The parents of Alfie Evans, a 21-month-old baby with a mysterious illness, received a devastating blow from a high court on February 20 as Justice Anthony Hayden ruled that the baby’s ventilator is to be turned off.
Kate James, 20, and Tom Evans, 21, have been battling Alder Hey Children’s Hospital in Liverpool since June 2017. After being admitted to the hospital in December 2016, baby Alfie’s condition began to decline and the hospital began to pressure the parents to remove their baby from life support.
In his written decision, Judge Hayden acknowledged the Catholic faith professed by Alfie’s parents, saying “it is important that these beliefs are considered within the broad gamut of relevant factors” in relation to Alfie’s “best interests.”
Judge Hayden then proceeded to cite Pope Francis’ November 2017 open letter to the Pontifical Academy for Life as a justification for the forced removal of Alfie’s life support. He said:
The position of the Roman Catholic Church is sometimes characterized inaccurately in cases concerning these difficult ethical issues. Mr Mylonas’s document is an open letter, by His Holiness Pope Francis to the President of the Pontifical Academy for Life, dated November 2017. In his message Pope Francis called for “greater wisdom” in striking a balance between medical efforts to prolong life and the responsible decision to withhold treatment when death becomes inevitable. His letter identifies that not adopting or suspending disproportionate measures can avoid over-zealous treatment. I would not presume to add any gloss to the following extracts…
The relevant portion of Pope Francis’ letter, which was used by Judge Hayden to justify his conclusion, speaks of the moral permissiveness for withdrawing treatment for the dignity of the patient. Pope Francis’ letter says:
Greater wisdom is called for today, because of the temptation to insist on treatments that have powerful effects on the body, yet at times do not serve the integral good of the person. Some sixty years ago, Pope Pius XII, in a memorable address to anesthesiologists and intensive care specialists, stated that there is no obligation to have recourse in all circumstances to every possible remedy and that, in some specific cases, it is permissible to refrain from their use. Consequently, it is morally licit to decide not to adopt therapeutic measures, or to discontinue them, when their use does not meet that ethical and humanistic standard that would later be called “due proportion in the use of remedies.” The specific element of this criterion is that it considers “the result that can be expected, taking into account the state of the sick person and his or her physical and moral resources.” It thus makes possible a decision that is morally qualified as withdrawal of “overzealous treatment. Such a decision responsibly acknowledges the limitations of our mortality, once it becomes clear that opposition to it is futile. “Here one does not will to cause death; one’s inability to impede it is merely accepted.” This difference of perspective restores humanity to the accompaniment of the dying, while not attempting to justify the suppression of the living. It is clear that not adopting, or else suspending, disproportionate measures, means avoiding overzealous treatment; from an ethical standpoint, it is completely different from euthanasia, which is always wrong, in that the intent of euthanasia is to end life and cause death. Needless to say, in the face of critical situations and in clinical practice, the factors that come into play are often difficult to evaluate. To determine whether a clinically appropriate medical intervention is actually proportionate, the mechanical application of a general rule is not sufficient. There needs to be a careful discernment of the moral object, the attending circumstances, and the intentions of those involved. In caring for and accompanying a given patient, the personal and relational elements in his or her life and death – which is after all the last moment in life – must be given a consideration befitting human dignity. (emphasis added)
Judge Hayden, in his decision to order the removal of Alfie’s ventilator, reflected the above highlighted portions of Pope Francis’ letter as the justifying basis for his conclusion:
The continued provision of ventilation, in circumstances which I am persuaded is futile, now compromises Alfie’s future dignity and fails to respect his autonomy. I am satisfied that continued ventilatory support is no longer in Alfie’s best interest.
This isn’t the first time that Pope Francis’ letter has been used to justify decisions by government authorities to withdraw life-saving treatments. Just this past December, pro-lifers fighting against a euthanasia law in Italy said that the letter weakened the resolve of some Catholic politicians to vote against it.
Citing the very same portions of Pope Francis’ letter highlighted above, The New York Times concluded that “Pope Francis unexpectedly bolstered the prospects of the bill.” The Times article went on to say:
Supporters of the bill used the pope’s words to dismiss Catholic critics, noting that Francis had merely reiterated the longstanding teachings of the Roman Catholic Church when he said that its doctrine on the sanctity of life did not justify overzealous medical treatments to artificially prolong life.
Pope John Paul II’s 1995 encyclical defined euthanasia:
Euthanasia in the strict sense is understood to be an action or omission which of itself and by intention causes death, with the purpose of eliminating all suffering.
The Holy Father then explained that there is a distinction between euthanasia, as he had just defined it, and the decision to forego or discontinue what he called “aggressive medical treatment.” He said:
Euthanasia must be distinguished from the decision to forego so-called “aggressive medical treatment”, in other words, medical procedures which no longer correspond to the real situation of the patient, either because they are by now disproportionate to any expected results or because they impose an excessive burden on the patient and his family. In such situations, when death is clearly imminent and inevitable, one can in conscience “refuse forms of treatment that would only secure a precarious and burdensome prolongation of life, so long as the normal care due to the sick person in similar cases is not interrupted”.
With this in mind, Pope John Paul II firmly condemned euthanasia as an act contrary to the natural law.
Taking into account these distinctions, in harmony with the Magisterium of my Predecessors and in communion with the Bishops of the Catholic Church, I confirm that euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person. This doctrine is based upon the natural law and upon the written word of God, is transmitted by the Church’s Tradition and taught by the ordinary and universal Magisterium. (emphasis added)
While this may seem similar to what Pope Francis wrote in his letter to the Pontifical Academy for Life, and may appear to justify the decisions made by the judge in Baby Alfie’s case and the legislators in Italy, it is vitally important to also note that Pope John Paul II further distinguished between “medical treatment” and the natural means of preserving life.
In 2004, Pope John Paul II addressed a group of physicians in Rome, saying:
I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering. (emphasis added)
Even though Pope John Paul II did not mention ventilation in order to assist the lungs in maintaining the flow of oxygen, the administration of a ventilator is no more invasive or cumbersome than the artificial means of providing nutrition and water.
Dr. Paul Byrne, former president of the Catholic Medical Association and co-inventor of the first neonatal ventilators told LifeSiteNews, “A ventilator moves air into the windpipe and larger air passages. It supports respiration only in a living person. Oxygen goes from lungs to blood, then is circulated to all cells, tissues and organs, then carbon dioxide is picked up and carried back to the lungs to be exhaled. Respiration occurs only when life is present.” Dr. Byrne added, “The ventilator for breathing is analogous to a feeding tube. These tubes are life supporting only in a living person. To take the ventilator away from Alfie would be imposed death.”
In John Paul II’s statement to physicians, it is clear that the argument he provides for what constitutes euthanasia by omission would equally apply to the use of a ventilator:
The obligation to provide the “normal care due to the sick in such cases” (1) includes, in fact, the use of nutrition and hydration (2). 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.