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Paul Vallely: Alfie Evans and a child’s ‘best interests’ 

04 May 2018

This harrowing case calls for a more nuanced law, says Paul Vallely


Tom Evans, Alfie’s father, receives an embrace outside Alder Hey Children’s Hospital in Liverpool

Tom Evans, Alfie’s father, receives an embrace outside Alder Hey Children’s Hospital in Liverpool

NOW is not the time to discuss the conflict of ethical issues at the heart of the Alfie Evans case (News, 27 April), several commentators pronounced after the sad death of the toddler. But the corollary of that, in real terms, is simply that such a debate never takes place before the next harrow­ing case breaks into the news and we become locked into the same cycle, in which emotions often cloud the facts.

It is undoubtedly true that the death of Alfie Evans, like that of Charlie Gard last year, became deeply politicised (Comment 28 July, 18 August 2017). It is heartbreakingly hard, if not impossible, for parents to come to terms with the fact that their child is about to die. If they cannot fight death, they can always fight the doctors. And there are religious and ideological zealots waiting in the wings to take advantage of the parents’ agony.

The doctors and nurses of Alder Hey Children’s Hospital, who had cared for Alfie not just for days or weeks but for a full 18 months, were subject to a deplorable barrage of abuse from a group of outraged activists who call themselves Alfie’s Army.

International actors, from the Pope to the Vice-President of the United States, rallied to Alfie’s support. So did medical and political authorities in Italy, Germany, and Poland. Many roundly abused the Catholic bishops of England and Wales for spelling out of the traditional Catholic distinction between unnecessarily aggressive futile therapy and merciful palliative care.

British law insists that “the best interests of the child” are not always to be determined by the parents. It is an understandable principle, given the involvement of some adults in the sexual and physical abuse of their children, and given the religious objections of some parents, such as Jehovah’s Witnesses, to lifesaving interventions such as blood transfusions for their children.

It is wrong to see this, as so many foreign commentators have, as a clash of rights, with “the best interests of the child” set against “the rights of the parent”. Yet the case of Alfie Evans suggests there may be an argument for reassessing the way in which “best interests” are defined. Alfie’s parents were not refusing effective treatments; they were seeking additional interventions in the teeth of the judgement of the medical professionals that such interventions were futile.

Were those extra treatments potentially cruel, in that they would add to the suffering of a child, then the old arguments would obtain. But the High Court ruled that Alfie did not feel pain. In such a circumstance, it is difficult to understand in what sense the doctors’ estimation that it was in “the best interests” of a child that he should die should overcome the insistence of parents that life-support should be maintained in the hope of a miracle.

Utilitarians might argue that it is wrong to waste public money, which could be spent on the treatment of those who can be cured, in treating those who cannot. But, in Alfie’s case, the cost was to be borne by foreign governments.

This case was far more nuanced than the existing law seems to allow. There is a clear argument for a fine-tuning of the law here.

Read Andrew Brown’s press column on the story

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