Details are not plentiful about Alfie Evans' medical condition and treatment. Outsiders do not ordinarily have the right to know such things. I will limit myself to generalisations.
A particularly frustrating aspect of the debate online was the mantra sent up by those not on Alfie's team that 'the Church's teaching does not forbid the removal of artificial feeding and hydration' and the like. This is misleading, to say the least. It is also true that the teaching of the Church does not forbid moving a knife through the throat of an innocent person in a dark alley. The reason in both cases is the same. These are not adequate descriptions of actions for moral appraisal.
There is a very big difference between saying 'you've not given me enough information to be able to say whether this action is right or wrong' and saying 'this action is not wrong'. Liberal apologists want their readers to assume the second, but if challenged they will bleat that they only meant the former. This is intellectually dishonest.
In the dark alley, the questions we must ask are obvious enough. Did the agent know the person's whose throat he was cutting was innocent, or did he imagine the victim was an attacker? Did he know anyone was there at all? Was the agent in his right mind? And so on. Since there are an infinite number of possible complicating factors we can cut to the chase and ask one, ultimate question: what was the agent's purpose, or intention? What was he trying to do?
The answer gives us what the Common Law calls the mens rea, and what Aquinas calls the 'species' of the action. If the intention is innocent, there are further questions to ask: was the agent taking an unnecessary risk? I.e., was he negligent or reckless? And did he have a duty to be doing something different? If the intention is one of those the Church tells us are per se malum, evil in themselves, then othis is an action which can never be justified. The intention to kill the innocent is one such evil intention.
Until recently, the law of this country mapped onto the Natural Law, which the Church sets out, fairly closely, on matters of life and death. This is no longer the case. With recent developments in the law, which take the form of judge-made law and the official guidelines of the Crown Prosecution Service, the law of the land has turned into a swamp of moral and conceptual confusion. To put it at its simplest, it is no longer the case that the mens rea of ending the life of an innocent person (for practical purposes this just means a person not trying to kill you), is legally ruled out. Courts can and do decide that steps can be taken which we would most naturally describe as aiming at the death of a patient, if the patient is suffering, or if the patient's life seems to serve no useful purpose. 'Suffering' of course what pro-euthanasia advocates like to talk about: better still, 'intolerable suffering'. But it is noteworthy that the legal precedent for our descent into this legal abyss was set by the 'Bland' judgement back in 1993, about a man who was not suffering in the least: nor was he dying. He was in a coma, and was diagnosed as being in a 'vegatitive state'.
From a legal point of view, and hence from the point of view of the medical profession, the things Catholic ethicists say about the care of the terminally ill, such as that one not need not prolong their lives to an insignificant extent with burdensome treatments, no longer have any importance. They are just as happy to take steps with the intention of ending a life, once they have judged it best for it to end, as to end pointless treatment, like the antibiotics which might extend a painful death by a week or a day. They have no interest in the question of whether removing artificial feeding, hydration, and breathing equipment is aiming at killing or has some other justification. In medical ethics textbooks and in courtrooms alike the distinction is regarded as footling and of no ethical significance. This is a reality to which Catholic commentators wishing to think the best of the medical profession need to wake up to.
Nevertheless, it remains true that to aim at the death of an innocent human being is a grave wrong, a wrong, indeed, which cries out to heaven for vengeance. It is something which should be ruled out of consideration by the strongest taboo, and to fail to do this undermines the entire edifice of respect for our fellow human beings.
Removing feeding, hydration, and breathing assistance are not ruled out by the Natural Law. No, indeed not. Just ask the doctors why they are removing them. Are they needed urgently in another part of the hospital? Have they become a source of discomfort for the patient? These not merely logically possible: it can be so in real cases. In Alfie's case, it seems extremely unlikely, however, as he was not suffering: according to the doctors he was incapable of suffering. It seems probable, therefore, that they were removed in order to hasten his death. Which is to say that the intention of this action was that he die.
At any rate, if this is so it fits in with a lot of recent cases, and a lot of recent discussion. Readers may remember the 'Liverpool Care Patheway', which advocated, or seemed to permit, in some cases, sedation and starvation. Since this was only one option among many, under particular circumstances, a bit ambiguously, the Bishops of England and Wales were eager not to oppose it. It was left to a Jewish lawyer, Baroness Neuberger, to condemn it in a public enquiry in 2013, after a campaign by the press which, no doubt, left out a lot of nuances. But without overturning the legal precedent set by the Bland case and others, we are inevitably going to slide back to this kind of practice: it is exactly what one should expect.
I have the greatest respect for our medical profession, and I owe them a lot in looking after my loved ones over the years. Would I trust them to care for an incurably ill family member in an ethical way? Sadly, no. And nor should anyone.
This is part of a four-part series on the Alfie Evans case:
Alfie vs. the System
Alfie and the Natural Law
Alfie and end of life care
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