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Legatus Magazine

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Charles S. LiMandri | author
Jul 01, 2018
Filed under Ethics
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Alfie Evans Case — poster-child for health care ‘best interest’

Two months ago, the British court senselessly ordered two-year-old Alfie Evans to be taken off life support, despite his parents’ desperate pleas and a worldwide outcry. In the aftermath of Alfie’s government-mandated death, many of us are asking whether our government has the power to determine when life is simply too burdensome to justify saving. But with the federal government’s waning influence over individual health care as a result of the weakening of Obamacare regulations, another question arises: Whether the health care providers and insurance companies could trump the rights of families in cases like Alfie’s. After all, in many cases, providers and insurance companies do have the power to ration health care. The degree to which they do is up to us.

Currently, the federal government prohibits hospitals from withholding or withdrawing infant life support. There are, however, three exceptions. Life support may be withdrawn if: (1) the infant is chronically and irreversibly comatose; (2) life support would merely prolong dying or be futile in terms of the infant’s survival; or (3) the life support itself, under the circumstances, would be inhumane. These exceptions can give doctors too much power to make end-of-life decisions. Given the possibility of coercion or undue influence on parents, the current system is set up for an Alfie Evans-like tragedy here in America.

Moreover, many in the medical profession, including the American Academy of Pediatrics, are advocates for the “best interest standard,” which gives doctors the ability to make arbitrary decisions about what is in the best interest of infants. The standard does give parents a role in the decision making. However, parental rights can be seriously compromised by health care providers and insurance companies that may pressure parents to make the more “economical” choice under the guise of an infant’s “best interest” and against the backdrop of skyrocketing hospital bills.

Another source of pressure can come from hospital “ethics committees,” which many consider to act like “death panels.” For example, the Texas Advance Directives Act empowers hospital administrators to arbitrarily withdraw or withhold care, regardless of the reason and the patient’s condition. The danger of the Texas law is illustrated in the case of Christopher David Dunn. In that case, a “bioethics committee” ruled that a 46-year-old man’s life was not worth living, and it therefore withdrew his life support. His family vigorously pleaded for his life to no avail. While many have defended such committees as an appropriate way to strike a balance between the patient’s right to life and the medical professionals’ reasonable end-of- life treatment, the potential for abuse is enormous. Indeed, many ethics committees have little guidelines and accountability; and, with the pressure of insurance companies and other health care providers, the risk of exploitation is very real.

Most agree that prolonging a painful process of dying for a terminal patient is inhumane, and they argue that doctors should not be forced to provide such treatment. Moreover, there is no constitutional right to receiving medical care paid for by others. But, as advocates for life, we must be vigilant in ensuring that health care providers and insurance companies do not have the arbitrary power to decide if one life is worth more than that of another. Furthermore, the withholding of food and hydration to a patient in need of it can never be morally justified. This is in keeping with the mission of faithful Catholics, who started the hospital system long ago based on the belief that nothing is worth more than the life of a person created in the image and likeness of God.

ATTORNEY CHARLES S. LIMANDRI is a past member of the Legatus board of directors and a recipient of the Legatus “Ambassador of the Year” award. He is the president and chief counsel of the Freedom of Conscience Defense Fund (www.FCDFlegal.org).

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