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Tom Evans' son

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... a study of the case reveals that there was competence and goodwill on all sides.

Michael
Pakaluk

There is a great, old tradition in Catholicism of celebrating a Requiem Mass about one month after someone's passing, the "Month's Mind." Since Alfie Evans died on April 28, we can fittingly remember him this month. It is also the month of his second birthday, May 9.

You know the basic details of his life. When he was six months old he was admitted to a hospital because of seizures. Doctors found his brain was deteriorating, but they never figured out why. Since brain tissue does not regenerate, but for a miracle, the condition would not reverse. Eventually he lost all but the most rudimentary, "vegetative" functions. However, he could be kept alive with a ventilator and feeding tube, and his seizures could be controlled by medicines -- it seems, indefinitely.

About a year after Alfie was admitted, his parents and the doctors had a stand-off. It's dangerous to simplify a complicated case, but the issue seems to have been this: The parents, especially the father, Tom, believed that Alfie was still "there" and wanted him to be kept alive. Indeed, Alfie sometimes seemed to emerge from his sleep and open his eyes when his dad spoke to him. Tom wanted no effort spared for his son, no possibility overlooked, to the point of extreme heroism, if necessary.

The doctors, in contrast, believed that all appropriate medical treatments had been applied, and that the character of Alfie's life would not improve. They wanted to stop "treating" the child and instead switch to "hospice" mode, allowing him to die.

British law holds that, when parents and doctors disagree, a court decides based on the standard of what is in the best interests of the child. The court sided with the doctors: Alfie must be allowed to die.

The pope visibly intervened and pleaded for the parents' wishes to be heeded. The Bambino Gesu in Rome was prepared to admit the child. Alfie was granted Italian citizenship to ease the transition. A medical transport plane was waiting -- money was not an issue, plenty had been raised.

But British legal authorities insisted: we must act in the best interests of the child. If allowing him to die now is in his best interests, as a court has decided, then any other path of action is not in his best interests. It would be unlawful for the child to be dealt with against his best interests!

People who had not been following the case started to pay attention at this point and thought, "This is insane," making observations such as:

-- Even if it was "beyond the call of duty" to deal with Alfie as his father wished, surely that kind of heroism should not be forbidden!

-- Even if doctors should not be forced to treat a patient against their judgment, surely courts cannot prevent other doctors from providing further treatment, if they are willing!

-- A court might have competence to decide a local dispute between these doctors and these parents, but what court has competence to decide what is in a person's best interests, all things considered?!

-- How can it be that the parents, in admitting their child to a hospital, put themselves at risk of, in effect, losing custody of their child, if it turned out they disagreed with the doctors' decisions?

-- Why should parents be prohibited from switching from some doctors to others, as they wish, just as they can change lawyers or accountants, as they wish? After all, it is of the essence of a professional to be in the service of the client.

-- In any case how can it be in anyone's best interests to die? From a human point of view, death is always a calamity, and the court had no competence to decide from any other point of view.

Yet a study of the case reveals that there was competence and goodwill on all sides. The doctors were among the best in the world and were trying to do everything they could to help Alfie. The nurses were deeply caring and highly dedicated. Both the court of trial and the appeals court were punctilious, accurate, and thorough. Alfie's mother and father, Kate and Tom, showed extreme devotion. Indeed, although a simple person, Tom became knowledgeable about the relevant medicine and even impressed the judges with his sophistication. The point is, they were in no sense dogmatic or ill-tempered, irrational persons.

So, one important question the Alfie Evans case raises is: How can it happen that good professionals, who act by the best standards they know, who are scrupulous in following the law, and dealing with sensible clients, end up doing something which is not simply wrong, but also whacky and bizarre?

Many commentators wrote as if personality and prejudice were determinative. The judges and doctors were arrogant elites, they said, dismissive of the plain man's point of view. Or, in a society of socialized medicine, doctors are seen as agents of the state, and the individual is easily seen as "belonging" to the state.

These commentators missed the fact that Alfie's treatment was completely in accordance with law. Therefore, the case asks us to see that law inevitably ends up expressing philosophical principles. Some such principles embraced in Britain are unsound. It is possible to identify these, but only by a careful reading of Justice Hayden's opinion, and the Appeals Court decision. There is no royal road to that sort of critique.

Michael Pakaluk, an Aristotle scholar and Ordinarius of the Pontifical Academy of St. Thomas Aquinas, is professor at the Busch School of Business and Economics at The Catholic University of America. He lives in Hyattsville, MD, with his wife Catherine, also a professor at the Busch School, and their eight children.

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