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.

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There are 42 comments.

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  1. Thatcher

    Pradheep Shanker:

    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.

    Mr. Shanker,

    You have categorically condemned the actions of the British Government & Medical Establishment. They have no excuses and ample opportunity to reconsider their faulty judgment. They are foolish in the extreme as the ramifications of their actions will be noted by a Candid World.

    Regards,

    Jim

    • #1
    • April 25, 2018 at 8:14 pm
    • 9 likes
  2. Coolidge

    The worst evil of socialism is not the taking of property from one for the benefit of another, though that is bad enough. The worst evil of socialism is that it causes people to believe and behave as though they have a moral authority, and obligation, to intrude into the lives of others in the name of fiscal responsibility.

    I can think of no more reprehensible example than this.

    • #2
    • April 25, 2018 at 8:45 pm
    • 14 likes
  3. Thatcher

    Pradheep Shanker: 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.

    Mr. Shanker,

    As I have explained many times on Ricochet, Socialism may call itself progressive but it is in reality regressive. It is a retreat to the values of the Middle Ages. The Enlightenment introduced respect for the autonomy of the individual. Socialism wishes to retreat back to the womb of the Middle Ages. They claim to be interested in science but really they are only capable of a scientific ideology which is not science at all. They must destroy respect for individual autonomy to accomplish their evil task. We have had ample evidence in the last 125 years of the horrific results of this soulless ideology.

    This is the place and this is the time to say no, never again.

    Regards,

    Jim

    • #3
    • April 25, 2018 at 9:14 pm
    • 7 likes
  4. Podcaster

    Skyler: The worst evil of socialism is that it causes people to believe and behave as though they have a moral authority, and obligation, to intrude into the lives of others in the name of fiscal responsibility.

     

    Dr. Walter Gross was a German physician who bought into eugenics lock, stock and barrel. He was appointed by Hitler to create the National Socialist Office for Enlightenment on Population Policy and Racial Welfare. One of their projects was the magazine Neues Volk (New Race or New People), which was distributed to schools and doctors’ offices. Its primary purpose was to make the “scientific” and “medical” case for the Nazi eugenic program.

    Here is a poster advertising the magazine.

    The translation as provided by the United States Holocaust Memorial Museum:

    “This hereditarily ill person will cost our national community 60,000 Reichmarks over the course of his lifetime. Citizen, this is Your Money.” (In 1934 the exchange rate was 3.28RM to $1US. Adjusted for inflation they’re claiming a lifetime cost of over $345,800)

    And many of the “fact-based scientific” community happily went along. The rest were too afraid of the power of the state to say anything.

    And speaking of the power of the state, the local constabulary in the UK issued this warning on Twitter: “We’ve issued a statement this evening to make people aware that social media posts which are being posted in relation to Alder Hey and the Alfie Evans situation are being monitored and may be acted upon. (Emphasis mine.)

    From their Facebook page:

    Chief Inspector Chris Gibson said: “Merseyside Police has been made aware of a number of social media posts which have been made with reference to Alder Hey Hospital and the ongoing situation involving Alfie Evans.

    “I would like to make people aware that these posts are being monitored and remind social media users that any offences including malicious communications and threatening behaviour will be investigated and where necessary will be acted upon.”

    Basically, if Dr. Shanker were in the UK the police would probably investigate him for this “malicious communication.”

    Seems to me the NHS and the Merseyside Police would be downright comfortable had the UK lost the war.

     

    • #4
    • April 25, 2018 at 9:33 pm
    • 18 likes
  5. Member

    Skyler (View Comment):

    The worst evil of socialism is not the taking of property from one for the benefit of another, though that is bad enough. The worst evil of socialism is that it causes people to believe and behave as though they have a moral authority, and obligation, to intrude into the lives of others in the name of fiscal responsibility.

    I can think of no more reprehensible example than this.

    You are correct. Thank goodness it can’t ever happen here.

    • #5
    • April 25, 2018 at 9:33 pm
    • 3 likes
  6. Member

    Perhaps the UK is more like North Korea than they know, albeit a well-fed totalitarian state. The fear that his parents might run off to Rome with their own child the UK has now built a wall, not unlike East Germany had to keep it’s citizen’s confined, and compliant to the lack of the freedom to travel.

    Since Alfie has been granted Italian citizenship the British government is now holding an Italian citizen as a hostage.

    • #6
    • April 25, 2018 at 10:15 pm
    • 15 likes
  7. Coolidge

    Doug Watt (View Comment):

    Since Alfie has been granted Italian citizenship the British government is now holding an Italian citizen as a hostage.

    I don’t know if actively killing a child is fairly described as taking a hostage, but I agree with your sentiment.

    • #7
    • April 25, 2018 at 10:19 pm
    • 3 likes
  8. Member

    Skyler (View Comment):

    The worst evil of socialism is not the taking of property from one for the benefit of another, though that is bad enough. The worst evil of socialism is that it causes people to believe and behave as though they have a moral authority, and obligation, to intrude into the lives of others in the name of fiscal responsibility.

    I can think of no more reprehensible example than this.

    But fiscal responsibility isn’t even an issue here – the Italian hospital is willing to provide the care, and others will pay for the transport there. Letting Alfie’s parents take him to Italy costs the British government nothing. What’s really going on is an unwillingness to relinquish power over the lives and deaths of government subjects.

    • #8
    • April 25, 2018 at 10:20 pm
    • 15 likes
  9. Thatcher

    Mr. Shanker,

    Well, I might as well go for the trifecta.

    If Thersa May is listening, please intervene, stop this madness, and let the child go to Italy.

    If my sophisticated arguments won’t work, how about an old movie scene and an old movie song.

    The Scene.

    The Song.

    The Lyric

    What’s it all about, Alfie?
    Is it just for the moment we live?
    What’s it all about when you sort it out, Alfie?
    Are we meant to take more than we give
    Or are we meant to be kind?
    And if only fools are kind, Alfie
    Then I guess it is wise to be cruel
    And if life belongs only to the strong, Alfie
    What will you lend on an old golden rule?
    As sure as I believe there’s a heaven above, Alfie
    I know there’s something much more,
    Something even non-believers can believe in
    I believe in love, Alfie
    Without true love we just exist, Alfie
    Until you find the love you’ve missed you’re nothing, Alfie
    When you walk let your heart lead the way
    And you’ll find love any day, Alfie
    Alfie

    Songwriters: Burt Bacharach / Hal David

    I’ll try anything. Just let Alfie go.

    Regards,

    Jim

    • #9
    • April 25, 2018 at 10:22 pm
    • 3 likes
  10. Member

    A couple friends suggested we raid the hospital with the marines. I’d favor it, I think the marines would too, except for the practical difficulties.

    How about Congress pass a Magnitsky act against the entire NHS? Make sure to draw lots of comparisons to the Russian oligarchs and how they hunt down dissenters and kill them all across the globe. Who new in England all they had to do was make sure they ended up in the tender mercies of the British doctors.

    • #10
    • April 25, 2018 at 10:25 pm
    • 4 likes
  11. Member

    Painter Jean (View Comment):
    But fiscal responsibility isn’t even an issue here – the Italian hospital is willing to provide the care, and others will pay for the transport there.

    I’d say fiscal discipline is precisely the issue here. NHS rations care. A living Alfie would de-ligitimize their business model. Cries of “if Italian healthcare can save Alfie, why can’t the NHS?!” would expose an even greater scandal throughout UK than the current one. NHS would have to own up to the fact that it provides sub-par service to UK citizens. Any attempt at reform would necessitate greatly increased expenditures.

    • #11
    • April 25, 2018 at 10:44 pm
    • 12 likes
  12. Member

    …and welcome to Ricochet, Dr. Shanker.

    • #12
    • April 25, 2018 at 10:48 pm
    • 9 likes
  13. Member

    Painter Jean (View Comment):

    Skyler (View Comment):

    The worst evil of socialism is not the taking of property from one for the benefit of another, though that is bad enough. The worst evil of socialism is that it causes people to believe and behave as though they have a moral authority, and obligation, to intrude into the lives of others in the name of fiscal responsibility.

    I can think of no more reprehensible example than this.

    But fiscal responsibility isn’t even an issue here – the Italian hospital is willing to provide the care, and others will pay for the transport there. Letting Alfie’s parents take him to Italy costs the British government nothing. What’s really going on is an unwillingness to relinquish power over the lives and deaths of government subjects.

    And what will happen if Italian healthcare proves superior to the NHS? Am I the only one who thinks these doctors are being selfish and paranoid?

    If you think you have nothing to worry about, check out Terri Lapoint on Facebook.

    • #13
    • April 26, 2018 at 12:21 am
    • 6 likes
  14. Thatcher

    Contrary to their own laws, the Brits do have a death penalty. Instead of using it against criminals, they reserve it for weak and infirm.

     

    • #14
    • April 26, 2018 at 2:51 am
    • 17 likes
  15. Member

    Pradheep Shanker: 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.

    It has indeed become a natural progression. We have been like the proverbial frog put into water and now we are being boiled. Hilary White writes about The smiling executioner: when death becomes an obligation. We’ve gone from the concept of personhood informing ethics to utilitarianism. As she writes:

    Utilitarianism proposes that because there is no God, and we live in a materialistic universe devoid of objective meaning, human life is no more significant than any other animals; the “greatest good” is pleasure and therefore the rule of medical practice is to avoid human suffering at all cost. There is no such thing as inherent “personhood” in Utilitarianism [4]. Personhood in this ideology is a legal fiction conferred by the State according to various arbitrarily determined standards.

    [4] The concept of the person as a legally protected entity appeared in Roman jurisprudence, but as we understand it now was mainly a product of medieval Christian philosophy and is based on the concept of the human being created in the image and likeness of God.

    In other words:

    (O)ur entire civilization (has moved) away from what we could call “classical ethics” – that in medicine we call Hippocratic ethics and into a totally new paradigm, something alien and ultimately – if taken to its own internal, logical conclusion – obscenely evil.

    You have written a very good article Dr. Shanker but I question the use of vegetative state for a human being. I think the use of that word helps the utilitarians. The soul is the principle of life. Since animals and plants are living things, they have souls, but not in the sense in which human beings have souls. Our souls are rational – theirs aren’t – and ours are rational because they’re spiritual, not material. By claiming that a human has gone to a vegetative state suggests that the spiritual soul no longer exists – that he is no longer in the image and likeness of God and that there is no more value in the person. I would like to see the use of vegetative state discontinued.

    • #15
    • April 26, 2018 at 4:58 am
    • 3 likes
  16. Member

    I have a serious question: Aren’t these actions, both of the government and the government’s physicians, violative of the Hippocratic Oath, of “Do(ing) No Harm”? It seems to me that intentionally making it possible for an infant to die is doing plenty of harm!

    • #16
    • April 26, 2018 at 5:04 am
    • 4 likes
  17. Member

    Sabrdance (View Comment):

    A couple friends suggested we raid the hospital with the marines. I’d favor it, I think the marines would too, except for the practical difficulties.

    How about Congress pass a Magnitsky act against the entire NHS? Make sure to draw lots of comparisons to the Russian oligarchs and how they hunt down dissenters and kill them all across the globe. Who new in England all they had to do was make sure they ended up in the tender mercies of the British doctors.

    Trade Sanctions and Drone Strikes seem more appropriate. I mean its good enough for Assad.

    It isn’t like May’s government can’t be described as sadistic and evil.

    • #17
    • April 26, 2018 at 5:13 am
    • 1 like
  18. Coolidge

    George Townsend (View Comment):
    It seems to me that intentionally making it possible for an infant to die is doing plenty of harm!

    If only that were the case. They aren’t just unplugging a machine. They’ve stopped feeding him. That is inhuman.

    • #18
    • April 26, 2018 at 5:51 am
    • 3 likes
  19. Member

    Dr. Robert Moynihan through The Moynihan Letters has been giving updates regularly on this story and it’s heartbreaking. Many issues:

    He received many vaccinations at once and other medications as a baby. He was born healthy and deteriorated after. He has not been diagnosed with a disease. He will be two in two weeks and I am not sure of the details, but after two years there can be repercussions from vaccine health related issues then, including lawsuits. They expected him to stop breathing right after the tube was removed. It’s now day three.

    He opens his eyes and looks at his dad. Glenn Beck said he saw pictures of when he was in the hospital and his nose was crusted up, there was mold on the breathing tube and he was soaking wet up to his arms – he has not been given permission from the family to release the pictures.

    The parents had to beg that he be given water after the tube removal. Then they had to beg for nutrition. Italy, thanks to the Pope, granted him citizenship and Italian physicians have been offering to take care of him for months – and run other tests – some think he needs to be detoxed. When they removed the tube they gave him more powerful drugs, including Fentanyl.

    His young parents have never given up on him. A petition with over a half million signatures so far to release Alfie to Italy has not worked.

    Another baby with a rare disorder named Charlie Gard, was also not allowed to be treated elsewhere and did pass away. His parents’ wishes fell on deaf ears.

    https://www.washingtonexaminer.com/the-lesson-everyone-missed-in-the-charlie-gard-story

    No matter what happens, there is a spotlight on live or die issues and the rights of families over authorities who are overstepping their boundaries. Thank you for highlighting this important story.

    • #19
    • April 26, 2018 at 6:41 am
    • 5 likes
  20. Member

    This is what Obamacare had/has in store for us. Or was it Hillary care, or Romney care? Or even congressional care as they lack the backbone to change it.

    • #20
    • April 26, 2018 at 6:55 am
    • 4 likes
  21. Member

    There is no greater act of tyranny than for government to claim ownership of a child. Nothing in life could so obviously precede the social contract than the bonds of immediate family. 

    The number of hospital workers, politicians, and government bureaucrats whose opinions must align for Alfie to be refused transfer to Italy is remarkable. There are probably a dozen procedural ways the physicians’ guardianship could be challenged or relinquished. 

    • #21
    • April 26, 2018 at 7:08 am
    • 12 likes
  22. Member

    Aaron Miller (View Comment):

    There is no greater act of tyranny than for government to claim ownership of a child. Nothing in life could so obviously precede the social contract than the bonds of immediate family.

    The number of hospital workers, politicians, and government bureaucrats whose opinions must align for Alfie to be refused transfer to Italy is remarkable. There are probably a dozen procedural ways the physicians’ guardianship could be challenged or relinquished.

    I agree. 

    • #22
    • April 26, 2018 at 7:46 am
    • 3 likes
  23. Member

    The family is now asking that he be allowed to come home. 

    • #23
    • April 26, 2018 at 8:10 am
    • 3 likes
  24. Member

    Painter Jean (View Comment):
    What’s really going on is an unwillingness to relinquish power over the lives and deaths of government subjects property. [FIFY]

    Everything within the NHS, nothing outside the NHS, nothing against the NHS.

    UPDATE:

    Speaking of “nothing against the NHS”:

    • #24
    • April 26, 2018 at 8:24 am
    • 7 likes
  25. Member

    Aaron Miller (View Comment):

    There is no greater act of tyranny than for government to claim ownership of a child. Nothing in life could so obviously precede the social contract than the bonds of immediate family.

    The number of hospital workers, politicians, and government bureaucrats whose opinions must align for Alfie to be refused transfer to Italy is remarkable. There are probably a dozen procedural ways the physicians’ guardianship could be challenged or relinquished.

    I forgot to add please say prayers for Alfie and family – 

    • #25
    • April 26, 2018 at 8:39 am
    • 5 likes
  26. Member

    Front Seat Cat (View Comment):

    Aaron Miller (View Comment):

    There is no greater act of tyranny than for government to claim ownership of a child. Nothing in life could so obviously precede the social contract than the bonds of immediate family.

    The number of hospital workers, politicians, and government bureaucrats whose opinions must align for Alfie to be refused transfer to Italy is remarkable. There are probably a dozen procedural ways the physicians’ guardianship could be challenged or relinquished.

    I forgot to add please say prayers for Alfie and family –

    Indeed! We all need those prayers, especially the child.

    You know, I can’t get over it. We use to be Englishmen. We broke away because we wanted to lives our own lives. Now, in the field of medicine, with cases such as this, the Brits are proving more tyrannical than ever, under the guise of being “helpful”!

    • #26
    • April 26, 2018 at 8:59 am
    • 2 likes
  27. Member

    Ontheleftcoast (View Comment):

    Painter Jean (View Comment):
    What’s really going on is an unwillingness to relinquish power over the lives and deaths of government subjects property. [FIFY]

    Everything within the NHS, nothing outside the NHS, nothing against the NHS.

    Mark Steyn argued before the adoption of Obamacare that it would mean the US becoming like Britain in that every election thereafter would become about which party could better manage healthcare. Now that it is clear Obamacare will not be repealed, Republicans are becoming more secure in focusing the debate on management. Even calls for repeal were only presented in terms of replacement. Such spin becomes less necessary with each passing year. 

    What began with the Magna Carta dies on a hospital bed.

    • #27
    • April 26, 2018 at 9:02 am
    • 3 likes
  28. Coolidge

    When the authorities governing the NHS watch The Man in the High Castle, who do they view as the good guys? 

    I know I’m hitting Godwin’s Law, but there is a plot line in the show about euthanizing a young man for being diagnosed with a chronic disease. 

    • #28
    • April 26, 2018 at 9:10 am
    • 2 likes
  29. Member

    There was a similar case in Britain just last year – Charlie Gard in which the British courts denied the parents request that they be allowed to take their young son to the USA for experimental surgery basically because, according to the court, it was in Charlie Gard’s best interest that he die.

    • #29
    • April 26, 2018 at 9:14 am
    • 5 likes
  30. Member

    This cartoon from the National Catholic Register sums it up perfectly.

    • #30
    • April 26, 2018 at 9:33 am
    • 3 likes
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