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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.