FRITSCH: A closer look at the Alfie Evans case

May 8, 2018

Two year-old British toddler Alfie Evans died last Saturday following prolonged hospitalization for neurodegenerative disease. Evans became the focus of worldwide media attention after his doctors sought court approval to stop medical treatment (including artificial ventilation and food and water) against the wishes of Evans’ parents. 

Many pro-life activists warned that the decision to withdraw treatment was motivated by a eugenic mentality according to which Evans’ life, due to his increasing disability, was lacking in value and therefore could (and should) be quickly ended. While it is impossible to determine the motivations of Evans’ physicians, we can analyze the ethics of their recommendations from a Catholic perspective. 

Evans’ case involves issues of treatment access and end-of-life care which are currently gaining prominence in North America and in Europe. In this article, we will explore the Catholic position on medical treatment and end-of-life care as applied to Alfie Evans. In Part 2 of this discussion, we will examine these principles in light of current trends in medical treatment and access to care across the life cycle. 

Before evaluating the actions of Evans’ physicians, it is important to note that the Catholic position on medical care in general, and end-of-life care in particular, seeks to avoid certain extremes. The Church does not require that a sick person undergo every possible medical treatment. The Church recognizes that certain medical procedures may be of little benefit or unduly burdensome and therefore extraordinary. 

While one is obligated to use ordinary means to maintain life, a patient has the option to forego extraordinary procedures, even where doing so could hasten death. At the same time, the it is not appropriate to withdraw or forego treatment with the aim of causing death. While it is licit to withdraw a treatment that, because of a particular condition, is likely of little value, it is illicit to withdraw the same treatment because the individual’s continuing life itself is deemed of little value. 

Was it morally permissible, in light of these principles, for Evans’ doctors to seek withdrawal of artificial ventilation? Maintaining an individual on mechanical ventilation, especially where there is little or no hope of recovery, may constitute extraordinary, and therefore optional, medical care.

Evans was initially hospitalized in Dec. 2016 after experiencing seizures. He remained hospitalized for the next 13 months, during which time he continued to experience neurological decline from unknown causes. Testing performed during this period revealed continuing degeneration of Evans’ brain. Evans’ parents could, in short, have licitly determined that discontinuing ventilation for their son was appropriate, in light of his continued decline and the unlikelihood of recovery. His physicians’ decision in this regard is discussed below.

Evans’ doctors also sought court approval to withdraw his food and water. Foregoing nutrition and hydration is subject to a different analysis than foregoing medical treatment. Provision of food and water, even through artificial means such as a feeding tube, does not, from a Catholic perspective, properly constitute medical care (which may be deemed extraordinary and thus foregone). 

Food and water are more properly viewed as something to which each human person is entitled by virtue of his human dignity (consider here the corporal works of mercy). While there are circumstances in which nutrition and hydration need not be administered (because actually harmful to the patient), it is impermissible to withdraw them as a means of causing death. There are no reports that providing Evans with nutrition was causing him harm. 

For Evans, then, there appeared no reason to withhold nutrition other than for purposes of hastening his death, which is always morally illicit. 

In addition to the moral issues inherent in the withdrawal of treatment, the actions of the British court system are also a source of concern. Following its approval of the decision to withdraw Evans’ treatment, the courts barred Evans’ family from taking him to other doctors who had offered to continue his treatment. 

Not only was Evans precluded from transferring to another facility but he was, according to many reports, also precluded from returning home with his family after treatment was withdrawn. It is not surprising that physicians and patients may at times disagree about whether particular treatments are appropriate. 

What is both surprising and disturbing here is the apparent position of the British court that it was inappropriate for any medical professional to provide Evans with life-sustaining treatment. According to Evans’ hospital, continuing to maintain his life was both “unkind and inhumane.” While the motivations for this statement are uncertain, it implies that Evans’ life had ceased to have value and that Evans was simply better off dead. 

This dangerous position, that certain lives are of less value and are therefore less deserving of care, is not only diametrically opposed to a Christian worldview, but is increasingly common among some in the medical field. In Part 2 of this article, we will examine this mindset as it increasingly relates to end of life care and treatment access.

Julie Fritsch is the director of the Office of Pro-Life Activities.