New York City, N.Y., May 1, 2018 / 01:36 pm (CNA/EWTN News).- Alfie Evans, a disabled British toddler who died Saturday after a contentious legal battle over his treatment, captured the attention of Catholics around the world, including Pope Francis. While he suffered from undiagnosed neurological problems at Alder Hey Children’s Hospital, Alfie’s parents sought to treat him elsewhere, while physicians opposed the move, arguing that continuing treatment was not in the child’s best interests.
The case raised questions about the right of parents to make healthcare decisions for a child, about ‘ordinary’ and ‘extraordinary’ means of treatment and life-support, and about the treatment of patients with disabilities. Alfie Evans died after his parents lost legal appeals, despite diplomatic interventions supporting their efforts. He lived, unexpectedly, for five days after physicians removed life support.
Charles C. Camosy is associate professor of theology at Fordham University and author of several books on Catholic ethical reasoning. Last week, he authored “Alfie Evans and our moral crossroads,” published by the ecumenical magazine and website First Things.
In an interview with CNA editor-in-chief JD Flynn, Camosy discusses some of the ethical aspects regarding the case of Alfie Evans.
Some of the discussion regarding Alfie Evans’ situation centered around ‘extraordinary’ and ‘ordinary’ kinds of life-saving treatment. Questions were frequently raised about whether Alfie was receiving ‘ordinary’ or ‘extraordinary’ treatment by physicians at Alder Hey Children’s Hospital.
How does the Church understand the idea of ‘ordinary and extraordinary’ medical treatment?
This is an essential aspect of the Church’s teaching, especially at the end of life.
‘Ordinary’ and ‘extraordinary’ have nothing to do with the frequency with which a particular culture offers a treatment. Ordinary treatment, rather, refers to treatment that is morally required while other kinds of treatment- extraordinary treatment- may be refused or withdrawn–so long as one is not aiming at death, and has a proportionately serious reason.
The distinction is largely accepted by most medical communities today, and was pioneered by the Catholic Church in the late Middle Ages when thinking about battlefield medicine and whether or not a soldier could refuse a life-saving amputation without aiming at their own death. The answer was “yes,” and the intense pain of an amputation without pain medicine was the proportionately serious reason. In such a case, death is merely foreseen but not intended.
The Church generally allows individual patients or their surrogates (with a strong preference for the family) to make this kind of moral judgment for themselves, unless it is perfectly obvious that one is aiming at death or that there is nothing like a proportionately serious reason.
It is important to mention that giving someone food and water, even through technical means, is not considered means of “medical treatment” and is not a medical act according to Catholic teaching. It is care which comes from basic human decency.
You wrote in First Things last week that disabled patients sometimes suffer from “slow coding” or “show coding” in hospital settings. Can you explain what that is?
I wouldn’t say it happens often, but it happens often enough that medical ethicists think it is worthy of debate.
Sometimes a physician and/or other members of the medical team believe that further intense treatment of a disabled child is inappropriate. Sometimes they may have a point–like when pounding on the chest of a child after cardiac arrest is likely to do little more than break her bones. But sometimes, as I believed happened in the Alfie Evans case, it is because physicians and/or other members of the medical team think the child is so disabled–perhaps due to a devastating brain injury or disease–that further life is not in the child’s interest.
Now, a medical team and hospital is rarely forced into caring for a patient, so one option is to refer the parents to another medical team or hospital who will treat the child. But sometimes, despite agreeing with the parents that the child is a “full code” and everything will be done, the physician and/or other members of the medical team will only make a half-hearted effort at treating the child. This is called a “slow” or “show” code, and some medical ethicists defend the practice.
But as I mentioned in my First Things piece, that is only one way that health care providers can and do manipulate parents to get the outcome they want. Numbers can be fudged. Studies can be selectively referenced. Directive language–especially about disability–can be used.
Health care providers have a ridiculous amount of power. We ought to be far more critical in holding them to account.
You have discussed the concept of “ableism.” What does this mean?
Ableism describes a particular kind of unjust discrimination. In this case, it is discrimination in favor of those with able bodies and minds. Physicians tend to be at particular risk for ableism and often rate quality of lives of disabled patients worse than the patients do themselves.
How might those biases have impacted decisions made about the medical care of Alfie Evans?
The treatment Alfie was being given were working quite well, doing precisely what it was designed to do. He needed help breathing, but so do many disabled people. His brain damage was profound, even to the point where it is likely he wasn’t conscious of being intubated, and was almost certainly not suffering in any meaningful sense. And though he was likely to die, he was never diagnosed with a disease and we have absolutely no idea how long he would have lived had he been given treatment that is standard in other countries.
Given all these facts, the concern that Alfie’s doctors and Judge Hayden had with his brain seems impossible to miss. Though misleading euphemisms were offered about other matters of concern (as they almost always are when the truth is difficult to name), it is very clear to me the decision was made on an ableist basis. The decision wasn’t made because, like getting one’s leg cut off without pain medicine, the treatment was too burdensome. It was made because Alfie’s brain was so damaged that his life was no longer consider dignified–and it was [judged to be] in his best interests to die.
His death was not merely foreseen. Those who wanted Alfie’s life support withdrawn were not happy that he started to breathe afterwards. (And, indeed, there is at least some evidence to suggest that Alfie was given drugs after extubation which made it more difficult for him to breathe.) On the contrary, the point was for that for Alfie to die was in his best interest.
This is unlike the amputation example where, if somehow the soldier lived after refusing treatment, everyone involved would be thrilled. The soldier’s death was never part of the object of the act. Not so with refusing to treat Alfie Evans.
What reasoning did some Catholic commentators proffer to support Justice Hayden’s decision? What is your response to that reasoning?
Catholic commentators who support Hayden’s decision are right about a lot of things. They are right that the Church doesn’t make an idol out of preserving life. In fact, we invented the tradition which resists that kind of idolatry. They are right to say that we don’t simply allow parents to do whatever they want with their children in a medical context–especially if it could reasonably be construed as abuse. They are right to say, if it was really about burden of treatment, that Hayden’s decision could be consistent with Catholic teaching.
But I fear much of the commentary has been too deferential to those who hold power in this case: the doctors and the jurists. They deserve a far more skeptical eye, especially given the power they wield over the life and death over the most vulnerable.
Catholic teaching never permits aiming at the death of a patient, either by action or omission. This case, again, was not about the burden of extraordinary treatment, but about the disability of a child. Our job as Catholic Christians is to see the face of Christ in little Alfie–not to accept the position that his treatment was futile because his brain damage prevented him having certain abilities. And when there is legitimate disagreement about what is in a child’s best interest, and abuse is not part of the scenario, the Catholic position is to defer to the parents. They know the child and his interests best. The three of them belong to each other in a special and unique way. The doctors and judges will not be visiting Alfie’s grave. His parents will be.
Two other quick things to mention:
First, the charge of “vitalism” has been thrown at people who didn’t want action aiming at Alphie’s death. It is not always clear what this charge is trying to identify, but if it is the position that human life is valuable as human life–regardless of what it can “do” or how much it can “produce”–then many of us, I hope, will plead guilty. A human person is a living member of the species Homo sapiens. Nothing more. Nothing less.
Second, it has been a shame that so many people have tried to read this issue through the life/choice abortion binary. Once again, it appears, the abortion wars have infected a very different kind of moral and legal issue.
Pro-lifers have, for some time now, been concerned with vulnerable lives beyond birth. Often in close cooperation with disability-rights groups, we fight against euthanasia. We fight against human trafficking laws. Many of us reject the death penalty. We are deeply, concerned, obviously with infanticides perpetrated by people like Dr. Kermit Gosnell. We fight for vulnerable human life, especially when–as Pope Francis warns–our throwaway culture treats it like so much trash.
There is absolutely no reason that the fight for Alfie and others like him needs to be about abortion. People who disagree about that issue should be able to agree that Alfie matters just the same as any other little boy, and that his parents ought to have been able to pursue his best interest in ways that other parents are permitted to do.
What might the life and death of Alfie Evans portend for the future of healthcare ethics and policy? What should it teach Catholics about prophetic witness?
We are at a very dangerous moral crossroads. Before the attention that the Alfie Evans and Charlie Gard cases brought with them, these practices were hidden away, with little-to-no public scrutiny. What will we do now that these practices have been brought to light and are defended by some doctors and judges? Will we step up and be heard? Will we be on the side of the disabled and the parents who fight for them? Or will we capitulate to ableist assumptions and the practices of the powerful?
Pope Francis was on the right side of both the Charlie Gard and Alfie Evans cases, resisting the throw-away culture’s attempt to dispense with them. Let us get behind the Holy Father and continue to resist the throw-away culture by standing up for the disabled, in this case and the similar cases which are sure to come.
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These Bishops are heretics, and in a Church which worshipped Jesus as Lord, instead of worshipping Bishops, they would be invited out the door to start their official fake church, rather than insisting on their standing as “krisjuns” and “katlicks,” which impression apparently persists in their minds because they are well groomed, well fed and nicely costumed.
Yea, verily, in service to inclusivity, the ceremonial scriptural citations surely will not exclude the below from both the Old and the New Testament and, in the interest of ressourcement theology, also something from a Church Father:
The Old Testament: “Neither shalt thou desire thy neighbor’s wife, neither shalt thou covet thy neighbor’s house, his field, or his manservant, or his maidservant, his ox, or his ass [!], or any thing that is thy neighbor’s” (Deuteronomy 5:21).
St. Paul: “Do you not know that the unrighteous will not inherit the kingdom of God? Do not be deceived. Neither fornicators, nor idolaters, nor adulterers, nor homosexuals, nor sodomites, nor thieves, nor covetous, nor drunkards, nor revilers, nor extortioners will inherit the kingdom of God” (1 Corinthians 6:9-10).
St. John Chrysostom: “The road to hell is paved with the bones of priests and monks, and the skulls of bishops are the lampposts that light the path.”
I believe that Cardinal Jozef De Kesel and all the Catholic bishops of Belgium who agree to bless and validate homosexual unions and sin, contrary to Scripture and the Church’s teachings, will be condemned. They have no longer the authority to be shepherds of the Church.
I have found, the best way to handle the schism of the German Church, is to put their evil defiance directly up against our Lord Jesus Christ. You do this by switching to the issue of Divorce and Remarriage, which the German Church also wants to change. Jesus is VERY CLEAR on this issue. When asked what we must do to go to heaven, Jesus’ very second command is to not commit adultery, and, according to Jesus, divorce and remarriage is committing adultery. So now you have the German Church in clear defiance to our Lord God and Savior Jesus Christ, rather than the German schism versus the Catholic Church teachings.
Then the Pope anathematizes the schism German Church on all issues of evil defiance to our Lord Jesus Christ. If the schism German Church repents of all their evil, then they can come home to Jesus and His Church.
Mark 10:6
At the beginning of creation God made them male and female; for this reason a man shall leave his father and mother and the two shall become as one. They are no longer two but one flesh. Therefore let no man separate what God has joined.” Back in the house again, the disciples began to question him about this. He told them, “Whoever divorces his wife and marries another commits adultery against her; and the woman who divorces her husband and marries another commits adultery.”
Mark 10:17
“Good Teacher, what must I do to share in everlasting life? Jesus answered, “Why do you call me good? No one is good but God alone. You know the commandments: ‘You shall not kill; You shall not commit adultery;'”
Luke 16:17
“The law and the prophets were in force until John. From his time on, the good news of God’s kingdom has been proclaimed, and people of every sort are forcing their way in. It is easier for the heavens and the earth to pass away than for a single stroke of a letter of the law to pass. Everyone who divorces his wife and marries another commits adultery. The man who marries a woman divorced from her husband likewise commits adultery.”
Malachi 2:16
For I hate divorce, says the LORD, the God of Israel, And covering one’s garment with injustice, says the LORD of hosts; You must then safeguard life that is your own, and not break faith.
1 Corinthians 7:10
To those now married, however, I give this command (though it is not mine; it is the Lord’s): a wife must not separate from her husband. If she does separate, she must either remain single or become reconciled to him again. Similarly, a husband must not divorce his wife.
Wisdom 14:22
Then it was not enough for them to err in their knowledge of God; but even though they lived in a great war of ignorance, they called such evils peace. For while they celebrate either childslaying sacrifices or clandestine mysteries, or frenzied carousals in unheard of rites, They no longer safeguard either lives or pure wedlock; but each either waylays and kills his neighbor, or aggrieves him by adultery. And all is confusion– blood and murder, theft and guile, corruption, faithlessness, turmoil, perjury,…
Matthew 19:4 The Question of Divorce.
“Have you not read that at the beginning the Creator made them male and female and declared, ‘For this reason a man shall leave his father and mother and cling to his wife, and the two shall become as one’? Thus they are no longer two but one flesh. Therefore, let no man separate what God has joined.”…
…”but at the beginning it was not that way. I now say to you, whoever divorces his wife (lewd conduct is a separate case) and marries another commits adultery, and the man who marries a divorced woman commits adultery.”
Genesis 2:22
This one shall be called ‘woman,’ for out of ‘her man’ this one has been taken.” That is why a man leaves his father and mother and clings to his wife, and the two of them become one body.
Matthew 19:16
“Teacher, what good must I do to possess everlasting life?” He answered, “Why do you question me about what is good? There is One who is good. If you wish to enter into life, keep the commandments.” “Which ones?” he asked. Jesus replied, “‘You shall not kill’; ‘You shall not commit adultery’…”
Two points (of many) for our Orwellian Church. The headline isn’t quite accurate if you include Francis in the Vatican because he blesses same sex couples too. And as far as the “For a welcoming Church that excludes no one” silly statement goes, how long will it be before Catholics with respect for Catholic tradition and the Communion of Saints be included in the Church?
Hold firm in your faith brother. Strengthen your family and your community ties. Strengthen your parish ties. The ecclesia is our mother and we must remain faithful to her, no matter how it hurts. I am appalled by what is happening in Europe but all will be revealed for the sin that it is. It’s just a matter of time. God bless you.
APOSTATES…ALL OF THEM.
“Catholic bishops in Belgium . . . .The bishops of Flanders also . . . ”
Which is it?
“Woe to those who call evil good, and good evil;
Who substitute darkness for light and light for darkness…”
—Isaiah 5:20
It’s just a matter of time until “Fr.” Martin shows up waving the flag.
They are indeed heretics, Chris – thanks for stating the obvious.
All are welcome in Christ’s Church.
But you don’t get to make the rules – you have to FOLLOW the rules.
God speaks to their point of view and it is not encouraging unless they repent and accept the rules and tenets of the church!
Philippians 2:21 For they all seek their own interests, not those of Jesus Christ.
Romans 1:29-31 They were filled with all manner of unrighteousness, evil, covetousness, malice. They are full of envy, murder, strife, deceit, maliciousness. They are gossips, slanderers, haters of God, insolent, haughty, boastful, inventors of evil, disobedient to parents, foolish, faithless, heartless, ruthless.
Psalm 10:3 For the wicked boasts of the desires of his soul, and the one greedy for gain curses and renounces the Lord
.Jude 1:16 These are grumblers, malcontents, following their own sinful desires; they are loud-mouthed boasters, showing favouritism to gain advantage.
2 Timothy 3:4 treacherous, reckless, swollen with conceit, lovers of pleasure rather than lovers of God,
Prayers for the Holy Spirit to regenerate them. Prayers for Papa that he will do what is just.
Operation Synodalweg, a Vatican sponsored deftly engineered putsch to destabilize universal Catholicism now having predictable outcome? Belgium, the home of Godfried Danneels, apparently was ripe as the first expected domino.
Greatest of all synods, the grand Synod on Synodality the major arm of a veritable Von Schlieffen Plan? Synodalweg is comparable to the earlier, smaller audacious assault through the ‘impassible’ Ardennes. If the Vatican had focused on effectively managing Synodalweg, what occurred in Belgium wouldn’t likely have occurred [at least not so soon]. Similarly, would the appointment of radical Luxembourg cardinal Pierre Hollerich SJ as Synod relator have been made if attention weren’t fixed [cardinal Walter Kasper, perhaps a convenient headline grabber denouncing Synodalweg] on Germany’s collapse into apostasy?
Whatever may be, the process of reactionary effect appeared in the making. Our clerical sentinels were snoozing, or just plain in cahoots while supposedly guarding the ramparts. At least this is a wakeup call. They’re still numbers of sufficiently faithful to turn the tide. As at the miracle of the Marne.
Here is a novel approach to evangelization: just preach the Gospel! You know, the four that are in the Bible. It worked for Jesus. With a little faith and humility it might even work for us!
Pope Francis now has to decide. Is Pope Francis going to enforce Church law and order, from the unequaled authority of the Chair of St. Peter, and intervene, or are all Bishops of the world now free to lead in any direction they choose?
Matthew 12:25 “A kingdom torn by strife is headed for its downfall. A town or household split into factions cannot last for long.”
Abraham Lincoln “A house divided against itself, cannot stand.”
All “united” groups need one person, in unequaled authority, to choose the direction in which all members of the group will be compelled to follow, in order for the group to stay united. Almost all organizations, companies, countries, clubs, militaries, religions etc., put one person in unequaled authority, over all the rest of their group members, and these leaders enforce the direction the whole group will go, and it is this enforcement which unites the group as a whole.
Matthew 12:25 “A kingdom torn by strife is headed for its downfall. A town or household split into factions cannot last for long.” Twelve Apostles with equal authority, equals twelve Churches. Tens of thousands of Bishops, with no one enforcing their actions, equals tens of thousands of Churches.
If Pope Francis chooses not to enforce law, order, and compel all Catholics to be united in the one direction we will all go, then the Catholic Church, “split into factions cannot last for long”.
I can’t wait until we have blessing ceremonies for kleptomaniacs, and
blessing ceremonies for adulterers, and
blessing ceremonies for masturbators, and
blessing ceremonies for gossipers, and
blessing ceremonies for [insert your own inclusive sin].
I think the number of parties in a union will be the next frontier. If we can’t tell someone who they can or cannot love how can we dictate how many? That at least has some precedence biblically-unlike the gender question.
What is it with Belgium? Heart of Western Europe, beautiful medieval art, music, and traditions of piety, and a population that unites the Latin and Germanic peoples.
But also: Flemings and Walloons hating each other, King Leopold in the Congo (Conrad’s Heart of Darkness), Rexists in WW II, apostasy, pedophilia scandals, assisted suicide for children and depressed people, etc., etc., etc.
Does all that simply display what has happened to us?
As a consolation to those long-suffering, real, and betrayed Catholics in Belgium, we are reminded of the response to the 4th century Donatist heresy, and the fact that the validity of the sacraments does not depend upon the holiness (or not) of the ordained priests. This, too, from the life of St. Theresa of Avila:
“…I beheld my Lord, in that great majesty of which I have spoken, held in the hands of that priest, in the Host he was about to give me. It was plain that those hands were those of a sinner, and I felt that the soul of that priest was in mortal sin. What must it be, O my Lord, to look upon Thy beauty amid shapes [two looming demons] so hideous? The two devils were so frightening and cowed in Thy presence [….] So troubled was I by the vision, that I knew not how I could go to Communion [….]
“Our Lord Himself told me to pray for that priest; that He had allowed this in order that I might understand the power of the words of consecration, and how God failed not to be present, however wicked the priest might be who uttered them; and that I might see His great goodness in that He left Himself in the very hands of His enemy, for my good and for the good of all [….]
“I understood […] what a horrible thing it is to receive this most Holy Sacrament unworthily, and how great is the devil’s dominion over a soul in mortal sin” (“The Life of Teresa of Jesus,” autobiography, Newman Bookshop, 1943, Ch. XXXVIII).
A singular fruit of Pope Francis’s refusal to clarify AMORIS LÆTITIA…a foundational attempt by some countries of Western Europe to bless sodomy.
Homosexual agendas have been BACKED by Francis and his never-ending Pontificate.
It’s a “done deal”. Satan is running rough-shod over remaining, barely-awake
Catholics.
Francis will be remembered as the first Pope who, through his refusal to teach the Doctrine of the Church and open toleration for those who defy it, has presided over not one, but two Schisms in Belgium and Germany.
This is one issue Francis got right, “You cannot bless sin.”
No, he didn’t.
How is this ‘pastoral’ approach bringing active homosexuals back to Christ if a country’s Catholic Church ‘blesses’ the very sexual union the Catechism prohibits and the pope is complicit by his very silence or his telling the hierarchy that their approach is correct?
You haven’t taken note of how he talks, and has always talked out of both sides of his mouth like the most shameless cynical banana republic tyrant?
How inauthentic does a heart, mind, and soul have to be than to employ a term and actually believe a term like “the sin of backwardness?”
“The present article offers a study of the way in which a generation of theologians at the Louvain Faculty of Theology – in particular exegetes such as Lucien Cerfaux, Joseph Coppens, and Albert Descamps – have dealt with the aftermath of the modernist crisis. Focussing on the period between the early 20th century tensions that paralyzed catholic theology and exegesis, and the era of aggiornamento set pf by Vatican II, we concentrate upon the way in which these Lovanienses sought to integrate historical criticism and theology. While our main focus lies with the exegetes tackling the (in)compatibility problem, reference will sideways be made to the way in which the faculty kept track with more dogmatically and/or church historically focussed movements in the preconciliar era, such as the so-called nouvelle théologie-movement. In this juncture, the role played by Louvain professors such as Gustave Thils and Roger Aubert cannot remain unmentioned” (Abstract. The Louvain Faculty of Theology and the Modern(ist) Heritage Reconciling History and Theology Karim Schelkens).
I offer this post in response to questions, why Belgium? Yes, once a European center of Catholic culture, since post WWII [and earlier] a demise perhaps later centered at the Leuven University [the Louvain]. Recalling when preparing for ordination in Rome the talk by faculty was the modernist philosophical theological trend at the Leuven. Aftermath Vat II another factor. Morality collapsed, one shocking account was the scandal of government officials sexually abusing children held captive in locales for that purpose. “Police are investigating child sexual abuse allegations involving a federal Cabinet minister and a regional government official, Belgian newspapers reported Saturday.The investigation follows three months of scandals centering on a child pornography ring that left at least four girls dead” (Associated Press Nov 17 1996 2:00am EDT). “Belgium’s Government slid deeper into crisis today as the Parliament began investigating allegations that a Deputy Prime Minister had engaged in sex with under-age boys” (Top Official Faces Charges in Belgian Sex Scandal Reuters Nov 20 1996).