If I had to pick top Catholic voices in the public sphere I’d want to hear from on a case like that of Charlie Gard, those belonging to the staff at the Anscombe Bioethics Centre at Oxford and Crux’s own Austen Ivereigh would be very high up on the list. It is therefore with some hesitancy that I respond to their critiques of my position on the case.
Everyone who is familiar with Catholic teaching in this area knows that one may licitly remove even life-saving treatment as long as (1) one is not aiming at the death of an innocent person and (2) one has a proportionately serious reason for performing an action with such profound consequences.
In my original argument, I not only emphasized this aspect of Catholic teaching, I highlighted the fact that it has been around for centuries and served as the foundation for secular distinctions between killing and letting die. I’ve also written an entire book about how this distinction would work with regard to babies like Charlie, particularly (but not only) when it comes to just distribution of resources.
My main argument was that the decision of the physicians caring for Charlie, and of the courts which sustained their decision, was one which aimed at Charlie’s death by omission. It seems clear, for instance, that if Charlie were to continue breathing after the court-ordered removal of his ventilator the aim of these deciders would be frustrated. The object of their act, therefore, is the very definition of euthanasia according to Catholic teaching: An omission which by intention causes death.
Ivereigh’s critique was scathing. Because the physicians and judges were acting in “the best interests of the patients” he claimed that it is “grotesquely insulting” to argue, as I did, that they would be displeased if Charlie continued to breathe on his own after ventilation removal.
But I’m honestly perplexed as to why Ivereigh has this view. What in the current trajectory of secular bioethical thought leads him to conclude that there is something incompatible with well-meaning people acting in the best interests of a mentally disabled person and also aiming at their death?
In their response to the case the staff of the Anscombe Bioethics Centre (ABC) note opinions from the very judge that Ivereigh correctly noted was acting in Charlie’s best interest which appears to confirm my understanding of their judgement. The ABC writes:
In the High Court, Mr. Justice Francis repeatedly stated, with approval, that “Charlie’s parents accept that his present quality of life is one that is not worth sustaining.” Francis also cited one doctor as saying that the severity of Charlie’s condition was such that “it could be argued that Charlie would derive no benefit from continued life.”
So let’s be clear. The “quality of life” and “benefit from continued life” judgments being made have little or nothing to do with the burden of Charlie’s artificial ventilation. The mild discomfort of such treatment, if Charlie can feel it at all, can be mitigated by various therapies, including deep sedation.
No, if Charlie started breathing again after ventilation was removed, Justice Francis would not be pleased with the outcome. He, along with many others, have explicitly made the judgment that Charlie’s life overall is not worth living. They have made the judgment that it is time for Charlie to die in his own best interests, and the means by which they will accomplish this is by removing Charlie’s life support. We ought to call this what it is: Euthanasia.
Now, the ABC rightly points out that the decision to stop ventilating Charlie could in theory still be correct if done for morally legitimate reasons. They correctly note that the tradition “does not oblige the use of medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to their expected outcome.” They also correctly note that “as the chances of improvement fade and the time remaining grows short, the burdens and side effects of the treatment are a reason to forego intrusive and extraordinary means.”
But then they stop, failing to explain how these well-articulated moral principles apply to the particular case of Charlie Gard.
I reserve the right to change my mind, but at this point I cannot understand how the benefits of what ventilation brings (Charlie’s very life) could possibly be proportionate with the mild burdens created by the treatment — which, again, can be mitigated by therapy.
Indeed, the only way such burdens could be proportionate appear to involve one of two judgments: (1) The huge expense of the treatment makes it extraordinary or (2) “Charlie’s very life” is not worth that much after all. The judgment present in (1), as I argued at length in my book on the topic, could be consistent with Catholic teaching. Indeed, Charlie’s parents should take into consideration just distribution of resources when it comes to a decision to spend nearly two million dollars of health care on a single person.
But the judgment present in (2), it should be clear, cannot be consistent with Catholic teaching. The lives of all human persons, no matter how profoundly disabled, are equal in moral worth. Indeed, the Catholic requirement to have a preferential option for the most vulnerable means being particularly critical of the judgment of privileged persons that someone who cannot speak for themselves has a life that is of little or no worth.
Let me close by raising a worry about where this kind of reasoning is already leading us. Secular medical ethics is becoming more and more comfortable with directly aiming at the death of infants like Charlie. Indeed, the Journal of Medical Ethics held an ‘infanticide symposium’ back in 2013; the title they used for the special journal issue? “Abortion, Infanticide, and Allowing Babies to Die.”
The move many of those arguing for infanticide are making is quite simple. “Look, we are already aiming at the death of babies by omission,” they say. “Even religious people have no problem with this. What’s the difference between aiming at death by omission and aiming at death directly?”
Nothing. Both Catholic moral theologians and those arguing for infanticide in the JME symposium agree about this.
We should take great care never to endorse an omission that aims at the death of an innocent person, period, full stop. But in a bioethical age of creeping infanticide, we should be even more careful than usual to safeguard this principle. The equal moral value of the voiceless and vulnerable depends on it.
Charles C. Camosy is Associate Professor of Theological and Social Ethics at Fordham University as is author of Too Expensive to Treat? Finitude, Tragedy, and the Neonatal ICU.