Alfie Evans and the hard facts of healthcare

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Alfie Evans

In a case reminiscent of the medical and legal circumstances surrounding Charlie Gard last year, British infant, Alfie Evans, is now the center of a controversy over the delivery of care and the boundaries between the rights of parents and the powers of the state. In both examples, the staff of the National Health Service determined that the child in question suffers from an incurable and terminal disease and should be allowed to die, while the parents understandably want to preserve his life. And in both, last-minute offers of treatment in another country have been made, heightening the intensity of the melodrama.

The right wing on social media is predictably clamoring for the government of the United Kingdom to allow the baby’s parents to take him to Rome for the treatment offered by Vatican doctors and are using this case as evidence that universal healthcare systems do not work and must be rejected here in America.

I will be thought of as cold-hearted by pointing out that there is an appeal to emotion fallacy here, so I will address this immediately. Human beings have emotions. We could even say that we are emotional, and that is different in an important way. I possess books, and I am a reader and a writer. If I lost my entire library in a fire, I would still be someone for whom words are a part of my being. In the same way, I experience emotional states moment by moment, but emotions — speaking broadly to include desires and drives — are a part of what puts me into motion.

To test this, consider a question that I get impish fun out of asking my students: Why should human beings exist? They stumble around, searching for an answer that can be based solely on objective reasoning, but in the end, we have to admit that we should exist because we have a desire to do so. The universe does not need us.

Taking the desire to continue existing as a given, then, is all we can do. If aliens demand that we defend our right to be, we are in trouble, but when arguing with each other, this basic impulse is a part of our nature and outside of a philosophy seminar does not need to be justified beyond saying that if we do not acknowledge each other’s wish to live deserves to be respected, we are on the verge of violence.

Emotional appeals in this context are fallacies, however, if the argument is that we should consult how we feel about a particular topic to reach what we claim is a logical conclusion. My emotional states about two triangles is irrelevant to whether or not they are congruent. The life of a child is not the entirely same as the status of geometric figures, of course, but there is a similarity in the question of what is the best treatment to give to Alfie Evans. Assuming that we want the most compassionate balance of elements in continuing life with a minimum of pain, the question becomes one of what is the best course of treatment to get to that end. The emotions drive us to want that, but the facts provide the answer.

And on that, I must leave things to the medical professionals. In each case, there will be experts who say do this or do that or do the other. The doctors who are treating Alfie Evans say that it is in the child’s best interest to allow him to die, due to the extremity of suffering that he is experiencing. That is a tough claim to hold to in the face of the anguish of the parents, and when there is any doubt, allowing them to seek extraordinary measures is hard to argue against, especially since if the expense will be taken on by others.

Expense is at the heart of the matter for those of us who are not directly connected to this case. Again, that sounds cold, but the question for the rest of us is one of access to treatment. Many Americans base their arguments against universal healthcare on the assumption that such a system would mean that advanced and excellent care would no longer be available if we are trying to provide care to everyone. The cost would be too high. Is that true?

The short answer is no. Healthcare costs in the United States are much higher than many other countries in the developed world, and unlike those countries, we are not covering everyone. But what about the delays in treatment or in access to care? We consistently score at or near the bottom in a variety of measurements of effectiveness and timeliness of care, and while elective treatments may take longer, life expectancy is also longer, and I have a hard time seeing delays in such things as a strong argument against retaining our system that denies essential care to many.

The reality is that every healthcare system is going to have advantages and disadvantages, and we can always find an anecdote to make things look bad. With regard to social policy, however, we have to balance benefits and harms. A system that results in a thousand unnecessary deaths is worse than one that produces a hundred. The families of the hundred will be outraged, and we should feel compassion for them and work on reducing the number who endure that suffering. But a hundred deaths is objectively better than a thousand deaths, and the real data show that what we do in the United States is not working. The Alfie Evans case does not change that, nor is it a good argument against universal healthcare.

The simple answer is that if the parents have treatment options offered to them — options that are supported by medical science, not homeopathy or some other form of woo — let them try. It is fair to say that the child is suffering needlessly, and that seems to be the concern of the National Health Service. Still, if a chance exists to save his life, it is hard to say that the attempt should not be made, especially since a stubborn refusal to do so only makes the system look bad. And as much as that is a fallacy in thinking, public opinion translates into votes. But the good of systems like the NHS is much greater than the harm, and that is a point that we must drive home if we care about the well-being of everyone.

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