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refers to treatment that is morally required while other kinds of treatment- extraordinary treatment- may be refused or withdrawn–so long as one is not aiming at death, and has a proportionately serious reason.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.
[…]
I’d tell the French government to go jump in a lake. The Catholic Church needs to stop accommodating to the immoral pagan culture. Christ expects nothing less.
You gettin’ soft in your old age, Backwards?
Whatever happened to ‘Smack ’em wid a 2 x 4′?
😆
If it’s an entire culture, then Paul is the one with the answer, because we ain’t big enough. He goes straight to the top, as should we:
De 32:25 ‘Vengeance is mine, and retribution, At the appointed time when their foot slips, For the day of their disaster is near, And what awaits them will come quickly.’
Hebrews 10:30
For we know the One who said: “Vengeance is mine; I will repay.” And again: “Jehovah will judge his people”
“In God we trust”, innit?
Seriously, if this thread progresses well, you’ll see better suggestions than yours or mine. Stay tuned
Shape of things to come.
Indeed.
Coming to a theatre near you.
So now the amoral cowards who run France are going to suppress Catholic teaching and bolster perversion?? Persecution of priests? I thought that ended after the bloody collapse of the French Revolution, where killing Catholics was all the rage.There is a world of difference from allowing secular legal tolerance of different lifestyles and trying to cherry pick beliefs away from religions by making select beliefs “illegal”. Will they now mandate women priests on the basis of “discrimination” too? Will this ditsy broad Berge who is persecuting Father and the Church name herself Pope? She might as well if she sees herself qualified to decide what constitutes Catholic belief. Notably, the French have been super welcoming to Muslim immigrants who have created a cultural uproar there , not to mention enacting more than a few terror attacks. I guess we can see whose religion they favor in France. American citizens, especially Catholics: keep your tourist dollars OUT of France. By the way, KUDOS to J.K. Rowling to standing up to similar crazed nonsense from the govt of Scotland. Scotland has made it a jailable offense to call a trans person by their REAL sex. Rowling told them to take a hike. She is a person whose courage should be copied.
Yes & no. France recently kicked an imam out of the country for disrespecting the French flag. Some things are tolerated, some things not.
I appreciate what J.K. Rowling did. Scotland’s an object lesson of what can happen when a small extremist political party with a slight majority gets in power. Our two party system has it’s troubles but when you have 4-5 parties vying in elections things can get weird.
Where are the rest of France’s priests and bishops?
Blessing the very very couples that Raffray is exhorting to fight against their weakness
They are scared out of their cassocks
I’m happy that father stood for the truth. Sodomy is not acceptable but correcting them is kindness. To not gently enlighten them of end of life in hell is not God’s plan.. Practicing same sex lifestyle is a demonic lifestyle that evil promotes to destroy humanity that they hate. God is love always. Purity brings peace and happiness.
They’re only demanding a pinch of incense.
LOL. Good one, and historical.
Where are the other Catholic priests?
In all of France, is only one priest preaching the truth of the Catholic faith in the face of such persecution?
Poor Jesus. He deserves so much better.
It would seem that The Universal Church has given up to secular demands. A sin is a sin. Has GOD sent out an email about this big change? We didn’t get the notice. Perhaps it is included in the email that states we no longer need to attend mass and concentrate on God’s gift to us. Does God no longer count? “No matter what, The Gates Of Hell shall not prevail against it.”
Talk to any and ALL of the Catholics in France that assist in the LATIN MASS and en masse they’ll say the same thing this man has been singled out for saying. How fine a point do I have to make on the issue of Vatican II? It should be anathematized. I know the charge: “off topic”. Really? Had we never LOST the Catholic Faith to the cra-cra following V-II, we would never have to be in the position of apologizing for the Catholic Faith as it makes its ascendancy again – and it is in ascendancy – as you look to the Latin Mass communities. Deo gratias et Mariae!
I recently checked on how things inside Russia are. I do this from time to time. This time I discovered that most of the Eastern Orthodox priests who did not approve the war are now prohibited to serve; some retired, some left Russia. I also recalled a case of a woman who stood silently in front of the church building with a piece of paper on which was written “You shall not kill” and was quickly arrested. (Another person who later attempted to stand with an empty piece of paper, nothing written on it, was arrested too.) It is Orwellian but what is written in the article, about a priest who is prosecuted for calling homosexuality “a weakness” and a sin, is equally Orwellian.
So, in Russia you can be prosecuted for displaying the commandment “you shall not kill” while in the West you can be prosecuted for saying that homosexuality is a sin.
I have been writing for some time that the West is becoming as totalitarian as Russia but in disguise; Russia destroys a person openly (via murdering) and the West – covertly, via a demand to tolerate everything which the state designates as tolerable. Funnily enough, in pre-revolutionary Russia brothels were called “houses of tolerance”. Every time I hear “tolerance” I recall that fact and laugh. The West is becoming a huge “house of tolerance”.
About 40 years ago, I knew a politically and socially liberal woman who was dating a man who, together with his parents, had emigrated from the USSR in the 1970s. He once told her that her politics sounded just like that of the Party officials and commisars he’d left behind in the Soviet Union. She found that puzzling; I wonder if she still does.
I’ve heard people who’ve fled from socialist regimes say they see the same warning signs appearing in the US.
If you look up the history of the Epoch Times, the founder says the same thing.
Homosxexual acts are the sin, not homosexual desires. Read the exposition of what the chatecism teaches.
You do not need to back up your statement with a reference to the catechesis – I know that you are correct. I was retelling the quote from the article:
“The French government has initiated a series of legal measures against Father Matthieu Raffray for calling homosexual relations sinful and for describing homosexuality as a “weakness.””
and did it without a distinction present in the original because I was concerned with shaping other thoughts. My mistake. I suspect most readers understood what I meant though.
OTOH, at least this priest is being hounded by the state, not his bishop.
Cleo, give it time.
In their attempt to be tolerant of all those migrants settling in Europe, those governments are flagrantly intolerant of Christianity and the very roots upon which Europe flourished.
But wasn’t the “Christianizing” of Europe a bit bloody at times?
Coming to America, if we continue on the road we are traveling
Of France et al, we read: “Homosexual acts are a sin, but I think people don’t know what a sin is anymore…”
The French novelist also got this right, back in the 1940s:
“The modern world will shortly no longer possess sufficient spiritual reserves to commit genuine evil. Already . . . we can witness a lethal slackening of men’s conscience that is attacking not only their moral life, but also their very heart and mind, altering and decomposing even their imagination . . . The menacing crisis is one of INFANTILISM.”
(Interview with Samedi-Soir, Nov. 8, 1947, cited in Hans Urs von Balthasar, “Bernanos: An Ecclesial Existence” [San Francisco: Ignatius, 1996], 457, caps added).
In the not distant future, many of us who choose to proclaim Christ, His Church and His truth, will be imprisoned or killed for doing so. Pray for us, holy martyrs, and lend us your strength and peace in the face of persecution. I think the storm that’s coming will make the Coliseum look like a picnic.
Dear Ms Berge,
“In the face of hatred I’m not going to let anything get by”
AS YOU WISH
“Government minister for equality between women and men and the fight against discrimination”: Ain’t that a mouthful.
St. Thomas Aquinas, pray for us.
Macron is nothing more and no less than a well tailored modernist Jacobin supported by his appointee, the new age madame DeFarge, Aurore Bergé. New age France must protect the purity of its woke image, the only European nation to include a right to murder prenatal infants in its constitution. Macron’s ego now dangerously apparent in his Napoleonic willingness [ironically the only French president never to have served in the military] to send French troops to oppose Russia in the killing fields of the Ukraine.
France,where their great Icon, Notre Dame burned.Perhaps God allowed that to happen because He saw the evil actions of many of the French people coming, such as putting abortion rights in their Constitution and the persecution of good and honest priests, such as this one.It seems as though God is removing His protective Hand from France.
The French government openly discriminates against the Roman Catholic Church and the French people shrug their shoulders.
I’m under the impression that the Church in France is actually showing some signs of life.
Still waiting for the bishop to slap this priest down as we saw a couple of months ago in Ireland. (Not sure if the Institute of the Good Shepherd is under a bishop).
I thought we saved this country once in the name of freedom?
it IS sinful!
Wow 😯 finally a proud Catholic moment.
You’ve lost the argument already the moment you acquiesce to the presumption that “homophobic” is an actual word.
Godspeed.
John 3:19
The Bible has a clear understanding of human nature.
Men love the darkness more than the light because their deeds are evil!