Let's
briefly review the events. On February 20, 2018, the English court judge,
Anthony Hayden, a well-known supporter of homosexual couples adopting children,
authorized the doctors of Alder Hey Children’s Hospital in Liverpool to kill
Alfie Evans, a two-year-old boy, detaching him from machinery that allows him
to breathe and feed himself. It is a death sentence for suffocation and lack of
water and food. Alfie is guilty of being a burden on society. Providing air and
food to a health facility costs it. Why waste so many resources? Alfie has been
in a semi-vegetative state for some time (perhaps because of the drugs given to
him by doctors) and is suffering from a rare, unknown or undiagnosed disease.
He no longer has a life worth living. His best interest, so doctors and the
judge argue, is to be killed. The parents? Hayden believes they are not in a
position to decide which child's best interest is. They would like to save him,
keep him alive. For this reason, a legal guardian is appointed for Alfie. The expropriation
of the child by the English authorities is complete. The parents cannot take
their child to other hospital facilities or have other doctors assist him. They
can only wait for the death sentence to be carried out by the hospital doctors.
Many
people around the world are moved and frightened by the suffering of the
parents and the fate of little Alfie as decreed by
Judge Hayden, but justice must follow objective criteria. Just when feelings
and emotions cloud the mind, it is up to the judges to ensure that they act
according to the objectivity and the best interests of the parties. This in
itself is right. Judges who, despite emotional pressure, act firmly according
to justice should be praised. The most curious thing is that, given the
membership of Alfie's family to the Catholic Church, Judge Hayden, stimulated
in this sense by the doctors of
the hospital themselves, decides to argue the justice of his decision based on
Catholic doctrine. This is how this is explained, in an interview with Tempi.it, by the new president of the
Pontifical Academy for Life appointed by the Pope, Monsignor Vincenzo Paglia:
“[it is] good to read the full text of the judge to understand the complexity
and the delicacy of the clinical situation of Alfie. As well we must keep in
mind - and seriously - the drama of what parents are experiencing. At the end
of a wide and detailed medical analysis, the judge, considering that the
parents are Catholics, decides to consider also the position of the Church. And
then it refers to three texts, finding among them a complete coherence: the
Catechism, the document on euthanasia of the Congregation for the Doctrine of
the Faith of 1980, the speech of the Pope of 2017."
Paglia has no
doubts and, at the precise request of the interviewer who urges him on the fact
that Judge Hayden would therefore have decided the “killing” of Alfie by virtue
of a Catholic reasoning that the Pope would also sign, answers:
“[…] to speak of “killing” is
neither correct nor respectful. In fact, if the repeated medical consultations
really showed the absence of a valid treatment in the situation in which the
little patient finds himself, the decision taken did not intend to shorten the
life, but to suspend a situation of therapeutic obstinacy. As the Catechism of
the Catholic Church says, this is an option with which we do not intend to
"procure death: we accept that we cannot prevent it" (CCC 2278).”
The words of
Paglia raise a fuss. How does the new President of the Pontifical Academy for
Life support the English judge on the interpretation of Alfie's case in terms
of therapeutic obstinacy? Let’s read the whole point of the Catechism in
question:
“2278 The interruption of burdensome, dangerous, extraordinary or
disproportionate medical procedures with respect to the expected results can be
legitimate; it is the renunciation of "therapeutic obstinacy." In
this way we do not want to procure death: we accept that we cannot prevent it.
The decisions must be made by the patient, if he has the competence and the
ability, or, otherwise, by those who legally have the right, always respecting
the reasonable will and the legitimate interests of the patient.”
The choice of
words of the Catechism is crucial. Therapeutic obstinacy occurs when using
"burdensome, dangerous, extraordinary or disproportionate" medical
procedures that are not suitable for preventing death. In such cases, the
decision to "pull the plug" does not mean "to bring about
death" but is equivalent to the recognition by us creatures "that we
cannot prevent it." There is no need to be a member of the Pontifical
Academy for Life to understand how far this point of the Catechism is from the
idea of taking away from a child the air and food needed to live. There
should be no need to dwell on this because the Catholic bioethics has always
accepted it carefully and unanimously.
Some doubts have been
raised in the past, even in the highest spheres. On July 11, 2005, S.E. Msgr.
William S. Skylstad, the then President of the US Episcopal Conference, sent
two questions about nourishment and hydration to the Congregation for the
Doctrine of the Faith. We read these questions and their answers:
First question: Is the
administration of food and water (whether by natural or artificial means) to a
patient in a "vegetative state" morally obligatory except when they
cannot be assimilated by the patient’s body or cannot be administered to the
patient without causing significant physical discomfort?
Answer: Yes. The
administration of food and water even by artificial means is, in principle, an
ordinary and proportionate means of preserving life. It is therefore obligatory
to the extent to which, and for as long as, it is shown to accomplish its
proper finality, which is the hydration and nourishment of the patient. In this
way suffering and death by starvation and dehydration are prevented.
Second question: When nutrition
and hydration are being supplied by artificial means to a patient in a
"permanent vegetative state", may they be discontinued when competent
physicians judge with moral certainty that the patient will never recover
consciousness?
Answer: No. A patient in
a "permanent vegetative state" is a person with fundamental human
dignity and must, therefore, receive ordinary and proportionate care which
includes, in principle, the administration of water and food even by artificial
means.
The Supreme Pontiff Benedict XVI, at the Audience granted to the undersigned
Cardinal Prefect of the Congregation for the Doctrine of the Faith, approved
these Responses, adopted in the Ordinary Session of the Congregation, and
ordered their publication.
Rome, from the
Offices of the Congregation for the Doctrine of the Faith, August 1, 2007.
William Cardinal
Levada
Prefect
In the notes
to these questions, the Congregation for the Doctrine of the Faith further
specifies, in the words of John Paul II, that:
“The sick person
in a vegetative state, awaiting recovery or a natural end, still has the right
to basic health care (nutrition, hydration, cleanliness, warmth, etc.), and to
the prevention of complications related to his confinement to bed… “The
obligation to provide the ‘normal care due to the sick in such cases’
(Congregation for the Doctrine of the Faith, Declaration
on Euthanasia, p. IV) includes, in fact, the use of nutrition and
hydration (cf. Pontifical Council Cor Unum, Some Ethical
Questions Relating to the Gravely Ill and the Dying, no. 2, 4, 4;
Pontifical Council for Pastoral Assistance to Health Care Workers, Charter
for Health Care Workers, no. 120). The evaluation of probabilities, founded
on waning hopes for recovery when the vegetative state is prolonged beyond a
year, cannot ethically justify the cessation or interruption of minimal
care for the patient, including nutrition and hydration. Death by
starvation or dehydration is, in fact, the only possible outcome as a result of
their withdrawal. In this sense it ends up becoming, if done knowingly and
willingly, true and proper euthanasia by omission.”
These clarifications do not deal directly
with the case of ventilation, but the rationale of the general indications
provided by John Paul II on the "right to basic health care" is wide
enough to include it. Ventilation does not serve to keep a dying patient alive,
but only to allow him to receive oxygen. The patient who is subject to
ventilation (but also to nourishment and hydration) may die from natural causes
like anyone else, in the same way as a cardiopathic patient with a bypass or
who follows a functional therapy to dilute his blood. Ventilation is therefore
normally an ordinary and proportionate tool of basic health care due to each
patient. On the other hand, Alfie's ventilation is not the most invasive. Now
it is reduced to a small tube in the nose, and as the last hours show, after
the first attempted murder, it is so little "extraordinary" that the
baby has continued to breathe even without it. To clarify: all the tools of
assistance, including the basic ordinary ones, can become therapeutic obstinacy
if they are no longer able to reach their goal, such as nourishment in the case
of feeding and oxygenation in the case of ventilation. None of these tools
implies an absolute moral duty. Therefore, we must not interpret them in a
formalistic manner. But if they are in objective conditions to reach their
goal, then they cannot be interrupted. Removing oxygen, food or water from a
patient does not mean allowing him to die from natural causes.
Moreover, with regard to the
questions reported, Alfie is not in a permanent vegetative state, nor is he in
a coma, and nor has he been in that little-diagnosed state of partial
unconsciousness for more than a year. It is not even said that he is in a
vegetative state. The doctors themselves who kidnapped him, preventing his
parents from taking him to other hospitals and even preventing any other
doctors from visiting him, talked about a semi-vegetative state. As I said, it
is even possible that this state is the effect of the work of those who thought
he would die shortly after the detachment of the respirator. Alfie’s survival
of yesterday's attempted murder is a wake-up call to the validity of that “wide
and complex medical analysis,” to put it in the words of Paglia, which was put
by the judge at the base of his death sentence. Another alarm bell for the
Catholic Church, in this case, should have immediately come from the activism
of the judge in favor of homosexual adoptions, which is premised entirely on
the radical separation of the “good of the child” from a natural family with a
father and a mother. Those who are familiar with this subject must immediately
question the suitability of an activist of this kind to determine what is in
the best interest of Alfie, removing him from parental authority and condemning
him to death. Ethics has its continuity. One cannot perfectly understand the
best interest of the child in one case and completely misunderstand it in
another.
The fact is that,
faced with the judge’s demands to execute Alfie, and with his citations of the
Pope and the doctrine of the Catholic Church, the ecclesiastical authorities,
starting with the Pope, should have immediately voiced their opposition. It
would not have taken much to realize that the case of Alfie has nothing to do
with therapeutic obstinacy and to explain to faithful Catholics all over the
world that the Church cannot tolerate euthanasia either by action or by omission.
Given the current trend in England and other countries to legitimize euthanasia
and eugenics with the pretext of aggressive treatment, the responsibility of
the church's munus docendi should
have immediately entered the high alert level.
Let's leave the
responsibility of the munus docendi to
one side, however, and focus on the case of Alfie. Judge Hayden is incompetent
on Catholic doctrine and is manifestly unsuitable to judge Alfie's best
interest but he is still a judge. If he has to change his mind, he needs
objective arguments. You cannot say “Yes, look, you're right but, please, consider
the pain of the parents and the solidarity of many people in the world.” A
judge of conscience who believes he has decided well cannot and must not give
in to requests of this kind. Judge Hayden needed to be told clearly and firmly
that he misinterpreted both the Catholic doctrine and the concept of
therapeutic obstinacy. Clarity and firmness on this point could also change the
attitude of other British authorities and those slices of public opinion who do
not understand why we should make so much fanfare for this child, whose best
asset “officially” would consist in dying immediately by suffocation and
dehydration. Perhaps a strong truthful position on the part of the Church could
even bring Queen Elizabeth out of the total indifference she has shown up to
now about the matter.
Clarifying the objective immorality of
taking air, water and food away from Alfie by starting “procedures” meant to
make him die should be the primary and solemn responsibility of the Church in
such a case, not only with respect to the munus
docendi in general, but also with respect to the concrete possibility of
saving the life of this innocent child. Christian charity should leave the ninety-nine
sheep on the mountain in this case and take care of this tiny helpless sheep. It should shout to the whole world
that the child must not be touched and that it would be a terrible murder to make
him die of asphyxiation or hunger and thirst.
The official Church, instead, the one that
has the power to dialogue with the powerful of the world, has so far chosen the
other path outlined by Paglia in that interview. She has decided to renounce her duty to inform Judge
Hayden and the world about how the objective truths of Catholic morality apply
to Alfie's case—and even to properly analyze how these truths apply to the case
in the first place. The only concern of the President of the Pontifical Academy for Life, perhaps
induced by the recent debate surrounding Amoris
Laetitia, is to point out that every concrete case requires “discernment,”
that moral questions cannot simply be tackled by gluing over abstract rules.
Now, that the application and understanding of moral norms require prudence is
an old and important truth that cannot justify renouncing one’s
responsibilities. Paglia speaks as if we should have an inferiority complex
towards the “complexity” of the judge's decision and the expertise of the
English doctors, as if we should let them act as they deem best because they
know more. If I had to think the worst, I would say that the goal, perhaps not
fully aware, is also the consensus of this world, the desire to be appreciated.
I believe that
only this approach by Paglia can shed light on the amazing output of the
English bishops, who have anxiously sought, not to save the life of Alfie, but
to defend the professionalism, honesty and the work of his executioners. The
Vatican has moved with enormous delay compared to the good of Alfie, in the
wake of the emotional wave of the pain of parents and the explosion of
solidarity all over the world. The Pope has relied on this, which is precisely
what the English authorities do not need. Rather, relying on feelings and
desires, trying to rouse sympathy for the torment of parents, acts as a
confirmation of the sentence of the judge and the consequential decisions. It
is like telling the judge that there is nothing wrong about his reasoning and
asking him to act based on emotions.
Let's reread the Pope's main messages:
“I entrust to
your prayer persons such as Vincent Lambert in France, little Alfie Evans in
England, and others in several countries who live, sometimes for a long time,
in a state of grave illness, assisted medically for their primary needs. They
are delicate situations, very painful and complex. Let us pray so that
every sick person is always respected in his dignity and cared for in a way
adapted to his condition, with the harmonious contribution of the family, of
doctors and of other health workers, with great respect for life” (Regina Coeli, April 15).
“Moved by the
prayers and immense solidarity shown little Alfie Evans, I renew my appeal that
the suffering of his parents may be heard and that their desire to seek new forms
of treatment may be granted” (Tweet, April 23).
Apart from the generality of these
messages, the most striking thing in the April 23 appeal, the main one from
which a breakthrough was expected, is that there is no trace of the serious
injustice perpetrated against Alfie. There are no references to the objective
principles of morality. There is no truthful judgment that it is immoral to
cause the death of that innocent child. The appeal is made in favor of the
suffering of the parents and their desire: a useless and counterproductive
appeal, I repeat, for a judge who (by hypothesis) is required to protect
Alfie's best interests also against the feelings of the parents and against the
people's pressures, potentially unjust and irrational.
The Pope has asked to do everything
possible to save Alfie, and we have all witnessed the praiseworthy efforts of
Mariella Enoc, President of Bambin Gesù
in Rome. The “possible” and desirable thing that the Pope can do, however,
after communicating empathy and emotions, is communicating the truth. He can
say clearly and firmly to the whole world that therapeutic obstinacy has
nothing to do with Alfie's case, that Catholic doctrine cannot be used in any
way to legitimize the work of Judge Hayden, and that provoking Alfie's death is
an infinite injustice and a very serious sin against God and against humanity.
So far, the Pope has asked to save Alfie as a tribute to his parents' pain and
desires. It's time to ask to save Alfie because Alfie is to be saved. There is
the possibility that this clarity on moral objectivity, this appeal to justice
rather than feelings, may in the next few days save this child or help save him.
This appeal would also help the whole Church, which is a witness of truth,
which has a primacy in the teaching of morals, and which cannot allow to
surrender its munus to an English
judge who has already demonstrated in many ways his incompetence and hardness
of heart.
