Holy Father, there is still time to do the possible and the impossible to save Alfie

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.