Alfie Evans and the Lethal Sympathy of Bioethics

This is a mirror of an essay from the website Studio Matters. Her questions concern the so-called “vegetative state” and at what point we may deem that any human being’s life is “unworthy of life”.

Maureen Mullarkey interweaves her writing with works of art which strikingly embellish and underline her points. Except for the first piece, the art she chose has been omitted to encourage readers to visit her page. As with all her essays, her choices of illustration reveal a thoroughgoing knowledge of art and its power to illuminate moral questions.

Alfie Evans is dead. Deemed unfit, the child was sentenced to death by dehydration and suffocation. We shun the term life unworthy of life but embrace its content. We mask the odor of it with smiling phrases like “end of life care,” cruel details dismissed in the “best interest” of the patient sacrificed to force of law. The act of killing is rephrased in the argot of compassion.

Language loosens constraint from the annihilation of life judged undeserving of the means to sustain it. With that language comes a sea-change in moral discernment. Our experts — lawyers, policy makers, opinion shapers, hospital administrators, doctors as well — have learned their phrases from the relatively new discipline of bioethics. It is the mental and moral vocabulary of bioethicists that provided the rationalizations at work in the sorrowful odyssey of Alfie Evans.

The lethal sympathy of bioethical theorizing has insinuated itself even into the conscience of clergy. British bishops, as a body, assented to those rationalizations. They wrung their hands but did not question the law’s refusal to permit Alfie’s parents to take their son out of the country. Not a single bishop demurred. While the child defied his sentence by breathing without life support, the bishops stayed safe and silent in their cathedrals. Worse, they challenged Bambino Gesu hospital to justify its offer to care for Alfie on medical grounds — as if clinical opinion trumped the morality their priesthood was pledged to protect:

It is for that hospital to present to the British Courts, where crucial decisions in conflicts of opinion have to be taken, the medical reasons for an exception to made in this case.

Required reading on the steady diminution of the ancient ideals embedded in the Hippocratic oath is “Annihilating Terri Schiavo,” a 2006 essay in Commentary by Paul McHugh, M.D., former director of psychiatry at John Hopkins. His early warning has gone unheeded:

“Contemporary bioethics has become a natural ally of the culture of death, but the culture of death itself is a perennial human temptation; for onlookers in particular, it offers a reassuring answer… to otherwise excruciating dilemmas, and it can be rationalized every which way till Sunday… The more this culture continues to influence our thinking, the deeper are likely to become the divisions within our society and within our families, the more hardened our hatreds, and the more manifold our fears.”

Looking ahead, he concluded: “More of us will die prematurely; some of us will even be persuaded that we want to.”

[McHugh’s essay is one of others on the limits of psychiatry collected in The Mind Has Mountains. The book is as pertinent today as when it was written.]

Simon Lancaster, writing in The Spectator, UK, spotlighted the term vegetative state. This was the wording at the core of Alfie Evans’ state-mandated extinction:

“There were two words that stood out in Mr Justice Hayden’s judgment: the idea that Alfie is in a ‘semi-vegetative state’. These words stood out for the simple reason that Mr Justice Hayden intended them to. He put them in bold and in italics, one of only two occasions he chose to in the 12,000-word judgment. He wanted the words to grab our attention and focus our minds, forcing the other words around them to blur.”

So let’s do what he wants. Let’s focus on those words. What exactly does it mean to say someone is in a ‘semi-vegetative state’? Does this term have any scientific validity? Well, a search through the Lancet produces a round number of results – zero. And if you Google the term ‘semi-vegetative state’, most references are about the Alfie Evans case.

Vegetative state is a purposeful misnomer that blunts our recognition of the humanity of a living person. Lancaster quotes a London doctor who rejects the term:

“What is scientific about it? Wherein does an unconscious man resemble a vegetable? Photosynthesis? Roots? Edibility? Science implies precise observation, confirmed by demonstration, leading to logical conclusions. I challenge anyone to demonstrate to me the vegetable attributes of a man.”

That recent article brought to mind an impassioned essay written some 15-20 years ago by a clinical neurologist on staff in an American teaching hospital. I did not take notes at the time. The name of the doctor, where he practiced, or where his testimony appeared is gone. Only the substance of his experience, and his drive to tell it has stayed with me, burned into memory.

He told of a single revelatory instant that shattered assumptions implicit in the vocabulary of his profession:

Together with young residents assigned to him, the neurologist was making routine rounds on the neurology floor. On this fateful day he was stunned to find among the patients his revered mentor in the years of his own residency. Here, lying in the ward unnoted, was a prominent neurologist whose research had advanced the field. The man in bed had discovered a particular chemical compound that was critical in the treatment of brain disorders. Now the neurologist himself was concealed within a vegetative state, declared insensate and devoid of cognitive function.

Shocked into a quixotic impulse, and forgetting the presence of observers, the doctor leaned over the man. In a clear voice, he addressed the older clinician by name and asked him a question that penetrated to the core of the inert man’s momentous achievement: “Doctor, what is the pH-value of [the critical compound]?”

Without moving or opening his eyes, the man in the vegetative state responded: “The pH-value is neutral.” It was the correct answer. He never spoke again.

*   *   *   *   *   *   *   *   *   *   *   *   *   *   *

O the mind, mind has mountain: cliffs of fall,
Frightful, sheer, no-man-fathomed. Hold them cheap
May who ne’er hung there.

Gerard Manley Hopkins

Postscript: Pope Francis was admirable in arranging to have Alfie transported to Italy. And yet… He made no public rebuke to the British-Welsh bishops in their abdication. Forceful in declaring the right of persons to emigrate, Francis stated no opposition to the UK courts’ refusal to allow a sick child out of the country. Could not the man who stood at the Mexican border to incite support for illegal migration take his own helicopter to Liverpool? Francis puts his physical presence on the line for his own politics. What a tremendous act of witness it would have been had he stood outside the Alder Hey hospital to testify against the guise Lebensunwertes Leben wears in our time.

Bookmark Studio Matters. Her perceptions are keen, her art choices wide-ranging and eclectic.

18 thoughts on “Alfie Evans and the Lethal Sympathy of Bioethics

  1. I think one of the factors in the universal decline of all civilizations is the increasing tendency to be consistent in all things.

    Take the concept of “sanctity of life”. It is obviously impossible to preserve all life to the ultimate degree, especially with medical technology. Most medical expense occurs in the last years of life, when technology is used to compensate for progressive deterioration built into the genes. My own heart valve replacement is an example. I appreciate it, but realize that the hundreds of thousands of dollars in involved could have been used to extend the life of infants in disease-ridden primitive African countries.

    The Catholic Church, in declaring the “sanctity of life” is being perfectly consistent with its own tenets by favoring socialized government, massive foreign-aid payments, and open borders. The Catholic Church opposed abortions (or even birth control) on the grounds that all life had a right to exist, but went on, perfectly logically, to favor massive welfare and even socialism, on the grounds that why should wealthy people have any special access to life-saving medicine?

    The sanctity of life argument actually caused the Christian governments of Europe, in the “Dark Ages” to abolish the death penalty. After awhile, it became clear that allowing habitual criminals to live made society unbearable for productive, non-criminal people, and the death penalty was reinstated, particularly in England.

    The case of Alfie raises many issues, but the least productive, to my mind, is the use of the phrase “sanctity of life”. Because this implies the use of massive resources to keep marginal people (or non-people) alive for limited periods of time.

    In the case of Alfie, there were people willing to sponsor his treatment, and his parents clearly wanted him to undergo the treatment. So, it was the state that claimed ownership of all people, an ownership that took precedence over parents, relatives, and community, and the state declared that Alfie would be better off dead.

    But, the state that sponsors massive bombing of civilians or the material and training support of vicious Islamic Syrian rebels, is unable to actively euthanize (I use the word knowingly) a baby to keep it from suffering by starving to death or dying of dehydration. This stems, perhaps, from the philosophy of a government that puts massive safeguards in the road of punishing the guilty, but cares much less about killing people as an abstract matter. It’s OK to die, but it has to occur as a result of a non-action, not an action.

    The image of Alfie obviously evokes lots of sympathy, and his treatment would even involve money not derived from taxes. So, what’s not to like? Allowing him to be evacuated would commit the British government to the principle that its people are not completely owned by the state, and not subject completely to its diktats.

    • Doesn’t Britain still officially have a monarchy, with Teresa May serving as “Her Majesty’s Prime Minister”? If society today is willing to accept the idea that people are subjects, perhaps it would be better to be subjects to an identifiable individual, who, like the Queen, may actually have some attachment to a remnant of traditional morality? Monarchy certainly has its problems, but it does at least focus responsibility on one person as opposed to a vaguely defined mob of proles dumbed-down to the lowest common denominator that can be plausibly called humanity.

      I’m writing this in desperation, but there must be some way out of the mess we have gotten ourselves into with the idiocracy of the past 100 years or so.

      • In Britain, judging by the apathy shown, people are not subjects, they’re objects. A robust culture needs verbs.

    • The Alfie case is just the first step. More and more ‘unproductive’ people who cannot ‘enjoy’ their lives will be ‘allowed to die’. As their numbers will increase, the category of people who would be better left without medical assistance or even ‘helped to die’ will grow increasingly broader. It will inevitably include people who might still live a long time with great use to themselves and to society. But society will strongly encourage them to die in order to save money that could be spent on healthier members.

      We see it already in countries like Belgium and the Netherlands where people get euthanised for such reasons as blindness or depression.

      All this leads to dehumanisation of society. We become like animals: only the fittest have the right to live, the rest should be pitilessly culled. It strongly reminds me of how disabled persons were treated in Nazi Germany.

  2. Allowing him [Alfie] to be evacuated would commit the British government to the principle that its people are not completely owned by the state, and not subject completely to its diktats.

    Precisely. Britain owns its citizens and may dispose of those it deems unnecessary. And the so-called Christian churches were silent. 1930s-40s Germans made more noise than the Brits have.

    • As far as I understand, the Christian denominations of Nazi Germany did make enough noise for the Nazi State to reconsider its murderous policy towards the dislabled. German Christians – at least a considerable part of them – showed a lot of courage in this matter, for people who disagreed with Hitler could easily end up in a death camp or on the gallows.

      Modern British Christians do not face such dangers, but they do not act as courageously. This is unsurprising, as the Church of England has been totally permeated by the anti-Christian spirit of this age and has become an obscene travesty of the true Christian Church. Very little Christianity is left in it. Some other supposedly Christian confessions of the UK are as bad, if not worse. And even the Roman Catholic Church under the leadership of its highly dubious Pope, who seems to be much more inspired by the current political fashions than by the Holy Scripture and Tradition, has apparently lost much of its salt.

      Things indeed look very bad for the UK. Its spiritual foundation almost destroyed, it will crumble down in the first serious storm.

  3. Oh, Baroness … what a team you and your good spouse make ! Thank you for this.

    • Most of us couldn’t/wouldn’t become neurologists. That’s one reason there aren’t very many of them.

      A friend has a young daughter who is suffering from some kind of chronic stomach disorder. We have been searching for a gastroenterologist since the family doctor hasn’t been able to figure out what’s wrong. I was intrigued to see that one pediatric gastro is also board-certified in neurology…at long last two very necessary disciplines have joined together. It’s been a while now since they discovered that the gut is lined with neural cells.

  4. I don’t undertsand RonaldB. He wrote “Because this implies the use of massive resources to keep marginal people (or non-people) alive for limited periods of time.” Yet he wrote “…and the state declared that Alfie would be better off dead.” He implied that the state wants to keep people alive, and yet in another sentence he implied that the state wants to keep people dead.

    • Maybe indeed RonaldB heart valve was a useless investment after all.
      As he said, it would have saved a lots of little black kids African invaders lives .Go figure

      • Yes, shouldn’t we all be better without RonaldB? Just think of all the nice little African kids he deprives of their breakfast.

    • The state should never have arrogated unto itself the decisions that better belong with families. Fact is, NHS can’t afford its “Alfies” but you can bet your last pfennig that anyone wealthy enough to command the services of those doctors demanding Alfie’s death would have easily found medical experts to keep a rich Alfie going until the last.

      The British lower classes are used to being ground into the dirt.

    • For Pa: Please read more carefully. You stated that I implied the state wanted to keep people alive, and that I stated in another sentence the state wants to keep people dead. Your summary of what I supposedly said is [unrelated to the facts].

      What I did state is that the concept of “sanctity of life” used as a first principle, implies that a life should be extended at all costs whatever the consequences.

      I also stated, or rather implied, that the state considers people its own property, and thus the state jealously reserves the decision to itself, whether its subjects live or die.

      May I suggest the solution to not understanding what I say is to read what I say? And if it seems unclear, read it again. I have no objection at all to comments stating that what I said is unclear. In fact, I would welcome them.

      However, to Bret, the sentence reads

      The case of Alfie raises many issues, but the least productive, to my mind, is the use of the phrase “sanctity of life”. Because this implies the use of massive resources to keep marginal people (or non-people) alive for limited periods of time.

      It seemed rather obvious to me to mean that the second sentence referred to use of the phrase “sanctity of life”.

      For example, I consider Pa’s comment to be extremely unclear. Perhaps he would appreciate my pointing that out.

  5. Unfortunately resources within a state health service are not limitless. It is funded by people’s taxes and it is right that decisions are not made just by the patient or the patient’s representative. Otherwise we would have hospitals full of people on life support for years, and no resources to treat people who could make a full recovery.
    Little Alfie had a degenerative brain condition which meant in real terms, his brain could never maintain his bodily functions. He would never ever breath for long on his own, his growth would be stunted, eventually his heart would be unable to beat unaided. More importantly, whether we find it palatable or not, what makes us, us, our consciousness, was continually being destroyed by his disease. We are insulated from death, but it does happen, and sadly to babies as well as 95 year olds. Speaking from a medical background, little Alfie would have had no quality of life, no chance of recovery, no humanity and no dignity. I feel for the parents who fought so hard for their little son. And I am sorry if I am a dissonant voice, but keeping that poor little chap alive to postpone his parents’ grief is not humane. It is selfish.

  6. Maureen Mullarkey interweaves her writing with works of art which strikingly embellish and underline her points. Except for the first piece, the art she chose has been omitted to encourage readers to visit her page. As with all her essays, her choices of illustration reveal a thoroughgoing knowledge of art and its power to illuminate moral questions.

    A word of caution is in order. In a recent post (on the question of the Last Supper being a seder) she claims that the attendants at the Last Supper included Jesus and Mary and His Apostles and Their wives.

    A bit crowded, no?

    Of course, at the Last Supper/First Mass only Jesus and His Apostles were present and it was not a seder which only was created by Rabbis after the destruction of Jerusalem in 70 A.D.

    Ms. Mullarkey is also of the opinion that what one reads in the Gospels is not necessarily what was originally written by the Saints who wrote The Gospels under the inspiration of The Holy Ghost but, rather, some additions to them that were later written into the Gospels by some anonymous Christians and so, I guess, one must be a skeptic when it comes to The Gospel Truth.

    There can be no doubt that what she writes about art can be entertaining but what she believes about the Faith is quite another matter.

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