world. This desire is the more difficult to resist when resistance is needful, precisely because there are villains in the world and they do need resisting when and where we find them.

For now, we resist the temptation, and limit ourselves to consideration of the two major issues this unfortunate case has raised.

Crisis of confidence

The first issue is the crisis of confidence in the profession of medicine, which arises from the ethical standards that have come to govern medical practice across what we may call “the West” for short. The standard of “quality of life” with regard to medical care generally is a pertinent example. The standard has entered the medical profession by way of a sort of mission creep, related to the development of medical technology and technique.

As a guiding criterion in making specific care path determinations once the decision to treat has been made, “quality of life” actually makes a good deal of sense. When risks and benefits are weighed — questions from whether to repair a joint or replace it altogether, to what kind of heart procedure to attempt — do genuinely turn on a patient’s prospects for returning to normal life. It does not perform nearly as well when it is used as a standard against which to measure final decisions on whether to treat in the first place.

Bodily health has been the end of medicine since its practice as an art began. It continued to be the end of medical practice when medicine developed into a science. The reason civilization has devoted so much expense of time and treasure to the pursuit of bodily health — including the pursuit of bodily health through medicine — is that being alive is good.

Tragically misguided medical ethicists have made “quality of life” a controlling criterion for determining whether to give care, and — in some places, like The Netherlands — even applied the standard in a way that leads medical professionals to participate in the deliberate termination of life. In jurisdictions like Iceland and Denmark, somewhere between 95% and 98% of pregnancies returning a positive result from a Down Syndrome screen end in termination. That sounds a lot nicer than lebensunwertes leben, but that is what the standard means practically when applied in such ways.

Due to a complex confluence of reasons, many of our societies have moved away from the conviction that life is a good, and the medical profession has gone along the same path as the societies in and for which it operates. When knees and elbows are in play, the consequences of this distancing are not often easily perceptible. Sometimes, however, people get very sick, indeed, and doctors do not know how to heal them, or even what is making them ill.

In such circumstances, “quality of life” is not a reassuring standard for people who are jealous of their lives and those of their loved ones. In an essay examining the issues involved in the case of Charlie Gard — in some respects a similar case, though drawing the similarities with too much celerity or facility is ill-advised — I put the matter this way:

In the midst of all this, there is a crisis of confidence — one might even say a crisis of faith — in the medical profession, arising from the direction in which medical ethics throughout the West have turned. Essentially, the medical profession — sometimes under the pressure of politicians and bureaucrats, sometimes more pro-actively — has distanced its practice from the core conviction that life is a basic and irreducible good, to which patients have an inherent and inalienable right, which right must be defended at all costs and against every usurper — even the one who possesses the good, hence the right to it.

Nota bene: the right deserves protection at all costs: the good itself is perishable, and when the good itself, from which the right arises, is in precinct of expiry, there are inevitably hard decisions to make, which for their right making depend on the clear and cloudless vision of the goods at stake and of the rights that arise from those goods.

We sense, we feel viscerally — even if not all of us are always able to articulate it — that something is not right in our stance toward life itself, and this makes decisions at what may well be the end of life even more difficult than they already are. At the very least, we want to be able to entrust our care and that of our loved ones to people who are not on the fence about whether life is a basic and irreducible good. If we do not recover that fundamental conviction and unambiguously enshrine it in law, the corrosion of our public institutions will continue apace with that, which has already done such grievous harm to our public spaces and counsels.

Distortion of the “best interests” standard

The second thing complicating this matter (and similar matters) is the distortion of the “best interests” standard. The president of the Supreme Court of the United Kingdom, Baroness Hale, laid out the jurisprudential grounds for that distortion in the Charlie Gard case:

[Gard’s parents contend that] In this sort of case the hospital can only interfere in the decision taken by the parents if the child is otherwise likely to suffer significant harm. But that apart, it is argued, decisions taken by parents who agree with one another are non-justiciable. Parents and parents alone are the judges of their child’s best interests. Any other approach would be an unjustifiable interference with their status as parents and their rights under Article 8 of the European Convention on Human Rights. But there are several answers to this argument.

Firstly, applications such as this are provided for by statute: the Children Act of 1989. There was an application for a specific issue order in this case, as well as under the inherent jurisdiction of the High Court. Both are governed by the same principles. Section 1, sub-section 1 of the Children Act 1989 provides that the welfare of the child shall be the paramount consideration in any question concerning the upbringing of the child in any proceedings. This provision reflects but is stronger than Article 3.1 of the United Nations Convention on the Rights of the Child, which says that in any official action concerning the child, the child’s best interests shall be a primary consideration.

Furthermore, where there is a significant dispute about a child’s best interests the child himself must have an independent voice in that dispute. It cannot be left to the parents alone.

Baroness Hale went on to explain that there was, in fact, risk of serious harm to Charlie, at least in the form of pain, and no chance for improvement. That was most likely the right determination. It is the prior determination — the finding of law — that matters here.

Across several jurisdictions, laws have been passed to give children a voice in cases in which their parents or legal guardians are divided, and to ensure minors’ rights are properly protected when their parents are neglectful or abusive. As Ed Condon argued in The Catholic Herald and Sohrab Ahmari also noted (following Condon) in a piece for Commentary, courts in the UK are now using those laws to invade and usurp the rights of parents who are determined not to abandon but to care for their children and unanimous in their decisions with respect to the kind of care they would seek, even when the doctors and the courts agree that the treatment course the parents prefer is not likely to result in significant harm.

The (ab)use of the “best interests” standard in Alfie Evans’ case was particularly galling for a further series of reasons.

Nobody was ever able to figure out just what was causing Alfie Evans’ distress. All anyone ever knew for sure was that he was very sick. “We’ve done all we can,” is not on its own sufficient reason to override parents’ determination to seek further treatment for a child — not in any sane jurisdiction, anyway. “There’s simply nothing to do for him, he’s too far gone,” is a different matter — and closer to the truth in Alfie’s case. Even the experts who examined him for the Bambino Gesù hospital here in Rome came to the same conclusion. Bambino Gesù was prepared to continue palliative care for Alfie, though, and to keep him on ventilation.

The galling thing, therefore, was that there did not appear to be any properly medical reason powerful enough to compel the courts to override the parents’ wishes to seek further, or different treatment, or even a different venue. In Charlie Gard’s case, his parents wanted to attempt a potentially painful experimental therapy that had virtually no chance of securing even slight improvement in his condition. Alfie’s parents ultimately wanted to live what time they had left with their dear boy somewhere — anywhere — that wasn’t Alder Hey.

The court, however, determined that Alder Hey would take Alfie Evans off artificial ventilation and apply a protocol denying him basic nutrition and hydration, even though Alfie was at the time able to metabolize food and water and responded well to them physiologically in medically verifiable ways. Even if the determination to suspend therapeutic treatment and let nature take its course was the right decision, the refusal of food and water would have led to Alfie’s death from starvation and/or dehydration. Whatever that would have been, it would not have been “nature taking its course”.

Reports are that Alder Hey eventually restored at least supplemental oxygen and some hydration, after Alfie failed to die as doctors had predicted he would soon after they turned off the ventilation machine. Alfie Evans refused to die for more than three full days, during which time there were several more hearings, including one before the Court of Appeal, in which Lady Justice [Eleanor] King (presiding) said, “The evidence is that he is unlikely to have pain, but that tragically everything that would allow him to have some appreciation of life, or even the mere touch of his mother, has been destroyed irrevocably.” If that is a reason to keep parents willing and able to continue to care for their child — albeit with the help of outside parties — from seeking such care, it is difficult to see how it could stand on anything other than the surreptitious presupposition that the child’s life is not worth the trouble.

In a March 6 ruling in which she granted appeal on the ground the trial court had not properly weighed parents’ wishes, Justice King quoted from the opinion of the judge at trial, which in turn quoted from Baroness Hale’s opinion in Aintree University Hospital NHS Trust v James [2013] UKSC 67:

[39] The most that can be said, therefore, is that in considering the best interests of this particular patient at this particular time, decision-makers must look at his welfare in the widest sense, not just medical but social and psychological; they must consider the nature of the medical treatment in question, what it involves and its prospects of success; they must consider what the outcome of that treatment for the patient is likely to be; they must try and put themselves in the place of the individual patient and ask what his attitude towards the treatment is or would be likely to be; and they must consult others who are looking after him or are interested in his welfare, in particular for their view of what his attitude would be.

Practically and legally, the decision-makers are the judges. Whether owing to flaws in their design, or to improper application by the courts, laws enacted to protect children from negligent parents seem now to be the principal tool with which judges work to separate children from parents who, in the judges’ estimation, love them so much they just can’t think straight. When one adds consideration of the parents’ circumstances in the two cases currently under examination — Gard’s and Evans’, whose parents were young, poor, and salty — the willingness of judges to behave as they have reeks of paternalism and elitism.

The quiet men with white collars

None of this is to say anyone involved — not a single doctor or nurse, not a single lawyer or judge — is a bad person. Given the right tools and put in the right circumstances, however, even people who are not bad can and will do very bad things.

It is also true and inescapable that some of the rhetoric from Alfie’s supporters was overwrought and frankly irresponsible when it was not criminal. People made death threats to hospital staff, there was appalling “legal” advice given by persons neither qualified nor disposed, and there was an eagerness to cry “Murder most foul!” in efforts to co-opt Alfie (and Charlie before him) for their causes. All of it was wrong, and none of it was helpful. In fact, the outrageous behavior of the zealots made it easy to discount the public advocacy of the many people — the vast majority of those enlisted in “Alfie’s Army” — who sought only to give moral support to a dying child and his parents, and to decry what they saw for what it was: a gross injustice. In the introduction to his Screwtape Letters, C.S. Lewis wrote:

The greatest evil is not now done in those sordid “dens of crime” that Dickens loved to paint. It is not done even in concentration camps and labor camps. In those we see its final result. But it is conceived and ordered (moved, seconded, carried, and minuted) in clean, carpeted, warmed and well-lighted offices, by quiet men with white collars and cut fingernails and smooth-shaven cheeks who do not need to raise their voices.

There will be other fights. There will be other times to shout defiance. The turn away from life’s goodness — from the clear and cloudless vision of it — has already done grave harm. We must arrest it and reverse it. If we are to overcome the wickedness and evil of our wicked and evil age, we must nevertheless be prepared to combat it not with clubs and pitchforks — or their digital cognates and equivalents — but with the quiet dignity of Alfie Evans, whose life was worth its living to the last.

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About Christopher R. Altieri 198 Articles
Christopher R. Altieri is a journalist, editor and author of three books, including Reading the News Without Losing Your Faith (Catholic Truth Society, 2021). He is contributing editor to Catholic World Report.


  1. The only question that needs to be asked is, “how soon can the human race nuke the freaking zombies who run everything?

    • There is certainly ambiguity in these cases but that all the more highlights the need to establish how decisions are made in the face of ambiguity. The U.S. criminal justice system, for example, is emphatic that the burden of proof is on the prosecution. The most important lesson for Guard and Evans cases, in my estimation, should be that a medical provider has the burden to demonstrate that the a parent’s decision is negligent or abusive if refusing to release custody of that parent’s child. The UK health care system seems to be allowing the judgement of medical experts to override the judgement of parents with very low burden of proof or standards.

  2. “None of this is to say anyone involved — not a single doctor or nurse, not a single lawyer or judge — is a bad person. Given the right tools and put in the right circumstances, however, even people who are not bad can and will do very bad things.”

    That makes no sense at all. What is a bad person if not someone who does bad things? Just as a sinner is someone who sins.

    • “None of this is to say anyone involved….”
      What a pitiful, spineless comment. What an insult this comment is to Alfie Evans and his parents.

  3. Another topic extends to the paradigm shift of the Church of Pope Francis.

    “Cardinal” Paglia joined the Bishops of England in abandoning the Evans family to side with the control of the state, dissolving the sacred bond of the family. Paglia has to revise his statement when the optics got bad.

    How is it that the Church has any meaning, when entire Conferences of Bishops and Pontifical Academies think and act like the NHS staff of England, and “appear to contradict” the position of Pope Francis? Are we to believe that Pope Francis disagrees with Paglia and the English Bishops?

  4. What is in the best interests of the patient is assumed the priority of the physician in Britain and supported by the legal system, whereas in America it remains the decision of the patient or proxy. Although a right to life has become theoretical in the US with physicians and ethics committees removing that right by providing selective information and emotional driven coercion. The Church traditionally has stood squarely with a patient’s right barring life saving procedures including nutrition and hydration if either causes medical complication and further suffering simply prolonging the moment of death. Alfie Evans was comfortable with life saving treatment and had the moral right to life desired by his parents. Altieri makes the right recommendation but neglects as noted by Chris [in Maryland] that the Church has apparently swung over to the side of a secular humanist approach evidenced by the tepid response even acquiescence by British Hierarchy. Baroness Nuala O’Loan has sponsored “legislation now before Parliament the ‘Conscientious Objection [Medical Activities] Bill’ that seeks not only to clarify the legal position for U.K. medical staff but also safeguard the legal principle of conscientious objection” (Edward Pentin NCR). The right to life of a patient now in question within the Church itself realizes the importance of Josef Siefert’s laity based John Paul II Academy for Human Life and the Family.

  5. The question arises:

    Was it “right and just” or was it “unquiet” and therefor somehow “undignified” (and thus wrong) that the young woman named Christine, reportedly (see NC Register story) a friend of the Evans family, who traveled to Rome and, on the night of Sunday 22 April, stood outside the fence of the Vatican screaming for Pope Francis to do something?

    It seems that being quiet is not a Catholic option, if the goal is the mind of Christ in these matters.

  6. It is not a duty to keep a completely unresponsive individual alive by artificial means for an indeterminate period of time. However, there were videos posted from only a week or two ago which showed this child interacting quite recently with his parents. It needs to be understood that Leftists live in contempt for the natural order of God in His creation. It is an existence predicated upon having been deceived into the embrace a disposition of self loathing with respect to Human life, but especially human nature when they assumed vulnerability to their father the devil. Unfortunately the English legal and “socialized” medical system is dominated by these individuals as ours here in the US will soon be. The larger question here is why Christians, who strenuously object to such killings are so entirely steeped in complacency that they did not storm the walls of this hospital by the thousands instead of a few hundred if that was necessary to save the life of this child. We left his broken and grieving parents to submit finally in exhaustion to those determined to kill their child. Leftists, as I once was I might add, would not have hesitated for a moment to make such a showing to impose their vile agenda on just one person. Most Christians would not leave the comfort of their home to forstall the taking of an innocent and vulnerable life to save Christ if He was being crucified again, not as an adult but as a child by our governments and our courts. We do not have the abortion slaughter by contract child killers and child killing such as this by so called “legal and medical professionals” for convenience because our governments and courts mandate them. We have them because by our complacency, we allow it, personally doing little except whining as they occur unconstrained by our own action. If the Pope had simply gone to the hospital where this child was being eliminated by suffocation and starvation and had invited a couple hundred thousand of his closest friends to the event, the child would be alive today. Complacency of Christians is the only reason we have abortion and child killing for convenience worldwide today. It is a disgrace for which I am assured we will soon be held accountable.

    • Thankfully, someone has said it. Yesterday I was told that what the world does, is not my business and I should not worry. Actually, I worry, and I speak up, as I do believe that is exactly what Christ expects from us. I am appalled by the apathy of The Church of England in this case, and yes, The Pope needed to do more than “tweet”.

  7. Will reread for deeper observation. Still comes down to the state/corporate (medical tyranny) declaring, “We’re doing to kill this kid and there’s nothing you can do about it”.

    In any deep depth review of Alfie’s case do not dismiss the question if the boy’s condition was treatment/intervention caused. Vaccines – as was observed by his aunt.

  8. The days of persecution and destruction are swiftly coming. Let serious Catholics face facts – it will be our own families and friends and “co-religionists” who are going to persecute us. That is how it is done in totalitarian states, and that is what is unfolding – with the enormous help of the 5th column inside the Catholic hierarchy, major religious orders like the SJ, Marianists, OFM and the admin & faculty controlling 95% of “Catholic” (ie post-Catholic) colleges.

    There appears to be nothing but Church rupture and destruction ahead.

  9. The medical details–indeed, the medical facts–became TOTALLY irrelevant the moment Alfie’s parents wanted to remove him and the hospital made him a prisoner.

    It was at that moment that the hospital became a death camp, and they manifested their intention to murder Alfie.

    The lesson that must be learned–and enforced by law–is that no medical facility has the authority to keep anyone prisoner.

    • Spot on.
      Britons are subjects, Americans are citizens.
      Americans have a Bill of Rights, “endowed by their Creator”.
      Britons do not.
      If there was ever a time for the British Sovereign, Defender of the Faith, to speak and act on behalf of one of her “subjects” it was this past week. The Queen was silent. The Royal Family was silent.
      Britain is doomed. So be it.

      • Governments that reject natural, inherent, inalienable rights are totalitarian; no matter how benevolent they might appear at times.

  10. O.

    So, now the Holy Father is out there tweeting that we should all lay down our weapons.

    I suppose he thinks THE GOVERNMENT WILL KEEP US SAFE.


  11. “None of this is to say anyone involved — not a single doctor or nurse, not a single lawyer or judge — is a bad person.”

    A delusional, spineless statement made by someone who will fold and run
    when the chips are down. This statement is completely in line with the disgraceful
    inaction and silence by Catholic bishops of England and Wales ignoring the Evans family.

  12. Here is the BAD and USELESS performance of the Catholic hierarchy in England:

    – the bishop of Liverpool Malcolm McMahon did not visit Tom and Kate Evans and their son in the hospital;
    – he (or his staff) issued a public statement (I believe it was in Dec 2017 or Jan 2018) express concern for the suffering family, and erroneously stating that Tom and Alfie Evans were NOT Catholic;
    – in sum, the Bishop of Liverpool and his “Catholic” Brother Bishops couldn’t have shown they cared less…they were so “busy” being whatever they are, that they showed they are NOT shepherds of their flock…they don’t even know their own sheep.

  13. This is what happens when Christians are too complacent. This time it is Alfie Evans, next time it may be you or one of your family members. Medical kidnapping has taken place in the U.S. Fighting with “quiet dignity” does nothing. Time to bring out out the clubs and pitchforks. This child was murdered. We should do everything in our power to prevent the murder of children.

  14. The whole point of this case is that:

    A – when the family of Tom and Kate and Alfie Evans were kept prisoner by the hospital and its agency and its state-serving court…

    B – Cardinal Nichols and Bishop “Alfie Who?” Mcmahon and the English Conference of Bishops took sides against the Evans family to imprison their son do that he died when and where and how the hospital and agency and court decided.

    And we learned what we suspected “accompaniment” meant in this new cult being built by Count Paglia of the revised Death Academy of Team Francis: it means paying therapeutic lip service to poor Catholic people…all the way to the death chamber.

  15. So here is the big opportunity that the post-Catholic Church in England missed.

    Poor Alfie Evans was most probably going to die…and so rather than help the Catholic child and father to the very end…they let the ugly state just move it along…that way the “very busy” Bishop McMahon et al did not have to fuss about changing their schedules…or…you know…actually supporting the suffering family.

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