Wednesday, April 25, 2018

Evening Note for Wednesday, April 25

Thought for the Evening: Medical Ethics and the Rights of Infants and Toddlers

It is difficult not to be a bit depressed about the current problems surrounding the infant Alfie Evans in Liverpool. Alfie was born with what seems to be a neurological condition that led to seizures when he was about twenty-three months old, when he was placed in Alder Hey Children's Hospital. He is in a "semi-vegetative state", but his condition has been up and down. The parents have been trying to get him moved somewhere that will not remove oxygen, food, and water; both Pope Francis and the Italian government have offered to pay for the expense of moving him and for all future care at Bambino Gesù. The Italian government even recognized Alfie as an Italian citizen so that he would be part of the Italian health care system. The Evans family has been blocked from doing this by both the actions of the hospital and by a court order ruling that this is contrary to Alfie's best interest, under a law that, as far as I have been able to see, seems to have been designed to give a court the authority to act in loco parentis when parents are guilty of provable negligence or abuse.

What is striking to me is the complete lack of serious medical ethics in the statements of the hospital and, to an even greater degree, in the comments of some of its defenders. There has been no serious examination of the actions of the hospital in terms of familial right over care, some form of which is the standard proxy, in most approaches to medical ethics, for patient autonomy in cases of children and those unable to make their own decisions. The parents in question are guilty neither of neglect nor of abuse, which are usually the only moral grounds nullifying the right of guardians to make health care decisions for their wards. I have seen literally no moral justification offered for this. I would be willing to accept that there is some arcane feature of British law that would make the relevant law applicable here rather than (as it very much looks) only in cases of neglect or abuse, but granted that, I have seen no indication from anybody about why this is not a moral backfiring of the law.

Every human being has a human right to palliation -- that is, every human being has a right to palliative care in non-triage cases where resources are available. This is not a triage case (the resources are not urgently needed to save the lives of others), and resources have been explicitly offered by third parties. I have seen nothing in any statement by the hospital or any defense by its defenders to show that this is not an egregious example of a human rights abuse. (Indeed, and this is very worrisome, any attempt to press for further clarification on this has been met with active hostility of the "We're Britain, we have one of the best medical systems in the world, how dare you suggest that we are violating anyone's human rights" sort. Getting this kind of response is always, always a glaring red flag that raises immediate questions.)

At one point, Alder Hey removed Alfie's oxygen on the grounds that he would die in short order. After more than half a day, they put him back on oxygen. It is unclear how this wasn't simply bungled, and it raises questions about why it is in Alfie's "best interests" to die in Alder Hey, which apparently denied him palliation and watched him gasping for breath for hours, rather than at an Italian hospital, which is willing to continue palliative care. The hospital certainly isn't informative about anything, and provides no morally useful explanation; its communications are always vague bromides and slogans like its recent one on the failure of the Evans's legal appeal: "Our top priority is to continue to provide Alfie with the care he deserves and to ensure his comfort, dignity and privacy are maintained at this time." How this claim is consistent with any of the hospital's actions is pretty much an unexplained mystery.

That both legal and medical systems will sometimes fail morally is inevitable. It is a grave misfortune and tragedy, and should not be treated glibly. But that is the most depressing aspect of it all, the glibness of all the defenses I have seen -- vacant of any serious consideration for the serious questions of medical ethics that have been raised, smug and self-righteous in the defense of what looks very much like the violation of the rights of the child to palliative care and the protection of his parents, or else an endless smokescreen of bromides and glittering generalities that show no serious critical examination of the issues. There are so many grave ethical questions raised by this case, and the hospital and the courts and their defenders seem to want to treat it all as "emotive nonsense", to use Justice Hayden's description, that will soon blow over. That's not how ethics works. That's not how people with a serious investment in ethics act.

Various Links of Interest

* David Shariatmadari on the Robbers Cave experiment

* The Charles S. Peirce Foundation is collecting funds to mark the poorly marked grave of C. S. Peirce, one of the truly great American philosophers. I'm not hugely impressed by the monument design, but it is absurd that there isn't some kind of monument there already.

* Tom Hendrickson on the value and importance of Neo-Latin.

* Eduardo J. Echeverria, Conscience, Newman, and Vatican II

* Frog and Toad Attend a Philosophy Class at "JSTOR Daily"

* I kept intending and forgetting to mention it, but MrD had a good post a while back on the liberal arts.

* Joseph Heath, Against the racialization of everything, argues that, with respect to Canadian discourse, at least, some problems are such that treating them as racial problem will not give you good solutions, primarily because racial categories are sometimes too crude and clumsy to do justice to actual people.

* Garnette Cadogan, Walking While Black

* ThonyC's discussion of Robert Bellarmine's interactions with Galileo

* Thomas Weinandy, The Four Marks of the Church

* Boxes and Diamonds: An Open Introduction to Modal Logic

* Amandas Ong on Edna St Vincent Millay

* Hannah Arendt on the time she met W. H. Auden

* Robert Pasnau on the parochialism of philosophy

* A very large quantity of copyright material in the U.S. will begin entering the public domain on January 1, 2019

* Evelyn Lamb, Decades-Old Graph Problem Yields to Amateur Mathematician

* Tristan Haze on what it is like to be a philosopher. I particularly like the part about the aesthetics of notation, which is an understudied field. Like much of aesthetics, there will always be matters of mere taste, but some aesthetic features of notation (elegance, simplicity, readability, power of summation, manipulability) are clearly linked what makes a notation work well to begin with.

Currently Reading

Sir Walter Scott, Waverley
Antonio Rosmini, Certainty
Magnus Magnusson, Scotland: The Story of a Nation
Dugald Stewart, Elements of the Philosophy of the Human Mind

Alberto Vanzo, "Empiricism and Rationalism in Nineteenth-Century History of Philosophy" (available here)
Maureen (Molly) Brady, "The Forgotten History of Metes and Bounds" (available here)
Lawrence B. Solum, "Virtue as the End of Law" (available here)
Jonathan Simon & Colin Marshall, "Mendelssohn, Kant, and the Mereotopology of Immortality" (available here)
Christopher Hom, "Pejoratives" (available here)
Gregory Johnson, "From Swedenborg's Spiritual World to Kant's Kingdom of Ends" (available here)

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