Alfie Evans and the Metaphysics of Suffering

Alfie Evans passed away a few days ago, but the controversial questions his short life raised remain unabated.

It’s a complicated case about which legitimate disagreement can justifiably be held. But at the heart of the debate is the metaphysical issue of value/worth. The courts ruled that it was in Alfie’s “best interests” to be removed from life support, and further that it was against his “best interests” to be moved by his parents for treatment elsewhere. But what is someone’s “best interest”? How do we determine this? Who gets to determine this?

Humans regularly judge that it can be in a living creature’s best interest to die. For instance, when we come across an animal undergoing immense suffering with no reasonable  hope of recovery, whose pain seemingly outweighs the value of the short life they have left, many people often decide that the best course of action is to “put down” the creature, to “put it out of its misery.” In doing so, they judge that the creature’s best interest is to cease living.

A similar rationale was applied in the case of Alfie Evans. Alfie suffered from extreme brain damage, and it was the opinion of most doctors that he most likely had no conscious mental activity. If there were any conscious mental activity, it was most likely filled with experience of intense pain. With no diagnosis, no prognosis, and the likelihood of a very short life, the doctors and judges ruled that Alfie’s “quality of life” was such that it was in his “best interests” to be removed from life support.

For many people, perhaps all of this makes good sense. I understand the opposing position. I strongly disagree, but I understand it.

However, instead of presenting an argument in defense of my own view, I want to offer a few thoughts on the significance of the disagreement itself.

The fact is, the doctors and courts ruled the way they did because we as a society have no coherent notion of redemptive suffering. Our entire way of life is largely defined by an aggressive endeavour to escape any and all semblances of pain. Pain and suffering have become absolute evils; their negative value trumps even the value of human life. This is the only possible justification for any sort of euthanasia. It was the only possible justification for removing Alfie Evans from life support.

And this way of thinking about things arguably makes sense, when we’re talking about animals. But humans aren’t mere animals; we have rational souls. We have capacities that transcend the material; and hence we have value that transcends our capacities for pleasure and pain. Suffering is not an absolute evil.

Perhaps one places the primary justification for Alfie’s termination not in the pain he might have been feeling, but in his lack of conscious mental activity overall. Human persons have worth and rights; but personhood is dependent upon mental activity. This is the only possible justification for any sort of aborton.

But even if one thinks that a certain level of mental activity is a prerequisite for personhood, this simply could not have been the fundamental rationale for prohibiting life support. Keeping Alfie Evans alive — especially when it was clear that doing so would come at no cost to the hopsital or state — could only be ruled to not be in his best interest if his life carried with it a certain amount of suffering. Lack of conscious mental activity might (on this view) reduce one’s level of personhood, but how could it justify a court sanctioned prohibition of life support? After all, courts don’t prohibit spending resources on keeping our pets alive, even though we don’t consider our pets persons.

It must, then, have been Alfie’s seeming lack of conscious mental activity in conjunction with his potential for suffering which resulted in the court’s decision that it was in his “best interests” to be removed from life support. Alfie Evans’ life was deemed not worth living because it would be a life of pain. But no consideration was given to the possibility of it being a life of dignified pain, a life testifying to the love of family and the radical lovability of the lowest of the low.

Pain is not an absolute evil. There is redemption in suffering.

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