Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
Alfie and the Failure of Medical Ethics
The case of Alfie Evans once again brings to light the ethical and moral landmines that are promulgated as governments intrude further and further into the personal lives of its citizens.
Young Alfie suffers from a so-far unknown and undiagnosed congenital ailment that has left him in a near-vegetative state since late 2016. As such, the officials of the UK’s National Health Service have brought it upon themselves to hasten the death of the child … for his own well-being.
If you think that is sarcasm … it is not. The Royal College of Pediatrics literally made that argument this week. And that would be bad enough except for the fact that there is no medical or moral reason for their conclusion. So far, there is little to no medical evidence that the child has been suffering at all.
Well, that is not totally the case. The child did suffer over the last 24 hours … after NHS physicians removed his ventilator and then for hours refused to provide any ancillary support to reduce his difficulty as he was gasping for air and suffering from dehydration. In short, the physicians themselves have caused more suffering than any decision the parents have recently made.
This debate could have been avoided if the UK had taken up the Italian government’s offer to fly Alfie to Rome and provide him with any care he required. With the blessings of the Pope himself, Italy even granted Alfie citizenship on Monday. Italian diplomats further offered to evacuate him by military air ambulance to an Italian hospital for treatment and, if needed, end-of-life care.
The UK government said “No thanks.”
This ultimately is where the medical ethical questions of this case erupt into a flaming pyre of injustice.
The subjugation of the parental wishes, in this case, was problematic from the beginning, as it has been in other cases in the British system over the past few years. This child, by all accounts, is going to die very soon. The only question is the manner of his death and whether the parents will have the power to make those final decisions. The physicians and judicial system are circumventing that most basic of decision-making processes and replacing it with their own questionable morality and dubious science. Furthermore, they are circumventing those parental wishes for absolutely no benefit to the child in question. Medically speaking, nothing they are doing at this point is benefiting the child in any real way.
Ethically, there are very few reasons for medical professionals to reasonably be allowed to circumvent the wishes of the appropriate guardian in patients’ cases. One is if the guardian’s decisions are causing damage to the patient, risking the patient’s life, and well-being in some way. The second reason is even weaker morally and ethically: if the guardian is wasting the public money in their efforts and, thus, the government deems it a waste of time and money to continue.
In this case, there is no question the guardians have the best wishes of the child at heart. Physicians have not proven at any point that the choices the parents wish to make would cause any damage to the child. And now, there is no demand on the public system to pay for this child’s care. Italy and others are willing to take responsibility.
And still, the UK refused.
To compound matters, the doctors’ decisions have not only not alleviated Alfie’s suffering, but have compounded it. They have refused to follow the parents’ wishes, all the while worsening Alfie’s suffering, without ever admitting the absolute fact that they have no proof whatsoever that the parents’ treatment choices would have caused more pain and suffering than their own.
This case illustrates the worst abuses of authoritarian rule, compounded by the archaic medical philosophy of paternalism. Paternalism is the belief that physicians and medical professionals, being more educated and knowledgeable about health issues, should decide what is in the patient’s best interests, without regard to the patient’s own wishes.
Paternalism was a common practice among doctors before the middle part of the 20th century. But as individual freedoms grew in the Western world, patient autonomy (the belief that patients were intelligent and knowledgeable enough to make decisions for themselves) became predominant. The British have clearly taken a few steps backward into the 19th century with their recent behavior.
And that ultimately is the greatest crime here. The physicians, in this case, are not improving the well-being of Alfie in any manner whatsoever. They have replaced the will and personal wishes of Alfie’s parents with that of their own. This would be possibly acceptable if they were either increasing the chances of survival of their patient or decreasing the patient’s suffering. In their meandering way, they have improved neither for Alfie, and only caused him, as well as his parents, more suffering in the process.
The UK has basically criminalized the most basic of duties: a parent’s right to fight for the well-being of their child in the manner they deem fit. It has replaced parental morality with its own secular philosophy, instituting a culture that believes death is, in many cases, superior to life. We’ve seen this throughout Europe, as various countries devalue the lives of imperfect people and, in some cases, having national policies to eradicate genetic anomalies such as Down’s Syndrome.
The dark road that the English health system continues to travel down, with its authoritarian arrogance and abuse of its citizens, is one that all countries around the globe should learn from — and fear. Simply put: this is the natural progression of a slowly progressive authoritarian society that robotically acts without thinking, without regard to ethics and morality, and ultimately crushes individual choice and personal freedom.
Pradheep J. Shanker, M.D. M.S., is a practicing Diagnostic Radiologist and Managing Partner of his radiology group based in Ohio. Outside of Medicine, he has been focused on promoting various efforts on public policy regarding health care and education on both the state and national levels.
Published in Healthcare
GT,
Perhaps the British judges need to regain their “piece of mind”. After all King George only had the best of intentions for the “colonies”. Hopefully, a cure for this “madness” can be found.
George III on America
Regards,
Jim
The English appear to have lost their faith and those who are Christian leaders (the Catholic bishops and the Queen) are almost silent. The statement from the UK bishops was pathetically weak and limp-wristed. Where are any Christian men who will fight for this boy and his family?
There is something rotten in that hospital – it has the stench of Satan running through it. The hospital was previously involved in an organ scandal and inspectors have previously warned that the hospital may not be safe. Stories now circulate that the hospital has something to cover up.
When Alfie dies, as a baptized Catholic child, his pure soul will be with God. He will be a saint. One can only pray for those who are making the murderous decisions in this case. I fear a different fate awaits them.
May God have mercy on us all.
Michelle Malkin wrote this to remind folks who think it’s only happening over there.
I really don’t want to go through this painful news cycle again, so soon after Charlie Gard.
In the US, parents have a right to assert their religious beliefs in tandem with their traditional right of control over minor children. A belief in the sacredness of life can constitute a “religious belief”, due to to the broad, amorphous way in which our Supreme Court has defined, or refused to define, “religion” . To terminate a child’s life against the parents’ wishes is a civil rights violation.
Let mom and dad take the kid wherever they want to, even if only to die! This is the second time recently(that we know of) that U.K. parents have lost custody because they wanted to take every chance to preserve their child’s life!
….and the Dems are openly running as socialists? Great. These two little boys’ pictures should be on Tshirts and all of us on the Right should wear them daily as midterms and 2020 approach.
This case is maddening. And so is the condescension the pro-NHS side is showing.
The controversy flows, in part, from a clash between two radically different ethical principles. The judges and doctors believe that medicine exists to prevent human suffering; Alfie’s parents (and all self-respecting Christians) believe that medicine exists to preserve human life.
Now, do we truly want to grant the state the power to determine which principle is correct? I sure as heck don’t. But that’s what the British doctors and judges are doing — claiming that their system of ethics is correct . . . because, science!
They are failing on both counts. By cutting off food and oxygen, they increased his suffering while shortening his life.
Like many around here, I have reserved a long, foul and inappropriate tirade for those who are bringing the same thing to this country. Thank you, John McCain.
I’m not sure that’s true.
Are you familiar with the work of ParentalRights.org? They are trying to get an amendment passed asserting the right of parents or guardians to control their children’s education and healthcare.
I’m in Massachusetts, and about three years ago we had a terrible and long-running case in which Boston Children’s Hospital actually kidnapped a child, Justina Pelletier. The father and mother wanted the child to be treated at the Tufts New England Medical Center, where the child had been under the care of a specialist in mitochondrial disease. At one point, Alan Dershowitz offered to represent the parents because, he said, “If there are two diagnoses, the parents have the right to choose between them.” He did not ultimately represent the parents, but his assertion may have been the basis of the eventual out-of-court settlement* between the Pelletiers’ and BCH’s lawyers.
Eventually the Department of Social Services released Justina to another facility, who eventually released her to her parents. She is home and doing quite well at the moment. However, if Boston Children’s Hospital had been allowed to prevail, she might have died. They withheld treatment, claiming that there was nothing wrong with her. She was in terrible shape when she was finally released from BCH.
People have this issue backward anyway. It is not that the parents have rights. It’s that the child has the right to the protection of an adult whose rights are protected by our Constitution.
Edit: *I used the wrong word here. It was not a “settlement” per se. It was the agreement the parents had to sign to get their daughter released. In fact, the Pelletiers are suing BCH, as I understand it. I don’t know where the lawsuit stands right now.
Good post but this last line isn’t right. Parents do have rights to raise their children as they see fit and to make medical decisions and legal decisions for them. The child has certain rights as well.
I once read an eight-hundred-page book on juvenile justice, and the author stated at the beginning that juveniles have no rights articulated anywhere in the Constitution. Our Constitution was not written for children.
I was also the legal guardian for a mentally ill person the entire time I was raising my own three kids. I took the responsibility very seriously. And it changed how I viewed my legal responsibilities with my own kids. My legal role in their life was to protect them because they could not protect themselves. They couldn’t sign off on medical care, rent an apartment, buy or drive a car, vote, or sign a contract. Neither could the mentally ill person I was the legal guardian for.
Our focus on the parents’ rights has obscured the children’s rights to the protection of an adult at all times. That was my point.
By the way, that was one of the problems in the Justina Pelletier case. She did not have the right to refuse medical care or sign for it. She wanted to leave, but BCH and the Department of Social Services would not let her until she turned 18. She was close to it–16 and a half or 17. That’s why it was an issue.
Children do not need special rights delineated in the Constitution. They have the same rights to own property, due process, etc.
However, it is implied in the Constitution that age can change one’s rights. There is an age limit to be president, for instance. Age can be a factor in what rights someone has.
As for an adult needing a guardian, that adult’s right to autonomy is curtailed via due process. Children do not merit due process to curtail their rights, nor should they.
I like your view that a child has a right to the protection of his parents, but that is not the end of the story. Parents have a natural right to raise their children however they wish, so long as the child’s physical health and emotional well being are not in jeopardy.
The Supreme Court has ruled that termination of parents’ rights is the death penalty of civil law. Our nation recognizes parents have rights over their children.
It is true in my state. If you message me your email,I will send you an article I just had published in lur state bar magazine.
Just because they want to make it the subject of “an amendment” does not mean the right doesn’t already exist.
Under US Constitution, the parents’ constitutionally protected privacy interest in making important decisions on behalf of their minor children includes the right to assert the child’s right to life.