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refers to treatment that is morally required while other kinds of treatment- extraordinary treatment- may be refused or withdrawn–so long as one is not aiming at death, and has a proportionately serious reason.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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Oy veh. “We will not have a future unless we also place value on our present.” Sounds just like St. Augustine. My tail is wagging so hard it hurts! And yet his talentless, vapid goo is so depressing. Good Lord, at least German heretics believe in something. “I know your works: you are neither cold nor hot. Would that you were cold or hot! 16 So, because you are lukewarm, and neither cold nor hot, I will spew you out of my mouth.” Rev 3:15-16
He’s not listening … many, many Catholics are discouraged, frustrated and fed up with our pope. He needs to get out more. Typical out-of-touch prince, who loves his status more than the flock.
Well, his status is entirely due to Pope Francis; he has no interest in listening to other voices.
Nor does the Pope.
I don’t want to sound harsh. I just want to laugh. And believe me, I’m no backwardist – I’m actually allergic to Latin and Greek. Meditating on Scripture and Tradition is hard work. But this road apple in a red hat can’t even go back far enough to quote Pope Benedict XVI in the vernacular.
“Cupich” – a name that will go down in the annals of Church history as…
The French celebrated another Historic Coupe d’état on this day, and undoubtedly had Cupich been alive he would have had absolute confidence in the good intentions of those freemasonic sympathisers too.
The French traitors in the 18th century – many of whom would, like Cupid, have been validly baptised and full of zeal for the Spirit of the Age as a new source of Lodge-invented Revelation – took hundreds of the 40.000 Catholic clergy who died rather than accept one Iota of untruth, and left them stripped naked with neither food nor water in cages on the prison ships mooored off the Atlantic coast to rot.
With 300 million baptised victims of freemasonic New World Order since 1789* the unswerving support accorded by Cardinal Cupich to the Great Apostasy is difficult to comprehend. And yet, having promised annual Pedophile Clean Up Reports at McCarrick-Con II – never delivered because there is no clean-up – we have to understand that Cardinal Cupich is by large the best candidate for the next Spirit of Francis Award Ceremony.
*Pierre Hillard, Catholic French historien
“Cupich, who has been a cardinal since 2016 and is also a member of the Vatican’s Congregation for Bishops, concluded with a call for attentiveness and openness.”
And where is Cupich’s own attentiveness and openness? In my 75 years as a Catholic I have never encountered such a stone-cold clericalist sycophant and ideologue who, like his puppetmaster, delights in smashing and excluding anything authentically Catholic in his path.
Well the purpose of any religion, and certainly the message of Christ is to provide moral guidance. Some behaviors are destructive and thus considered sinful. Other behaviors are meritorious and are to be encouraged. If the message of your church becomes “anything goes” then you don’t have a religion.
Religions have arisen spontaneously throughout the history of the world when people have been willing to make a covenant with each other, and with a force they recognize as God to behave in constructive and salutary ways. In principle, people can be good to each other without a formal religion, but it is far more likely that such societies devolve into selfishness, chaos, violence and hate. But if the bishops and clergy no longer want to be the teachers of a consistent code of moral precepts, they should stop the pretense. Germans can eschew their government paycheck and become live-in boyfriends; Francis can make money selling buckets of his own urine.
Blaise Cupich says of the German bishops, “They are good shepherds who do their best to listen to the voice of the faithful, to see their wishes and hopes.” Good shepherds lead their flocks. They don’t bend to the wishes of the sheep.
Good shepherds lead their flocks as Christ would – in the way of Truth.
Good shepherds honor God the Father of Our Lord Jesus Christ.
Good shepherds do not worship false gods. Good shepherds do all they can by the power of grace to assist the sheep in the salvation of their souls.
Good shepherds know that all the sheep are different in their individual needs but that no sheep should be cared for any less than the others.
Good shepherds feed their sheep in ways each of them needs to grow. A good shepherd doesn’t feed his sheep with food that might be good for some sheep and not good for others.
A good shepherd lays down his life for his sheep and does all he can to protect all the sheep from going astray
and away from predators.
Now think of Cupich and his fellow homosexualist hierarchs.
If we don’t respect a “union” – civil or otherwise, then why would we rain down our blessings?
Per WIKI:
The eight Beatitudes in Matthew:[7][8][9]
3 Blessed are the poor in spirit,
for theirs is the Kingdom of Heaven.
4 Blessed are those who mourn,
for they will be comforted.
5 Blessed are the meek,
for they will inherit the Earth.
6 Blessed are those who hunger and thirst for righteousness,
for they will be satisfied.
7 Blessed are the merciful,
for they will be shown mercy.
8 Blessed are the pure in heart,
for they will see God.
9 Blessed are the peacemakers,
for they will be called the Sons of God.
10 Blessed are those who are persecuted because of righteousness,
for theirs is the Kingdom of Heaven.
11 Blessed are you when people insult you, persecute you and falsely say all kinds of evil against you because of me.
12 Rejoice and be glad, because great is your reward in heaven, for in the same way they persecuted the prophets who were before you…
The four Beatitudes in Luke 6:20–22 are set within the Sermon on the Plain.
20 Looking at his disciples, he said:
“Blessed are you who are poor,
for yours is the kingdom of God.
21 Blessed are you who hunger now,
for you will be satisfied.
Blessed are you who weep now,
for you will laugh.
22 Blessed are you when people hate you,
when they exclude you and insult you
and reject your name as evil,
because of the Son of Man.
“Blessed are you, Simon Bar Jonah for no man but the holy ghost has revealed these things to you. Therefore, you are Rock and upon this rock, I will build MY church (emphasis His) and the gates of Hell will not prevail against it”. We can’t build the church in our image. It can’t be a church where man is center-stage. It has to be a church that serves, adores and loves God, not man. Man’s abject and sinful behaviors can’t be divinized. Man’s brokenness can’t be accommodated. It has to be rebuked. If the church isn’t going to bring us to Christ, it has no real value, no true worth. It doesn’t exist to tickle man’s ears, to tickle his fancy. It exists to get him to Heaven from exile, from this Valley of Tears our it suffers an identity crisis.
“Cupich added: “I have great confidence in the course the Holy Father has set. I know that there are critical voices, but they are few. They are loud, but they are not many.”
St. Peter was at the, year 33 A.D., Church Council which decided to have Jesus put to death. The reason St. Peter did not speak up, is because he was fearful of the God authorized Church leaders who were bullying God’s Faithful. There are many devout Catholics today, who, similar to St. Peter at the Church Council of 33 A.D., are fearful of God authorized Church leaders bullying them.
Matthew 26:57 Jesus Before the Sanhedrin.
Those who had arrested Jesus led him away to Caiaphas the high priest, where the scribes and the elders were assembled. Peter was following him at a distance as far as the high priest’s courtyard, and going inside he sat down with the servants to see the outcome. The chief priests and the entire Sanhedrin* kept trying to obtain false testimony against Jesus in order to put him to death, but they found none, though many false witnesses came forward. Finally two came forward who stated, “This man said, ‘I can destroy the temple of God and within three days rebuild it.’” The high priest rose and addressed him, “Have you no answer? What are these men testifying against you?” But Jesus was silent. Then the high priest said to him, “I order you to tell us under oath before the living God whether you are the Messiah, the Son of God.” Jesus said to him in reply, “You have said so.* But I tell you:
From now on you will see ‘the Son of Man
seated at the right hand of the Power’
and ‘coming on the clouds of heaven.’”
Then the high priest tore his robes and said, “He has blasphemed! What further need have we of witnesses? You have now heard the blasphemy; what is your opinion?” They said in reply, “He deserves to die!” Then they spat in his face and struck him, while some slapped him, saying, “Prophesy for us, Messiah: who is it that struck you?”
I think God is letting Satan have his way with the Church and the world to sift out true believers. We have to focus on Jesus, not on the Vatican.
I think the big error in English speaking Synod coverage is that it only seems to focus on a Western European/American perspective. What about Asia, Africa and Eastern European bishops etc? I’m sure they must have some serious reservations about Germany and the agendas of liberal US laity and clergy. I’d love to hear what Bishops in other parts of the world are saying. Germany has money but few practicing members. They’re a fringe when compared to the universal Church. It’s good to remember how big the Church is.
I guess the wolves in sheep’s clothing aren’t even bothering to dress up as sheep anymore.
Same sex attraction people carry a great cross but if they act out sexually in their attraction it is a disorder and sinful. That is Church Teaching. How can you bless that. How can a Catholic Cardinal not know that? Come on get it and stop contributing to the liberal heresies out there in the name of progressiveness. That mindset is the cause of the division. May God have Mercy.
Is it too much to ask in these days of madness that Catholic priests, bishops, cardinals and, yes, popes actually *be* Catholic? That the principles they espouse be those of the actual Catholic Church?
Yes, it seems that it is too much to expect.
Because expecting Catholic principles to be espoused by our Church leaders means that we are rigid, hidebound, regressive and inflexible ideologues who have no concept of the radical love of the god of the left.
Cupich, for one, clearly has no intention of believing or acting as a Catholic prelate. The wisdom of the God of Abraham, Isaac and Jacob — the God who is Jesus — is far beneath him. He is an intellectual who sees the world through the way more advanced, more virtuous, more now-a-go-go lens of leftism.
Which is to say, his allegiance is to the ersatz mock Catholic-esque church of the evil ratfaced character. The unholy spirit.
And so sexual sins of all types are promoted as holy, pride is deemed a virtue, and all manner of violence against humanity is celebrated.
And the family is untenable, suicides skyrocket, and the children who actually live to be born are mutilated, sterilized and traumatized.
This is what the Synod on Homosexuality — in which the poor Holy Spirit is relegated to the role of a ventriloquist’s dummy, mouthing leftist bumper sticker slogans in the voice of Jesuitical James Martin — is supposed to bring about.
Come, Lord Jesus, come…
“He is an intellectual…”
Based on…?
LOL!
Progressives like Cardinal Cupich are all superior in intellect to those of us of inferior vision who dare to question them.
Don’t believe me?
Then ask ‘em!
Yea, verily, the interviewee doth maketh some good points. But, if yours truly were to publicly mouth my own myopic mumblings, I might be soundly judged and deservedly so.
As for “CLARITY” on what is meant by the blessing of same-sex “couples,” I might be faulted for splitting hairs while a larger clarity would notice the range fire of gender theory running wild across our culture and that has even torched much of the Church. I would be faulted for fiddling whist Rome burns.
With regard “LEADERSHIP,” yours truly might recall the recent butting aside and upstaging of Cardinal Di Nardo as president of the USCCB. If this golden-boy routine were my concept of “leadership,” I might even be excluded from ANY office position within the USCCB. In the past and in the future.
Were yours truly to suggest that those were “FEW IN NUMBER” who are concerned about the lack of clarity, and worse, over the past decade…I surely would be remiss to notice the departure of half a million Catholics from the Church in Germany in the past year alone. We now have three languages in the Church: the Vernacular, the Latin, and those who vote with their feet. The synodality of “walking together”, that!
As for the Germans, I too would point to “GOOD INTENTIONS,” yes surely! But “the road to hell is paved with good intentions…”
Which is to say, on these points, yours truly would be guilty of “selective blindness”, a universal human frailty–of which some clerics in high places seem curiously self-exempt.
Butt, yea verily, who am I to judge?