The Death of Alfie Evans: Winners and Losers

You’re following the Alfie Evans case, right?

They’re killing that boy. Don’t try to Philippa Foot me about the difference between “killing” and “letting die.” The U.K. didn’t let Alfie die. They usurped the right of medical decisionmaking from Alfie’s parents, in violation of their fundamental human rights. They decided, based on their bloodless utilitarian ethics (so much for the neutrality of the secular state in questions of conscience!), that it would be best for Alfie to die, and then  they deployed armed officials of the State to prevent anyone from trying to save him — especially the boy’s own parents. They aren’t innocent bystanders simply watching Alfie, helpless to save him without extraordinary aid; they are active participants in a flagrant attack on the fundamental human rights of Alfie’s parents. They have made every effort to prevent Alfie from receiving extraordinary aid offered (at no cost to them) by, variously, Alfie’s parents, the Catholic Church, and the government of Italy. I am by no means convinced that Alfie’s parents’ proposed course of treatment is, objectively, the right call, but, in the absence of neglect or abuse (as traditionally understood), his parents are the only ones with the right to make that call. The British state’s interposition — not to save Alfie’s life but to ensure that it ends — is unconscionable.

Between this and Charlie Gard, the United States should impose sanctions on the barbaric United Kingdom. Even if it means I don’t get to watch Broadchurch anymore.

Let’s get to it, then.

Loser: The British monarchy. What the devil is the point of having a Queen if she doesn’t intervene to protect one of her subjects in a case decided in her own name? In this populist era, I’ve been sympathetic to the idea of a head-of-state who isn’t democratically elected or appointed. But if that just means having a national figurehead who smiles at state dinners and does nothing to embody or uphold the basic principles of the nation… well, forget it. If this is what Blackstone’s “rights of Englishmen” have come to, I’ll stick with my messy Republic. Unlike most of the Commonwealth states, we still have freedom of speech in America, too, and I suspect that, too, is related to our fanatical constitutionalism. Speaking of which…

Winner: The Second Amendment of the United States Constitution. I agree with the Supreme Court that the Second Amendment encompasses a broad individual right to bear arms for self-defense, particularly against the sort of tyranny we’ve been known to establish here in the United States. But, after a litany of mass shootings in the past several years, I have occasionally wondered whether the Second Amendment is, on balance, a good thing. I have considered whether it would be a good idea to repeal it, then introduce some of the gun control measures it currently prohibits. (Much of the gun control debate annoys me because so many gun controllers are so dishonest about their desire to make the Second Amendment a dead letter without going through the mandatory constitutional amendment process… but serious arguments for repeal deserve to be considered seriously.)

The Alfie Evans case, however, is a stark reminder of the importance of the Constitution’s last bastion against tyranny. The American court system wouldn’t dare try to substitute its prudential judgment for a parents’. It wouldn’t even cross the American court system’s mind. We would not tolerate it if it tried. Deep down, Washington knows this — and it knows we have the tools — pardon, I should say, the arsenal — to enforce our judgment. Thus, an Alfie Evans case is unthinkable here.

Do you doubt me? Then imagine what would happen if Alfie Evans lived in Nevada, not Liverpool, and that his father was not affable Tom Evans but instead Cliven Bundy. I’m not certain how it would have played out, and I’m not at all confident it would have ended in a more just outcome, but it certainly wouldn’t have ended with helpless parents and helplessly supporters standing helplessly by while the State starves a child on a whim. (Hey, bee tee dubs, food and water are not extraordinary means; withholding basic sustenance is not the same as turning off a ventilator. Forced starvation is murder, plain and simple.) Everyone knows this, and this provides a check on the State that tends to keep us from even getting into confrontations like this. So, today, I thanked God for the Second Amendment.

Loser: Universal health care. While I’m disclosing heresies I’ve recently considered, here’s another for you: I’ve been toying with the idea of single-payer health care, or one of the various other flavors of “state-run health system” that the Democrats keep pitching. I’m as convinced as ever that such a system would be rotten, corrupt, and numbingly expensive, and that we could do far, far better with a market-oriented reform that empowers states to follow something closer to the Singapore model. But the current system is also rotten, corrupt, and numbingly expensive, and, last summer, Republicans blew their last chance to pass a market reform for a generation. In a choice between market-guided health reform and Obamacare, I’ll choose the markets every time. But in a choice between a terrible single-payer system and Obamacare? It’s not as clear to me that “Medicare for All” would actually be worse, at least on the individual market. (Like most Americans, I’m very happy with my employer-provided health insurance, but, like most Americans, I’m terrified of what would happen to my family if I lost my job and I were thrown into the horror show of individual-market medical insurance.) So I’ve been thinking seriously about whether, given the abject failure of Republican reform, adopting a universal health care model or a “public option” might be a better path than continuing into the thicket of Obamacare cost increases.

But the Alfie Evans case reminds me that government-run health care isn’t just a question of maximizing efficiency, minimizing costs, and extending flexible coverage networks. (Pray for me, for I really am a technocrat at heart.) Putting the State in charge of life and death for every citizen also entails a vast cultural change. A change that tends to leave the State with a very high opinion of itself. Given Godlike power over its citizens, is it any wonder that the British State decided to take the place of Alfie’s God-given parents and sentence the child to death? We must never grant the American State the same power over our children. Maybe truly ground-up, state-based universal health care (like Vermont’s failed proposal) could work without sending us into Light Yagami territory, but the Alfie case persuades me that a proposal like Sen. Sanders’ national “Medicare for All” plan must be resisted absolutely.

Winner: His Holiness, Pope Francis I. Say what you will about the Francis papacy. I don’t have to, because I’ve got Ross Douthat saying it all for me. But the Pope has acquitted himself well in this case. His direct intervention may very well have led to Alfie receiving Italian citizenship at the last second, his placement of the Church’s resources at Alfie’s disposal was a generous gift, and his simple moral witness in the case has been profound. My opinion of Francis, the pope, has (if anything) worsened since I wrote this post, but this once again proves that Francis, the man, remains a compassionate Christian of principle and courage who will probably get to Heaven before I do. It’s always nice to be reminded of that, especially in the wake of his shameful conduct in Chile (which was, sadly, all too familiar anyway). Pope Francis was a good look for the Catholic Church this week.

Loser: The authority of experts. “Alfie has no chance of improvement, so we must let him die” the doctors said. “He will die within minutes of his ventilator being turned off,” they also said.

36 hours later, the second claim has been definitively refuted — at this writing, Alfie is still alive and still breathing on his own. So why on Earth would anyone believe the first claim anymore? Nobody even knows what condition Alfie has, yet these “experts” who couldn’t even let him die correctly are telling us with certainty that there is no possibility of recovery, now or in the future?

Yes, there’s now some revisionist history going around where the doctors claim they knew all along Alfie could last longer than a few minutes. This is a lie. The court records are perfectly clear: Alfie’s medical team asserted repeatedly that Alfie was “100% dependent” on mechanical respiration and that, even in the “unlikely” event that he “can breathe without assistance,” “his respiratory effort will not sustain life.” This was a key finding of fact in Mr. Justice Hayden’s original ruling against Alfie. And it was completely, wonderfully wrong.

A casual observer might reasonably suspect that Mr. Justice Hayden and the Alder Hey medical team need Alfie Evans to die now, because Alfie’s survival would deeply discredit them and their entire system.

EDIT: See update at bottom of article.

Winner: “Lebensunwertes Leben.” Mr. Justice Hayden’s ruling is uncommonly kind to Alfie’s father, who did foolish things judges hate like representing himself. Mr. Justice Hayden’s words about Alfie and his parents are compassionate and generous. I have no doubt that he was well-intentioned. Yet his ruling, along with his subsequent rulings preventing anyone from helping Alfie, have struck a tremendous blow for the old doctrine that “life unworthy of life” should be terminated.

To be sure, the medical facts in this case still leave it one step removed from the Nazi position that handicapped kids should be actively sought out and killed for their own good. Yet I think not enough people recognize what a very short leap it is from this to that. Mr. Justice Hayden’s kindly words carry most of the key ingredients of a full-blown ideology of death.

As the original “medical futility” justification for the ruling against Alfie continues to erode, and the State is gradually exposed as being stubborn for the sake of saving face, the way Mr. Justice Hayden has gutted the very notion of parental rights becomes all the more terrifying. When the U.K. legalizes euthanasia (and, as a post-Christian nation, is this not inevitable?), it is difficult to see how the legal principles articulated in this case could avoid being extended to justify the State actively killing disabled children, against the will of their parents, even if their parents promised to care for them on their own dime. Even the Belgian euthanasia project hasn’t made such a bold attack on patient autonomy and guardian rights yet.

Loser: Alfie Evans.  They’re killing that boy.

UPDATE 26 April 2018: The Liverpool Echo, which is a division of the Daily Mirror so take it with a grain of salt, asserts that, during an oral hearing in the case, one doctor asked to testify said, “Once ventilation is removed, then depending on the situation of the child, we may have a period where they breathe for hours, days, sometimes much less.” This is obviously much closer to the truth than what other experts quoted in the final ruling said. Michael Mylonas, QC’s claim that instantaneous death was “never suggested” is still obvious rubbish, but it seems important to note that at least one expert got this right.