Alfie and parental rights

One positive aspect of the debate about the Alfie Evans case - and heaven knows there are plenty of negative aspects - is the way that the rights of the parents came into focus. Over the last several decade the rights of parents have been eroded in every area of family life and every area of law: in education, in child safeguarding, and in healthcare. There has been some push-back on the role of the secret Family Courts and the Social Services recently, and this may have helped to draw attention to the rights of parents in the Alfie case as well.

Children who are too young or too ill to consent or withhold consent for medical treatment must not be deprived of medical treatment just for that reason. It has always been the case, and it remains the case, that parents are able to consent, or withhold consent, on their behalf. The same is true of children's property: parents act a trustees and can consent or not on behalf of their children in relation to property owned by their children. It is an obvious legal doctrine and a very necessary one. If you take your child to hospital for treatment, you will be asked to sign special forms giving consent to the treatment. Sometimes you have to sign over and over again as treatment goes on.

An attitude has developed, however, among some in the medical, legal, and political establishments, which regards this as a tedious and unnecessary rigmarole. Once a child is under the care of a qualified doctor, it would be wrong for the parents to refuse to consent to whatever treatment or lack of treatment the doctor thinks is appropriate. There is something slightly creepy about a doctor or social worker asking a parent to sign a form handing over the legal right to do something and simultaneously whispering that, if the parent doesn't sign, there'll be trouble. A lot of parents are getting this creepy impression.

Alfie and end of life care

I have been reading the key legal judgement of the Alfie Evans case: a long document, but an interesting one. It emerges, for example, that Mr Justice Hayden, whose judgement it is, is not able consistently to use an apostrophe correctly. But another piece of poor style struck me more. Reporting the views of one of the doctors, Hayden remarks that, in this doctor's view, 'Alfie’s prognosis is futile.' (para 25).

Literally, this means that the prognosis this doctor had made was a waste of time: it wasn't going to achieve anything. On the contrary, of course, the prognosis was not futile: Hayden found it very useful. What he actually meant, presumably, was that the prognosis for Alfie was poor, and yet I think Hayden wanted to convey more than that by his strange use of the term 'futile'. He wanted to convey the idea that it was Alfie's continuing life which was, in some sense, futile.

It is common enough to say that medical treatment is futile, and this phrase is also found in the judgement. But we should be alert to what is going on in even this phrase. Futility is a property of means in relation to a given end. It is futile to try to build a house out of rice-paper. It is futile to defend oneself against an assailant with a rubber sword. Those means chosen to those ends are not going to do the job successfully. Continued artificial ventilation, food and water was not going to restore Alfie to health. Nor, on the balance of probability, were the treatments offered by the Bambino Gesu hospital in Rome. This does not make them absolutely futile, however, since there may be another possible goal to which they could be effective means. This is the prolongation of Alfie's life. This runs into the objection, however, that on Hayden's view such a life as Alfie had was itself futile.

Alfie and the Natural Law

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?

Alfie vs. the System

The controversy about the illness and death of Alfie Evans in Alder Hey Hospital in Liverpool makes me want to say a few things to clarify certain issues. I don't have inside information about medical or other details so I won't be going into those.

In this post I want to say something about about the various agencies of the state which were involved: the National Health Service, the Courts, the Police. In similar cases the Social Services can be part of the circus. A lot of people on social media, often from outside the UK, have had some very harsh things to say about these agencies. Those of us who live here and have to deal with them, and see others deal with them, are able to have a more nuanced attitude.

There is, all things considered, a lot to be grateful for in these institutions. I've personally had very good experiences with them, both directly and indirectly. The people working in them are often overworked and under paid. They have a high degree of professionalism. They are not financially or politically corrupt or corruptible in the ways that make dealing with similar organisations in other countries a constant problem. We should be proud to live in a country where they are, basically, on your side, if you have a problem. But they have their limitations.