Alfie Evans in Alder Hey Children’s Hospital, Liverpool. Image: Ropi/Zuma Press/PA Images.
On April 28th, 23-month-old Alfie Evans died five days after his life support machine was switched off. The entwined web of legal, medical, and ethical issues brought to light by the case has provoked fierce reactions across the globe. On both sides of the Atlantic, the libertarian right have weaponsied Evan’s death to attack the NHS and British legal system, with figures like Nigel Farage branding it “state-sponsored euthanasia”. But contrary to their claims, this tragic story is not the result of government overreach. Rather, it is indicative of the damage being wrought to public services and human lives by the shrinking of the state, a policy that the right has vociferously fought for.
In the US, commentators such as Liz Wheeler, a host for the ultra conservative news network OAN, have sought to link Evan’s death to the UK’s universal health care system. But even if an American hospital was willing to keep Evans on life support, it would not be able to do so indefinitely given the financial burden on his parents. Regardless, the opinion of the international medical community is that the outcome would have been the same. Impartial medical experts offering opinions, available to read in the court judgements, comprehensively assessed any likelihood of recovery and found none; MRI scans of his brain found the majority of his brain was already crippled beyond repair. They submitted that Evans would never make any developmental progress (motor skills, vision, hearing, social, or emotional) and his illness was irreversible and terminal.
Having already exhausted all their medical knowledge, experience, and options, Alder Hay Hospital continued to keep Evans alive, at no cost to the parents, supporting his failing organs, enabling him to breath, and treating recurrent infections Evans could not fend off himself. Accordingly, Alder Hay provided palliative care to Evans, which some critics have misleadingly tried to equate to euthanasia. It is at this point that a Vatican-run hospital, Bambino Gesú Hospital, and the Pope intervened. Their intentions however have been misreported. The Italian hospital offered no therapeutic benefit, no increased chance of survival. There was no last ditch option maliciously refused to the parents by a child-murdering government. The British government were not a party to any of the legal proceedings, and the constitutionally endorsed independence of the court ensures the government cannot simply dictate their adjudications. To chastise the state is to erroneously conflate the two.
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.— Pope Francis (@Pontifex) 23 April 2018
Recognising this, the courts and medical specialists at Alder Hay concluded it was in Evans’ best interests to end his suffering by switching off the life support machine keeping him alive. This was against the wishes of his parents, and certainly their opinions were taken into account. However, it is not in their best interests that the courts and doctors are charged with protecting. They are the guardians of a young man unable to communicate his own wishes. It is a wretched decision to have to take, but arguably, those we entrust with such tragedies were in agreement: it was time to let Evans’ life reach a natural conclusion.
We cannot imagine the suffering which Evans’ parents have gone through. This has been a horrifically sad story from start to finish. However, as a society we must seek to draw beneficial reforms from what has gone before, recognising where we have failed each other.
Let Evans’ legacy be a call-to-arms to support a health service wishing to protect its citizens
Incorrect legal advice from the Christian Legal Centre prolonged and increased the suffering of the parents and child involved. It gave them a false hope. It misled them as to the actions of the doctors and the position of the law. This cannot be forgotten. Looking forward, we must invest in legal aid access and supporting organisations like Citizens Advice, which have been stretched to breaking point by vicious budget cuts and austerity measures. Hospitals must be enabled to bring in greater specialist grief counselling facilities, to open up a passage of communication between parents and doctors. The adversarial nature of court proceedings should be avoided at all costs, it is to the benefit of neither party. Clinical Ethics Committees are notoriously poorly resourced, resulting in them fighting a battle with one arm tied behind their back. The answer to this case is most certainly not to turn towards a single-payer healthcare system (as seen in America). As former President Obama noted in his 2009 State of the Union, a medical cost induced bankruptcy occurs every 30 seconds due to a system rampantly providing unequal levels of accessibility to care.
The answer is to double-down on our support for universal health care. As citizens touched by Evans’ story, we must come together to fund charities and research into incurable conditions. We must support political parties seeking to empower our NHS and research facilities to provide pioneering treatment and developing those miracle cures we seek. This is clearly not yet the case under our current neoliberal system. Healthcare blind to social class is irrevocably entwined to the very fabric safeguarding British communities, providing protection and care for those other countries would readily leave behind.
Let Evans’ legacy be a call-to-arms to support a health service wishing to protect its citizens, to formulating a legal system accessible by all, and to campaigning for research into conditions not seen as profitable by corporations. It is only through standing up for these notions that we can prevent the suffering of Evans and his family from being in vain.